HELP- There’s a monster in my toybox!

06 Wednesday Feb 2013

Posted by kolubcbad in Autism, Behavior Analysis, Community, Early Intervention, Education, play, Rett's, Social Interaction

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autism, behavior support, early intervention, individualized, play, social emotional support

Part 1 of Series: Helping caregivers and teachers support children to meet fearful challenges

Shannon’s Story

Shannon and Gina sat in a free play area near their preschool teacher. “SQUAWK!” came the loud animal sound when Gina pushed the button on a new toy. As the toy noise grew louder, Shannon’s eyes opened wider and wider until she froze, a look of sheer terror on her face. She started to back away and wailed, sinking onto the floor and crying.”Oh no,” gasped her teacher. “Put that toy away!” While Shannon cried, their teacher pulled Gina aside and said “I’m sorry, but Shannon is afraid of that toy. Next time we will remember to play with it when she’s in another room.”

Devon’s Mom’s Dilemma

Devon and his mom Jenny walked down the sidewalk with their next door neighbors. As they neared the playground, Devon suddenly grabbed his mother’s skirt tightly and shrieked. “NO BIRDIES! NO DOGGIES!” At this, Jenny’s face grew red as she picked up Devon and held him tightly. She looked at her neighbor helplessly and apologized: “I’m just so sorry… We can’t go any further with you. He’s been doing this every time. He has this issue with ducks and dogs and birds now. I think even if we don’t see one he’ll be afraid one might get him.”

Toward more supportive, long term strategies

At first, it may seem supportive to shield a child from their fears.

But both teachers and parents want and need solutions that will ultimately help children face and overcome challenges. So when there is a question, especially when a particular strategy feels good or soothing or produces relief in the short term, it’s a good idea to ask ourselves, “is this procedure also supportive in the long term?”

If not, how can Shannon’s teacher and Devon’s mom learn a more therapeutic approach? And why is that important? Let’s review these scenarios again, to better understand why and how to take a supportive long term approach. What might Shannon’s interaction with the toy, and Devon’s interaction with park creatures, have in common?

First, these scenarios are similar in how they are resolved.

In both interactions, a pattern is being established: the child first encounters a fear, or “fear inducing stimulus”, and then others respond by helping the child to escape or avoid it.

Second, these scenarios are similar in how they affect other people.

From the perspective of Shannon’s peers, her inability to play with that toy meant that they couldn’t either, at least not when she was around. From the perspective of Devon’s neighbor, the neighborhood kids couldn’t play with Devon in a park. This concept, the idea that Devon can’t play in the park, and that Shannon can’t play with toys that make animal sounds, limits interaction opportunities. It also risks changing the way peers think about approaching Shannon and Devon.

Third, these scenarios have similar “reductive” effects on the children’s “repertoire” or world. Have you ever met a family member or caregiver who says, “we used to love to do ___” but we can’t anymore”? Perhaps a family used to go to the movies, or out to dinner, or have friends over, or go to museums, or go hiking. During the initial conversation with families, that blank is filled in by all the things they need to avoid now because of fears of how people will react, fears that it won’t go well, fears that it will be too difficult, embarrassing, or noisy. Often those fears are REAL at the time! Perhaps people DID stare and talk at church when a family’s child loudly refused to stop standing on the pew. Perhaps all the teachers and mothers DID stare and talk in the parking lot as a child disrobed in public and threw a tantrum before leaving the store. Perhaps it WILL be difficult, embarrassing, or noisy. But keep reading. We can do this together.

Fourth, understand it’s a cycle: handling scenarios by allowing “fear habits” to persist, allows learners to skip learning opportunities and continue to repeat old harmful habits instead.

If Shannon and Devon can’t play with certain toys or in certain places, they have reduced opportunities to learn about those things and places, and no opportunity to learn that they are NOT scary.

Fifth, if these scenarios become habits, they make it more difficult for the child to handle or face similar or other fears in the future. These situations do not teach the child how to be more successful in coping with scary, new or different events.

Bottom Line: Instead of stopping or thwarting learning opportunities, we can expand them.

Come back Friday to learn how!

A family finds ways to honor their resolution: Increase inclusion this year

10 Thursday Jan 2013

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Last time, we heard about a family with three children. Their parents reported feeling pulled in all directions.

Identifying a need: better inclusion of children with special needs in their families

We asked the family to identify the biggest area we could make an impact. The family thought about it, and decided they most needed help involving their 7-year old child with special needs, in the family’s after- school routine.

Originally, they were concerned because their home felt chaotic every afternoon before dinner. Their child with special needs had adopted a routine of pacing around the home, using loud, disruptive self-stimulatory behavior for several hours while his several other siblings did homework together, received coaching on their math problems, and helped prepare the family’s meal. There were many reprimands provided as the child became more vocal, attempted to get attention from his mother while she assisted other siblings, and attempted to gain access to their refrigerator before dinner. The situation normally turned into chaos as the child with special needs began to self-injure, his siblings became frustrated and stormed off to escape the noise, and argued with each other as his parents tried to make dinner while managing the behavioral challenges.

Putting it together

The behavior analyst supported the family to start small, by identifying one family chore the student with autism could do to help the family.

No one had considered this before! The student had never been asked to do chores before. Different family members expressed that they didn’t know it was alright (or safe) to ask their sibling with special needs to do chores. They also expressed that they thought it would just create more problems if they asked the child to help with housework, and worried that it might even be inappropriate.

But by starting very small, and working together, the family discovered the student loved to help.

And the family gradually began to involve ALL their children in the after-school routine.

At first, only one thing changed after school: ALL three siblings were instructed and helped to select a “chore” from a new family chore chart.

Soon, the family reported they felt “more like a family”. But that’s not all!

Meaningful results

At first, the family included choices like “straighten all the pillows in the living room”. This was something the child with autism did ANYWAY! He usually did this during the evening as part of his repetitive routine.

But NOW, after he did it, his family could enjoy and discuss his participation in the routine.

Then, he learned to return to the chore chart after doing his one, easy chore, and check to see what was happening next.

Here are some other ways the student began to be involved more in his family, by altering ONE expectation in their routine:

Before	After
School or IEP goals were practiced only at school	The student began to practice his IEP goals at home. The opportunity to practice skills in many settings instead of one, and with all his family members instead of just with his teacher and therapist, strengthened the skills.
Greg used to refuse to participate with most instructions, and his mother had stopped instructing him to help out at home because it almost never worked.	After Greg learned to participate in a single chore during the family’s routine, the family used a behavior analytic “shaping procedure” to gradually increase the amount of time he participated. He is now participating for 60 minutes with occasional breaks to run around the house. His mother is working with the behavior analyst on how to make her instructions most likely to insure success and participation.
His siblings used to roll their eyes and go in another room when their brother disrupted their homework routines by constantly running in circles in the living room while they worked.	Now, Greg AND his siblings find quick “activity breaks” on the schedule between chores or homework. Now, they set a timer for 2 minutes and jog, jump on a mini-trampoline, or do jumping jacks together. Then they select their next task and everyone goes back to work.
His behavior used to seem like “a problem to get rid of”.	Greg’s family learned that his behavior was not totally inappropriate- rather, it was often inappropriate to the setting. NOW, they plan in advance to provide times Greg can fulfill needs for motor movement, sensory input, or interaction. Because they actually schedule these things in their afternoon routine, Greg’s needs AND those of his siblings could still be met. Greg gradually used self-stimulatory behavior less and less, and participated in family interaction more and more.
Greg’s mother reported feeling “powerless” and “helpless” and “guilty”, facing the challenge of managing Greg’s behavior while she attempted to help her other children.	Greg’s mother reports feeling “empowered”, and she now plans car trips, Saturday mornings, and family vacations with her new skills: She plans in advance how everyone will be involved in the activity, what kind of instructions or breaks or encouragement they might need, and what kind of visual tools would be helpful on the outing. She begins each family outing by reminding everyone of these expectations.

How can your family or community insure a special needs child is included this year?

Your friendly neighborhood behavior analyst is ready to help!

Of Elves and Shelves

08 Tuesday Jan 2013

Posted by kolubcbad in Uncategorized

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autism, elf on the shelf, holidays, inclusion

In the Cusp Emergence neighborhood, most of the holiday decorations have been put away.

To the families who used the popular shelf elf concept during the holidays: have you put away your elf?

Many of the families we serve enjoyed using the elf and their children enjoyed it too.

Cusp Emergence loves hearing about ways families successfully involved special needs members in their holiday routines.

In our picture today, this family’s Elf has Autism, just like one of his family members!

Thank you to OperationJack.org for sharing their photo with us!

And have you noticed? In terms of numbers, it’s pretty normal these days to have autism.

Or maybe “normal’s just a dryer setting”.

But however you think about it, it can be challenging to balance the needs of all family members with the support of a special needs child. How much? How often? When is it alright to let everyone do their own thing?

Tune into our next post, to learn how one family of five faced this challenge two years ago, and resolved to learn to include ALL family members in more supportive ways.

Did you make New Year’s Resolutions?

It’s not too late to commit to finding a new way to foster inclusion in your family.

Using the Reverse Social Story during the Holidays

14 Friday Dec 2012

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reverse social story, social emotional support, social story

Q&A Series: Parents ask about social emotional support

Today’s Q&A: How can a reverse social story be part of family behavior support around the holidays?

A: A reverse social story helps others relate to our loved ones.

A reverse story is related to the “social story”, but it is not one that your child will use. Instead, it is one designed to help OTHERS relate to your child or loved one.

What’s a “reverse social story” for?

Cusp Emergence uses Reverse Social Stories to address physical, behavioral, social, emotional, memory or cognitive, or a combination of these needs.

A Reverse Social Story facilitates relating to your loved one by using a combination of words and pictures, depending on the audience, that tell a story.

In this story, you can

Highlight what your loved one is great at doing
Help others understand how to support your loved one’s special need or challenge
Name specific ways your child or loved one can be involved and participate in meaningful events and interactions
Review specific challenges your loved one faces, and describe to others how to:

talk about these challenges

prevent unsafe interactions

redirect challenging interactions to become more therapeutic and supportive

provide supportive environments during special times or events including:

holidays, parties, family emergencies, babysitting or respite care, trips to the community, transitions, or unexpected changes

How can circles of friends and acquaintances use the “reverse social story”?

Ways people have benefited from the reverse social story include:

Family members of a child or family member with special needs read it to prepare for his holiday visit
The boss and co-workers of a woman whose son had special needs, read it to prepare for his attendance at a company picnic
The preschool staff at a child’s new school read it to prepare for his transition into their classroom
The family members of a woman with Alzheimer’s used it to share their mom’s preferences, needs, and locations of special items, with new nursing home staff.
The young cousins of a child with Autism learned in advance how to include him in play and conversations
The aunts and uncles of a little girl with Rett’s syndrome learned ways to prevent unsafe behaviors while babysitting while visiting over the holidays

Who writes a “reverse social story”?

We can help…

As a behavior analyst and social emotional support provider, Dr. Kolu facilitates writing Reverse Social Stories for clients. Cusp Emergence offers workshops on Writing and Using your Family’s Reverse Social Story.

Or you can do it yourself.

After a brief training on how to write a Reverse Social Story, one of our clients (a mother of a young child with special needs) wrote one of the most useful, beautiful Reverse Social Stories we’ve ever read.

Coming Next: What to include in your family’s “reverse social story”

Today’s Q&A: How can behavior support help families around the holidays?

06 Thursday Dec 2012

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NEW Q&A Series: Parents ask about social emotional support

Today’s Q&A: How can behavior support help families around the holidays?

Q. How can behavior support help families around the holidays?
A. Use this simple strategy: Provide extra practice with safety instructions

Ways to use this strategy:
-Embed instruction practice in games
-Find times each day to use a playful “stop/ go” game with children.
Example:
In a simple “stop and go” game, instructions to “STOP!” or “GO!” (or ANY instruction that rarely gets practiced but is important, like “COME TO ME” or “SIT DOWN”) can be interspersed with fun gross motor, fine motor, or verbal activity.
-The point of the game, is that when the parent or caregiver gives an instruction, the child practices immediately stopping, listening, and doing, in order to experience a fun outcome.
-This game can be used as “priming”, or practicing the safe behavior in a less intense context BEFORE going outside or walking across a parking lot where it is absolutely CRITICAL to follow the instruction.
-Some parents practice “stop and go” listening in the hallway before going on trips to a store.
-Play Simon Says with variations like “mom says”, “grandma says”, “dad says”, “babysitter says”, or “sister says”
-Write funny instructions down and put them in a container. Players take turns drawing an instruction and trying to do it. Players can take turns deciding what the “payoff” will be for following these instructions. For some families and children, it is fun just to choose the snack or hot cocoa flavor for when the game is over. Others may want to choose the next game, choose to earn stars they can trade for free time or their favorite chore, or earn special 1:1 time with a family member after the game.

Ask your friendly local BCBA or Social Emotional Support provider which programs they recommend strengthening or practicing the month before and during holidays or a visit that is out of the ordinary.
Game players can practice skills they will need during the holidays.
Examples:
“go get mom and tell her something”
“find a family member who is hiding”
“follow 2-step instructions”
“tell someone you need a break”
“find and use a chill-out space at a holiday party”

Let others know when you see them doing what is expected or needed for a given social situation.
-Remind others how to listen (or be safe or be helpful) before it will be required.
Example: 6-year old Bobby is about to attend the holiday parade with his family. His babysitter reviews with Bobby while they park the car. She says, “This will be fun! There are a lot of people around. I want you to hold my hand anytime we stand or walk together. That way we’ll all stay safe. What do you need to do?” Bobby says “hold hands.” Babysitter says “that’s right! We’ll hold hands.”
-Family members can repeat back the “need” or the “rule” or “expectation” in their own words.
-Most families find it helpful to state expectations before the event (remind children and others what is needed or expected to be successful and be a part).
-Families need to use words that their members can understand, and that help them practice the social skills that will contribute to family harmony. It’s really important to hear these words often BEFORE the social situation where they really need to be used.
Example: Young children might need to hear “we stay in our seats at dinner”, or “let’s sit while we eat”. Older children might need to hear “if someone is telling a story at the dinner table, we can help (be a supportive big sister) by looking at them and then asking a question about the story.”)
-Use only positive instructions: Use “we can” and “let’s do ___” language. Say what we CAN do. Instead of saying “no running!”, say “we can walk in the house.”
-If something is “forbidden” (like “running in the house”, make sure you find times and places where that thing IS okay. Example: “We can WALK in the house. We can GO OUTSIDE (or go to the basement) to play running games.”

Benefits of using these strategies
-Builds the skill with less stress for parents or caregivers and child or client
-Gives child (or client) the opportunity to receive teaching when the parent (or caregiver) is focused. Parents get much better at this the more they do it.
-The child receives practice hearing and following the instruction at a neutral, non-threatening time. Children get much better at this the more they do it.
-Research provides lots of evidence that teaching does not occur in a crisis situation; learning how to use an alternative behavior takes lots of practice.
-Gives family members practice noticing and “reinforcing” the act of listening to an important instruction and following it right away.
-Gives family members lots of practice listening to others at neutral times. All this practice can make it easier to follow a safety instruction that is given “when it counts” (at a critical time).
-Builds practice and skills with MANY people who might act as teachers or caregivers, instead of just “hoping” a child will listen to a new teacher or caregiver
-These strategies are not new, hard, expensive, or strange… but effectiveness requires practice.

Bottom Line: Find the strategies above that your family can do, and do them often.

Payoff: That way, WHEN IT COUNTS, it won’t be as difficult to insure a child follows through, listens, or helps out, if s/he is already practicing it and receiving lots of feedback on it.

Stay tuned:
Our upcoming Q&A in this series deals with holiday travel and meeting new family members:
Q: How can I prepare my child for interacting with extended family for the holidays?
A: Use The Reverse Social Story!

School of Play

04 Tuesday Dec 2012

Posted by kolubcbad in Autism, Behavior Analysis, Early Intervention, Education, play, Social Interaction, Uncategorized

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autism, behavior management, language, leisure skills, play, school of play, social emotional support

School of Play ©
Our school of play division provides one-time, brief, or long-term play or leisure skill-based individualized client supports, training, and education.

WHO can benefit?
Groups: Schools, classes, churches, businesses (gyms, pediatric doctors or dentist groups, therapists)
Families: Families affected by behavioral, developmental, social, emotional, or other challenges
Individuals: Children, staff, teachers, administrators

WHEN?
Our clients can benefit from School of Play © services whenever:
-A child gym owner sees staff struggling to help young mothers engage their children in play, interaction, or language, and enjoy the gym activities at the same time
-A community or church member runs a play group in a church or gym, and is not sure what to do differently to support new students with autism
-A community or church play group is not sure how to support children with language delays
-A parent needs the babysitter to manage behavior more effectively when supporting the family’s children
-A parent’s child with autism doesn’t know how to play with his siblings
-A family’s two year old with autism doesn’t like to play with his parents
-A family’s or organization’s group of therapists is great at 1:1 instruction, but they need help getting children to interact with each other
-An organization’s therapists are highly skilled at discrete teaching, but provide less effective naturalistic teaching

WHY does it work?
Cusp Emergence provides play and leisure skill support that is:
-Compatible with IFSP or IEP goals
-In some cases, able to be funded by a state’s early intervention services if the client qualifies
able to improve family or team interaction
-supportive of social, emotional, or behavioral wellness
-provided in the community or home setting
-consistent with research proven methods with demonstrated effectiveness
-administered by qualified, educated, trainers with extensive experience collaborating with parents, educators, therapists and community members

HOW can clients benefit?
-Learn to arrange environments to make appropriate effective language and communication more likely
-Learn to arrange environments to support play
-Learn to teach staff, babysitters, community, or family members to provide supportive environments
-Learn to arrange environments that prevent behavior challenges
-Receive support from our School of Play division in your group or home

HOW does it work?
-An initial consultation takes place to discuss the family’s or group’s needs
-Next, a workshop or future education is planned based on individual needs
-Follow up support is available for families or groups on a schedule determined together with the client

(click here to check out Building Your Workshop)

Build-Your-Own-Workshop

04 Tuesday Dec 2012

Posted by kolubcbad in Autism, Behavior Analysis, Community, Education, Uncategorized

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autism, early intervention, education, family, play, social emotional support, workshop

Cusp Emergence is excited to offer a Build-Your-Own-Workshop feature to families, groups, and communities.

1. Consider what your workshop will address, and why you need a workshop.

Need to learn general ways to provide social, emotional, and behavioral support?
Need to practice behavior management for specific behavior challenges?
Need to teach your family or group about managing a particular behavior challenge?
Need to support a student or family or community member with cognitive or developmental challenges?
Want to know more about how social-emotional and behavioral wellness relate to physical health?
Want to learn a particular technique (for example, for teaching skills or shaping language, appropriate behavior, play, or social interaction)?

2. Think about who will participate, where you’d like the workshop, and how long your group would like the workshop to be

3. Contact Cusp Emergence!

CONTACT CUSP EMERGENCE:
720.263.CUSP

Social Emotional Support: Part 3 (How does it work?)

15 Thursday Nov 2012

Posted by kolubcbad in Autism, Behavior Analysis, Behavioral Cusp, Community, Early Intervention, Social Interaction, Uncategorized

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autism, early intervention, individualized, intensity, S/E, social emotional support

Social Emotional Support should be practical, and fit into a child’s family routine or team involvement.

How does Social Emotional Support work with other therapies? Does it replace Speech Therapy?
Social Emotional Support can complement, but does not usually replace, therapy by an experienced, licensed and trained speech therapist, especially if the child is diagnosed with an issue that would benefit from Speech Therapy. Instead, S/E can facilitate other therapies the child is already receiving, and brings a therapeutic perspective that can enhance the benefit of Speech, Occupational, Physical, or other supports. For example, some children may use dangerous or unsafe behaviors, or escape from unbearable or undesirable situations after inappropriate behavior. Other children benefit from learning how to “turn down” or “turn up” sensory stimulation, without using unsafe behavior. They can learn safe ways to express that there is too much, too little, or uncomfortable stimulation. We can help other therapists to integrate behavioral wellness into their sessions, and how to incorporate motivation and timing and behavior techniques into their strategies. Note: Some of the most powerful technologies in teaching children with autism (and diverse learners worldwide) have been generated by behavior analysts who collaborate with, or have backgrounds in, speech and language therapy. (PECS, or the Picture Exchange Communication System, is a good example of this.)

How do we do it?
Step 1: Assessment
A behavior analyst as S/E provider can assess a child’s strengths, challenging behavior, and family’s concerns, then generate individualized strategies to support the child’s growth. Often an assessment called an FBA, or Functional Behavior Assessment, is conducted over a couple of weeks to understand the reasons and ways that the environment is contributing to the child’s challenges. We learn what situations are most difficult and how to address them by strengthening more appropriate and successful alternative ways for learners to meet their needs.

Step 2: Collaborate
Next, we team with the child’s family and other providers or community members. We use a collaborative strength-based service model to determine measurable goals the child will meet by learning new skills, behaviors, and new ways to use their strengths. Then we discuss ways (strategies) that will be used to get there.

Step 3: Teach family and therapists to use consistent strategies; monitor strategy effectiveness
Collaboration results in setting measurable goals and developing a plan listing specific strategies families will use to meet the goal.

Families often ask whether we use individualized strategies or apply the same kind of support to every child.
We use individualized support. There are also many core “evidence-based” strategies that we use because research and practical application consistently shows they benefit children with autism and related challenges. Read more about the EI Colorado recommended strategies here.

Step 4: Support the child’s transition out of early intervention.
This step involves thoughtful planning for how the child and family will move to the next steps and environments as needed. Local agencies partner with schools to provide families with options for continued therapies in preschool if needed. Social emotional support providers can work with families to put the currently effective strategies in writing to share with important new people in the child’s life. Some families benefit from continued consultation from a BCBA, who can help teach preschool teachers and therapists how to keep making progress by providing continued individualized support based on the child’s needs. (Check out a previous related post on supporting a child’s transition).

Social Emotional Support and Intensity of Behavior Analytic Intervention
Although intensive intervention is recommended and effective for building skills and relationships with children with autism, the intensive aspect of intervention is not characteristic of the time-limited S/E support under Early Intervention Colorado’s guidelines. Instead, this model provides a brief assessment as needed followed by an hour or so of weekly therapy with the child that consistently includes caregiver education. By focusing on engineering change in families and team members, we set caregivers up to learn preventative successful techniques to support their child’s speech, motor, play, self-help and social skills.

Social Emotional Support: Part 2 (Where and how)

15 Thursday Nov 2012

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BCBA, BCBA-D, behavior analysis, community-based, cusp emergence, S/E support, social emotional support

Social Emotional Support: Where? How?

Note: This segment is Part 2 of a Series on Social Emotional Support by a Behavior Analyst

Where?

Social Emotional Support can be provided in the home and in the community, wherever it fits in to a child’s and family’s life. Often we identify, with the family, that there are a few especially challenging environments or places. We educate and collaborate. By using modeling and supportive feedback directly in those places, a team can support a family planning to re-enter environments and situations they have been avoiding due to difficulties coping with challenging behavior, social, or communication needs. Sometimes we educate in the grocery store, we practice going to story time at the library, or we meet a family in a gym. We go where the difficulties are, so that the teaching is effective and the family learns to implement the strategies when therapists are NOT there. We also teach in the family’s home, at times of day that the family needs support. Some families benefit from a weekly afternoon play session, while others benefit from sessions that target particular routines or tasks. Sometimes we provide support during a meal, or during a specific self help routine.

Why do it in the community?

Generalization can mean a child learns to do things s/he first practiced at home, in other places, with other caregivers, and in other situations. Generalization will not always happen by itself. Planning for generalization is important, and is almost always a big part of what the behavior analyst does.

Some places we have provided Social Emotional Support:

family’s home
church daycare
community daycare
community gyms
community children’s museums
a local library
local parks
schools
doctor’s offices
dentist office waiting room

How is Social Emotional Support funded?

In Colorado, families whose children qualify for Early Intervention services could receive Social Emotional support at no cost until their child is 3 years old, by Board Certified Behavior Analysts or other specialists authorized to be providers. In situations when the child does not qualify by the state definition but still has needs in this areas, some families choose to private pay and contract with an agency or provider who can meet their needs, or to enroll in parent education or training that can help. Grants may be options for some children on waiting lists for specific autism waivers through Medicaid, or for children with significant needs. Grants can fund co-pays for children whose insurance reimburses ABA coverage. Some providers offer sliding scales for families without insurance, and some agencies offer payment plans.

Note: Cusp Emergence offers Dr. Kolu’s Preventative Environments Training to the community, and provides social emotional education programs to preschools, churches, and other community businesses. We also offer a sliding scale to families in need, and can train family members or friends to act as therapists. University students, caring family members, and babysitters can all be trained to be excellent therapists who supplement a child’s program.