Rachel Azrin, Board Certified Behavior Analyst
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When does a parent decide to get help with a child they suspect problems such as autistic behaviors or other behavior problems. 

12/26/2013

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Parents are usually in turmoil about when to start to look for help with their child. There are several points to consider in the list below.
1.  Parents often think a child will "grow out of a problem".  This is determined on a case by case basis. If the behavior is severe, frequent or noticed by others in the community or family it should most likely be addressed. Yes, it is true some problems you do grow out of but it is best to seek out a professional in the area of the problem as a precaution to confirm whether or not treatment or assessment is needed.
2. Parents can try exhausting ethical methods they have learned to use in our culture and then turn to the professional once the methods do not have much effect. 
3.  One thing to consider is that if you wait to long the behaviors may become worse and may not be as easy to eliminate.  For example, if a child is head banging to communicate it may accelerate and be more resistant to treatment.
4.  Some behaviors such as aggression or self-injury can lead to medical problems if left untreated for a long time.  For example, damage to the brain or skull can result from head banging. 
5.  If early intervention is not done quickly the child may be held back or not allowed to enter the next grade when starting school. For example, many schools require basic skills to move to the next grade such as toiling themselves. 
6.  Once behavior patterns are formed between the parent and child it is more difficult to break them if you wait a long time. For example, a mother that hugs the child after a tantrum may have trouble changing this habit.
7.  Many of the developmental skills such as eating, dressing, toileting and communicating are accomplished before entering the school. If you wait to help your child with these skills you are loosing time in their development and the result is they are developmentally delayed compared to other children.
8. Some parents might consider paying out of pocket for the evaluation if they have the money to do so. The advantage of paying our of pocket is that the child does not get labeled early in life which may stigmatize him later. 
9.  Finally, parents should consider the long term cost of not seeking professional help.  A child with developmental disabilities can cost large amounts of money per year for the rest of their lives.
10.  Finally, parents should realize that the time and effort they take now will reduce the effort they will need later. For example, if a child is not toilet trained or eats by himself the parent may be changing diets and feeding the child when he is an adult. 
Generally, parents should consider the above items and make the best decision for their individual child that will lead to him/her having a full and meaningful independent lifestyle as possible in the future. 
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Preparation for the holidays to prevent behavior problems. Prepare for the food, gifts and to prevent childrens problems. 

12/24/2013

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Caregivers and parents often prepare gifts for the holidays but not for the children. Here are some tips for the vacation days ahead!
1.  Prepare a schedule and review it with the children. Place strategic reinforcers during the day for good behavior on the schedule and discuss them with the children.
2.  Talk generally about the holiday and what it means and what others expectation is of their behavior. For example, grandma will be there she love to hear about your school and what you are learning. Also, more generally, the purpose of the the holidays is to be nice to family, enjoy our selves and have a peaceful visit so your father will relax if you behave yourself and ask him politely to play a game with you. 
3.  Make sure that items such as bedtime or other health related items are honored so that they are not overtired and cranky during the holidays. Before going on the trip make sure they take all vitamins and take those with you. Also, if there are any  medical issues such as coughs make sure to address them with your pediatrician before the holidays. A cold given to another  elderly relative could be very dangerous for that relative and create problems for you on the holiday
4.  Let children pack as much as possible and take responsibility for their own belongings.  They will feel more involved in the trip, have less inappropriate behavior when you do it for them and feel like they are more important and better about themselves. 
5.  Take small games or activities to use during time they are not occupied during the trip or vacation time. 
The extra effort to prepare for the holiday will make it much more enjoyable for you, your relatives and the children too!!
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How to use electronics as a reinforcer without causing increase in tantrums or other behavior problems with autistic, aggressive and other childhood behavior problems or developental delays?

12/23/2013

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Computers and electronic devices have become very powerful reinforcers for many children in the past few years.   Parents and Caregivers can use the following methods to more effectively and without behavior problems such as tantrums.
1.  First thing the caregiver should do is select the reinforcers specificlally through asking the child or an inventory which identifies the most powerful electronic reinforcers. 
2.  Next the caregiver or parent should explain specifically to the child what he has to do to attain the reinforcer. For example, the parent might say if you do your chores, have no tantrums or screaming, get ready for school on time then you can use the iphone that day.
3.  Next once a behavior occurs he/ she will not gain access to the reinforcer the next day or longer as specified by the parent or guardian. This should be a definite rule regarding how many days or hours of good behavior are required to attain the electronic and how many days he/she must have good behavior in order to attain the reinforcer for a specified amount of time. 
4.  If the child resists giving up the computer or phone there are environmental ways of preventing the use of them without a struggle. One way is to put the phone away once they go to sleep if there was a tantrum that day.  Secondly, the keyboard or mouse can be put away in a locked reinforcer cabinet if there is a tantrum and the reinforcer is the computer. Another technique is to remove the battery from a device, turn off the fuse box.
5. Parents might consider adding a password that can be turned on and off on a electronic device or computer. 
6. Parents should consider turn off a television with the remote or if there is a parental lock or timer this can be useful in making sure the reinforcer is delivered consistently.  
7.  Parents should try to give the child at least one or two warning statements so that the child is prepared and realizes that he has not behaved appropriately. 
8.  Finally it is important to make sure that the parent states the rule as a house rule and not as something mean imposed on the child. Also, the parent should state something empathetic such as " I wish you could have earned the phone or computer today that is too bad I am so sorry about that. Maybe you will earn it tommarow." 
9.  In order to prevent a tantrum parents should include the time from the loss of the item to the time it will be earned as a criteria for earning the reinforcer again. For example, if you are good and do all your chores and no tantrums or screaming you will probably be able to earn computer time tommarow.
In general, the parent should be viewed as a  sort of Santa Clause or bearer of gifts for the child not an negative person that enforces the contingency. This attitude of the parent will lead to a more postive relationship with the parent, less arguments and behavior problems in the future!:)





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Teaching new skills and how to fade out physical assistance with autism and children with developmental disabilities. 

12/19/2013

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Parents and caregivers often want to teach an autistic or developmentally delayed children. After identifying a targeted behavior and assessing what level of assistance is needed. The person teaching should start at the level the child is currently functioning  at. If the child needs complete or full guidance to perform the task that is the level of assistance to start at.  Next after reinforcing the child at this level then move to less assistance or partial guidance. This can be done by moving gradually up the arm for example or using less physical contact to perform the task such as just one finger or sporadic touching of the arm. After reinforcing the child with partial guidance one touch and fading away from the child. Perhaps just giving one or two instructions and one touch and then reinforcing when he performs the task. Finally the trainer moves away physically from the child and just gives the one or two specific instructions and then reinforcers the child. This guidance training procedure can be used with almost any skill you want to teach your child.


Summary= Full guidance-Partial guidance- Verbal prompts
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Attempts to perform the inappropriate behavior should be addressed in treating behavior problems for autism an other behavior problems. 

12/18/2013

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Parents or Caregivers should be sure to address attempts to perform the inappropriate behavior for the following reasons. 
1. Reoccurrence of the behavior problems-  If you only address the targeted behavior the precursors of the behavior may increase and the behavior may start occurring again if the child does not have consequences or reinforcers for appropriate behavior. 
2. Maintenance long term-  In order to maintain good behavior the program should address even attempts in order to maintain the absence of the behavior problems.
3. Development of appropriate behavior may be reduced- If attempts result in reinforcement then they will continue and the time used to display attempts may not be used for appropriate behavior such as learning to request what the child wants. 
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Sensory issues that should be addressed before or during treatment for autistic behavior problems.

12/16/2013

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Autistic children frequently have accompanying sensory medically involved issues that should be addressed by parents either before or during the treatment to assure more success with training. The following is a list of areas to look at and refer the child to specialist if it appears there are problems. 
1.  Hearing referral should be suggested to the parent or caretaker if any deficit is noted or suspected during the behavioral assessment.  This might be referral to an audiologist or to an ENT or someone with specialization in the area of hearing. 
2.  A full physical should be done to evaluate if there is any pain that could interfere with perceptions of senses. For example, allergy or tonsils may interfere with the ability to swallow or  learn speech if the client senses pain when they speak.
3. The evaluation of the vision of a child is important in determining if they are able to see. Recently, it was determined that autistic children often focus on the mouth more than the eyes.  It makes sense that increase his ability to see a face through glasses or other corrective treatment for vision might be helpful. If one eye is "lazy" this might interfere with perceptions and sensory awareness of the environment. 
4.  Some children may not have good strength in there fingers which may limit there ability to grasp and feel certain items. Exercises or occupational therapy might strengthen there ability to grasp objects  and more sensory awareness during the manipulation of the objects. 
5.  Parents might want to evaluate dental health too. The pain of a tooth may distract the child and reduce his awareness of other activities around him. 
6. Preventative measures should be taken to maintain peak sensory awareness. For example, brushing the hair away from his/her ears to prevent infection or water from getting into the ear canal. Drying the ears may also prevent any infection or problems with water in the ears. 
7. Pain in any part of the body may distract from the child's ability to focus on what is going on in his environment. This includes stomach aches, pain in tonsils and any injuries. Even a stomach ache may lead to the child focusing on that pain instead of the task requested. 
In general, referrals should be made when any problem is suspected during the functional assessment. The healthier and happier the child is the faster he will learn. Pain and medical conditions can distract the child awareness through his senses and lead to slower learning and development during early childhood. 
 
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Running away problem with children how to prevent. 

12/12/2013

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Parents or caregivers often have problems with children running away. This occurs with normal children, children with disabilities, children with behavior problems, children with autism and teenagers often have this problem.  The consequences of running away can be devastating present inconvenience  of time and money to the parent or caregiver. Prevention of this behavior is simple and will cut back on all these consequences for the caregiver.  The following are some ideas to prevent the problem.
Generally the following are ways of making the environment in the home much more reinforcing to the child so that the incentive to leave is reduced. 
1.  Parents or caregivers might make a list of reinforcers for each of the children and try to include them in the home environment. For example, if the child likes games include in the home fun computer games, board games, basketball hoops or other equipment to provide them with this reinforcer in the home when their behavior is good or during leisure time.
2. Similarly, if a child likes certain foods or social attention these should be provided for good behavior in the home and the absence of the behavior of running away.
3. Weekly conversations about how to improve your child's' life at home is also useful
3.  If the behavior of running away occurs then the reinforcers above should not be available for a specified short period of time. Also, parents or caregivers should try not to give to much attention when the running away occurs since this may be reinforcing to the person. For example, yelling, talking to much about it or touching or holding the child in your lap may be reinforcing. This will decrease the likelihood the running away will  occur again. 
Generally, caregivers and parents should realize that the child will run away when things in the home are not as reinforcing as they are in the places the child is running away towards. The increase in the number of reinforcers in the home and the more pleasant the home is the less likely they are to leave.

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How to choose a household chore for my child with behavior problems, autism or developmental delays.

12/11/2013

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Parents or caregivers might consider the following in choosing a chore for there child.  
1.  Consider the physical abilities and limits of your child. If the chore involves lifting something heavy or using alot of motor movements that the child cannot do easily it will be difficult to motivate them to do the chore. For example, if you want the child to put things away on a high shelf or use a heavy vacuum this should be considered. You might want to purchase a lighter vacuum that does not have a cord in order to make the chore easier and more likely to be preformed. 
2.  The parent should consider the mental or intelligence level in choosing a chore. If you ask a child with a low IQ or to clean his entire bedroom this may be overwhelming and it may not occur. In contrast if you ask the child to put the blanket on the bed and pick up the blocks this may be easier. Giving him simpler chores may be easier for the child to accomplish and to motivate him to do on a daily basis. 
3.  The task should be one that the child might enjoy. Try to match his preferences or reinforcers with the chore. For example a child that likes sensory reinforcement may enjoy the water while washing the dishes. Another example is a chore such as serving guest lemonade may be enjoyed by a child that likes social interaction and praise! 
4.  The parent or caregiver should consider the long term goals for the child in choosing a chore. For example, if the child goals is going to be living with with his natural family (rather than  in a home or a group home) maybe try to choose tasks that are useful to the other people in the household with tasks such as cooking.  If the child is trying to learn a trade for the future making some money for himself perhaps a chore such as washing cars would be useful and he could later work in a car wash. If the child is going to try to work on the computer in the future perhaps helping the family by printing coupons for groceries' will help to develop the skills needed for a job with computer work. 
Generally, all of the above factors should be considered in choosing a task for the child. The caregiver or parent should try to find a task that the child can do, that is enjoyable for the child, that is physically and mentally possible to do and finally that fits in with his long term goals and dreams for the future. This type of chore will be more useful to teach him/her and more likely to be consistently performed by the child. 

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