Parents and therapist often are not sure which behaviors to prioritize in training new skills or choosing replacement behaviors.The following identifies some important factors to consider in the selection. One factor to consider is to try to select a skill that will lead to the long term goals of the client. This often requires alot of imagination, observation and research to come up with some alternative goals with the client and his caregivers that will lead satisfying to a more satisfying lifestyle for the client. Once these goals are established all other training should be in agreement with these long term objectives. A second factor to consider is the inappropriate behaviors and the caregiver or trainer should attempt to design acquisition skills that will most likely reduce those behaviors. This may be done by teaching skills that are difficult to do at the same time as the inappropriate behavior or skills that result in the same types of reinforcement. Parents and trainers should always keep in mind that teaching skills that are not connected to the overall treatment plan goals to achieve will not lead the client as rapidly to acheiving the satisfying lifestyle the client and family want to achieve.
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Parents should always make an effort to rule out any signs of medical issues in order to increase the effectiveness of the behavioral treatment. If the child has a medical issue it may reduce, slow down or prevent the child from a complete habilitation from behavioral intervention or mainstreaming. Some medical issues to keep in mind include the following. The following list includes some items that research has suggested a relationship to developmental delays and autistic type behaviors. One example is hearing or hearing problems. Numerous research articles and papers at conferences have talked about the strong relationship between hearing problems in clients with autism, aspergers, aggression and developmental delays. They often present data with a direct correlation between these problems or control studies. These children usually have a history of ear infections, tubes in their ears or pain in their ears. When a behavior therapist or parent does an assessment this is a very useful thing to ask about when reviewing the history of the child and the "organism" variables in the SORC analysis. If the parent or child has a history of ear problems they should be referred to a specialist for ear problems not just the general practitioner. The reason for this is that often a general hearing test may not pick up some more specialized problems with the ears. A specialist such as an otologist or ENT is preferred to be sure there is no problem that could jeopardize learning for the child. Other examples might be medical problems that lead to sleep problems, genetic disorders that causes a variety of problems, small seizures that are not detected, vision problems, allergies, stomach problems and constipation. These topics will be discussed more in depth in future blogs. Medical issues should be ameliorated so that the child can progress to his upmost ability developmentally through behavioral interventions.
The latest trend is to buy and iPad, Ipod or other computer gadget and expect learning to magically occur. In most cases more is needed. I a few cases the child may learn on their own but in most cases parents should consider the following in order to have success. One point is that often a child with autism is not visually motivated to use the equipment. In this case the parent can motivate the child with extrinsic reinforcers for use of the equipment. For example, if the child plays one educational game or looks around on the web for 30 minutes then the child receives a preferred food snack such as chips or an activity. Another point is that the computer must have reinforcers within the aps that reward the child automatically. For example there are programs such as "head sprout" that include reinforcers within the educational game at the end of a correct response by the child. Parents should be careful to set-up reinforcers within the device programs and extrinsic reinforcers in order to achieve optimal chances of success when purchasing an electronic gadget so that the money is put to good use and learning occurs in the child!!
Caregivers and Parents often complain that there child does not sleep. Some options and ideas about what issues to bring up to doctors and behavior analyst are listed below. The first thing a caregiver should do is to make some sort of data sheet or log with the behavior analyst recording how much sleep the child is actually getting and at what time of the day.
A second suggestion is to rule out any medical problems. Children often suffer from sleep apnea, allergies, colds, urinary tract infections, or incontinance, ear infections or other medical conditions or side effects of medications that lead to a reduced number of hours of sleep. Situational problems such as living arrangements that are loud or noisy, roommates, recent break-up of parents, loss of a relative, stress at school or with other problems. The above issues should be addressed before designing complete and effective sleep program procedure. Note:These are just a few of many items to consider Clinicians are often presented with physical symptoms that suggest medical involvement during assessment or intake. The first thing that therapist should consider doing is to recommend that the parent or caretaker immediately or as soon as possible follow-up on a medical issue. The medical issue should be ruled out and addressed by the parents in order to treat the client effectively with behavioral treatment. Some examples of medical issues might be something as simple has hearing loss or ear infections. There is a large body of research and talks at conferences about the relationship between hearing or ear problems and diagnosis such as autism or other developmental delays or diagnosis. There is a large body of research regarding other medical problems such as blood pressure, diabetes or low blood sugar, constipation and the resulting behavior problems that may occur. A thorough physical or a specialist such as an otologist may be a good recommendation. If there is a strong reason to believe that a general physical may not be sufficient then an expert in the problem such as an otologist or cardiologist might be something for the caregiver to consider in order to completely rule out the medical origin of the behavior. However, even if there are medical causes of a behavior one can still treat the problem with non-restrictive behavioral procedures. Often the behavior problem has both medical and behavioral causes that are revealed in the functional assessment. Therefore both behavioral and medical treatment can work together to resolve the issues and the child can look forward to the possibility of achieving a normal life without behavior problems!
Pshychotropic medication and behavior therapy work together and separately. There are advantages to using behavior therapy in conjunction with medication. The parent or client can gradually reduce the medication as the problem behavior becomes manageable or disappears. This is usually done with through the use of graphic displays of the progress/outcomes, data collection sheets, observation in different environments and analysis of the trends of the problem behavior compared to the medication changes.
It should be noted that some problems do respond well to medication based on the research and some problems are merely improved by a sedation of all behavior. One might consider researching the medication to affirm that there is some validated benefit before using it for yourself or a child. It is helpful to note exactly when the changes are made in the clients medication so that it can be determined whether any benefit is derived from the medication. Discussion about reduction or changes should be brought up at each meeting with the doctor prescribing the medication. It is useful to bring a graph of the behavior and general procedures used so that the doctor understands all variable affecting the progress of the clients behavior. For example, if a new program procedure started last month and the behavior decreased dramatically then a reduction in the medication might be discussed and considered. Generally, the doctor usually reduces the medication slowly so that there are no side-effects. Generally, taking medication for long periods of time or even short time periods can cause serious and mild side effects and this should be considered in deciding whether to use medications. It should be noted that each individual case is deferent and other factors in the environment or health factors also effect the behavior of the client. Individual differences and specific graphs or data should be used as tools in making decisions about whether to take medication, reduce medication or change medications. Behavioral Procedures and Effectiveness in increasing or decreasing the desired targeted behaviors8/1/2013 Many Procedures have bee identified in Studies as effective. However, it is crucial for both parents and researchers to consider the exact methods they use to implement the procedures and compare them to what was done in the research in order to make sure they are implemented in the same manner and are effective. In fact it is very common for a proven procedure to be ineffective or actually make the behavior worse if they are implemented inappropriately. Almost all Procedures such as reinforcement, token programs and overcorrection must be implemented in the specific manner that will allow them to perform functionally and increase or decrease the behavior. For example, a therapist that give reinforcement without smiling and just say "good job" may be meaningless to the client and the function of the behavior if not done in the correct manner or even could increase inappropriate responding. The therapist/parent/teacher should be careful in some areas in particular for example the non-verbal behavior must match the words. If you say "good job" then a beautiful smile, clapping or jumping up are examples of non-verbal behaviors that will stenghten the procedures.
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Isn't it true that the brain is an amazing organ? Some people function with only a small piece of their brain..that were in accidents or injuries. I have had many clients with alot of seizure, lobotomies and brain damage yet they learn to do almost anything... so I think even if the research specifically has not been done the outcome of teaching people shows that the brain can develope and grow in most all areas of learning and performance. |
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