Community presentation autism and aba 03.2015
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An Introduction to Autism and Applied Behavior Analysis (ABA) - Elevate Therapy LLC - Free community workshop
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Community presentation autism and aba 03.2015
- 1. AN INTRODUCTION TO AUTISM AND APPLIED BEHAVIOR ANALYSIS
- 2. WHAT IS AUTISM SPECTRUM DISORDER? A developmental disorder characterized in varying degrees by difficulties in social interaction, communication, and repetitive behaviors. DSM-V merged autistic disorder, Asperger’s and Pervasive Developmental Disorder-Not otherwise specified (PDD-NOS) into one umbrella term: Autism Spectrum Disorder (ASD) Current statistics identify 1 in 68 American children as on the autism spectrum Prevalence is higher in boys than girls, 1 out of 42 boys and 1 out of 189 girls are diagnosed with autism spectrum disorder www.autismspeaks.org/what-autism, www.cdc.gov
- 3. DSM-V DIAGNOSTIC CRITERIA A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and- forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers www.cdc.gov
- 4. DSM-V DIAGNOSTIC CRITERIA B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases). Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). www.cdc.gov
- 5. DSM-V DIAGNOSTIC CRITERIA C. Symptoms must be present in the early developmental period D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co- occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level www.cdc.gov
- 6. EARLY SIGNS AND SYMPTOMS OF AUTISM: POSSIBLE RED FLAGS Not respond to their name by 12 months Not point at objects to show interest by 14 months Not play pretend game by 18 months Avoid eye contact and want to be alone Have trouble understanding other people’s feelings or talking about their own feelings Have delayed speech and language skills Repeat words or phrases over and over (Echolalia) Give unrelated answers to questions Get upset by minor changes Have obsessive interests Repetitive behaviors (flapping hands, rocking body, spinning) Have unusual reactions to the way things sound, smell, taste, look, or feel www.cdc.gov
- 7. EARLY SIGNS AND SYMPTOMS OF AUTISM: SOCIAL SKILLS DEFICITS Does not respond to name by 12 months of age Avoids eye-contact Prefers to play alone Does not share interests with others Only interacts to achieve a desired goal Has flat or inappropriate facial expressions Does not understand personal space boundaries Avoids or resists physical contact Is not comforted by others during distress Has trouble understanding other people's feelings or talking about own feelings www.cdc.gov
- 8. EARLY SIGNS AND SYMPTOMS OF AUTISM: COMMUNICATION DEFICITS Delayed speech and language skills Repeats words or phrases over and over (echolalia) Reverses pronouns (e.g., says "you" instead of "I") Gives unrelated answers to questions Does not point or respond to pointing Uses few or no gestures (e.g., does not wave goodbye) Talks in a flat, robot-like, or sing-song voice Does not pretend in play (e.g., does not pretend to "feed" a doll) Does not understand jokes, sarcasm, or teasing www.cdc.gov
- 9. EARLY SIGNS AND SYMPTOMS OF AUTISM: REPETITIVE BEHAVIOR Lines up toys or other objects Plays with toys the same way every time Likes parts of objects (e.g., wheels) Is very organized Gets upset by minor changes Has obsessive interests Has to follow certain routines Flaps hands, rocks body, or spins self in circles www.cdc.gov
- 10. CAUSES AND RISK FACTORS We do not yet know exactly what causes ASD. However, progress has been made in identifying some factors that make a child more likely to have an ASD. There seems to be a genetic factor. Children who have a sibling with ASD are at a higher risk for also having ASD. The prescription drugs valproic acid and thalidomide have been linked with ASD when taken during pregnancy. Children born to older parents are at a greater risk for having ASD. Research continues to search for risk factors and causes of ASD. www.cdc.gov
- 11. I THINK MY CHILD MAY HAVE AUTISM, WHAT SHOULD I DO? See your child’s primary care physician Write things down (questions, concerns, observations) Start early Ask questions Trust your instincts See your local Regional Center
- 12. I THINK MY CHILD MAY HAVE AUTISM, WHAT SHOULD I DO? Early Intervention (0-3) If your child is under the age of 3, they qualify for early intervention services The Regional Center and/or insurance company will fund all serivces School Age (3+) Children 3 and older enter the school system An IEP will be created, and the child will receive services through the school district, whether this is speech and occupational therapy, and/or special education services. The child may also be eligible for services outside of school through the Regional Center and/or insurance company
- 13. WHY EARLY INTERVENTION? Neural circuits, which create the foundation for learning, behavior and health, are the most flexible during the first 3 years of life. Over time, they become increasingly difficult to change. High quality early intervention services (25-40 hours per week, evidence-based practices) can change a child’s developmental trajectory and improve outcomes for the child and family Intervention is more effective and less costly when provided earlier in life rather than later Center on the Developing Child at Harvard University (2008). InBrief: The science of early childhood development. http://developingchild.harvard.edu/download_file/-/view/64/
- 14. WHAT IS ABA? Applied behavior analysis is a process of studying and modifying behavior It is the only evidence-based procedure that has been tested and proven effective for individuals with autism and other developmental disabilities By changing the environment (triggers and responses to behavior) we can change the behavior
- 15. ABCS OF ABA A Antecedent B Behavior C Consequence A = Antecedent = what happens in the environment before the behavior, what triggers the behavior B = Behavior = what the person says or does, the response C = Consequence = what happens in the environment after the behavior, reinforces or punishes the behavior
- 16. HOW WILL ABA HELP MY CHILD? Decrease challenging behaviors We will take a close look at any challenging behaviors and determine what purpose the behavior is serving. What is the child trying to communicate with the behavior? Then we will create a behavior plan and teach everyone involved with the child what to do to prevent the behavior and what to do if the behavior occurs. Teach new skills A big reason why children engage in challenging behaviors is because they do not yet have the skills to get what they want and need appropriately. We break things down into small, manageable parts and teach them systematically until the child has the new skill mastered. We also focus on making sure that these new skills are used in the natural environment.
- 17. HOW WILL ABA HELP MY CHILD? Increase Independence We place a large emphasis on functional skills (communication, interacting with others, self-care) We are thinking about the long-term goal of having the child be as independent as possible Increase the family’s ability to engage in typical activities We want you to be able to do things as a family that you would typically do if you didn’t have to worry about big tantrums (e.g., going to restaurants, grocery shopping, going to movies) We will go out into the community with you and support you in using ABA strategies in these types of situations
- 18. WHAT TO EXPECT IN A GOOD ABA PROGRAM Designed by well-qualified professionals (BCBA) Implemented by well-qualified professionals (RBT) Individualized and detailed assessment of the child’s strengths and areas of need Socially significant, comprehensive, meaningful, and objectively defined treatment goals Data collection and review resulting in sound clinical practices
- 19. WHAT TO EXPECT IN A GOOD ABA PROGRAM Incorporating numerous ABA techniques and principles Emphasis on personal independence Abundant learning opportunities within each and every session Consistent intervention practices amongst all team members Use of positive practices Generalization of skills to other people and other environments Regular parent training Regular meetings amongst all team members
- 20. HOW DO I GET ABA SERVICES? SB-946 This bill passed, requiring private insurance companies to cover ABA as a treatment for autism Child must have a diagnosis of autism Medi-Cal In July 2014, the Centers for Medicaid & Medicare services issued federal guidance to the states indicating that ABA is a covered benefit for children under 21 years. It is expected that they will begin covering ABA services around late 2015, early 2016, as they are still determining regulations and rates. Regional Center Regional Center continues to cover services for those with Medi- cal of self-funded plans not covering ABA services.
- 21. RESOURCES Milestone Tracker 2 months to 5 years, developed by the CDC http://www.cdc.gov/ncbddd/actearly/downloads.html Regional Center www.lanterman.org www.elarc.org Autism Speaks www.autismspeaks.org 100 day Kit https://www.autismspeaks.org/ family-services/tool-kits/100-day-kit Autism Health Insurance Project www.autismhealthinsurance.org Elevate Therapy www.elevate-therapy.com
Notas del editor
- Social issues are one of the most common symptoms in all of the types of ASD. People with an ASD do not have just social "difficulties" like shyness. The social issues they have cause serious problems in everyday life. Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving "bye bye". Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an ASD might have a very hard time learning to interact with other people. Some people with an ASD might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with an ASD have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them. People with an ASD might have problems with showing or talking about their feelings. They might also have trouble understanding other people's feelings. Many people with an ASD are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with an ASD. Anxiety and depression also affect some people with an ASD. All of these symptoms can make other social problems even harder to manage.
- Each person with ASD has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them.1 Others might speak, but not until later in childhood. People with ASD who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with ASD say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with ASD, "Do you want some juice?" he or she might repeat "Do you want some juice?" instead of answering your question. Although many children without an ASD go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with an ASD can speak well but might have a hard time listening to what other people say. People with ASD might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with ASD might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an ASD might smile while saying something sad. People with ASD might say "I" when they mean "you," or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an ASD might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the "kid-speak" that is common with other children.
- Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an ASD might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or "stimming." People with ASD often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with ASD. They might "lose control" and have a "melt down" or tantrum, especially if in a strange place. Some people with ASD also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.
- See your PCP They can use a screening tool to determine if your child meets criteria for the diagnosis They may give a diagnosis or refer you for further testing with a specialist Professionals that can diagnose: Developmental Pediatrician Child Neurologist Child Psychologist or Psychiatrists Write things down Start writing down your concerns so that you can accurately remember what behaviors you are noticing Take note of behaviors of concern, milestones that haven’t been reached Write down your questions for the professionals. What do you want to know? Start Early It can be a long process to receive a diagnosis and even longer to receive services The earlier the child receives intervention, the better the outcome Even if the doctor tells you that there is nothing to be concerned about, you will be informed on what to look for and when you should be concerned Ask Questions If being a parent is a new role for you, don’t worry about asking too many questions No one expects you to be an expert. If you have a concern or are not sure about something, ask! The more information you have, the better you will be able to help your child Trust your instincts Know that if you have a concern, it is likely valid You know your child best Regional Center In California, there are Regional Centers that receive money from the government to assist people with developmental disabilities. They have qualified professionals who can evaluate and diagnosis ASD as well. Regional Center may fund the services, or assist you in receiving insurance funding for services.
- In ABA, we take a close look at what happens right before a behavior occurs and what happens right after. In analyzing these, we can determine what triggers a behavior and prevent it, take a different approach to getting our kids to do things, and see if we are reinforcing behaviors that we don’t want to reinforce. We also use this format to teach new skills. We introduce various stimuli and teach an appropriate response through reinforcement.