What behaviors does ABA seek to increase or decrease?
Applied behavior analysis (ABA) uses the principles of behavior for increasing and decreasing specific behaviors of social significance. Behaviors to increase or decrease are selected in collaboration with parents. Additionally, it is wise to involve other relevant stakeholders, like extended family or your child’s teacher.
When selecting ABA goals, it’s important to consider:
For challenging behavior, it’s crucial to consider how much is the behavior impacting the child’s functioning, learning, social opportunities, or ability to access the community. If parents cannot take a child to the store because of tantrums, it can impact a family significantly. (e.g., decreased access to social skills, difficulty completing common routines, or cost of childcare so the parent can go to the store). Similarly, if a child cannot communicate his or her wants or needs, this may cause problems for the family system as a whole.
It is important to consider the following points for increasing skills:
* What should the child be doing?
* How far outside of typical development is this behavior?
* Typically, what should a child this age be doing or expected to do?
* In what manner are these skills pivotal to future areas of development?
Small steps may lead to a larger goal
All goals should be prioritized based on some of the questions listed above. It is also essential to consider prerequisite skills and look at the larger picture. It may be that before you get to the big point of concern that there are other smaller goals to meet along the way. If your child cannot wait at home for five minutes, then waiting at a store for a toy may be more difficult. First, work on the smaller skills to build to the larger ones. With patience and practice, your child will be on their way to achieving their goals.
ABA therapy can be implemented in different environments, like home, our clinics, or in the classroom.
At NSPT, your child will receive 1:1 therapy along with the ongoing analysis of his/her progress to ensure he/she is continuing to progress and succeed.
https://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2019/03/pexels-photo-296308.jpg?time=15609156127501088Erin Shoshanahttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngErin Shoshana2019-03-13 02:26:282019-05-15 09:43:37Increasing & Decreasing Behavior With ABA
Language development for children diagnosed with Down Syndrome can be challenging and confusing. Factors such as cognitive and motor delays, hearing loss and visual problems can interfere with language acquisition. It’s important that a child’s caregivers provide a variety of opportunities to increase language development.
Using many normal everyday activities can enhance the child’s language and expose them to new concepts. The language you teach to your child will assist them in learning and generalizing new information.
The following are early intervention strategies that can be used to help children with Down Syndrome develop and increase their understanding of language:
Take advantage of language opportunities during daily routines:
Activities such as taking a bath, cooking, grocery shopping, changing a diaper, or driving in the car are a wonderful time for learning. Caregivers can consistently identify actions, label items, expand on their children’s utterances to facilitate vocabulary acquisition and overall language development. It takes a lot of repetition for children to learn and start to use words appropriately. Include a variety of words that include all the senses. “Does the water feel hot?” or “Can you smell the cookies?” When speaking, identify textures, colors, express feelings etc.
Read, read, read:
It can never be said enough how important reading is to children. When reading a book, it’s important to not only read the words on the page, but to talk about what is on the page, what the characters are doing or how they might be feeling. Make reading a book an interactive experience.
Incorporate play time with other kids:
Children can learn a lot just by interacting with other children as they are interested in and motivated by their peers. They imitate each other’s actions and will learn from them. Play time with other children will also help them develop social skills. Concepts such as sharing, taking turns, pretend play, creating, etc. can all be increased.
Play with them:
Children don’t know how to play with toys and games on their own, we need to show them. Get on the floor and play with blocks, balls, bubbles, sing a song, etc. During this time talk about what you and the child are doing (Ex: stack up the blocks, let’s blow more bubbles, it’s my turn) and expand on their utterances. Play time is critical for children to develop their ability to focus and attend to a task. When you are engaged together in a task, you are developing a special bond with your child and they are learning!
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Play skills are one of the most important areas that children, especially those with Autism, need to learn. These skills provide opportunities for the child to entertain themselves in meaningful ways, interact with others, and learn important cognitive skills. A successful way to teach play skills to children with autism is to initially teach the specific play skill in a very structured manner.
Break the play skill into small, discrete steps and teach one step at a time. As the child demonstrates success in learning one step, add the next step. (After the child can add eyes to Mr. Potato Head, then add ears, then arms, etc.)
Use modeling to teach the skill (e.g. the adult builds a tower of Legos as the child watches, then the child builds his own tower).
Always provide reinforcement (behavior specific praise “Nice job putting the piece in the puzzle”, immediately following the child’s demonstration of the skill.). As the child exhibits improved accuracy of the skill, reinforce successive approximations.
The child should have plenty of opportunities to rehearse the skill in a structured setting. Practice, practice, practice!
In the structured setting, have the learning opportunities be short and sweet, so the task does not become aversive to the child.
Fade the adult prompting and presence out gradually, so the child can gain more independence. Systematically fade the reinforcement so that it is provided after longer durations.
Remember to keep the activity fun and exciting. You want your child to WANT to play with the toys and games.
Once the child masters the skill in the structured environment by independently completing the play tasks for extended periods of time, he or she can then begin to practice and develop the skill in more natural settings. Bring the toys and games into other rooms of the house, to school, and eventually have peers present, so the child can use the skills learned in a social setting.
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2017/09/Blog-Play-Skills-FeaturedImage.png?time=1560915612186183North Shore Pediatric Therapyhttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngNorth Shore Pediatric Therapy2017-09-25 05:30:422017-09-22 16:39:32How to Teach Play Skills to a Child With Autism
A school speech-language screening allows a speech-language pathologist to observe the child’s language understanding and use, production of speech sounds, vocal and nasal quality, and social language skills. The screening typically follows a checklist that a speech-language pathologist administers in approximately 15-20 minutes.
Most screening tools yield a “pass” or “did not pass”. If a child did not pass the screening, then a comprehensive full speech-language evaluation is recommended. Following this process, an intervention plan is created and proposed if needed.
A hearing screening is equally important and recommended upon entering kindergarten. The screening is typically a hand raising game an audiologist administers in approximately 10 minutes. If a child did not pass the screening, a comprehensive full hearing test is typically recommended. Normal hearing in children is important for normal language development. If a child has hearing problems, it can cause problems with their ability to learn, speak or understand language.
Speech and language skills are used in every part of learning and communicating with other children in school. In kindergarten, children learn the routine and structure of a typical school day and need to be able to follow directions, understand ideas learned in class, communicate well with their peers and teachers, practice early literacy skills and use appropriate social skills within the classroom and during play.
Screenings can be a great tool to determine if a child warrants a full speech-language or hearing evaluation. A screening alone is not diagnostically reliable and should only be used as a tool to decide if an evaluation is necessary.
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Parents often worry when their child reaches 18 months or 2 years of age and does not talk much or at all. Some children exhibit late language emergence, also known as late talking or a language delay. Approximately 10-20% of 2-year-old children exhibit late language emergence. A late-talking toddler is typically defined as a 24 month old who is using fewer than 50 words and no two-word combinations. While research shows that late talkers catch up to peers by elementary school, approximately one in five late talkers will continue to have a language impairment at age 7. For some children, the late emergence of language may indicate a persistent language disorder, also called a specific language impairment. For other children, late language emergence may indicate a related disorder such as a cognitive impairment, a sensory impairment, or an autism spectrum disorder. Many parents wonder if their late-talking toddler will catch up naturally or whether speech-language therapy is recommended.
The following signs may indicate that a child will not naturally “catch up” in language and therefore may require therapeutic intervention:
Language production: The child has a small vocabulary and a less diverse vocabulary than peers. A child who uses fewer verbs and uses primarily general verbs, such as make, go, get, and do is at risk for a persistent language disorder.
Language comprehension: The child has deficits in understanding language. The child may be unable to follow simple directions or show difficulty identifying objects labeled by adults.
Speech sound production: The child exhibits few vocalizations. The child has limited and inaccurate consonant sounds and makes errors when producing vowel sounds. The child has a limited number of syllable structures (e.g., the child uses words with two sounds, such as go, up, and bye instead of words with three to four sounds, such as down, come, puppy,black, or spin).
Imitation: The child does not spontaneously imitate words. The child may rely on direct modeling and/or prompting to imitate (e.g., an adult must prompt with, “Say ‘dog,’ Mary” instead of a child spontaneously imitating “dog” when a parent says “There’s a dog”).
Play: The child’s play consists mostly of manipulating or grouping toys. The child uses little combination or symbolic play, such as using two different items in one play scheme or pretending that one item represents another.
Gestures: The child uses very few communicative gestures, especially symbolic gestures. The child may use pointing, reaching, and giving gestures more than symbolic gestures such as waving or flapping the arms to represent a bird.
Social skills: The child has a reduced rate of communication, rarely initiates conversations, interacts with adults more than peers, and is reluctant to participate in conversations with peers.
The following risk factors exist for long-term language disorders:
Otitis media (middle ear infection) that is untreated and prolonged
Family history of persistent language/learning disabilities
Parent characteristics including less maternal education, lower socioeconomic status, use of a more directive instead of responsive interactive style, high parental concern, and less frequent parent responses to child’s language productions
For children displaying any of the above signs or risk factors, a comprehensive speech-language evaluation is recommended.
Paul, R. (2007). Language Disorders from Infancy through Adolescence: Assessment & Intervention. Elsevier Health Sciences.
Motor speech disorders are neurologically-based speech disorders that affect the planning, programming, control or execution of speech. In order to produce speech, every person must coordinate a range of muscles and muscle groups, including those controlling the vocal cords, the lips, the tongue, the jaw and the respiratory system. Movements must be planned and sequenced by the brain and then carried out accurately to create speech! A child with a motor speech disorder may be learning to understand and use language, but is constrained in the ability to plan, sequence and/or control movements of muscle groups that are used to generate speech due to neurological and/or neuromuscular impairment. Motor speech disorders include apraxia of speech and dysarthia.
What is apraxia of speech?
Apraxia of speech (AOS) is a neurogenic speech disorder in which an individual has difficultly moving his/her lips or tongue in order to say sounds correctly, despite no presence of muscle weakness. This may be due to a disruption in the message form the brain to the mouth when speech is produced.
Two main types of apraxia of speech include acquired and developmental. Acquired apraxia of speech (AoS) is caused by damage to the parts of the brain involved in speech production and involves loss or impairment in existing speech skills. AoS may include co-occurring muscle weakness that negatively affects speech production, as well as language difficulties that result from brain damage. Causes of AoS include stroke, head injury, tumor or illnesses affecting the brain.
Developmental apraxia of speech, or childhood apraxia of speech (CAS), is present from birth and occurs in the absence of muscle weakness or paralysis. There is no known cause for CAS, however, some researchers suggest it is related to overall language development, some say it is neurologically based and others reference a genetic component.
What is dysarthria?
Dysarthria is a neurologically based motor speech disorder, caused by damage to the central or peripheral nervous system that results in impaired muscular control of the speech mechanism. These disturbances of control and execution are due to abnormalities in the muscles used for speech that can include weakness, spasticity, incoordination, involuntary movements or excessive, reduced or variable muscle tone. Dysarthria specifically affects face muscles, vocal quality and breath control. Causes of dysarthria include stroke, brain injury, brain tumors, conditions that cause facial paralysis, as well as tongue or throat muscle weakness. There are five categories of dysarthria that include flaccid, spastic, hypokinetic, hyperkinetic and ataxic.
Children with motor speech disorder demonstrate neuroplasticity for speech learning. Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning, experience or following injury. Therefore, early intervention for treatment of motor speech disorders in children is critical. Consistent treatment frequency and opportunities for repetition are important to fully develop the child’s neural connections in order to change speech sound input (from the brain) into actions of the speech mechanism in order to create meaningful speech!
If you believe that your child shows signs of a motor speech disorder, do not hesitate to consult with a speech-language pathologist.
https://secureservercdn.net/22.214.171.124/fnf.6b5.myftpupload.com/wp-content/uploads/2017/07/Blog-Motor-Speech-Disorders-FeaturedImage.png?time=1560915612186183Megan Siekkinenhttps://secureservercdn.net/126.96.36.199/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngMegan Siekkinen2017-07-17 05:30:552017-07-14 15:05:01What Parents Need to Know About Motor Speech Disorders
Auditory processing refers to what we do with the messages we hear. An auditory processing disorder occurs due to an auditory deficit that is not the result of other cognitive, language, or related disorders. However, children with an auditory processing disorder may also experience other difficulties in the central nervous system, including learning disabilities, speech-language disorders, and other developmental disorders. Auditory processing disorder may also co-exist with other diagnoses, such as ADHD or Autism.
10 Signs of Auditory Processing Disorder
Difficulty understanding speech in noisy environments
Inability to consistently and accurately follow verbal directions
Difficulty discriminating between similar-sounding speech sounds (i.e., /d/ versus /t/)
Frequently asking for repetition or clarification of verbally presented information
Poor performance with spelling or understanding verbally presented information
Child typically performs better on tasks that don’t require or rely on listening
Child may not speak clearly and may drop ends of words or syllables that aren’t emphasized
Difficulty telling stories and jokes; the child may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response
Easily distracted or unusually bothered by loud or sudden noises
Child’s behavior and performance improve in quieter settings
How is Auditory Processing Disorder Diagnosed?
An initial diagnosis of auditory processing disorder is made following a comprehensive audiological evaluation, which is completed by a licensed and ASHA accredited audiologist. Following the diagnosis, the speech-language pathologists at NSPT work closely with the audiologist and collaborate on an ongoing basis. Children with an auditory processing disorder benefit from working closely with both speech-language pathologists, as well as occupational therapists. Professionals at NSPT can collaborate with teachers and other professionals to provide recommendations to help set up a successful learning environment for your child. Therapy will include activities to increase auditory closure skills, vocabulary building, discrimination skills, grammatical rules, and auditory perceptual training.
Bellis, Teri James. Understanding Auditory Processing Disorders in Children. American Speech-Language-Hearing Association.Retrieved from http://www.asha.org.
Potty training is a big milestone for any child. It definitely is an important milestone for parents as well! No more diapers!! However, there are some things to keep in mind prior to considering potty training as well as during potty training.
When should you consider potty training?
On average you would consider potty training when the child is around 2.5 years of age and above, can hold urine for 60-90 minutes, recognize the sensation of a full bladder, and show some form of awareness that they need to go to the bathroom.
Do at a time when you can spend large amounts of time at home! Some parents find it best to do in the summer (less clothing!).
What schedule should you use when potty training?
You want to take your child to the bathroom every 90 minutes, if your child urinates then you wait for the next 90 minute interval, if not you reduce the time by 30 minutes.
Consistency is extremely important to ensure success.
While on the toilet what should we do?
Praise your child for sitting appropriately on the toilet.
You can do activities with them as long as they are not too engaging or involved.
If they do urinate you want to CELEBRATE!
You need to wait up to 15 minutes if there is still no urination, then you let them get off and bring them back after 60 minutes (this keeps decreasing by 30 minutes each time there is not urination).
What should you do when there is an accident?
It happens! Make sure you have your child help you clean it up, this is not meant to be punishing but more a natural consequence of having an accident. Keep a neutral tone and assist your child if needed to clean up the mess.
If your child is having too many accidents you may need to shorten the intervals of going to the toilet, or it may be that your child is not ready to be potty trained yet. Always rule out any medical reasons as well!
Things to remember!
When starting potty training you want to make sure you child can sit on the toilet for up to 15 minutes with minimal challenging behaviors.
The goal is INDEPENDECE, you want to work towards your child walking to the bathroom on their own and removing and putting on their underwear and pants independently as well as washing their hands.
Make sure you child is in underwear throughout potty training! NO DIAPERS/PULL UPS!
Diapers and pull-ups are okay during nap time and bed time.
Number one thing to remember is PATIENCE, try to be consistently upbeat and encouraging to your child and deal with accidents as calmly as possible!
It is important to ensure that potty training is as positive an experience as possible for your child! Maintain your positive energy and constantly praise appropriate behavior seen throughout the potty training process! This will encourage your child to become more independent as well as want to go to the bathroom more often on their own!
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2017/04/Blog-Potty-Training-FeaturedImage.png?time=1560915612186183Parineetha Viswanathanhttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngParineetha Viswanathan2017-05-02 05:30:332017-04-28 15:34:335 Things to Keep in Mind When Potty Training a Child with Autism
What is a Picture Exchange Communication System (PECS)? PECS is a form of Augmentative and Alternative Communication (AAC) which uses a picture/symbol system to teach initiation of functional communication. PECS was developed by Lori Frost and Andy Bondy in 1985 to be used with preschool children on the autism spectrum who demonstrated little to no socially-related communication. Examples include: children who avoided interactions with others, did not approach others to communicate, and/or only communicated when prompted to do so.
Myth #1: The Picture Exchange Communication System is strictly used for nonverbal children or children on the autism spectrum.
A common misconception about the Picture Exchange Communication System (PECS) is that it is strictly used with nonverbal children. While PECS and other forms of AAC have proven very useful and successful with nonverbal children, the system services many other populations with the purpose of eliciting and initiating functional communication.
To fully understand the meaning of functional communication, a distinction must be made between actions directed to the environment vs. actions directed toward a person. A child may climb on a step stool to reach a toy car on a shelf. From this action, we could infer that the child wants to play with the car. However, this is not communicative. If this same child looks from the car to his mother, or leads his mother over to the car, this is considered communication. Neither interaction involved speaking, however the distinction is that communication occurs when an action is directed towards someone else to achieve a certain outcome.
Therefore, Picture Exchange Communication System is appropriate, not just with children or adults that are not verbally communicating, but with those who are verbal, yet lack person-directed communication.
Other populations where PECS might be appropriate (to name a few):
-late-talking children (research is showing benefits for the introduction of AAC as early as 12 months)
-adults with aphasia
-Childhood Apraxia of Speech (CAS)
-children with reduced speech intelligibility
-verbal children with reduced social language and initiating
Myth #2: Using PECS will deter my child from communicating verbally
For some children, verbal communication can be a challenge; speech and language are not developing as quickly as would be anticipated and, accordingly, result in accompanying frustration and associated behaviors. Introduction of an augmentative and alternative communication system like PECS can help bridge the gap for children who are not yet verbally communicating but need an accessible means of communication as speech and language develop. Without an effective means of communication, these children are at risk for social, emotional, and behavior problems, including feelings of frustration and isolation.
Often, parents are concerned that using an augmentative or alternative form of communication will replace or deter verbal communication. In fact, research has shown just the opposite:
“Research over the past 25 years has shown not only that use of augmentative communication systems (aided or unaided) does not inhibit speech development but that use of these systems enhances the likelihood of the development or improvement of speech.” (Bondy & Frost, 2004)
The PECS program mirrors the acquisition of typical language development; children are taught one-word labels for frequently requested items before transitioning to formulation of two-word utterances. Verbally requesting and labeling can be targeted in conjunction with the program. The PECS program also details modality transitioning (i.e., transitioning from PECS to verbal communication), if and when it is appropriate.
If your child is using PECS now, this does not mean that you are “giving up on speech”. It is a system that is being utilized to give your child a means of communicating and interacting with others while speech is developing.
Myth #3: PECS cannot be used with children who have visual impairments, fine motor, or gross motor difficulties.
PECS can be used with a wide range of age-groups and disabilities. Accommodations can be made for children and adults with visual impairments, fine motor, or gross motor difficulties, to name a few.
Pictures can be made in various sizes to accommodate visual impairments. Additionally, you or your child’s speech language pathologist can select and modify pictures to suit your child’s needs; photographs can be used instead of clipart or Boardmaker pictures, and images can be modified to create more contrast.
Pictures can also be put on objects (e.g., bottle tops) to make them easier to grasp and pick up from a table or book for children with fine motor difficulties.
Step 2 of PECS involves ‘distance and persistence’, meaning a child is taught to move across a room, multiple rooms, etc. to select a picture from his book and persist when giving it to his communication partner. Students that are non-ambulatory can use a voice switch or a button to request his communication partner in order to perform the exchange.
If you have questions about PECS and if it would be appropriate for your child, please consult with a licensed speech language pathologist.
https://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2017/04/Blog-Picture-Exchange-Communication-System-FeaturedImage.png?time=1560915612186183Lauren Kastanhttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngLauren Kastan2017-04-19 05:30:372017-04-14 15:30:25Common Misconceptions About Picture Exchange Communication System
Obviously, no baby is going to spend 100% of their time playing on the floor or a mat/blanket. At some point you need to cook or shower and you need a place for the baby where they’re safe from the toddler, the dog, or somewhere you know they won’t roll away. This is the time to use the exersaucer, sling seat, or bumbo seat; but try to limit the time spent in these devices to 20-30 minutes per day, collectively.
Here’s why you should consider moving away from positioning devices…
The biggest problem with these devices is children are placed in them well before they have the proper trunk and/or head control to really utilize them properly. With an exersaucer, most babies are also unable to place their feet flat on the bottom but are still pushing up into standing. This can increase extension tone, decrease ankle range of motion/muscle shortening, and can possibly be linked to future toe walking.
With a bumbo or sling seat, the baby is not placed in optimal sitting alignment causing poor sitting posture. While these appear to provide great support and make 4 month old babies look like they can sit independently, the truth is the device isn’t allowing your baby to utilize their core muscles to actively sit.
The bottom line is, if the positioning device is doing all the work, what is your child learning to do?
The best place for your child to play and spend the majority of their time is on the floor or on a blanket/mat. This allows them the opportunity to properly explore their environments and practice typical movement patterns like reaching for their feet, rolling to their side, rolling over, spending time in prone, pivoting, and creeping/crawling.