Written by Sudha Ramaswamy, PhD, BCBA-D, LBA

Myth #1: ABA is not a scientifically proven form of therapy for autism.

Over the past 50 years, an extensive body of literature has documented the successful use of ABA-based procedures to reduce problem behavior and increase appropriate skills for individuals with autism and related disorders. The research base consists of numerous studies involving single-case experimental designs.  Nearly six hundred peer-reviewed studies that have been published, demonstrate the effectiveness of ABA with individuals with autism.  A number of organizations endorse ABA as a scientifically proven approach for treating children with autism and related disorders.  These include, but are not limited to: American Academy of Neurology, American Academy of Pediatrics and American Psychological Association. ABA is also supported by the U.S. Surgeon General:  “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”

Myth #2: ABA therapy is only for learners with autism.

ABA is the practice of applying the psychological principles of learning theory in a systematic way to alter socially significant behavior. The practice is used extensively in education, healthcare, animal training, and business management.  ABA has been empirically demonstrated to be effective individuals to overcome many types of social and behavioral problems such as quitting smoking, addressing personality disorders, treating obsessive compulsive disorders, and many other issues. Behavioral principles have been applied for learners with autism since the late 1960’s and 1970’s. Studies are available that support the use of ABA programming with learners affected by a number of different disorders including language delays and emotional behavioral challenges.   Here is a relevant article about the application of behavioral science to all facets of life:

Myth #3: All ABA programs are the same.

ABA is a science of individual behavior that has its theoretical grounding in   High quality ABA programs for autism are not “one size fits all.” Rather, each program is developed to meet the needs of the individual learner. The goal of any ABA program is to help each learner work on skills that will help them become more independent and successful in both the short term as well as in the long term. A qualified behavior analyst designs and directly oversees the program. The behavior analyst will customize the ABA program to each learner’s skills, needs, interests, preferences and family goals.

Myth #4: ABA involves only Discrete Trial Training at the Table Top

Discrete Trial Training (DTT) is one approach used in ABA, but it is not the only method of choice.  DTT is a great method to use because it gives therapists the ability to focus on exactly what the learner needs to be successful. It allows therapists to set up clear expectations for the learner and teach in a systematic manner. It is fairly common that learners who have a lower level of verbal behavior or who are younger in age start with a more structured DTT, then transition to a more naturalistic teaching scenarios. Indeed, the most effective teaching includes teaching in all settings throughout the day, across persons and scenarios.  Incidental teaching or “natural environment training” includes working with the learner in natural settings.

Myth #5: ABA therapy promotes robotic behavior.

Behavioral rigidity is one of the characteristics of autism.  Thus, ABA methods target a variety of skills including generalized responding and creative behavior. As a result, a quality program will teach learners to respond in natural and creative ways. ABA treatments seek to overcome rigidity by teaching multiple exemplars and teaching for generalization to the real-world situations relevant to the learner.  In the beginning of a program, responses might seem overly simplified and therefore “robotic” but as the skills progress those skills are eventually developed and transferred to naturalistic settings.

Myth #6: ABA programs institute procedures that are too tough on kids.

In the early days of ABA, punishment was used more often but today positive reinforcement is overwhelmingly in practice.  Punishment may be used in rare cases, for example, to prevent serious self-injury, but not before all reinforcement-based methods are exhausted first.  If punishment is absolutely necessary, reinforcement procedures targeting alternative behavior should also be in place.  There’s also a common stereotype that ABA therapists are strict taskmasters.  If a therapist is overly stern and not making sessions fun and engaging, it’s just bad teaching, not ABA. Good therapists will find a way to understand the whole child and create a program that takes into account the child first, then methodically address skill deficits in an engaging manner.

Myth #7: ABA uses bribes consisting of food to manipulate the learner’s behavior.

The difference between bribes and reinforcers can be explained by examining when those events occur.  Reinforcers occur after a behavior and are specifically to increase a particular type of behavior.  Bribes, on the other hand, are made before the person engages in behavior.  Regarding reinforcers, food is a particularly useful reinforcer at the beginning of an ABA program, especially if the individual is a young learner and/or has little to no language skills.  However, pairing the food with other items, such as social praise, toys and books, for example, allows those things to become reinforcers themselves and helps expand that learner’s community of reinforcers.

Myth #8: ABA teaches rote responding and not the how and why of behavior

Any good ABA program should be designed to address all the needs of the individual learner. This includes concepts such as social interaction, complex language, problem solving, flexible thinking, and perspective taking.  Although these skills are much more complex in nature, they are amenable to the same behavioral principles that guide all of our learning. Thus the complexity and creativity of the home program will really depend on how experienced the person running the ABA program is at addressing these types of skills.  Decades ago in the early days of ABA, there was far less experience addressing these more complex learning processes. However, those deficiencies were a result of the professional’s inexperience applying behavioral principles and not problems with the principles themselves. Because ABA is a science, the field itself has evolved over the last several decades with evidence that can be found in studies published across the globe.

Links:

https://www.huffingtonpost.com/anthony-biglan/perhaps-behavioral-science-may-prove-to-be-our-most-important-science_b_6764296.html

Finding the right therapist can feel like a daunting task.  With so many different provider options with differing approaches and areas of expertise, the decision can feel overwhelming.  Of course, getting a recommendation from your child’s school, medical provider, or a friend or family member is a good first step, but there are specific things that you should be looking for when initiating treatment or considering a change in your current provider.  Some questions to ask yourself include the following.

Does the provider specialize in treating the types of difficulties that my child is encountering?

Even though you may not fully understand the underlying reasons for your child’s difficulties, your current concerns about how they are doing emotionally and behaviorally should drive your selection.  Important questions to ask yourself include, “Does this provider specialize in working with children?” “Are the treatment approaches that they specialize in proven effective for children with my child’s needs?” “Do they have any special certifications or trainings in treating the difficulties that my child is encountering?”  This information should be easily found on a provider’s website, but if not, these questions can be asked during the initial phone contact or intake meeting.

Is my provider able to clearly explain to me their understanding of my child’s difficulties and collaboratively develop specific treatment goals?

Although an exact understanding of what is driving your child’s difficulties may not be immediately apparent as every child is unique and complex, your provider should be able to articulate their basic understanding to you as well as how they are going to gather additional information in order to increase this understanding.  With this explanation in mind, they should also work with you to identify treatment goals so that it is clear what would indicate treatment success, and interventions should always be focused on working towards those specific goals.  Your provider should also be able to clearly explain their therapeutic interventions and their intended purpose.

Does my provider communicate with me about my child’s progress in therapy, reach out for updates about how he or she has been doing, and include me in sessions?

Psychotherapy with children is only effective when including their parents in treatment.  Although therapists need to keep confidentiality in mind so that your child continues to feel safe in sharing personal things in session, your child’s therapist should be communicating with you on a consistent basis.  This communication is essential in helping your child’s therapist better understand your child’s difficulties and areas of success, as well as ensuring that everyone is on the same page regarding how to best support your child.  Areas of discussion should include techniques that are being worked on in session and how you can reinforce them at home, topics that come up in session that increase your understanding of your child’s experiences and reasons for their difficulties, and successes seen in session.  Your provider should also be open to including you in family sessions if there are topics that should be discussed with everyone present or thoughts and feelings that would be helpful for your child to share with you.

Is the provider willing to collaborate with my child’s school or other providers if I would like them to?

A good provider understands that the best treatment will include obtaining and sharing information with other providers so that everyone is on the same page in working with your child.  These conversations can greatly enhance your child’s therapist’s understanding of your child’s difficulties and help inform their work with him or her.  If your child is experiencing any emotional or behavioral difficulties at school, the most effective treatment will include collaborating with the school on how they can support your child in making progress through implementing specialized interventions such as a behavior plan or safety plan.  If your child is seeing a psychiatrist, it will be important for your child’s therapist to share their observations with the psychiatrist to help inform their decision in what medication to prescribe. Overall, the more people that your child’s therapist can collaborate with, the more effective treatment will be.

Is my child making progress?

This may seem to be an obvious question to ask yourself but it can be a bit more complex in nature at times.  Yes, your child should be making progress in therapy, but it is also important to keep in mind that progress can be very slow in nature.  Therapy is a process and every child responds to it in a different way – with some making quick progress and others taking it a bit slower.  If your child does not seem to be making progress, your child’s therapist should be open to discussing this with you.  During this discussion, they should be able to articulate what progress they have seen in session and if not any, their understanding of why this is.  Sometimes it may take several sessions for your child to feel comfortable with their therapist and to start opening up to them about their difficulties.  Sometimes your child may also be hesitant to engage in activities that target their difficulties and implement techniques practiced in session at home.  Regardless of the situation though, your child’s therapist should be open to discussing any delays in progress with you and what they are doing to continue working towards the intended goals.  Your provider should also be willing to discuss with you their own limitations and if they know of any other treatment approaches that might be more beneficial in helping your child even if it means referring you to another provider.

If at any time you ask yourself these questions and come to the decision that your child’s therapist is no longer the right fit, please rest assured that this is okay.  All therapists are unique in their own way and because of that each and every therapist will not be the right fit for every family.  Frequent changes in therapists can be difficult though for children as they need to continually try to open up to someone new, so before making the decision to let your child’s therapist go, please consider scheduling a meeting to discuss your concerns and try to problem-solve how to move forward in a way that best supports your child.

What is homeopathy?

Homeopathy was developed in Germany in the late 1700s by a man named Samual Hahnemann.  It is a practice of healing techniques based on the theory that the body is naturally equipped to relieve itself of unwanted symptoms—it just needs assistance from the right sources.

Homeopaths administer naturally occurring substances to patients, which they believe facilitates the body’s natural processes to counteract specific ailments.  At a broad level, homeopathy practitioners’ try to treat symptoms by understanding how the body functions as a whole.

What is homeopathic medicine?

Homeopathic medicine involves directly administering natural substances in medicinal form. Substances are diluted with alcohol or distilled water, a process homeopaths call “dynamization” or “potentisation” and then shaken thoroughly, called “succession”. Substances that do not dissolve on their own, such as stones, are crushed, and ground with lactose.

Hahnemann believed that the process of making homeopathic remedies activated the “vital energy” of the diluted substance, and successive dilutions would make them more powerful. Scientists are skeptical of this because, at commonly used dilutions, it is unlikely that any molecules of the original substance will remain.

It is important that you consult your physician before taking these medicines, because certain dosages of natural substances can be harmful or even fatal. The FDA regulates homeopathic medicines for this reason.

Are there reasons to try homeopathic remedies to resolve ASD?

Homeopathic medicine, when approved by a doctor and used in conjunction with a research-based treatment, should not hurt your child with ASD.

There is currently no evidence to suggest that these treatments are effective, but if it your pediatrician confirms it is safe, it should not hurt to try.

There are some parents who report they feel it is helpful to their children. There are also benefits to feeling that one is providing every possible treatment for their child. Finally, there is much about ASD that we do not understand.  It is always possible that there is an alternative treatment could eventually be found to be an effective treatment for ASD.

Are there reasons to avoid to employing homeopathic remedies for ASD?

Yes.

Some homeopathic treatments could be harmful to your child—always consult with your medical physician and make sure the medicine has FDA approval before implementing a homeopathic treatment.  Homeopathic medicine can also be harmful if used in lieu of an effective treatment.

Spending months pursuing something that does not help your child in lieu of something that would help your child denies them learning opportunities and increases their pre-existing deficits.  The treatment with the most empirical evidence for effectively reducing behavior challenges in ASD and increasing skill acquisition rate is Applied Behavioral Analysis.

Does homeopathic medicine work?

The short answer is—no.

To elaborate, there is no empirical evidence to suggest that homeopathic medicines work. Right now, empirical studies investigating the efficacy of homeopathy indicate it is ineffective. Homeopathy has been around for over 300 years. If there was evidence it was effective, scientists probably would have found it by now. Empirical evidence requires replicability, observation and data.

There are anecdotal (stories of success without any data or further proof) of homeopathic medicine being effective, but scientists require more than a correlation before declaring something effective.

Other Complimentary/Alternative Treatments for ASD

There are dozens of “complimentary/alternative” treatments for ASD. Auditory integration, chelation therapy, yoga therapy, music therapy, dietary supplements, craniosacral massage, chiropractic manipulation, transcranial magnetic stimulation, and more. These are considered “alternative” treatments because they are not based on the principles of evidence-based medicine, and/or studies of the efficacy of these treatments are not judged by standards of scientific research.

Randomized controlled clinical trials, and meta-analyses supporting these treatments are not available. If you want to employ one of these treatments, do not do it at the expense of an evidence-based treatment and confer with your child’s medical provider first.

Should I put my child on an “Autism Diet”?

Some care providers recommend children with ASD eliminate gluten and/or casein from their diet. This can be recommended for children who already have gastrointestinal issues.

Casein

Casein is found in dairy products. There are families who report that when they remove this protein from their children’s diets, their ASD symptoms improve. Pediatric gastroenterologist, Kent Williams, MD, of Nationwide Children’s Hospital, in Columbus, Ohio says that there is not clear evidence to support this and further research needs to be done.

This research is currently underway. Some experimental studies have found that a casein free diet can improve symptoms. As with all treatments—one should consult a pediatrician or medical specialist before implementing a major dietary change.

Gluten

Gluten is a protein found in seeds of wheat and other grains including barley and rye. It is commonly found in foods like breads, crackers and pastas. Individuals with celiac disease (roughly 1% of the population), are advised to avoid gluten because it triggers an intestine-damaging immune system response.

Gluten is also something people who are allergic to wheat need to avoid. Individuals with a wheat allergy or celiac disease can develop inflammation in their small intestines leading to abdominal pain, uncomfortable bowel movements, chronic fatigue, difficulty processing, headaches and more. A third group of people exist who do not have these diseases, but notice that they feel better when they avoid gluten. Experts refer to individuals in this group as having the condition “non-celiac gluten sensitivity”.  Colloquially, most people know it as “gluten intolerance”.

The Celiac Disease Foundation defines Non-Celiac Gluten Sensitivity as having any of symptoms of celiac or wheat allergy (“foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue) when one has gluten in their diet and is not diagnosed with celiac disease or wheat allergy.  The symptoms improve after one keeps a gluten-free diet, and return once gluten is reintroduced into one’s diet.

Some researchers such as Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, have suggested that some people who feel they are “gluten intolerant” are actually just sensitive to more than one ingredient in grains, and things besides just gluten are triggering the immune response.

Most children with ASD do not have celiac disease or a wheat allergy.  If they do have symptoms of non-celiac gluten sensitivity when they eat gluten products, they are often labeled “gluten intolerant”.  The most commons symptoms of gluten intolerance include: bloating, stomach pain, diarrhea, nausea, and fatigue.

Evidence that implementing a gluten free diet can improve symptoms of ASD is mixed. It is important to always consult with your child’s pediatrician before implementing major dietary changes like a gluten-free diet.

What is the bottom line?

There is no reliable research indicating that homeopathic remedies can improve symptoms of ASD.

In fact, certain homeopathic treatments could potentially be harmful. There is also limited and conflicting evidence around other complimentary treatments. Responsible caregivers should have some empirical research backed evidence to support the ASD therapy or medicine they choose to implement for their child before trying any form of alternative treatment.

If you heard of a treatment you want to try that is not empirically backed, always consult with your child’s doctor first.  No matter what, caregivers should use homeopathic treatments in conjunction with a research backed treatment—i.e. ABA Therapy!

References:

https://www.medicalnewstoday.com/articles/312898.php

https://time.com/4781442/non-celiac-gluten-sensitivity/

https://www.autismspeaks.org/what-autism/treatment/complementary-treatments-autism

https://www.health.com/mind-body/homeopathic-fda-policy

https://www.webmd.com/balance/what-is-homeopathy#1

https://www.livescience.com/31977-homeopathy.html

https://www.sciencedaily.com/releases/2012/02/120229105128.htm

https://www.autismspeaks.org/node/112986

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540005/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597185/

https://technology.mythosproductions.com/?p=240

According to a survey conducted by the American Psychological Association (APA), 13- to 17-year-olds are experiencing stress at a higher level than they themselves consider to be healthy.  What’s the main source of this stress?

School tends to be the top stressor for teens while getting into a good college or deciding what to do after graduating comes next.  For some teens, stress is a source of motivation to achieve, which can lead to growth, but for others, it can lead to emotional problems such as anxiety, sadness, irritability and anger.  Due to this, it is important to take a hard look at the stress that is being placed on teens and consider ways that this stress can be mitigated.

How do I know if my teen is overly stressed?

Recognizing the symptoms of unhealthy stress levels is the first step in helping your teen.  According to the APA, the signs to look out for include irritability, anger, excessive worry, insomnia or sleeping difficulties, and disordered eating (either over- or undereating).  If stress goes uncontrolled, teens may even start engaging in the use of illegal drugs or engage underage drinking.  Studies have also shown that teens that are experiencing unhealthy stress levels may start engaging in self-harming behaviors and begin to have thoughts of suicide.

Because of this, it is very important to keep the lines of communication open so that your teen can open up to you about their experience.  Spend some one-on-one time with your teen each day, during which they are allowed to lead the conversation.  Avoid lectures and instead allow your child to share with you whatever might be on their mind.  Ask open ended questions and listen intently.

What are the specific steps I can take to help my teen cope with stress?

There are several things that both you and your teen can be doing to help mitigate stress.  Some steps include the following:

• Maintain rituals and routines – Constancy, which rituals and routines can provide, is important for teens during turbulent times. These rituals and routines also provide a time for family members to connect.  Try to establish seasonal (e.g., holidays), weekday (e.g., dining out on Wednesday nights), and daily (e.g., ending the night with a special TV show together) routines that your teen can count on and look forward to.
• Help your child manage stressful tasks by teaching them certain skills – Take time to sit down with your child and help them break down larger tasks into steps. You can also help them write out “to do” lists and set target dates for when each task needs to be completed.  Help them organize their school materials in folders – one for each subject.
• Encourage healthy behaviors – Physical activity and getting good rest each night are great ways to help manage stress. Help your child identify physical activities that they might enjoy and either encourage them to engage it in alone, join a class, or join a team.   Help your child create a bedtime routine that includes relaxing activities (e.g., reading, taking a shower/bath, drinking tea) for them to engage in, which will help them fall asleep rather than activities that will keep them awake such as screentime, studying, and watching TV.
• Model healthy behaviors – The best way to teach and encourage your child to manage their stress is to show them healthy ways that you manage your own. Show your child that you take time for self-care, including engaging in relaxing activities (e.g., spa days) as well as healthy practices such as exercising and eating right.
• Be honest with your teen (and with yourself) about the high expectations and requirements of selective colleges – If your teen has their eyes set on a selective school, assist them in identifying the certain admittance requirements of the school and talk about whether or not they are feasible. Talk with your teen about the potential things that they might miss out on if they are devoting their time to fulfilling these requirements and discuss the potential emotional impact of focusing on admittance to that particular school.  Help them understand that a great education can happen at a number of other schools that may not be as selective and talk with them about specific individuals who have been very successful without attending a selective school.  According to Randye Hoder from Your Teen for Parents, “When teenagers are not competing to get into the most selective schools, they can focus instead on deep learning, creativity, a sense of purpose, and personal connection with friends and family.”
• Make sure that your teen knows that you value them for who they are and not what they achieve – Spend time with your teen during which achievement isn’t the focus of the conversation or activity. Identify your teen’s interests outside of school and engage in them with them.

What are the specific things that my teen should be doing in order to manage stress?

There are several things that your teen can be doing as well to help mitigate stress such as:

• Listening to music
• Visualization – Taking a break by closing their eyes and visualizing a space in which they feel calm and content. Encourage your teen to visual their space in as much detail as possible by having them thinking of what they see, hear, taste, feel, and smell in that space.  Your teen may also want to visualize performing just as they would like to on a test, music performance, etc.
• Deep breathing – Deep breathing is a great way to slow down the heartrate and increase mindfulness, which can lead to stress reduction. Have your teen close their eyes and take deep breaths in through their nose and then out through either their nose or mouth.  Have them focus on their belly rising as they fill up their lungs with air and then falling when they expel it.
• Exercise
• Progressive Muscle Relaxation (PMR) – Your child can practice tensing and relaxing the different muscles groups in their body. Have them start with their face and work their way down.  Tense and relax each muscle group (e.g., face, neck, shoulders, arms, fingers) repeatedly before moving on to the next one.  This type of activity can release tension from the entire body and reduce overall stress.
• Staying organized
• Eating right
• Positive thinking and affirmations – Self-talk can be very helpful during times of stress. Have your teen identify negative statements that they might have on their mind and replace them with positive ones. For example, if your teen repeatedly thinks, “I will fail this test,” have them reframe this though by saying instead, “I have studied hard for this test and will not fail.  I will do my best and that is what matters.”

Although following the aforementioned tips may lead to a great reduction in stress, if symptoms persist or increase in severity, it is important that you seek professional help for your teen.  Psychologists are experts in helping teens mitigate stress and are available to help.

Resources used for this blog:

https://www.verywellmind.com/top-school-stress-relievers-for-students-3145179

https://yourteenmag.com/teenager-school/teens-high-school/high-school-stress

http://www.apa.org/helpcenter/stress-talk.aspx

Anger is an adaptive and harmless emotion that every child experiences. Anger is an important emotion as it provides information to children about when they are being wronged. Youth learn to assert themselves through experiencing anger and by learning to regulate this emotion. Therefore, the adaptive expression of anger is an important skill that develops throughout childhood. In this sense, there are expected differences in the way anger is regulated and expressed based on the child’s developmental level.

For example, when children are very young, their anger may be expressed through tantrums, which often include crying, screaming and minor aggression. In older children and adolescents, a child’s anger may present as irritability. This is usually evidenced by frequent arguing or talking back to adults or by withdrawing from others when upset.

There are certain times in development when parents can expect to see increased anger in their children. For example, when children are between the ages of one to three years old they may present with increased tantrums. When youth enter into adolescence, they may also show increased anger, often directed toward parents. In fact, studies have shown that on average, teens and parents experience conflict approximately 20 times each month.

When should I be concerned about my child’s anger?

While some degree of anger in children and adolescents is normal, anger in youth can also be indicative of underlying difficulties. There are a number of warning signs that a child or adolescent’s anger is cause for concern:

• The expression of anger is developmentally inappropriate. This usually presents as tantrums occurring later on in childhood.
• The child’s anger is accompanied by aggression (such as hitting, kicking, biting or punching) or destruction of property. This is especially concerning in older youth and adolescents.
• The child experiences anger with great frequency. He or she may present as irritable or angry more frequently than not.
• The child’s anger reactions are of great intensity and present as disproportionate to the situation that triggered the anger.
• The youth’s anger and accompanying emotional reactions last for extended periods of time and may not resolve even when the cause of the problem has been addressed.
• The frequency and severity of anger responses are distressing to the child or interferes with his or her functioning.

Why is my child experiencing difficulties managing his or her anger?

Difficulties with anger regulation are common in various psychological disorders including Attention Deficit Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder, Mood and Anxiety Disorders, and Autism Spectrum Disorder. However, anger difficulties can occur in youth even when there is not a related diagnosis present.

Significant anger difficulties rarely resolve on their own and can often lead to a number of academic and interpersonal difficulties. Anger concerns can be addressed by treating any underlying disorder and also through cognitive behavioral treatment focused on teaching adaptive emotion regulation skills. This treatment modality typically involves both parents and children. Sessions generally involve identifying the child’s triggers for anger, identifying their current responses to anger and coming up with alternate responses, such as taking breaks before trying to address the issue. Depending on the age of the child, treatment also involves identifying and challenging any associated maladaptive thought patterns.

Resources:

APA, Developing Adolescents, 2002

Newcorn, Ivanov, Chacko, Halperin, 2010

https://www.webmd.com/

ABA is a safe and proven therapy for removing socially and physically harmful behaviors, including behaviors associated with ASD.
ABA relies on evidence-backed principles based on academic study, which are applied based on direct observation by the therapist in a clinical setting.  A licensed and certified behavioral therapist is specifically trained to apply ABA safely and effectively, and to design programs in a way that reduces behaviors in the long term.

ABA often appears very natural to an observer.  This is because a trained ABA therapist will meet a child where they are, and then gradually guide them to experience their full potential.  A lot of ABA will therefore look like play.  Some very early learners cannot absorb information the way a typical child does. DTT (Discrete Trial Training) may be used with children like this until they develop the foundational skills to be successful in more natural forms of play.

Sometimes, ABA may cause a child to temporarily intensify a behavior when the therapist does not reward or validate the behavior in the first instance—this is part of the process of extinction and, while it can be uncomfortable, is a normal part of the child learning that a harmful behavior will not help the child to get what they want.

In short, ABA is a safe, highly beneficial therapy.  But if a therapist is not properly trained or attuned to the child, the therapist could inadvertently make target behaviors worse or lead to the creation of new problem behaviors.  As with any type of therapy, it is important to look closely at the specifics of the therapist and the therapist-child relationship to determine if your child is receiving ABA therapy that is meaningful and helpful.

Here is some information to help you evaluate ABA in a particular situation.

How to know if your ABA therapist is qualified to provide Applied Behavioral Analysis?

Your ABA therapist should be a Board Certified Behavior Analyst (“BCBA”) or have another certification from the Behavior Analyst Certification Board (BACB).  Alternatively, your therapist should be a graduate student in ABA receiving direct, weekly supervision by a BCBA.  Other individuals may or may not be talented providers, but they are not qualified to provide ABA services and may have never formally studied ABA.

Notably, different states have different rules when it comes to who is legally permitted to provide ABA.  Some states, like New York, have strict criteria that overlap with the criteria to become a BCBA.  In other states, however, a master’s degree in a therapeutic field is all that is legally required to provide ABA without supervision.  Providers should be able to give proof of their credentials upon request.

How do you know if your child’s ABA therapist is providing appropriate therapy?

• Goals should be established between the parent and the professional. Any goals your ABA therapist wants to work on with your child should be explained and communicated to you up front.

A qualified, experienced behavioral analyst should explain what they are doing and why, which behaviors they are targeting and why, and whenever possible, find a way to address these behaviors in a way that conforms to their code of ethics (is evidence based), while also making parents feel comfortable. Goals should be established between the parents and the professional.

• Therapy should also be individualized to your child.

Part of what makes ABA (when done well) so effective, is that it is individualized to each child’s unique needs. If your child’s therapist has procedures written up for your child that look like they were made for another child (have the wrong name, etc.), this could be a sign that this person is not thinking of your child’s unique needs.

• If something isn’t working, it should change.

If your child is consistently melting down during therapy during the same task (for more than 6 consecutive days), your ABA therapist should be discussing why they continue to elicit this behavior, why they think this is happening and what they want to do to help a child improve. Most good therapists want children to be able to feel successful, calm and happy. This doesn’t mean they aren’t afraid to elicit a tantrum (actually, good behavioral intervention often intentionally elicits tantrums), but the goal is always for these tantrums to extinguish. The reason that ABA therapists take such scrupulous data is to see if an intervention is effective or not. If the data indicates and intervention is not effective, they change what they are doing.

What is DTT (Discrete Trial Training)?

Discrete Trial Training is an intensive, highly structured form of ABA therapy in which children are required to sit for significant periods of time and run drills.  This particular style of ABA is not appropriate for every child.  Unlike other applications of ABA, DTT does not look like natural play.  DTT is useful for very early learners who do not yet have the skills to absorb information from their natural environment, but who are capable of learning with targeted motivation and encouragement.  DTT helps these early learners build numerous skills quickly, which is crucial for children who are developmentally delayed.  The goal of DTT is to develop the building blocks to engage in more creative, functional, natural play.  As your child’s skills evolve, DTT should be faded from their therapy sessions, and a more advanced type of learning like PRT (Pivotal Response Training) can begin.

• How long should a particular DTT session last?

Depending on the age of your child they should be given appropriate breaks.  Sitting for DTT longer than 30 minutes is probably too long for most children under 5.  Furthermore, DTT should not be the only technique your therapist applies. DTT should be mixed with other activities that allow your child to move around, explore and grow.

Is the point of ABA for my child to be indistinguishable from his peers?

The goal of ABA is unique to each particular family.  Therapists work with clients and families to establish goals that are appropriate based on the child’s development, the family’s priorities, and the child and family’s sensibilities.  Not all children with ASD are the same, nor are their families.  A good therapist will work with your family to target a goal that is right for you.

• Really, ABA wants to be socially significant

ABA therapy should target goals that are socially significant, meaning that what a therapist teaches a client makes a meaningful difference in their lives, and the lives of their families. Overall, ABA therapists want to teach children skills that will help them be successful across settings and situations.  They want to use scientifically validated approaches to make this happen. They want to make sure that they are being consistent, effective and using the principles they are trained in and qualified to assess to help their clients succeed.  Sometimes this goal is speech, sometimes it is toilet training, and sometimes it is matching pictures of animals.  If a parent and therapist disagree on the importance of a goal, they should talk about it together and come to a conclusion that is right for the child.

Does ABA force children to do things that are physically painful?

No—an ABA therapist should not make a child do something that is physically painful.  That said, a family may want to desensitize a child to certain textures or sounds, and an ABA therapist can facilitate this, likely in conjunction with an Occupational Therapist.  For example, if a child cannot stand the sensation of soap, it may be appropriate for a Behavioral Analyst to work on desensitizing them, so they can bathe, avoid getting sick, and participate at school.  ABA therapy teaches this should be done gradually, methodically, and compassionately.  First, they may just have the child tolerate having the soap next to them, then they might touch it for one second. They should not be pushed to another step until they are very comfortable with whatever step they are currently working on. So, if your child cannot tolerate being in the same room as soap, they should not be asked to wash their hands yet.  A good therapist will not try to rush this process, so the child will not experience pain.

Should my therapist ever use aversives with my child?

The use of punishment (introducing a consequence that makes a behavior less likely to happen in the future) should only be used if all other attempts at reinforcement have failed.  Furthermore, punishment should only be considered for dangerous behaviors.  If a child is engaging in a behavior that’s very dangerous to themselves or others, punishment may be introduced for safety purposes.  Just like if a neurotypical child tries to touch a hot stove and a parent screams “NO!”

The purpose of ABA is not to force children to engage in activities that hurt them. It’s not to make them look normal.  It’s not to make them touch things they don’t like, smile when they aren’t happy, or force them to confirm to social norms that are uncomfortable and don’t make a meaningful difference in their lives. The purpose of ABA is to use evidence based strategies to help children actualize their full potential, usually with a lot of laughter, fun and adventure along the way.  If you have any questions about ABA, and how to know if it is right for your family, please email me at db@manhattanpsychologygroup.com

More information about the benefits of ABA:

https://www.youtube.com/watch?v=68XQBechJb4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196209/

https://www.autismspeaks.org/what-autism/treatment/pivotal-response-therapy-prt

https://www.ncbi.nlm.nih.gov/pubmed/28963874

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488784/

https://www.appliedbehavioranalysisedu.org/how-is-discrete-trial-training-used-in-aba-therapy/

https://www.autismparentingmagazine.com/what-is-pivotal-response-training/

There is a growing body of research that indicates how deeply our brains are wired to seek social approval.  For example, a study done at Harvard in 2012 indicated that humans devote up to 40 percent of our time to self-disclosure, and that doing so can be as pleasurable as eating food or having sex.  It therefore ends up not being a surprise that social media sites such as Instagram, Twitter, Facebook, and Snapchat have taken center stage in many teen’s lives.  If you walk by a group of teenagers today, you will likely see them interacting with their phone just as much (if not more) than with each other.  Selfies are taken.  Pictures are snapped and then filtered. Groups of friends are photographed together. And all of this is mostly done with the intention of sharing it via social media.

Mental health consultants across the country though have indicated that social media has become an anxiety-provoking factor.  According to anxiety.org, this is due to the following experiences that teens have while using social media:

• Comparing their own experiences to those posted by others – People tend to post pictures of the fun things that they are doing. Some of these pictures may also be doctored by using filters, which may lead to their experience appearing even better than it was in real life. Scrolling through these pictures though can lead to your teen feeling as though they are not out living life in the same ways that others are and that their experiences are less exciting and appealing.
• Comparing their number of followers to others – Teens have indicated that it is the number of followers that is most important to them, not the quality of those followers. Therefore, feeling as though you have less followers, less “likes” or less retweets can lead to anxiety.
• Fear of missing out – Teens may see their friends and classmates posting pictures of themselves out doing things and might feel left out.
• Addicting nature of social media – A study by the University of Chicago indicated that social media can be more addicting than cigarettes. According to Graham Lavey, PhD, this addiction can then also interfere with physical and psychological well-being.

How do I help my teenager combat anxiety caused by social media?

• Help your child take an objective look at the media that they are viewing. Have them ask questions such as is this picture an accurate portrayal of this experience?  Has it been filtered?  Remind them that this picture was taken at one moment in time – one that the person thought was worthy enough to share – but that there are many moments throughout their day that they chose not to share.
• Encourage your teen to take a look at the effect that social media is having on them. Are they comparing themselves to others?  Are they spending time taking several pictures to find “just the right one” to post?  Are they feeling the need to filter their pictures to make them look better?
• Limit the amount of time that your teen spends on their phone.
• Have them put their phones away at bedtime.

If your teen seems to be addicted to social media or if its use is leading to significant symptoms of anxiety and depression, it may then be important to seek professional therapy for your child.

Resources used for this blog:

https://www.nytimes.com/2014/05/11/fashion/for-some-social-media-users-an-anxiety-from-approval-seeking.html

https://www.psychologytoday.com/blog/why-we-worry/201612/social-media-loneliness-and-anxiety-in-young-people

https://www.anxiety.org/social-media-causes-anxiety

http://www.nbc15.com/content/news/Instagram-giving-teens-anxiety-and-depression-454121863.html

Written by Sudha Ramaswamy, PhD, BCBA-D, LBA

How do you react to bad behavior?
If your children are concerned about negative consequences such as being punished when they make mistakes, they will not feel safe with telling you the truth. Practice neutral reactivity with your calm voice and body language (although it can be hard at times!) and focus on solutions that will solve the problem instead of assigning blame.

How do you connect with the emotion of the moment?
When your child is being dishonest, try to understand what made her feel that she could not be honest with you. Instead of pointing out the lie, try, “That sounds like a bit of a tall tale to me. Maybe you felt worried to tell me the truth. Let’s talk about it.” You will get the honesty you are looking for, as well as information that may help you encourage the truth in the future

Do you provide your child a chance to remediate the problem first?
Do not give your child the opportunity to lie by asking questions to which you already know the answer. For example, instead of asking, “Did you study for your math test?” try, “What are your plans for preparing for tomorrow’s test?” If your child has not studied, she can save the moment by focusing on a plan of action rather than lying to you.  Encourage any last minute attempt to “save the moment” by creating opportunities for telling the truth.

How can you reinforce and encourage honesty?
When your child tells the truth, praise her! Express encouragement when the truth is told for example, “That must have very hard for you to tell me what really happened. I admire your courage for telling the truth”

Do you own up to and celebrate mistakes (even your own)?
Think of mistakes as a way to learn to make better choices in the future. If children know that you will not be disappointed when they make mistakes, they will be much more willing to share the truth. To respond, say something like, “Here’s a great opportunity to think about what you could have done differently.  If you could have a chance to do this again, what would you do differently?” If your child’s actions negatively affected another person, ask, “What do you think can be done to help make the situation better for your friend?”

Provide unconditional love.
“I will always love you even though I am disappointed in your behavior”.  Make sure your child knows the distinction! Let them know that while you sometimes do not like their behavior, there isn’t a thing they could possibly do that would change your love for them.

What are ways for you to model appropriate behavior?
Be aware that children are observant and are always tuned in. Whether you are failing to correct the cashier who gives you too much change or making up a story about why you cannot volunteer for a school fieldtrip, remember your actions provide an important example for acceptable behavior.

According to the National Center for Victims of Crime, 1 in 5 girls and 1 in 20 boys is a victim of child sexual abuse (CSA).  For this reason, talking to children about good and bad touch is essential in helping them keep their bodies safe.

When is the best time to teach my child about good and bad touch?

Although children are the most vulnerable to CSA between the ages of 7 and 13, there are perpetrators who target victims as early as infancy.  Because of this, the best time to talk to your child about good and bad touch is as soon as they are capable of understanding your words.

How should I talk to my child about good and bad touch?

First, it is important that you talk with your child in kid friendly language that they will understand.  There many activity and educational books available (see resources below) if you feel that you need some help in figuring out the right language to use.  These books cover the different concepts that should be addressed when talking about good and bad touch and generally include the following:

• Talking about Bodies:
  • Let your child know that their body is very special and that it is important for them to take care of their bodies.
  • Educate them on the names of their different body parts – both private and not private. During this part of the conversation, do not shy away from using the correct anatomical names for private parts (e.g., breasts, vagina, buttocks, penis).  It is important that children know and practice saying the correct names so that they are not embarrassed and if they are touched inappropriately, they can accurately explain it to others.
  • Use the bathing suit rule – Tell your child that both girls’ and boys’ private parts are covered by their bathing suits.

• Talking about Good and Bad Touches:
  • Good touches:
    • Help your child identify good touches (e.g., hand holding, hugging, high fives).
    • Let them know that although these kinds of touches are generally okay, if they make them feel uncomfortable in any way, then they are not okay.
    • Also teach your child about touches that might not feel okay, but are still good for the body (e.g., shots, cleaning a cut).
    • Talk with your child about grown-ups who are allowed to touch their private parts at specific times (e.g., doctor, parent).
  • Bad touches:
    • Talk about touches that are not okay because they hurt or leave a bruise, a cut, or a burn (e.g., hitting, kicking, pushing). Let them know that it is not okay for other children to do these things to them and if an adult does, it is called physical abuse.
    • Tell your child that it is not okay for grown-ups or older kids to look at or touch their private parts and that it also is not okay for a grown-up or older kids to make them look at or touch their own private parts. Not okay touching of private parts is called sexual abuse.
  • Once you have talked about both good and bad touches, give your child some examples and see if they can identify if it is a good or bad kind of touch.

• What to do about Non Okay Touches:
  • Tell your child that they can say “No” or “Stop” or “I don’t like that” or “Don’t touch me” or anything else that means NO. Also tell them that they can run away.  Practice this with a role play.
  • Tell your child that sometimes a person who touches a child with a not okay touch will tell them that it is a secret. Talk to your child about what kinds of secrets are okay and which ones are not.  Let them know that this is not an okay kind of secret and so they should always be shared with a trusted grown up.
  • Help your child identify who they could talk to if someone has touched them in a not okay way.

Remember that talking about good and bad touch is not a one-time conversation.  Children learn best from repetition and openly talking about it will help your child feel more comfortable talking about it as well.

Useful activity and educational books:

“Let’s Talk about Taking Care of You” by Lori Stauffer, PhD and Esther Deblinger, PhD

“Good Touch Bad Touch” – http://www.villagecounselingcenter.net/Good_Touch_-_Bad_Touch_-_Workbook.pdf

“Some Parts are Not for Sharing” by Julie K. Federico (For ages 6 months and up)

“It’s MY Body” by Lory Freeman (For ages 3-8)

“Loving Touches” by Lory Freeman (For ages 3-8)

“My Body is Private” by Linda Walvoord Girard (For ages 6-11)

“The Right Touch” by Sandy Kleven (For ages 3-8)

“The Trouble with Secrets” by Karen Johnsen (For ages 3-8)

“Your Body Belongs to You” by Cornelia Spelman (For ages 3-6)

“My Body Belongs to Me” by Jill Starishevsky (For ages 3-8)

“A Secret Safe to Tell” by Naomi Hunter (For ages 3-8)

“Some Secrets Should Never Be Kept” by Jayneen Sanders (For ages 3-8)

 

Resources used for this blog:

https://victimsofcrime.org/media/reporting-on-child-sexual-abuse/child-sexual-abuse-statistics

https://b-inspiredmama.com/10-tips-for-teaching-kids-about-good/

Stauffer, L. & Deblinger, E. (2003). Let’s talk about taking care of you. Hatfield, PA: Hope for Families.

 

Autism Spectrum Disorder (ASD) is hugely variable.  People with ASD can have opposing symptoms. There are children with ASD who don’t like to be squeezed and cannot even tolerate a handshake—others crave the sensation so badly they bump their bodies into others. Sometimes individuals with ASD are so high functioning, people don’t immediately realize there is something different about them. Other times, they are unable to speak or take care of their physical needs. The futures of individuals with ASD can vary as much as their symptoms. Just like neurotypical individuals, the future of people with ASD depends on their strengths, passions and skillsets.

It is important to understand that a diagnosis of ASD does not mean that your child cannot make friends, date, go to college, get married, become a parent, and/or have a satisfying lucrative career.  Just as typically developing children need to develop skills to become successful adults, children with ASD require the same; however it’s important to note that this process often looks different than what a typically developing child experiences. It is widely understood at this point that children with ASD have better outcomes when they get diagnosed early and are inundated with evidence-based therapies to help them develop to the skills necessary to be functional and successful children and adults. The most well-known effective treatment to help children with ASD develop functional life skills is Applied Behavioral Analysis. Depending on their areas for growth children can also benefit from Speech Therapy, Physical Therapy and Occupational Therapy.

Autism and Marriage:

A diagnosis of ASD does not need to prevent anyone from getting married. Just as in any relationship, individuals with ASD need partners who are understanding and respectful of their needs. Sometimes they may need to have a more direct communication style in which partners clearly explain what they want and need instead of waiting for them to intuit it. This is not necessarily limited to couples where one individual has ASD. All couples need to find their own mode of communication that works for them. An experienced couples therapist can often help adults with ASD to navigate a romantic relationship.  In fact, couples therapy techniques already focus on teaching couples to take turns talking and make sure they understand each other, and are not created with ASD in mind. Below you can find some essays written by married adults with ASD to get a clearer picture on how this can work:

• http://offbeathome.com/adult-with-autism/
• https://www.autismspeaks.org/blog/2015/12/14/living-autism-and-having-wife-shows-you-unconditional-love
• https://musingsofanaspie.com/aspergers-and-marriage/

Autism and Careers

The skills an individual with ASD has will impact what kind of career they can explore. Of course, this is true of the general population as well.  There are several extremely successful individuals with ASD who have written about this.

Dr. Temple Grandin, perhaps the most famous individual with ASD today has some excellent advice for choosing a career when one has ASD based on individual thinking style:
https://www.iidc.indiana.edu/pages/Choosing-the-Right-Job-for-People-with-Autism-or-Aspergers-Syndrome

Dr. Grandin was able to find a career that allowed her to exercise her unusual thinking style and passion. She has revolutionized how slaughterhouses function today, humanizing and expediting the process in a way a neurotypical person would likely not have been able to imagine.

John Elder Robinson, in addition to being a very successful author, was able to use his “aspergian strengths” in a career in technology. Most notably, he built the trick guitars used by the band “kiss”. His autobiography “Look Me in the Eye” is an excellent portal into his unique mindset and paints a clear portrait of a functional adult living with ASD.

For individuals with ASD who cannot live independently, job opportunities exist as well. Multiple not for profit organizations in New York alone exist with the sole purpose of helping to find people with various challenges gainful employment opportunities. Some examples are here:

• https://careerssupportsolutions.org/
• https://www.arcwestchester.org/employ?gclid=CjwKCAjwssvPBRBBEiwASFoVd3jrbAUxjPbrIEd6vtYRfI7_5Edq-G8oLe83wFGPodk1O3QqpDjtthoCBK8QAvD_BwE
• https://experiencecle.com/our-work-2/

There are also halfway homes for people who want to live independently but need some extra assistance. Autism speaks has a resource guide to learning more about this:
https://www.autismspeaks.org/family-services/housing-and-community-living

If you have more questions, or need assistance coping with your child’s ASD diagnosis, you can call 646-450-6210 to schedule a consultation with one of our experienced Clinicians.