Transitioning to CBT from ABA

Many behavioral therapies have been used to treat young children with autism spectrum disorders (ASD), including Applied Behavior Analysis and Pivotal Response Training. Older children, teens, and adults with ASD may benefit from another intervention with a behavioral component: Cognitive Behavioral Therapy (CBT)

ABA was a fantastic therapy option for Jacob when he was younger but as we transitioned away from the all consuming ABA, we noticed that he would occasionally get hung up on things that needed to be addressed.  That is when we discovered Cognitive Behavior Therapy (CBT) to deal with specific situations, such as anxiety over school, being scared of the dark and taking overnight trips.  We were fortunate to find a local psychologist that specializes in CBT and we now call on him when issues pop up.  What I love about CBT is that we are able to acquire specific tools to address specific situations.  I have attached a link to a wonderful website that provides information on CBT for older children with ASD.

https://iancommunity.org/cs/simons_simplex_community/cognitive_behavioral_therapy

 

 

 

ABA vs. Floortime?

This article resonated with me in so many ways.  I struggled with which therapy was the right one to choose at the right time.  Ultimately, we did both ABA and Floortime.  I hope this is helpful in your journey as well.

Reprinted from the book Act Early Against Autism by Jayne Lytel. (Copyright © 2008 Jayne Lytel; published by Perigee. Reprinted with permission. This article may not be reproduced for any other use without permission.) In this excerpt from Chapter 6, “Promising Treatments,” Lytel compares the way she would work with her son Leo using Applied Verbal Behavior (AVB), a type of Applied Behavior Analysis, and Floortime, a more child-directed approach outlined in the book The Child With Special Needs. Besides providing a good comparison of the two approaches, this excerpt also illustrates the way parents think on their feet while applying treatments and interacting with their kids.]

If I were reading a board book to Leo during an ABA session, we might cuddle on the couch while I prompted him to turn the page: “Leo, turn page.” If he didn’t turn the page, I’d show, then help him.

Then I’d point to the first animal and say its name. I’d ask Leo to point to the animal and say, “Can you say ‘cat’?” If Leo complied, I acknowledged his success with praise and might say something like, “Good talking. You said that word so nicely. Leo, do you see the bird in the tree? Point to the bird. Good boy! Is the bird on a high branch or a low branch? You’re right! The bird is on a low branch.”

If I were doing Floortime, I could also be reading the same book, but I wouldn’t assume the role of task master while Leo played the role of learner. I’d find out what Leo might be interested in and work to develop a more equal partnership in conversation, much as in daily life encounters.

I’d let Leo explore the book, and if he took interest in an animal by making a suggestive sound or placing his hand on it (since he couldn’t point very well), I’d say excitedly, “Oh, a cat!” and look in his eyes so he could see the worried expression on my face. If Leo didn’t notice the bird, I might say, “Oh, no, a bird! Fly away, bird. The cat’s going to chase you,” and then I’d let out a big meow. I’d then say, “Fly, bird, fly.” If Leo waved his arms, I’d wave mine, too. If Leo said, “Tweet, tweet,” I’d develop a “tweet, tweet” dialogue with him. Or if he wanted to crawl off my lap and run around the house with me pretending to be a big chicken, I’d assume that role.

Our interaction would be characterized more by laughter, distinctive and exaggerated facial expressions and gestures, pleasurable tickles, stroking, and tender moments. I’d join Leo in the interaction and trade the lead back and forth, rather than dominate it, so that the emphasis was on Leo enjoying the fun of the social contact rather than showing me what he knew.

As I became secure in understanding both approaches, I could more clearly see their benefits. But I relied more on ABA since it was hard to have a back-and-forth interaction with Leo; he didn’t stick with one activity for very long, and his ability to reason and express himself verbally was poor. Nonetheless, I tried to incorporate elements from Floortime when I played with him.

According to ABA instruction, I’d get Leo to say words; describe actions, tastes, and smells; or tell me the answers to questions I’d taught him. I gave Leo praise, big hugs, or M&M’s when he did a good job. I borrowed elements of Floortime I found useful in challenging, arguing, and debating with Leo when he began to talk more fluently. For example, we once built a zoo out of blocks and plastic animals. Leo placed a lion in the same cage as a monkey. “Oh, no, Leo,” I said in a shaky, quivering voice. “What’s going to happen to the monkey if you leave him in with the lion?” I’d pick up the lion and let out a roar, moving it closer to the monkey. The point was to get Leo to think logically and to understand that actions have consequences. In reality, the monkey would be in a separate cage from the lion because, if not, the monkey would end up as the lion’s dinner. If Leo couldn’t make that logical connection, I’d help him problem solve or brainstorm a new idea to save the monkey’s life.

As I think back, I might have structured his therapy program differently and focused on Floortime and his social and emotional development, rather than on getting Leo to talk, if I’d taken the time to reflect on the purpose of all his therapy, which was to develop a deeper relationship with my son so that he could one day form relationships with other people. But I couldn’t find time for the reflection required to make sense of this. Where could I find the moments to reflect when therapy dominated our days? It would take another three years for me to understand that he needed more than language in order to develop the ability to feel and interact with others.

Inclusion at school/community functions

How many times have you attended a school or community function and realized that it was going to be a difficult situation for your child.  This was a huge problem for us because the space was too big, or too loud, or too bright.  Typically, within 2 minutes Jacob would lose it and we would have to leave abruptly.  Eventually, we stopped attending school events.  One day, I was thinking about this and realized that we were not alone.  Many families with children like Jacob were probably frustrated as well.  So I decided to present the issue of inclusion to our district PTO (parent teacher organization).  Before doing so, I sat down and composed a one page list of suggestions for inclusion at after school events.  This list can be used for any organized group that has been challenging because the correct supports have not been in place.  I hope that my list can help you move forward in your community.

Suggestions for inclusion at PTO school functions

-Consider having a quiet zone for children that may need a break from noise and stimulation         i.e.:  library, Occupational Therapy (OT) room or available classroom.

-Ask the principal and/or support service staff to “reach out” to families that have children with IEP’s.  These families may not feel connected to the community and a personal invitation could make them feel included.

-If a school event will be having a DJ and a microphone will be used, consider having the first 30 or last 30 minutes with “toned down” music and limited use of the microphone.

-Consider posting a picture schedule or signage with all the activities for that event.  Many children become overwhelmed if they are not able to visualize the sequences.

-When there is an event that is skills based or “sporty”.  Consider including a statement on the flyer or email “All ability levels welcome”.  Many parents are concerned about the perception that their child will finish last, not be picked for a team, not be as coordinated, etc.  This may be an opportunity to speak with the adapted PE teacher.

-Meet with school support services staff, such as social worker, OT and speech therapist prior to an event. If there are Special Education teachers, speak with them as well.  Ask them what the PTO can do to help accommodate all children so everyone can attend.

-Consider including a statement such as “To request specific disability accommodations, contact (name), at (phone), at least (___) days before the event.”  This could be stated on all flyers and advertisements, so that the entire community can see that the district values diversity and inclusion and is explicit about their events being open, accessible, and welcoming to all.

-Consider establishing a PTO point person to review accommodation requests. The point person should facilitate the request by contacting the appropriate event organizer to address the concern or request.

The IEP Process

I’ve just completed a chapter in my book called “Navigating the public schools:  How to work with them and not against them”.  This took me back to a challenging time in our lives.  I recall learning quickly that it was in Jacob’s best interest to approach the schools as a team member.  Decisions were made by a group of people and I knew that I had to be part of that team.  Going through some old files I found a few documents that were incredibly helpful during the IEP and team meetings.  I have shared them below for anyone interested.

Parents are key members of the IEP team.

Typically, we know our children best—not just their strengths and  weaknesses, but all the little qualities that make them unique.  A parents’ knowledge can keep a team focused on the “big picture”.

 We can provide information regarding our child’s interests, likes and dislikes, and learning styles.  We may not have all the answers, but we know what works and doesn’t work at home and in the community.

Listen to what other team members think your child needs to work on at school. They see your kids in a very different environment than you do.

Continue open dialog with the teacher to report on whether the skills the child is learning at school are being used at home.

By being an active IEP team member, we can also infuse the process with thought about long-term needs for our child’s success in later years. Your voice and vision, is your child’s future.

 

What is an IEP?

Once it is determined that your child meets the criteria to receive special education or related services, an IEP will be developed, this is a written statement or description of what will be done to help

The IEP will change based on the student’s needs.  It is a dynamic plan that is meant to be reviewed and revised when necessary.

IEP Timelines

-IEP must occur within 60 days after referral to determine eligibility (evaluations, observations, testing)

-If eligible, the meeting must occur within 30 days of that decision date days

Review of IEP must occur at least once a year, however meetings can occur at anytime to discuss changes and revisions

Every 3 years there is an eligibility review that would require another evaluation

-You should receive IEP goal progress reports along with report cards and progress updates like all other parents in your school community

-Try not to be nervous or intimidated going into these meetings.  Your voice is your child’s future

 

Dear Teachers and Support Staff:

Jacob Kaplan is a new Kindergartener at XXX and is a student in Miss XXX’s class.  Jacob has Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) which is a very high functioning form of Autism.  He is independent  and in most cases, Jacob will blend in with his classmates completely.  However, there are isolated moments that Jacob may become frustrated or not understand a social situation and we want to provide you with some information that may be helpful.

– The use of “First, Then”

– Visual timer

– Advance warning that an activity will end (possibly a countdown)

-Breakdown directions in simple steps

-Structure

-Checking for comprehension and repetition

-Eye contact when giving directions

-Strict, concrete language

-Taking breaks due to low frustration tolerance

-Give choices when appropriate

-Warning that loud noises may occur (music class, fire drill)

Please contact us with any questions, comments or concerns.  We want to be the best resource to help ensure a successful year for all involved.  I have included a resource page about PDD-NOS for your review.

Thank you for your support,

Beth Kaplan

Social Stories

 

I was going through some of my files this weekend and came across quite a few social stories that we used with Jacob when he was younger.  The social stories were very effective for traveling, going to the dentist, dealing with anger issues, etc.  I even went so far as to put a folder together with different social stories so they were always accessible.  I have attached a few stories that we used.  You can find free social stories on the web at sites such as:

dentist

Click this link to get a word template for when I get angry

http://www.oneplaceforspecialneeds.com/main/library_social_stories.html

or make your own with google images.  Good Luck!

 

Looking back on Floortime

This week my writing flowed, probably because my memories took me to a good place.  Up until now, my writing had been somewhat painful because of Jacob’s initial diagnosis and the unknown future.  I found myself going back to a time of hope and even a little bit of excitement.  I was revisiting the time that I discovered Floortime therapy, specifically The PLAY Project.  This was a good time for us because our Developmental Pediatrician, Dr. Solomon gave us so much to look forward to.  Not only were we embarking on a new therapy intervention, but the key component of this therapy was to have fun with your child and play.  Clearly, there is more to it than just play but I really enjoyed reliving the fun times with Jacob.  We had a lot of video footage from our play sessions and it was awesome to sit down at my computer this past week and watch my sweet boy play.  We did The PLAY Project for about 6 months and I watched all the video clips from beginning to end.  Wow, what a difference 6 months can make.  I plan to post some of those play videos on my website to share with everyone because those of you that are trying to find your way through these unchartered waters, remember to love, laugh and play with your special child.  They need to laugh and feel loved as much as you do.

How did I end up here?

Not in my wildest dreams did I envision writing a book and blogging with updates during the process.  I did not study journalism to become a writer but I do love to tell a good story and I know that I have a story to tell.  At first, the idea of writing a book felt overwhelming but with the encouragement of my husband, friends, and family, I thought, why not give it a shot.  It’s funny, I’ve been thinking about writing for a few years but did not sit down to write until this year.  Is it because Jacob is turning 12 years old this year and doing great or because I will be turning 50 next year.  Is it because I needed to accomplish something or prove something to the world.  I’m not sure if any of these are the reason I’m writing this now and quite frankly it doesn’t really matter.  One thing I know for sure is that it was an incredibly difficult journey and I felt so alone, most of the time.  My friends and family could not understand the pain that this journey caused me but I can empathize with the struggles some of you may be going through.

When I began writing, I cried a lot during the first chapter.  It was painful to relive but it was also cathartic because I knew there were brighter days ahead.  I can look at my amazing, soon to be 12-year-old son, Jacob and know that we did what we could to help him find his success.  I find the writing process challenging but also very exciting, so please follow me and maybe you to will find that same success!

Introduction: a little about me and my family’s Journey

Hi, I’m Beth Kaplan and I am writing my first book about my personal journey into the world of Autism.

Jacob was diagnosed at 20 months old and I knew instantly that my purpose in life was to make sure he had the best opportunities for a successful life.

Not only did I learn an enormous amount of information on Autism and supporting interventions, but the writing experience has also been a journey of self-discovery.  When I sit down to write a chapter I am taken back to a time of intense emotions, sometimes despair but most of all hope.  We’ve come such a long way and the future looks incredibly bright.

Over the course of the last few years, raising Jacob, I have not only become a fierce advocate but also an advocate for other families with children on the spectrum in our community.  I am amazed at how grateful people are to hear our story and can only hope that this book will touch others that may be struggling with similar challenges.

I am only just getting started on this new journey of sharing my story and hope that you find it compelling too.  Please follow my blog updates throughout this writing process and share the pain, joy and laughter with me.