What To Look for in Your Child’s Autism Assessment

Determining when and where to get an assessment for autism can be a daunting task for parents. Time, money, and finding a clinician trained in autism assessment in your area are all things that have to be considered.

Luckily, experts in autism have devoted extensive time to help determine the best procedures for providing a valid autism diagnosis. Below I have outlined a “best practices” core assessment battery for children when autism is suspected.

An Autism Diagnostic Assessment Should Include:

1.       Parent Interview – The parent interview about the developmental history, family history, and the child’s individual strengths and challenges is the foundation of the assessment.

2.       Direct Observation – The child should be observed engaging in various social interactions. The Autism Diagnostic Observation Schedule – 2nd Edition (ADOS-2) and the Childhood Autism Rating Scales-2nd Edition (CARS-2) are well-researched measures that provide robust information about the child’s behavior as it relates to symptoms of autism. Using the ADOS-2 or the CARS-2 as a direct observation measure is very beneficial to describe the child’s social strengths and weaknesses.

3.       Assessment of Cognitive Development – Cognitive functioning and problem-solving are an important part of a child’s development. An assessment of your child’s cognitive development can help inform intervention. It can also provide a baseline of your child’s functioning. Intensive applied behavior analysis (ABA) therapy has been shown to increase cognitive and problem-solving abilities in some children.

4.       Assessment of Language – An assessment of your child’s understanding and use of language is very important. Most cognitive assessments will include an assessment of verbal reasoning and vocabulary knowledge that will provide some information about your child’s language skills. Additionally, direct observation of your child during the assessment can provide an informal assessment of language and communication skills.

5.       Adaptive Behavior Assessment – Adaptive behavior describes what a child is able to do on their own. An adaptive behavior assessment can help determine what level of assistance a child needs when compared to others their age.

The information from each domain above should be integrated into a report by a licensed psychologist (PhD or PsyD) or a physician (MD or DO) that details the diagnostic classification that best describes your child. Recommendations based on the best available research and the priorities for treatment should also be included.

Remember that the above outline is describing the essentials of a “best practices” autism assessment. Additional assessment of other areas of functioning may be needed depending on the concerns for your child. The psychologist or physician will let you know if other areas should be added to the core autism assessment.

For more information about securing a best practices autism assessment at ABA Connect, please call us at 512-900-8116.

Stress Reduction for Parents of Children with ASD

Your well-being as a parent of a child with ASD is critical to your child’s functioning. I have listed some simple stress reduction strategies to help improve your emotional well-being as a parent of a child with ASD.

Social Support

Connecting with friends, family and others in the ASD community is a simple stress reduction activity. When you connect with others, it reduces loneliness and helps you feel supported. If you connect with other parents in the ASD community it can allow you to share triumphs as well as discuss challenges with others who have shared experiences. For social support within the ASD community, check out ABA Connect’s Facebook page and the Autism Society of Central Texas Calendar. Both of these sites are updated regularly and are full of events just for you!  Also, reference our Resources page to find organizations who design programs for persons with ASD and their families.

Schedule Time To Be “Mindful”

Take some time each day to focus on the present through a practice called mindfulness. Resist the urge to think about your child’s therapies, what’s for dinner, or anything else competing for your attention. Take some time, even if it is 10 minutes, just for you. Sit with your thoughts without judging them and focus on your surroundings, feelings, and any sensations you may feel without trying to change them. Mindfulness can include meditation or it can just be a specific focus on what you are doing in the moment. To learn more about mindfulness and how it promotes well-being and reduces stress, see the University of Berkeley Greater Good Science Center website. 

Delight In Your Child

Parent optimism has been associated with stress reduction, better parenting, and positive well-being. That does not mean parents walk around with rose-colored glasses. But, an increased focus on your child’s positive qualities and strengths can increase hope and optimism. Think of a cute thing your child did, a tender touch, or anything your child does that makes your heart melt. Reflect on those moments to boost your mood. If these moments do not readily come to mind, start today by looking out for things that make you smile about your child. One mother did this through an Autism Speaks blog that outlines five of her child’s personal gifts.

Foster Gratitude

Research in positive psychology shows that regular gratitude can improve happiness and life satisfaction. One way to do this is to write down three things that went well during the day before going to bed. You may start by doing this for just a week or you may try practicing it consistently. Once you develop the well-being habit of noticing the small things that go well during your day, it can increase positive feelings and decrease stress.

Ask For Help When Needed

Know if you are experiencing “caregiver fatigue.”  Caregiver fatigue can interfere with your ability to enjoy your child and engage in positive interactions.  Respite care for your child or help from family and friends can decrease stress and enhance caregiver well-being. If you feel you need additional help, consider joining a parent group led by someone experienced in children with developmental disabilities or consider individual therapy. HelpGuide.org offers good information about the signs of caregiver burnout and caregiver fatigue.

If you feel you need professional assistance, consider contacting our separate, but affiliated practice, ApaCenter. ApaCenter offers therapy and consultations for individuals, parents, and couples who want to improve their emotional and relational well-being.

Myths and Realities of ABA

A recent article highlighted many of the misunderstandings of what current ABA practices include. As mentioned in the article, and observed through personal experience, some parents and therapists alike reject the use of ABA, but tend to have some confusion about what ABA truly entails, how it is delivered, and for whom it can be helpful. As ABA is a very effective and evidence-based intervention for children with autism, as well as other developmental concerns, this very informative and insightful article prompted an interest in summarizing some of the myths and realities of ABA:

  • ABA is only for children with autism. Although ABA is an evidence-based intervention for children with autism, the true definition of ABA describes a much broader science of learning and human behavior. Many of the learning principles that guide the practice of ABA are applicable to broader group of children with other disabilities, typically developing children, and even adults! We all have things that motivate and shape our behavior, sometimes it just takes some extra work and creativity to use those motivations to help children with autism learn from and connect with their world!
  • ABA equals Discrete Trial Training. Many parents fear that ABA means your child will be sitting at a table for 40 hours per week completing learning drills that will turn him or her into a robot. Although this sort of technique has been used in the past (and may still exist at some practices), recent research suggests that a much more flexible, and play-based approach to learning is better for child development and generalization of skills to other settings. While some skills are still taught at the table, particularly those that are designed to prepare children for school-readiness, parents are encouraged to pursue ABA therapy that is described as play-based.
  • ABA rejects sensory needs. It is often obvious to parents and therapists that some children with autism have unique sensory aversions or interests. These strong sensory preferences can sometimes cause challenging behavior–whether that is to escape an environment that is unpleasant, or to gain access to preferred sensory input. The trick is to be mindful of how and when access to these preferences takes place. For example, children may quickly learn that throwing a tantrum gains them access to pleasant things, such as the sensory room. However, ABA therapists would encourage (1) teaching the child to appropriately request access to sensory input, or (2) providing sensory input in a proactive way (e.g., before tantrums or other challenging behavior occurs), and/or (3) using sensory input as a reward for other behaviors. Put simply, we don’t want to teach that tantrums gain rewards, whether it’s candy from the grocery store, or deep pressure from the squeeze machine.
  • ABA doesn’t allow play. As the field of ABA has developed over time, so has our understanding of how best to teach children with autism. Not surprisingly, the best way to teach children with autism is most similar to how we teach all children-through play! Contributions from the fields of behavioral science and developmental science have come together to hone in on the optimal strategies for teaching children with autism. Access to toys, movement, and preferred motivating rewards are now hallmarks of play-based ABA.

ABAplay

Parents should be encouraged to ask their therapists questions about the ABA strategies being used, and be thoughtful consumers about which ABA practice best fits their child’s needs. As always, open communication between parents and therapists is key! Further information about ABA can be found here.

Medicaid coverage for Applied Behavior Analysis (ABA)

I recently read a quote from a parent of a child with autism: “The hardest part about autism is knowing what treatments and therapies your child could benefit from, and not having the financial resources to get him the help.” (autismspeaks.org) For many parents, this is a heartbreaking reality. For families living in the state of Texas, this is even more challenging.

Currently, Texas denies Medicaid coverage for Applied Behavior Analysis (ABA), an evidence-based, behavioral therapy that has proven effective in treating the behavioral symptoms of autism. In 2014, federal guidance from the Centers for Medicare & Medicaid Services (CMS) advised states that they should cover medically lawsnecessary care for Medicaid-eligible children diagnosed with autism through the age of 21. These services include ABA, as well as speech, occupational, and physical therapy. Although other states quickly adopted this policy (e.g., California, Virginia), others required legal prodding (e.g., Florida), and still Texas maintains its stronghold in denying coverage.

Much of the controversy involves a complicated debate regarding licensure versus certification of ABA therapists. What is not up for debate is the profound benefit of early behavioral interventions for children with autism. Research has shown that early, play-based ABA can improve positive outcomes for cognitive abilities, communication, and social interaction skills (Rogers & Dawson, 2009). In addition, research suggests that the state of Texas would save over 2 billion dollars if funds were allocated to early intervention, rather than 18 years of special education costs through school (Chasson, Harris, & Neely, 2007).

It is important for parents to remain well informed about the policies in place that affect access to care. For a list of helpful organizations and websites to remain connected to the latest in autism news, please visit: http://abaconnect.wpengine.com/autism-resources/websites/

 

 

 

Knowing When to Ask is Key to Our Success – Pt .1

In my practice as a behavior analyst, I like to focus on helping the children I work with to increase desirable behaviors. In order to achieve this increase in behaviors, I use reinforcement and discrimination training techniques.

When working with the child to increase these desirable behaviors, it is often valuable to note the relationship between the time a behavior and its corresponding events occur. I do this by analyzing the behavior in what is known as the A-B-C diagram. In this diagram, the A is the antecedent, or event that occurs in time just before the behavior in question, the B is the specific behavior we’d like to see more of in the future, and the C is the consequence, or event that takes place in time just after the behavior has occurred. By using at the A-B-C diagram, we can better understand the behavior and its relationship to events in time.

For example; a mom asks her daughter, Bobbie to take her cup to the sink (antecedent), Bobbie quickly takes her cup to the sink (behavior), and Bobbie immediately gets a special treat (consequence). If the rate of Bobbie’s behavior of taking the cup to the sink when mom asks her to increases in the future, we learn that the special treat worked to reinforce the behavior. This is good to know! Now we have a way to see how the behavior increased.

reinforcement and discrimination training techniques

Whether you are a parent, teacher, or therapist, breaking the behavior and events down into these three parts is helpful. It helps us to get a clearer picture of certain behavior patterns, and also the A-B-C diagram helps us to develop tools in order to select more appropriate behaviors from the children we are near.