behavioral therapy advice please!

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EmilyV
Posts: 64
Joined: Thu Feb 09, 2017 9:41 pm

behavioral therapy advice please!

Postby EmilyV » Wed Jun 14, 2017 10:15 pm

We got 25 hrs of ABA therapy for my 2 year old toddler with ASD diagnosis, with normal cognitive abilities and relatively normal language, however I am not thrilled at what they are doing and am worried it's a huge waste of time. Please advice - should we continue working with them and adjust the program/change provider/change the whole therapeutic approach? We of course are lucky that our insurance covers it, I just wish it was going better. Maybe with his particular case another model of therapy is better? Should we consider RDI/Floortime/anything else? We want to do something that's proven to help.

This is what they currently do:
Their program is for him to get tokens for correctly saying words, or waving, and then he gets breaks all the time. So the words they are teaching him are what he already knows. Actually it's one of his strengths - he picks up words very fast naturally, after hearing them once or twice, without us teaching him - the problem is that we speak a different language at home. So they are drilling him on the English words and commands he already knows, to the point that he is getting bored, so the first time he answers correctly but by the 5th time he gets so bored and distracted that doesn't want to answer, this is why his scores are not 100% (needs to be that to move forward with the tasks). His problem is not inability to learn words, his problems are deficits in interaction, getting stuck on things, and I wish they did more to increase his interaction, joint attention, eye contact. During the breaks, which is the majority of the time (because he finishes his exercises fast) he gets "rewards" which is mostly playing with his preferred objects which are trucks, and he tends to engage in repetitive play with them. According to Denver early start model which we are practicing with him ourselves, we should REMOVE trucks and objects on which he gets stuck, so we can do more interactive things, but with our current professional ABA he spends most time in the session playing trucks!!! This seems like a massive waste of valuable time when his brain has the most ability to learn! Please advice!!!
We did ask our new BCBA for a reassessment because I think the current program is below his skill level, and they did reassess last week, and still report has not been written, BCBA is on vacation, and will only write new goals next week at best.... In our ABA service BCBA comes every week and we get weekly parent training for 1 hour.

Thank you for reading!

Grandmother
Posts: 52
Joined: Tue Jun 21, 2016 7:47 pm

Re: behavioral therapy advice please!

Postby Grandmother » Wed Jun 14, 2017 10:49 pm

Hi Emily, I was just starting to draft a response to Fay on another thread when I read your post.

My daughter wanted to do as much as possible so she did both ABA and RDI.  ABA was dropped since it seemed very "Pavlovian" to my daughter and it caused frustration for grandchild.  RDI (which also incorporated ESDM) worked much better for my grandchild and the therapist encouraged biomedical and recommended a nutritionist to help go gluten and casein free.  RDI was a wonderful fit as grandchild healed.

Found this on the difference, written by an RDI person so it's slanted of course, but it does describe the differences pretty well. With RDI, the parents are the therapists.

http://www.developmentaldiscoveries.com ... nd-RDI.pdf

What state are you in?

Grandmother
Posts: 52
Joined: Tue Jun 21, 2016 7:47 pm

Re: behavioral therapy advice please!

Postby Grandmother » Thu Jun 15, 2017 1:53 am

Here's my advice.  Do not give up the ABA you have until you have something that fits your child better.  Can even add something else at the same time.  Unless you feel it's causing more harm than good of course.

To check out RDI, here's something I found, not sure what all it offers, says "access to over 500 resources PLUS live webinars and our discussion forum",  free for 3 months only if you don't already have an RDI counselor.  Perhaps it'll give you enough info to decide if you want to try it or not.  There are also lots of videos on youtube, just put RDI in search, and you'll find parents doing interactions, more about it, etc.

http://www.rdiconnect.com/join-the-rdi- ... community/

Depending on where you live, there may or may not be a nearby counselor.  They are not in all states.  If nearby, they'll come to your house.  If not, the counselors operate long distance. Hopefully someone else will chime in about other therapies so you'll have even more choices. Best wishes.

Winnie
Posts: 4227
Joined: Sat Mar 18, 2006 2:48 pm

Re: behavioral therapy advice please!

Postby Winnie » Thu Jun 15, 2017 5:44 pm

Grandmother wrote: ABA was dropped since it seemed very "Pavlovian" to my daughter and it caused frustration for grandchild. 


Just some clarification on this basic (but often mischaracterized) point about ABA -- ABA is operant conditioning (Skinner) involving a voluntary response, not classical conditioning (Pavlov) involving an involuntary or reflexive response.
Winnie
"Make it a powerful memory, the happiest you can remember."

Winnie
Posts: 4227
Joined: Sat Mar 18, 2006 2:48 pm

Re: behavioral therapy advice please!

Postby Winnie » Thu Jun 15, 2017 5:55 pm

EmilyV wrote:We got 25 hrs of ABA therapy for my 2 year old toddler with ASD diagnosis, with normal cognitive abilities and relatively normal language, however I am not thrilled at what they are doing and am worried it's a huge waste of time. Please advice - should we continue working with them and adjust the program/change provider/change the whole therapeutic approach?

How wonderful to have those therapy hours covered!

You are absolutely doing the right thing by questioning aspects of programming or implementation with which you are not comfortable. Whenever anything about your program does not seem appropriate or appears to not be accomplishing a goal – question it! Anytime a child is not learning a skill, making progress, avoiding a skill, or seems frustrated, bored, unreinforced, etc., it is essential to evaluate what we are teaching, how we are teaching, and if our reinforcement is actually reinforcing. This is necessary ongoing no matter how experienced the therapy team -- often the problem is our teaching -- “dysteachia” (Dr. Partington’s term).

I had a lot of thoughts that may possibly apply to the task you described, and was making a mental list of questions you might consider asking your supervising BCBA next week, but was wondering if you could describe the results of the assessment the therapists are working from now (otherwise I may be speculating about a situation that doesn’t apply to your child at all).

Did the BCBA program supervisor do an assessment (especially like the ABLLS or VB-MAPP) that supports the teaching targets chosen for the current programming? I was just wondering if you could describe what his profile of strengths and weaknesses look like a little more specifically -- perhaps within an assessment category (if using the ABLLS -- like labeling, in this case).

EmilyV wrote:Maybe with his particular case another model of therapy is better? Should we consider RDI/Floortime/anything else? We want to do something that's proven to help.

I think it is a good idea to look under other therapeutic rocks anyway -- if even for augmenting the program he has -- but especially if you feel a program is inappropriate for your child. But it might be best to tweak his covered hours before throwing the baby out with the bathwater, so to speak. As far as “proven” is concerned, there are no independent studies supporting the effectiveness of RDI, though this doesn’t mean it wouldn’t help your individual child.
Winnie
"Make it a powerful memory, the happiest you can remember."

EmilyV
Posts: 64
Joined: Thu Feb 09, 2017 9:41 pm

Re: behavioral therapy advice please!

Postby EmilyV » Thu Jun 15, 2017 9:24 pm

Thank you for your responses, everyone! Very helpful advice.

Winnie, you asked about initial assessment. We believe it didn't go well and the report we saw was grossly off. It was one hour evaluation in his non-native language. They did Early Start Denver Model Curriculum checklist for young children with autism. He was 23 months - almost 24 at the time of the evaluation. They said in one place that all of his skills fall within level 1 (12-18 months), but in another place they said they range in levels 1 and 2 (level 2 is 18-24 months). They noted inconsistent eye contact in response to name (true). They noted strengths were gross and fine motor skills, and interest in novel objects. they did not observe any challenging behaviors. For comparison, we did a longer neurodevelopmental assessment at a pediatrician's office at 22 months where he showed language skills appropriate to his age, but a couple of months delay in motor skills. at the same time they did ADOS which was 20. Batelle's testing by Early intervention done at 21 months showed higher than average communication skills, and the only abnormal scale was adaptive scale. Basically they told they don't see clients with such a high communication score in early intervention much. Ages and Stages questionnaire testing which is filled out by parents (I filled it out multiple times at 18, 21, 24, 27 has been consistent with normal development but perhaps on the last one a borderline score for motor skills.
When i see the latest assessment report I can update you.
Thank you for looking into this!

EmilyV
Posts: 64
Joined: Thu Feb 09, 2017 9:41 pm

Re: behavioral therapy advice please!

Postby EmilyV » Fri Jun 16, 2017 9:34 pm

Grandmother wrote:
http://www.developmentaldiscoveries.com ... nd-RDI.pdf

What state are you in?


Grandmother,
Thank you so much for the link and explanation of the difficulties between ABA and RDI, this is super helpful.
We are in Massachusetts.

EmilyV
Posts: 64
Joined: Thu Feb 09, 2017 9:41 pm

Re: behavioral therapy advice please!

Postby EmilyV » Thu Jun 29, 2017 10:43 pm

So finally we got a report from the evaluation. They used Denver model for evaluation and determined he is on level 2 in all domains (level 2 corresponds to 18-24 months (he is 28 months), but later wording say level 2-3 (level 3 is 24-36 months). They say "His primary areas of needs are related to communication, both expressive and receptive language, and social deficits" -but assessment was done in his non-native language, and they note he used 2-3 words sentences in English. They noted his eye contact and response to name was age-appropriate, and also noted his play was repetitive. He demonstrated imitative skills, pretend play, spontaneous requesting and labeling. They mentioned fine and gross motor skills and interest in novel things were his strengths.


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