ABAI conference provides latest autism information for Little Star Center – Indiana ABA therapy facility

By Tim Courtney, senior clinical director

In keeping with its mission to provide the most effective interventions for learners, Little Star Center, an Indiana ABA therapy facility, is reviewing strategies learned recently at the annual Association for Behavior Analysis International autism conference in Las Vegas. Little Star sent three members of its staff to the conference, which focused specifically on the most current science-based approaches in assessment and treatment of autism.

More than 700 attended the January event, featuring prominent experts in autism:

Dr. Linda LeBlanc focused on procedures to teach individuals with autism to attend to both visual and auditory information when making discriminations. Individuals with autism often rely too heavily on one or the other. Dr. Leblanc provided several suggestions for strategies that we are reviewing as part of a teaching procedure review committee.

Dr. Gregory Hanley presented on an intervention to strongly consider when conducting assessments to determine why someone is engaging in problem behavior. He recommended that behavior analysts should not rely too heavily on just interview and similar assessment tools. Little Star will review the assessment procedure Dr. Hanley recommended and will make relevant modifications to our current behavioral assessment procedures.

Dr. Wayne Fisher discussed the new CPT codes. Dr. Fisher was an ad-hoc consultant for the committee that developed CPT codes. As a result of this discussion, a group of providers met after the first day of the workshop to discuss current challenges with implementing the codes. During the meeting it was decided to continue meeting as a small group to solicit information from other behavior analysts and develop tools to assist practitioners in implementing the codes. The group is currently working on a Wiki and procedures for surveying practitioners currently implementing the codes.

 

The gift of communicating with my son

By Brett Eastwick

I have been asked many times if it is harder being a parent to a child who has autism. It is not an easy question to answer. Having the perspective of raising children who are more typically developing and functioning, you would think it would be easy to determine how difficult or easy it is. It just isn’t.

There are areas that, of course, are easier. Communication stands out as a major area that is easier as a parent (until they become teenagers, that is. After that, good luck). Being able to communicate directly and effectively makes life easier for your child and you. Simple things like hearing “I’m hungry,” “I’m thirsty,” or “I’m happy” allow those around a child to take care of his needs and wants. Now, imagine not having that ability. Imagine that part of your brain being shut off, or only able to speak French around people who do not, or, perhaps even worse, being mute. And your hands won’t move. That is what it can be like for a person with autism.

Teaching a child how to communicate is, to say the least, a challenge. I have learners find echoics, whether just words or phrases, difficult to repeat or even aversive. Prolonged eye contact may also be a challenge for them. So much time and effort may result in being just as frustrating for both parties. I have asked myself, “Why can’t I teach my son to speak?” He can make sounds, imitate them, show you a person or item if you ask him to do so. Why can’t he speak?? The answer is easy. He has autism. He is unable to communicate the same way I do, the same way his mother and siblings do. The solution then, is clear. We have to learn how to communicate in a way in which HE is able to learn.

My son, Wyatt, uses ASL(American Sign Language)to make and maintain contact with the verbal world. It is what allows those around him to access his world. ASL is as real a language as English, Spanish or any spoken language. This is what he was able to learn to communicate with us. Why wouldn’t we use it to communicate with him? Some people ask me if I wish Wyatt could speak, if I wish he could just say, “I love you, Dad.” He does that every day. His hands are graceful and fluent. His communication is direct. Wyatt means what he says. Sign language allows his means of communication to be all that much more effective.

Brett is a therapist at Little Star Center.

Good-bye Alabama, hello Indiana ABA center

 

By Jamie Vandiver

Shortly after my son Camden’s diagnosis, I began checking into different therapies.  Living in a small, rural Alabama town, I quickly found my options and resources were limited, and almost non-existent.  I knew that in order for my son to receive the therapy he desperately needed, my family would have to move out of state.

After discovering Indiana has the necessary mandated insurance laws, I inquired about ABA centers in the state.  I chose Indiana since I have family members living within the state.  Luckily, this is how I learned about Little Star Center. I quickly scheduled a tour. I knew as soon as I completed the tour, it was the place for Camden. So, without hesitation, we packed up and moved 500 miles to Lafayette!

Little Star turned out to be a true blessing!  From the very first day, Little Star went above and beyond to make us feel welcomed. Every morning, as soon as Camden entered the building, he was greeted by his therapist(s) with a big warm “hello”.  Every morning made Camden feel right at home.  It touched my heart to see his eyes light up every morning.  The enthusiasm the staff carries cannot be matched!  I knew they truly cared about my son, and his progress.  They were always delighted to work with my son.  And, the atmosphere was always warm, inviting, and fun.

I liked the fact they included me, as a parent, in meetings.  They worked with me to develop a personal goals plan for Camden.  They also taught me many skills to use at home. I now have the skills needed to help Camden during his most difficult times.  The ABA therapy he received has improved his behavior tremendously.  He acquired many skills needed for everyday living.

Camden truly made great strides during his time at Little Star.  He has since transitioned successfully to a Pre-K program back in Alabama.  We often think about Little Star, and keep in contact with many of his friends and therapists. I can honestly say that Little Star was there for us each step of the way.  Above all, we were blessed to find an ABA center that truly understood the dynamics of our struggles.  They helped turn Camden’s struggles into achievements.  I will always give credit to Little

Star, along with the great people that make up their staff, for giving us hope, and for laying the foundation for Camden to have a better and brighter future!

Thank you Little Star!

Why I chose Applied Behavior Analysis Indiana

 

By Angela Vargas, M.S., BCBA

Like most other kids, I went through my list of what I wanted to be when I grew up: a lawyer (…too boring), a law and order SVU detective (…too scary), a wedding planner (…I probably wouldn’t be much good at that). This all changed when I learned that my younger cousin was diagnosed with autism. Initially, it didn’t affect me much. He lived in Colombia and my family had already moved to the United States by then. It was only a label. Then, my cousin’s family came to Wisconsin for a visit. Although he was only about 3 years old, I noticed slight differences in the way he interacted with others. “This must be the autism,” I thought.

As I got older, I heard my parents talking about the different hardships my cousin and his family faced in Colombia; limited resources and knowledge about autism being the two most prominent ones. My aunt and uncle tried to find a logical reason behind the diagnosis. Was it the Coke they gave him to drink when he was a baby? Whose side of the family did it come from? How was his birth different than that of his brother’s? All of these questions, left unanswered, only increased the familial tension. Finally, my aunt decided she would get her certificate in ABA at the University of North Texas so that she could be better informed about autism and hopefully guide my cousin’s treatment. Additionally, my cousin would make several trips to Florida to receive the needed therapy.

As it may come to no surprise, I ultimately decided that I wanted to pursue a career in the field of autism. After doing some research and talking to those in the field, I was given two recommendations: become a behavior analyst or a special education teacher. “Behavior analyst it is!” I thought, and I haven’t looked back since. Choosing to become a BCBA, while on a whim, was the best decision I have ever made. I have a profession, which I not only love, but one that constantly challenges me. Very few individuals can say that they are excited to get up and go to work every day; I am fortunate to be one of those who can. Each learner teaches me something different about life and resilience. Every milestone met, no matter how big or small, is groundbreaking. We all have a reason for pursuing a career in this field. Many of us have likely been affected by autism personally. Each and every time I work with a new learner, my cousin comes to mind. He may not have received the needed services. His family may not have been provided with the necessary support and information. He may not have had access to a service provider like LSC, something unheard of in Colombia. Luckily, I have the opportunity to be sure that his story is one never told by any of the families I work with. For this, I am eternally grateful.

Angela Vargas is a program manager at Little Star Center.

The awesomeness of riding a tricycle…or not!

 

By Siovhan Lawrence

In our family, April 2 is not just World Autism Awareness Day. It’s also the two-year anniversary of our son Bradley’s autism diagnosis. So far, we’ve learned many things on this journey. One lesson, in particular, we learned very early is setting realistic goals for Bradley while celebrating every single milestone – both big and small.

After a battery of tests with four-and five-letter acronyms and countless labs, we finally received an autism diagnosis for Bradley. The next step: Setting goals for our newly diagnosed son.  We were asked, “What are your specific goals for Bradley in the next six months?” How do you answer that?  We knew our son was delayed in every aspect and missed milestones. He was developing new interfering behaviors and was also showing regression. We answered with things we thought would be achievable. Roll a ball back and forth during play. Push a toy car around. Say the words “hi”, “bye”, “mommy”, “daddy” and “sissy.” We said we wanted him to wave, smile, respond to his name when called. Also added to our list were eye contact and an expanded food repertoire. WOW! Looking back now, we realize what a tall order that was.

In the following months we learned more about autism and the challenges Bradley would face.  Needless to say, during his next evaluation Bradley had not met any of our goals. Subsequently, we became less specific about our goals and focused more on understanding all of the intricate parts of each of those tasks.

After coming to Little Star Center (nearly 18 months after Bradley’s diagnosis), Brian, one of Bradley’s therapists, casually mentioned he was working on something with our son. He told us it would be a surprise.  At Christmastime, we were asked to come to LSC and receive our “gift.”  With all of the progress, setbacks, therapy and undeniable hard work, we had no idea what to expect. We walked into LSC and in came Bradley, riding around the corner on a tricycle. ALL BY HIMSELF! There he was pedaling, smiling and focusing. He lost a grip on the pedal, but he regained his footing. It was AMAZING! The best Christmas present ever!

As we celebrate Bradley’s progress over the last two years, we have learned to see the development of new skills and goals being met under a whole new light. Each and every moment of dedication from both the LSC staff and Bradley is monumental. Whether he is flashing one of his giant, infectious smiles or communicating one of his needs, we appreciate each moment and it fills our hearts with hope and pride.

Siovhan Lawrence is a mother of two. Her son, Bradley is a learner at Little Star Center.

 

 

 

 

Great speakers, informative sessions at ASHA convention

By Kasey Philpott, MS, CCC-SLP

I recently attended the annual American Speech-Language-Hearing Association’s (ASHA) convention in Chicago.  With over 12,000 attendees, the ASHA convention provides a plethora of learning opportunities for speech language pathologists and audiologists alike covering a variety of topics, including speech sound disorders, autism, augmentative and alternative communication (AAC), hearing loss, swallowing disorders, stroke and language science.

This year’s theme was The Magic of Teamwork: Science and Service Delivery, which offered several opportunities to hear from other professions including behavior analysts!

I had the pleasure of attending many sessions discussing autism treatment specific to AAC, social skills, feeding/swallowing and others. I also had the opportunity to see a few familiar faces, including Oliver Wendt, Ph.D, from Purdue University, who presented a case study on Experimental Evaluation of a Parent-Implemented AAC Intervention Protocol for Children with Severe Autism. Thomas Zane Ph.D., a Little Star Center advisory board member. He presented a poster session that looked at the evaluation of efficiency and preference for communication modalities.

Overall it was a great experience!  I’m looking forward to next year’s convention in Orlando, Fla.!

Kasey is a speech language pathologist & director of related services at Little Star Center.

 

Errorless Learning: When the Learner is Always Right…

Little Star Center (LSC) — created by a family of a child with autism — was the first in Indiana to employ Applied Behavior Analysis (ABA) treatment, which has long been considered the most effective intervention method for children with autism.  ABA features several instructional approaches for consideration when developing a learner’s personal program. One of the ABA evidence-based procedures used by the Little Star clinical team is ‘errorless learning’ or ‘errorless teaching.’ Errorless learning is a strategy to ensure independence in the learner and foster success by systematically fading out assistance. Learners (or all people, actually) , at times, become frustrated or discouraged if they make a mistake and may hesitate to try a skill again. Or, the learner learns a skill incorrectly, which then needs to be corrected. Frequently making errors or being asked to do work that is too difficult may provoke problem behavior such as tantrums, aggression or self-injury.

Errorless learning is the technique of making sure the learner provides the right answer to a question every time, reducing or eliminating mistakes.  A key element of errorless teaching is the therapist prompting the answer when the learner appears uncertain; increasing the likelihood the learner makes the correct response. Prompts are extra cues or hints to help the learner know what to do in a particular situation or time (including physical assistance, pointing, demonstrating, showing a picture, writing a checklist, or asking what the learner wants).  In addition to prompts, errorless learning uses positive reinforcement to assure the skill is performed again.

The process at Little Star sometimes involves flashcards with pictures or words on them or pointing to something. The learner is asked to identify the appropriate item, by matching, selecting or naming it.  If the learner hesitates in responding, the therapist prompts him/her as many times as needed for the learner to understand what is required.  The therapist monitors how often the learner needs prompting and how often he/she responds unaided in order to determine when to decrease prompting.

If the learner makes an error during the process of learning something new, the therapist does not make negative comments, nor provide reinforcement or reward.  In these cases, the therapist withholds reinforcement and presents the instruction again providing an immediate full prompt of the correct answer or presents a new instruction.

As the learner performs the targeted skill independently, the therapist reduces prompting. Once the learner has mastered the skill, it is revisited periodically for maintenance purposes and the process begins again with a new skill.

 

 

10.24.2012  Little Star Center, 317.249.2242

© 2012-2013 Little Star Center, Inc. All rights reserved.

 

Sensory Integration Therapy Effectiveness Remains Questionable

Sensory integration therapy (SIT) has been commonly used in the treatment of individuals with autism since the 1970s. The primary theory behind SIT is that some children with intellectual/developmental disabilities commonly have sensory needs (related to the five senses of sight, sound, taste, touch, and smell) that are not adequately met.  The goal of this method – which includes the brushing of skin, swinging and/or wearing a weighted vest — is to improve attention, reasoning and perception and decrease disruptive or repetitive behaviors. However, because this form of therapy remains largely untested, the success rate cannot be validated and the effectiveness of SIT remains questionable.

“Parents want to provide the best and most useful treatment for their children.  They mean well when they specifically request this method because it is popular” said Bruce Golde, Little Star Center Occupational Therapist. “Some 80% of occupational therapists working with children today still use sensory integration as a basis for treatment.  Sensory integration proponents believe it helps a child learn and develop normally, purporting to influence behaviors, improve learning and help with motor development.  However, after more than forty years in practice, sensory integration still has very few studies that include a control group, making it difficult to determine if improvement a child may realize could be due to other factors such as natural maturation.  Over the past eight years, more objective analysis has found other treatment inventions to be more effective than sensory integration.”

The 2012 Research in Autism Spectrum Disorders journal features an article on a research project on this topic which reviews and analyzes 25 studies on sensory integration therapy: Sensory Integration Therapy for Autism Spectrum Disorders: A Systematic Review by Russell Lang, Mark O’Reilly, Olive Healy, Mandy Rispoli, Helena Lydon, William Streusand, Tonya Davis, Soyeon Kang, Jeff Sigafoos, Giulio Lancioni, Robert Didden, and Sanne Giesbers.  Because many of these 25 studies were flawed, the reviewers determined that the evidence does not support the use of SIT as a treatment for children with autism spectrum disorders (ASD).

In addition, a recent article in the June 2012 issue of ADVANCE for Occupational Therapy Practitioners, titled “AAP Against SPD Diagnosis,” describes a new policy released by the American Academy of Pediatrics (AAP) recommending that pediatricians no longer diagnose sensory processing disorder (SPD) for children with sensory issues.  This decision is based on the lack of research on SPD as a condition unique from other developmental disabilities and the limited and inconclusive research on the effectiveness of sensory integration therapy on children with autism spectrum disorder. (The AAP Policy Statement “Sensory Integration Therapies for Children with Developmental and Behavioral Disorders” appears in the June issue of Pediatrics, an official peer-reviewed journal of the American Academy of Pediatrics that serves authors and readers of the general medical profession as well as pediatricians.)

“The truth of the matter is…we simply don’t know what is going on in the brain of a child with autism,” said Golde.  “We don’t know why a particular child has a preference for repeated touch.  Certainly, a child may enjoy the sensory integration activity, but beyond that, the therapy doesn’t result in significant behavioral changes.  Other forms of proven therapy are a better use of the child’s time.  Parents should explore and discuss treatment options before making a decision.”

Mary Rosswurm, Executive Director of Little Star Center and the parent of a young adult with autism, says “Bottom line, there is a difference between enjoyment and benefit.”

Little Star Center highly recommends parents visit the Association for Science in Autism Treatment (ASAT) website as a reference for unbiased and reliable information not only on sensory integration therapy but other intervention methods they may be considering. ASAT is a not-for-profit organization established in 1998 to disseminate accurate, scientifically-sound information about autism and its treatment and combat inaccurate or unsubstantiated information.

EEG Test in Young Children Offers Hope as Potential Diagnostic Tool for Autism

There has been much international attention on the recent publication in BMC Medicine of a study by Harvard University and Children’s Hospital Boston on EEG testing in young children as young as two years of age.  The study aimed to identify factors that separate children with autism spectrum disorder (ASD) from those without. One such article in ScienceDaily (June 25, 2012) summarizes the research conducted by Dr. Frank H. Duffy, Dept. of Neurology, and Heidelise Als, PhD., Dept. of Psychiatry, both at Boston Children’s Hospital.

The results revealed that children with autism exhibit consistent EEG patterns indicating altered connectivity between brain regions, “generally, reduced connectivity as compared with controls.”  In the ScienceDaily article, Dr. Duffy was quoted, “We studied the typical autistic child seeing a behavioral specialist — children who typically don’t cooperate well with EEGs and are very hard to study. No one has extensively studied large samples of these children with EEGs, in part because of the difficulty of getting reliable EEG recordings from them.”

The study offers hope that EEG may provide a diagnostic test for the disorder on several levels, including early diagnosis which would enable children to begin therapy right away.  In addition, it may help determine if Asperger’s should be considered a separate condition; indicate whether or not siblings of children with ASD may develop the same disorder; and track the effect of different types of autism treatment on the condition.

“We at Little Star Center want to start applied behavior analysis (ABA) therapy as early as possible.  We are really excited about the possibility of individuals being diagnosed as early as 18 months of age,” said Tim Courtney, Little Star Center Research & Training Director.  “Little Star  has had one learner undergo an EEG scan already to help us evaluate behavioral strategies to get kids to comply with EEG, and begin evaluating the effectiveness of ABA at changing the structure of the brain.  We hope to get more done moving forward as EEG diagnosis has an 80% accuracy rate.  In practice, we’d like to have the test done before a learner begins ABA training then scan a year later to determine the value of ABA. The child we scanned had already been receiving ABA training; so, we can’t do the type of comparison we ideally want in that case.  However, the doctor with whom we are working (Dr. Jane Yip) believes she saw ABA greatly helping the child.”

Dr. Jane Yip, PhD. is familiar with this study and is conducting more EEG’s in young children.  She noted that they are finding that “coherence” is affected in autism.  “Brain activity as a whole is functioning in a different way (in individuals with autism) from the neurotypicals (normals),” she said.  “It’s like a person who has broken a leg will limp and the entire gait will be affected no matter which angle you choose to look at it from. This is a new frontier.  It will be beneficial to further development of autism research to have data showing pre- and post changes of (brain) profiles and look for the biomarker that is most sensitive to treatment. Better visualization of results, both in behavior and brain performance, will help the children improve in a way previously undreamt of.  The test is confirming to parents that ABA intervention can produce rewiring in the brain.”

Dear Mary, July 13, 2012

Dear Mary is a bimonthly column whereby readers may submit questions to [email protected] and receive answers related to autism.  Mary Rosswurm is executive director of Little Star Center and also the mother of a son who has been diagnosed with autism.  She understands…

Dear Mary,

My son’s doctor recommended ABA therapy for him. He is four years old and doesn’t like loud places, lights on or other kids. I would like a home program for him.

Jeana, Indianapolis

 

Hi Jeana,

The reasons you described (dislike of loud places, lights or other children) strongly suggest why your son needs a center-based program and not a home-based program. A robust center-based program offers access to other children, a variety of staff, the speech therapist, occupational therapist, outings, group activities and multiple layers of supervisors. Since your son is four, the goal is to get him prepared for kindergarten, and it will be essential that he can tolerate noise, lights and other people. Addressing these concerns require clinical expertise and closely monitored programming.

While I know that as a mom you want to make your child comfortable — and he may be more comfortable at home with one familiar person working with him each day — that is not real life. He needs to be able to be around new people, in novel situations. Let’s face it – the world is bright, loud and full of kids. As he gets older, he will become more and more isolated if we don’t begin to get him used to these things.

For example, two years ago I was terrified of the iPhone – I had my old flip phone and I didn’t want to learn about this new kind of phone. It seemed very complicated to me and I didn’t see why I needed access to my email or the Internet constantly. I really resisted it until finally my supervisor insisted that I get one. Period, end of story.

So, at first I HATED it. I dropped calls all the time and couldn’t figure out how to turn the stupid thing off while I was on a plane that was heading for take off. I couldn’t work the tiny key pad (that wasn’t even real keys) and every time I tried to hit the “M” key, I would hit the “backspace” instead. I hated it and I was miserable. BUT…the more I used it, the better I got and I learned new things about it everyday. My co-workers would gently encourage me to try new features like the GPS or face-time.

Now two years later, I can’t imagine how I lived without it. I am comfortable with it. It simply was a new skill that I needed to learn, which is exactly what these obstacles are for your son – things he needs to learn to tolerate. It will take time, he may be upset at first, but he will get comfortable and be able to be around these things that he finds annoying right now. Don’t lose sight of the big picture – where do you want him to be when he is 8, 12, 15 and 30? Not home alone, but out with people in different places.

I would encourage you to look at a center-based program for your son and stretch his comfort zone!

Mary,

Executive Director, Little Star Center