Paragon AutismBlog

Manual link for comment:

https://townhall.virginia.gov//l/ViewNotice.cfm?GNid=1316

Parent template sample (for this template, delete any non-applicable information and replace items in parentheses):

Hello, I have had a BCaBA as my child’s ABA Supervisor for (# of months/years) during ABA therapy.  During that time, the supervisor provided the following services on a regular basis: On-site Supervision, Consultative Supervision, Parent Training/Guidance, and Assessment/Treatment Planning.

The BCaBA, under the direction of the BCBA, was a key team member for my child’s treatment, and should continue be able to bill for applicable services.

Other service provider template sample (replace items in parentheses!):

I am writing as a provider concerned with billing limitations placed on Board Certified Assistant Behavior Analysts/Licensed Assistant Behavior Analysts (BCaBA/LaBA) in the draft iteration of the DMAS ABA therapy manual.    According to Virginia Licensure Laws and BACB guidelines for the practice of Applied Behavior Analysis, BCaBA/LaBA’s are qualified to provide supervision (CPT code 97155), parent training (CPT code 97156) and conduct certain assessments/analyze data (CPT code 97151), among others duties, under the supervision of a Licensed Behavior Analyst.

It is estimated that (#) clients across (geographic area) from our agency will be adversely affected by this billing limitation.  Please enable BCaBA/LaBA’s to use the billable codes that are in line with their training.

Find your legislator:

https://whosmy.virginiageneralassembly.gov/

Reach out to your local General Assembly members after finding them here! All House offices are up for election, so they’re probably working hard to be responsive. Share your concerns and personal story, then ask for help making this change.

We will be continuing to add to this page as other ideas or information streams in.  Thank you for all of your help and support!

As you all know, we are very active in the community working side by side with professionals and parents/caregivers alike while “giving back to the community.”  Throughout our work in the community, we are given strong indications that parents and professionals alike do not understand what ABA is or what ABA has to offer.  More concerning than not knowing about the benefits of ABA or misunderstanding ABA, we are given the indication that many parents and professionals still believe some of the myths and misconceptions surrounding ABA.  Many of these parents and professionals will not ask questions or confront us about these myths/misconceptions.  Because of these myths/misconceptions, children who could benefit from ABA services are not receiving the services they need.  As a result, we are going to address some of the myths/misconceptions surrounding ABA.  If you have heard of a myth/misconception about ABA which is not addressed, please don’t hesitate to email us so that we may address them.

Some of the top myths/misconceptions about ABA are listed below and followed by factual information.

ABA only works on dangerous and inappropriate behaviors.  Behavior is anything a person does or can do.  ABA is the science of changing behavior.  ABA applies the laws and principles of learning and behavior to teach and/or increase socially appropriate and functional behaviors as well as decrease dangerous inappropriate behaviors.  ABA is utilized to decrease maladaptive and dangerous behaviors to include but not limited to:  elopement, aggression, tantrums, noncompliance, property destruction, self- injurious (self-harm) behaviors.  ABA is successful in increasing and/or teaching socially appropriate and functional behaviors to include but not limited to:  communication, expressive  receptive language, social skills, on-task behaviors, toileting, food acceptance, independent living skills, recreation/leisure skills, gross motor skills, and direction following.

ABA only benefits children with Autism.  Autism is a Developmental Disability.  Research has proven for decades that ABA can benefit individuals with Autism, Developmental Delays, and other Developmental Disabilities such as: Down Syndrome, Intellectual Disabilities, Fetal Alcoholism, Cerebral Palsy, etc.  The principles of ABA apply across individuals of all abilities and ages, across settings, and across all behaviors (dangerous/inappropriate and socially appropriate/functional behaviors).

ABA is new and not a scientific proven treatment or therapy.  Decades of research have proven that ABA benefits children with Autism, other Developmental Disabilities, and Developmental Delays.  The Surgeon General states, “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”  ABA is endorsed by:  Centers for Disease Control, National Institute of Mental Health, National Institute of Child Health and Human Development, The American Medical Association, Surgeon General of the United States, Autism Speaks, American Association on Intellectual and Developmental Disabilities, as well as The American Academy of Child and Adolescent Psychiatry.

Anyone can practice ABA.  The Behavior Analyst Certification Board sets forth stringent criteria for anyone who hopes to practice or practices ABA, the scope of their practice, ethical standards, and supervisory and educational requirements. https://www.bacb.com  As with all professions, some practitioners are better than others. A list of questions to ask perspective providers is located on the blog section as well.

Discrete Trial is the “bread and butter of ABA”, is all ABA is, and makes a child sit at a table and work on the same thing over and over.  DTT is just one of the techniques a therapist may use to teach a skill but should not be the only technique utilized.  DTT involves presenting material or a direction, prompting the correct response when needed, and reinforcing the correct response.  DTT may involve mass trials (working on same target multiple times) and may involve working at a table.   Repetition and controlling variables while learning a new skill may be needed by some clients.  Mass trials should lead into mixed trials (rotating various targets) depending on the client.  When teaching complex skills, a therapist may work at a table presenting the task and reinforcing the correct response; however, once the skills is learned, a good therapist will generalize the skill across, people and environments.  We all benefit from practicing new skills a few times in isolation at times.  A good ABA provider utilizes many individualized techniques to teach skills.  These techniques include but are not limited to chaining, shaping, discrete trial, natural environment teaching, incidental teaching, prompting/prompt fading, error correction, errorless learning, positive reinforcement.  When teaching a skill, a good ABA provider will add a generalization goal where the client will be able to perform the behavior or task in various environments, under various conditions, and across multiple people.

ABA teaches robotic responses.  When teaching a skill, sometimes it is important to teach one specific response under one specific condition; however, once the response is learned the direction, question, and conditions should be varied as well as multiple responses taught.   A child may learn the response “19 Smith Drive” when asked “what is your address” by the therapist but should also learn to answer “19 Smith Drive” when asked by a police officer “where do you live?”  A child should be able to wash their hands when told or when their hands get dirty.  A child should be able to wash their hands in their home with bar soap and with soap from a dispenser in a public bathroom.  A child should be able to greet various people in various ways and in various environments.

ABA therapists always give children rewards of food and candy.  Edibles are only used as a last resort when nothing else interests the child or when the child is working on requesting and they prefer edibles.  A good therapist will use “pairing” to produce more reinforcers if the client has limited interests.  Reinforcement is anything put into the environment or taken from the environment which increases the chances of the behavior happening again in the future.  Positive reinforcement is very powerful tool in teaching new behaviors.    A good therapist utilizes many types of reinforcers such as but not limited to:  praise, high fives, play time, toy, happy dance, pounds, stickers, wink, song, reading a book, etc.  Remember, reinforcers are individualized.  What one person likes, another may not!  A good therapist will utilize a preference assessment to determine various possible reinforcers to ensure that food is not the only reinforcer.  By having multiple reinforcers, the chance of satiation (occurs when a reinforcer has been utilized so much it temporarily loses its value) is minimized.  When learning a behavior, yes, it is important to reinforce the behavior immediately and every time at first. This is known as a continuous schedule of reinforcement.  A good therapist will thin the reinforcement schedule to increase the time or number of responses between reinforcement.  An intermittent schedule of reinforcement may be utilized and the schedule of reinforcement should eventually mimic reinforcement in the natural environment.

What myths/misconceptions have you heard?  Do you have questions regarding the information above?  Do you have questions about what “good” ABA should look like?  Don’t hesitate to contact us via email, Facebook, in person at our events, or by phone. Remember not all ABA models and companies are the same.  Paragon Autism Services provides award winning ABA services to children and individuals under 21 diagnosed with Developmental Delay and Developmental Disabilities (including autism) who are covered by Medicaid.  Call us today and find out for yourself why Paragon Autism Services has been voted 2018 and 2019 FredParent’s Family Favorite Special Needs Resource for our ABA services and 2019 Runner Up for our Outreach endeavors.

We would like to extend a huge, heartfelt, and humbled thank you to the community for your confidence, trust, and vote.   You have voted us FredParent’s Family Favorite Special Needs Resource Winner for our ABA services for the second year in a row!  We are honored and humbled to receive this award again this year.  Rest assured that we will continue to work diligently to exceed your expectations as we assist children with communication skill acquisition, social skill acquisition, independent living skill acquisition, and behavior reduction, etc.  We thank you for your continued trust and for allowing us to serve our community in a field which we are passionate about.  We would also like to congratulate the other amazing contenders in the Best Special Needs Resource Category such as:  Helping Hands, Children’s Hospital – Lee’s Hill, Parent Education-Infant Development Program (PEID), and Rehabilitation Services of Fredericksburg -MWH.  You are all fantastic providers who excel in your professions and in your service to our wonderful community.

We were also voted 2019 Runner Up in the Family Favorites Free Things to Do Category for our free recreational and educational Outreach events.   While this award is humbling and appreciated, we do not provide all our free recreational and educational Outreach events for the accolades; we do not accept grants; and we do not accept donations.   We offer these events as ways educate and also “give back” to the community. We encourage families to continue to take advantage of all the free recreational and educational events that Paragon Autism Services offers to the community.  We also encourage professionals to continue to request on-sight workshops so that individuals with special needs may be integrated into all realms of our wonderful community.  Thank you for the opportunity to continue to “give back” to our wonderful community.  Just watch and see what we are planning for the future.   If you have any ideas how we can better serve the community through recreation and education, please let us know!

Because of you, your trust, your confidence, your support, and your participation, we are and will contnue to Make a Difference Together!

On Saturday, May 18th, we had the privilege of presenting a workshop to families who were interested in “Helping Your Child Increase His or Her Communication Skills.”  Although many families signed up and a few attended, we received many calls and emails from concerned parents because they were unable to attend the workshop. As many of you who attend our free Outreach events know, we model many of the techniques taught, are available for questions, and help facilitate communication and social skills at all of our events.  As an additional resource, we are going to outline what communication is and provide eight steps for increasing communication skills.

• What is communication and reinforcement?  What are the modes of communication, and types of communication?
  1. Communication is behavior for which the reinforcement of the behavior is delivered by another person.  
     • A child points to a cookie.  Mom gives the child the cookie.  Communication!
     • A child asks for a cookie.  Mom gives the child the cookie. Communication!
     • A child hits mom, throws themself on the floor, hits their head against the floor, and cries.  Mom tells them not to hurt themselves and gives them a cookie. Communication!
     • A child gets their own cookie.  Not communication!
  2. Reinforcement is adding something or taking something away from the environment after a behavior occurs, that increases the likelihood of that behavior occurring again in the future.
     • Reinforcement could take the form of a tangible object, an activity, or attention.
       • Child asks for a cookie.  Mom gives the child the cookie.  Child asks Mom for cookies in the future.  Reinforcement!
       • Child says “rain” when it is raining outside.  Mom says “you are absolutely right, it is raining.”  Child tells mom about the rain, a dog walking by, or other environmental events in the future.  Reinforcement!
       • Child says “all done” while eating.  Mom takes the remainder of the food away.  Child in the future tells mom when they are finished.  Reinforcement!
  3. Modes of communication include: speech, gestures, speech generated devices, sign language, textual, PECS (Picture Exchange Communication System), and inappropriate/dangerous behaviors.
  4. Types of communication (verbal operants):
     • Echoic-repeating
       • teaches the child how to say words
     • Mands–requests
       • Easiest to start with because of immediate, specific, and usually tangible reinforcement.
     • Tacts-Labels and comments
       • Seeing a cat and saying or signing “cat”
       • Commenting about their favorite show.
     • Intraverbals-back and forth of communication, answering questions, fill in the blanks.
       • Twinkle, twinkle, little ______.
       • What is your name?
       • Holding a conversation.
• What are 8 steps to increasing communication skills?
  1. If your child does not have an appropriate means of communication, consult with a speech therapist or ABA provider.
     • Understand inappropriate and dangerous behavior is a means of communication which can be replaced with a  safer, more appropriate form of communication.
  2. Create motivation and opportunities to request.
     • Allowing your child to get everything themselves may increase independence but does not increase communication skills.
     • When your child is hungry or thirsty, prompt the request, and reinforce.
       • If you give small amounts, more requests will be needed.; until they are full of course.  Generally, a child won’t request if they have had a lot of something and are full. Would you?
     • Work on a request for outside after long periods of rain. (Don’t you want to go outside now with all the rain we have had?)
     • Don’t push your child on the swing right away.  Wait for a push request. If your child doesn’t request, prompt the push request and then push your child.
     • Put things up high so they need to request.
     • Withhold glue if they are doing an art project they like which requires glue.
     • Hide a shoe when they are getting ready to go outside.
     • Turn on their favorite show and talk to them about it or provide them opportunities to fill in the blank when talking about their favorite shows/movies (To infinity _______!)
  3. Understand what natural stimulus or condition evokes various types of communication and what type of reinforcement would be appropriate.
     • I answer a question or continue with the conversation because of something you said or asked; attention will reinforce my intraverbal.
     • I talk about the rain because I see the rain; attention will reinforce my (tact) commenting about the rain.
     • I ask for the loud music to be turned down because it hurts my ears; only the music being turned down would reinforce the removal of the loud music request (mand).
     • I ask for a cookie because I want a cookie; only the cookie would be a reinforcer for the cookie request.  
       • We want our children to ask for a cookie independently because they want the cookie not because someone is asking “what do you want?”.  While we often need to start with asking questions such as “what do you want?” we eventually want to fade that prompt.
  4. Provide prompts (cues) when necessary to assist your child in communicating.  Remember to fade your prompts. You don’t want your child to wait for someone to ask them “what do you want”,  to say “say cookie”, or “c”. to ask for a cookie.
     • Parents generally ask us “how do I know my child wants a cookie?’  or complain because they ask their child “what do you want” or “do you want cookie” and when they give their child the cookie, the child cries and throws the cookie.
       • The best way to determine if a child wants something is to observe them.  If he/she reaches for a cookie, prompt the cookie request and then give him/her the cookie.  
         • If your child leads you to the counter and points and you are unsure between two objects on counter, hold out both items and see which one they reach for, then prompt that request.
  5. Reinforce your child’s communication behavior (immediately and every time at first) with the correct reinforcer.  Eventually you will be able to tell them no, wait or provide an alternative but not in the beginning. At first you need to teach the value of communication through consistent reinforcement.
     • Your child asks for a break, give them a break right away.
     • Your child taps you and says “mom” give them your attention right away.
     • Your child starts to tell you about their day, talk about their day right away.
     • Your child asks you for a cookie, give them a cookie right away.
  6. Never stop at just requesting.
     • Think of your day.  Do you only request all day?  Do you only comment or label all day?  Do you only respond when asked a question or when someone says something to you?
  7. Slowly increase goals for articulation, sentence length, length of conversation, and number of topics of conversation.
     • A child usually can’t pronounce things perfectly if they are not speaking at all.  That comes with time, practice, and help.
     • A child usually can’t speak in full sentences at first.  That comes with time practice, and help.
     • A child can’t speak on multiple topics if they are only used to talking about their favorite topic.  That comes with time, practice, and help.
  8. Reinforce, reinforce, reinforce.  Fade later.
     

if you have questions regarding the information above, Autism, or are in need of local resources, please don’t hesitate to contact us at Tina@paragonautismserices.com.  We would love to answer questions about how ABA can assist your child with communication skills, how we can help increase other skill deficits areas and how we can help reduce inappropriate/dangerous behaviors. Remember not all ABA models and companies are the same.  Paragon Autism Services provides award winning ABA services to children diagnosed with Developmental Delay and Developmental Disabilities (including autism) who are covered by Medicaid and reside in Prince William, Caroline, Stafford, Spotsylvania, Fredericksburg, or King George.  Call us today and find out for yourself why Paragon Autism Services has been voted 2018 FredParent’s Family Favorite Special Needs Resource for our ABA services and Outreach endeavors.

• Speech Therapy  assists children in the areas of speech, language, thinking, and swallowing.  A Speech Therapist can provide nonvocal children with an alternative form of communication; assist a child in expanding their length of communication; improve articulation; assist with receptive language deficits; as well as assist with feeding issues.
• Occupational Therapy assists children in succeeding in their daily activities such as:  playing, learning, and socializing.  An Occupational Therapist can assist children with sensory processing issues,  problem solving, and provide environmental modification solutions.
• Applied Behavior Analysis assists children with skill acquisitions in areas including but not limited to: communication (receptive and expressive), social skills, play skills, toileting, food acceptance, etc.  Applied Behavior Analysis assist children with decreasing dangerous/undesirable behaviors to include but not limited to: aggression, tantrum, self-injury, property destruction, elopement, non-compliance, etc.

• “Investigators have suggested that, to achieve the best possible outcomes, children with autism should begin intensive behavioral treatment as early as possible, preferably before the age of 4 years” (Green, 1996).
• “Intervention for childhood autism based on applied behavior analysis and delivered intensively at home during the preschool period can bring about significant changes in children’s functioning”  (Remington et al., 2007).
• Thomas Frazier, Chief Science Officer for the autism advocacy group Autism Speaks, states: “there is compelling data from many studies that early intensive behavioral intervention is effective.  Many children who receive early intensive behavioral intervention show substantial improvements in cognitive function, language, and daily living skills.”

As many of you know, April is Autism Awareness/Acceptance Month.  In 2016, 1 in every 68 children were diagnosed with autism spectrum disorder.  As of April 2018, that number increased to 1 in 59 — a 13.2% increase since 2014.  This article will discuss autism, the signs of autism, and the importance of early intervention.

Autism spectrum disorder, ASD, is a developmental disability.  Developmental disabilities are a group of conditions which present themselves during early childhood and persist throughout one’s lifetime.  Many teenagers and adults are currently being diagnosed with autism based on the DSM5, the Diagnostic and Statistical Manual of Mental Disorders, which now states:  “Symptoms must be present in the early developmental period (but may not become fully manifested until social demands exceed limited capacities, or may be masked by learned strategies in later life)” https://cdc.gov/ncbddd/autism/hcp-dsm.html.  Autism is a spectrum disorder meaning it affects individuals differently and to varying degrees.  As with all individuals, individuals on the spectrum possess individual strengths and weaknesses.  Some individuals with autism may require a high level of support while others require minimal to no support to achieve independence throughout their daily lives.  Although individuals with autism spectrum disorder are as unique as all other individuals, individuals with autism spectrum disorder experience deficits in the areas of communication, socialization, and behavior.  Some individuals may be non-vocal and prefer to be by themselves; while others may communicate through assistive technology and lack the skill to socialize beyond greeting others; yet other individuals may speak in complete sentences but may not know when to end a conversation or recognize when peers are no longer interested.

While children develop at different rates, it is important to know your child and what skills are expected by certain ages in your child’s development.  “Children meet developmental milestones in the way they play, learn, speak, and act.”  The CDC has compiled a list of Developmental Milestones for children up to the age of 5 https://www.cdc.gov/ncbddd/actearly/milestones/index.html  You, the parent, know your child best.  As soon as you feel something “just isn’t right” with your child or he/she may not be meeting developmental milestones, discuss your concerns with your pediatrician immediately.  It is imperative that your child receives regular child checkups and that you discuss your concerns with your pediatrician.  Pediatricians will monitor your child’s development and ask you questions.  If your pediatrician identifies concerns or agrees with your concerns, he/she will do a developmental screening and your child may be diagnosed with one or multiple developmental delays. Your pediatrician will then refer your child for a comprehensive evaluation which will be conducted by a developmental pediatrician, a neurologist, a psychologist, or a psychiatrist.  Some signs of autism include:  little or no eye contact; little or no spoken words; little or no interest in other people or under/over reaction to odors, sounds, tastes, and textures; little or not interest in pretend play; lack of pointing to objects or looking at objects others point to; difficulties in changes with routine; and/or loss of skills once had.  Other signs can be found at https://www.cdc.gov/ncbddd/autism/facts.html.

The American Academy of Pediatrics (AAP) recommends, “All children be screened for ASD at ages 18 and 24 months along with regular developmental surveillance” and states that “research shows that early intervention can considerably improve children’s long-term development and social behaviors.”  While there is no cure for autism and a person can not “outgrow” autism, early diagnosis and intervention is vital while the brain is more capable of absorbing information and changing (brain plasticity).  Early intervention can greatly improve a child’s outcomes and increase the likelihood that the child will meet their full potential.  Early intervention is proven to be effective, therefore, the earlier you can obtain services for your child the better.  The Autism Society recommends early intervention for children diagnosed with Autism.  http://www.autism-society.org/living-with-autism/autism-through-the-lifespan/infants-and-toddlers/early-intervention/.  The National Institute of Child Health and Human Development states that “individuals can learn and benefit from interventions and learning at any age; however, the earlier the better.”

Children under the age of two who are suspected of having a developmental delay or developmental disability to include autism may qualify for publicly funded Early Intervention services such as Speech and Occupational Therapy under IDEA (Individuals with Disabilities Education Act).  Children of any age may also qualify for private intensive therapy covered by private insurance and/or Medicaid.  The first intensive therapy your child may benefit from is Applied Behavior Analysis (ABA).  ABA is a science which combines the laws and principles of learning and behavior to build skills in the areas of communication, socialization, toileting, feeding, independence, etc.  ABA can also reduce maladaptive behaviors and dangerous behaviors such as: aggression, tantrum behavior, self-injurious behavior, etc.  Speech Therapy is another intervention and can assist children in the areas of speech, language, thinking, and swallowing.  A Speech Therapist can provide nonvocal children with an alternative form of communication; assist a child in expanding their length of communication; improve articulation; assist with receptive language deficits; as well as assist with feeding issues.  Occupational Therapy can assist children in succeeding in their daily activities such as:  playing, learning, and socializing.  An Occupational Therapist can assist children with problem solving and provide environmental modification solutions.

Aside from early intervention and therapy, there is a lot of support for individuals diagnosed with autism and their families which are offered through government entities and private entities alike.  Families and individuals are encouraged to get involved in educational and recreational opportunities to include:  support groups for parents and siblings, recreational activities, and training/informational sessions.  Families and individuals are encouraged to explore and apply for government assistance such as:  Medicaid (FAMIS PLUS), Childrens Health Insurance Program (FAMIS), Medicaid Waivers, and private grants.  Children with autism could qualify for government funded Early Intervention services (PEIDS and Infant Toddler Connection) as stated above as well as special education services as listed under IDEA.  Families are encouraged to explore and utilize all options available.  A complete guide to supports and resources in Virginia, Roadmap to Supports, as well as many other resources can be found at http://paragonautismservices.com/blog/.  Paragon Autism Services invites families to utilize Paragon Autism Services for their knowledge, resources, free educational opportunities, and free recreational opportunities.

Choosing an ABA provider is an important endeavor and can be confusing.  Become an informed consumer and know what questions to ask a potential ABA provider.  Provider Questions

The Holidays can be full of fun and wonder; however, holidays can be stressful for families of children with disabilities.  Here are a few Holiday Tips for Parents to help reduce some of the stress and make the holidays more enjoyable for all.