What to expect from ABA therapy for a 2E 10 year old?

[Quarter Note]

The BCBA working with my ten-year-old son recommended that we start ABA therapy for 10 hours/week and then work up to 25 hours/week. All three of us are wondering what in the world an ABA therapist could do for all that time. I'm used to PT, OT, and speech therapy being one hour per week, but 10 to 25? 

My son is really, really angry about having so much of his day taken up. I'm not sure if we should back off from even 10 hours/week or ask him to at least give it a try for a while.  It would help if we knew something of what to expect.

Can any of you tell me some possibilities of what two hours a day of ABA therapy might look like? We've asked that the therapy focus on impulse control and mood regulation. 

Thanks!

[PeterPan]

Whoa, I can see why you're concerned and why your ds sounds frustrated!

What is going to be the training level of the people working with him? Is this in home? And who is setting the goals? Does your BCBA have experience with gifted kids? How verbal is he?

2 hours ago, Quarter Note said:

We've asked that the therapy focus on impulse control and mood regulation. 

Why? Not that I'm disagreeing that those are issues, but why ask a person with nominal training to do something that either should involve medication or a PhD psychologist or LSW counselor (licensed social worker)?

If you get the wrong goals, you're going to get the most behavioral, yucky outcomes, the stuff you hear people not liking. How about goals that are positive and involve communication, self advocacy, and social? 

For impulsivity, sorry but that's just a meds thing, plain and simple. Unless you've ABCd the behavior and he's eloping, but even then. 

For the mood regulation, that's a combo of meds and wanting interoception work and then Zones. And no RBT is trained or qualified to do any of that.

We had a behaviorist who was experienced with gifted kids and a gem. You're not wanting straight traditional ABA most likely. You're wanting something umbrella where they go more cognitive. There are programs from Social Thinking, etc. that the BCBA could do once a week and then have the RBT or home worker *reinforce* with carefully chosen goals. 

We *worked up* on hours. I agree with your ds there that it's inappropriate to just slam someone with tons of hours. Is this dc going to school? 

They pulled the "he needs 25 hours a week" thing on us when ds was at a low point a couple years ago. Really what we needed was better meds and good solid consistent interaction. It didn't have to be a paid worker and it didn't have to be RBT. We had to up our game and he needed his chemistry fixed. When we fixed the chemistry, he got a lot easier to work with. Then anyone can do it.

I'm not saying don't do the ABA. I'm just saying you probably better listen to your ds and slow down and think hard. He's giving you some good information here. He could be contributing on goals and what he WANTS to do should play a big part! Do you want that help with someone else spending time? I like to have it some and I also wanted to be more skillful myself. So you could get 2 days a week where it's really going well for a 2-3 hour block. Work up. 

For us it was hard to find workers who could keep up with ds. These are often college students. Our best worker of all was a doctoral OT student. She seriously kicked butt, because she had so much experience. She was whipper snapper smart and could adapt and work on the fly. She could roll with where he was. Some of what she could do for us was really good, mainly if I needed a break or needed to clone myself. But as far as mood regulation and actually solving the real problems, in the end *I* had to learn how. I had to make the chemistry changes happen, I had to do the Interoception work with him and I had to make sure he always has enough engagement, intentional engagement, to stay connected. 

I'm saying don't let them guilt you into ABA if your gut says no. It can be good, but you might need to get hold of it, figure out why, and make sure you're asking people to do what they're actually capable of doing. They are not bringing in phd psychologists, psychiatrists, etc. It's why we finally dumped our in home and got people who COULD work with him on his level. He needed people with more experience, at least a masters. Less hours, more quality. You know your kid, but I'm just saying that's what happened to us. 

It's ok to slow down, take a deep breath, talk it through. 

[PeterPan]

https://www.kelly-mahler.com/what-is-interoception/

Here's a link on Interoception. You can't regulate your mood if you don't realize how you feel. And even people who are hyper responsive for sensory can have interoception issues! It's very counter intuitive. So this is something you can work on with him that will be foundational, pivotal.

You can also read about the Zones of Regulation. But really, doing that requires his interoception to be there to give him that data so he can realize what zone he's in. So back up and work on the interoception and you'll probably be amazed how much improves.

Even brief mindfulness of 5 minutes is evidence based to give a 30% bump in EF=executive function. That impulsivity goes back to EF, so working on mindfulness (which is what you're doing with the interoception, hint hint) will actually prime his brain to be a bit more calm and connected for a bit. What I found with my ds was that doing the exercises for the interoception lessons was very calming for my ds and put him in this good place. Now Kelly has her new Interoception drive yoga and exercise cards, so you can create warm-up menus, break menus, whatever you want and get that burst of mindfulness and engagement and calm. 

This is not stuff a random RBT is going to do for your ds, lol. This is cutting edge, and it's usually going to be a phd psych/counselor, SLP, or OT. But you can do it!! If you want to do that work, don't sell yourself short. With these good materials YOU become a valuable part of the team. And when you're doing this intentional, high engagement work, that counts toward that goal of 3-5 hours a day of ABA and high interaction, high quality time, kwim?

Is he homeschooled or doing another kind of school? If he's being homeschooled, they may want to do part of his academics during his ABA time. If academics are not going well, you could ask the BCBA how to do them *better* to make them more effective yourself! If you want to outsource, fine. And if you want to be that person, you can do it to. 

For us, they advised we go to single sheet worksheets, things we could hand him one at a time. Lots of clear structure, with lists on the board, clear plan, things lined up. So people laugh at me and my worksheets, but it's very ABA. DTT (your ABA instructional technique for really classic ABA) is all about short sets of work with reinforcement. So you learn what reinforces your ds. They may be looking for external motivators, but my ds quickly got bored with them. He was motivated by INTERACTION. Playing games, even simple stuff like throwing beanie babies or a ball or a balloon back and forth is a big deal to him! So they helped us find these intrinsic motivators, things that were relational, things that made me valuable and made it a reward to be with me rather than a reward to escape me. 

So short work with clear structure, rewards/breaks that are relational and motivating, and suddenly I'm doing the ABA, kwim? It's ok to use someone else or it's ok for me to do it. It wasn't about hours so much as just getting it done. 

If you like your person, it's great to work with someone. I'm just saying don't let them snow you. You can find your mix of how this works. 

[PeterPan]

We use teletherapy services to get access to higher quality workers without so much of a drive. Now that's hard if they're asking him to do something aversive. But if they build relationships, it can work. My ds does 4+ hours a week with SLPs, music therapy, etc. that way. He also has peer chats where he has supervised conversations with a peer and SLP to work on social/conversation skills. I try to have something like that every day, partly for our sanity, well mainly for our sanity, lol. 

If they're offering you high quality people and you like the goals, that's great! My ds had a lot of issues with compliance and anxiety, and sometimes the workers made it worse by not really having tools to get compliance. So then my ds was treating ME with the noncompliance and attitude he was giving THEM. That was completely unacceptable and why we finally gave up. There are some battles you win by finally realizing you just have to win it, sigh. 

3 hours ago, Quarter Note said:

two hours a day

So this is just a suggestion, but I LOVE having someone take my ds on outings. I HIGHLY recommend you have one of your workers take him out for 2-3 hours on the town for planned outings. They can work on life skills and independence skills. You want him able to go to a restaurant and order, deal with novelty, deal with changes, shop, wait in lines, etc. Now I have a SIL who does this for ds, but if I didn't an ABA worker would be PERFECT. 

Remember, when you go to town, you aren't actually there to focus on him and behavior, are you? Nope. You're there with your long grocery list, plans, things on your mind. But if you ask them to go to town and get 4 items and mail a letter, he's getting all the attention and learning the skills. 

At home? I would have another day be life skills. So in our house we call it Filthy Friday, and we have a growing list of cleaning skills. There's a wonderful curriculum Cooking to Learn, so he can build his own recipe book of things he can make completely independently. Cooking is huge! It's life skills, it's motivating. So you want something not so fun followed by something he'll look forward to. So cleaning and then cooking works. 

A typical session for us they usually started by pairing. They come in and engage with him on his terms, notifying him at some point that at x time or in x minutes they're going to move on to doing xyz. And then they toggle back and forth with demands and motivator/reward tasks. They may even phrase it as taking turns. They usually wanted a list of 4-5 tasks for their block and they would let him choose which task to do first. That kind of thing. And I usually made lists where many things would be highly preferred. It's not like you start with all horrors, lol. You start with a list of demands that are all pretty easy for him to say yes to, lol. Then as they build a RELATINOSHIP, then they have more room to make harder demands. 

So if it's going well and being well done, he should pretty much feel like he enjoyed having them there and did a few things he hadn't planned on but overall had a good time. It's kinda like when Grandma comes, kwim? She might make cookies with you but she's also going to tell you to pick up. ABA should be like Grandma. She's not going to spank you and she's going to have some seriously good ways to get you to do what she wanted you to do while making it seem very nice.

Edited March 15, 2021 by PeterPan

[PeterPan]

3 hours ago, Quarter Note said:

start ABA therapy for 10 hours/week and then work up to 25 hours/week.

Yup, that's fine. And maybe you don't need 25. Like I said, for us we needed chemistry solutions more than we needed ABA hours. There's this tendency to make it seem like ABA solves everything and it DOESN'T. If the kid needs meds, he needs meds. 

Now my ds EATS UP good interaction. I'm always looking for great people. But we had trouble getting those kind of hours even with strong funding. Ds outgrew the lower skill workers. 

So just use your gut. See the kind of people they bring in, how it's working. Ask the BCBA what kind of goals she suggests. One thing I liked about our behaviorist instantly was that she saw POTENTIAL in my ds that I didn't. It's something I look for any time I'm hiring a new worker (SLP, anybody). What potential are they seeing in him that I don't see yet?

There's a saying that the person who sees the potential is the person to get you there. That for me is always my personal challenge. I have to stop and ask myself how my low vision of where we could be is holding us back and I look for people who have VISION of where this is going.

But like on that impulsivity thing, you can treat it as a behavior thing and ABA it, but I'd really be asking about meds. Just saying.

[PeterPan]

How are your ds' leisure skills? My ABA workers were awesome for working on leisure skills. These college kids can play nintendo like nobody's business, lol. I can't, so couldn't really teach him how to play together in Super Mario Bros and not get angry, kwim? You ahve to be pretty good to play and deal with his frustrations and stay calm. But they could do it easily, lol. 

So yeah, I was paying ABA workers to play nintendo with my ds, but now it's a solid leisure skill, something he can do with other kids if they come over, and I know he's not going to get angry or throw things or whatever, kwim? 

How is your ds with losing? Again, leisure skills. If he's terrible at losing, that can be an ABA goal! So he just thinks he's getting break/reward time with games, but you know you're working on ABA goals.

Even our beanie baby toss time that he thought was break was (shhh) working on our ABA goals. We wanted to "gentle' him because my ds was very rough. We wanted "modulation" where he could go from more amped to more calm or from throwing hard to softer. So we did it initially with *cotton balls* so he could feel his force. To him it was a reward, but we were working on behavioral goals.

But yeah, definitely think about leisure skills. It's something you don't have to have the sharpest worker to work on, and it really makes a big difference in their ability to enjoy life. We ended up buying things like ping pong and air hockey so we would have these things for them to do together. And it's also really dependable, because once he knows how to do them, then you have this motivating break activity that can go between harder demands. But it took a while to work through issues of modulation, losing, etc. 

Edited March 15, 2021 by PeterPan

[Quarter Note]

Oh wow, PeterPan!  I knew you'd come through!  I can't even quote everything that you wrote that I'll start thinking about.  I'll have my husband also read all your responses and we'll talk about it, but this is GREAT!  This gives me lots of ideas to talk about the next time that we talk with the BCBA.

Just to answer your questions, we are still working on getting some meds that will work for him.  We should know in about a week or two if what he's on will work or if we need to change.

He's also homeschooled, from the beginning, so he's never been in public school.  Public school would never have worked for him.

I was hoping that we'd talk to the BCBA about Interoception.  It's in the plans!

And boy, is he verbal - as long as it's his preferred topic du jour....  Anything else, he's a clam.

Thank you so much as always, PeterPan!  I'll come back after we've talked some more about all your advice.

[wendyroo]

My almost 10 year old gets 20 hours of ABA per week.

What it looks like at our house:
 - I write a list of tasks for DS each day. (At this point the tasks are more or less standardized each day of the week, so I just print off a week's worth of lists at a time.) The list includes hygiene and self-care tasks, school work tasks and chores.

 - The first thing the ABA therapist does with DS is turn the task list into a schedule. They intersperse breaks and therapy activities (board games, language strengthening games, social skills practice, etc) in with the tasks.

 - During ABA, the therapist works with DS on a lot of soft skills.
      - For over a year they have been working on following a schedule...it is still a daily (hourly) struggle, but it is one that the therapists have the patience for because they can focus a lot of attention on it for the hours they are here.
      - They work on emotional regulation - they have been building up a menu of coping skills (taking a one minute breathing break, coloring, verbalizing the size of the problem, stretching of taking a movement break, etc) and they help guide DS into actually using one of them instead of exploding...again, very much a work in progress.
      - They work on problem solving - they can afford to spend half an hour patiently guiding DS to the realization that instead of despairing, he could use a "tool" to get his car out from under the piano.
      - They work on sustained attention and focus.
      - They work on helping DS sort and organize his school supplies, clothes, library books, etc.

 - Since DS is one of 4 homeschooled siblings, some ABA time is devoted to helping DS work and play with the rest of the family. Board games are almost always played with siblings (and, gasp, sometimes they get to pick the game!). Joint playroom clean up is almost always undertaken during therapy when ABA can help keep DS focused on himself and not picking fights. 

 - They work on life skills and building up DS's sensory and anxiety tolerance. For this to happen, I have had to learn which therapists do best with what skills and then orchestrate tasks that build on those skills. One therapist is studying to be an OT, so I often schedule DS to cook, do handicrafts, practice tying his shoes, etc with her because she brings a lot to the table with those types of skills. DS's other therapist is good with talking DS down off a ledge, so DS sweeps the front porch with him (close to spider webs!!!), eats snack on the deck (there might be bees!!!), vacuums his bedroom (it's too loud even with the noise cancelling headphones!!!), etc.

 - They work a TON on interoception. During certain stressful tasks, his therapists ask DS how he is feeling, or what number he is at, as often as every minute...literally every 60 seconds by the clock. During those tasks, DS gets praise for verbalizing any feeling or number, and as soon as his feelings or numbers start heading in a negative direction, they start prompting with coping and regulation skills. It often takes them 30-45 minutes to make it through a stressful 10 minute task because they spend so much time helping DS keep himself regulated.

 - And when all of the structure and breaks and scaffolding don't work, and DS falls into a violent rage, ABA keeps him and the other kids safe. They calmly ride out the tantrum while enforcing safety boundaries, and then they hold DS responsible for his actions by overseeing the clean up of the tantrum damage.

 - Mostly, at our house, ABA is a second pair of hands so that I can meet the other kids' needs. ABA can spend half an hour keeping DS focused on writing his 10 spelling words. ABA can supervise DS cleaning up the entire tube of toothpaste he decided to squeeze into the bathroom drawer...even if it takes hours because he REALLY doesn't want to do it. ABA can help DS learn to peel a carrot, because he doesn't like touching the wet, cold carrot, and he can't figure out the right amount of pressure to use with a peeler, and his frustration tolerance is nil.

[PeterPan]

17 minutes ago, Quarter Note said:

And boy, is he verbal - as long as it's his preferred topic du jour....  Anything else, he's a clam.

ABA is good for that also a good SLP. An SLP can catch other issues too with narrative language, metalinguistics, etc. There's going to be that overlap. Problem is either party can over promise, under deliver. No one person can do it all, and so I'm just saying if you have coverage for SLP services then consider adding an SLP to your mix. If you find the right person, it can be really good. Just add/subtract hours, kwim? The SLP can line up peer conversation groups, whatever.

Peer work has really turned on some MAJOR LIGHTBULBS for my ds. We did some at a clinic where they were going through Zones of Reg, Social Detective, etc. We've done online peer chats. It's all good, whatever you can find. 

Think about it. If he's doing all his work with adults, how does it generalize? You want peers as part of the mix, and whoever makes that happen is golden. It can be the BCBA, SLP, whomever, but you want it. 

Remember what Ruth Aspy says. For peer work to be effective we need to know what we're working on, go work on it, then talk about how we did at working on the goal. Just throwing kids together doesn't make that happen and an RBT is not the person to make that happen. That's your master's level person, your SLP or BCBA. 

[PeterPan]

https://www.amazon.com/Stop-That-Seemingly-Senseless-Behavior/dp/1890627763/ref=sr_1_1?crid=1ZYVIR44RL6S2&dchild=1&keywords=stop+that+seemingly+senseless+behavior&qid=1615775480&s=books&sprefix=stop+that+seem%2Caps%2C196&sr=1-1  Have you already read this?

 

https://www.amazon.com/Verbal-Behavior-Approach-Children-Disorders/dp/1843108526/ref=sr_1_7?dchild=1&keywords=mark+sundberg&qid=1615775563&s=books&sr=1-7  This woman drives me crazy (there, I've said it) but it's basic stuff

https://www.amazon.com/gp/product/0966526600/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1  Things they like to hit in ABA. See the table of contents. 

There's one more book I'm looking for but that gives you a start. What I finally needed to see was what they were trying to do. I was kind of "out there" with my goals, but actually your ABA people are looking for really basic things. I'm not giving you a technical list here, but look at that last book and you'll start to see. They want them using their language and manding and interacting and they want self regulation. If language skills are backed up a bit, they're going to fill that in. But they are NOT a replacement for OT, SLP, etc. They're sort of one clearing house and a different perspective from those other places. They're going to do the same skill but get it APPLIED. And we need that! 

I just think if you're asking for emotional manipulation, you're not going to like what happens. Too much ABA (not done especially engagingly) and my ds goes really flat and robotic. It's a totally weird thing. You want positive, affirming, growth oriented, relational goals. He narrates so he can relate. He regulates so he can participate. Kwim? He waits so he can get his turn with the worker. It's not a skill in isolation but something that he wants to learn to do to get something else he wants. That's the whole idea behind VBA and their theories of language. The child is motivated to do it to get something he wants, the power of it. When the positive version of the behavior becomes motivating and gets him something he wants, he'll want to do it more. 

I would be concerned that a negative goal would turn punitive, kwim? I'd be expecting your BCBA to help you find the positive skill there you're wanting to see. We had goals with frustration tolerance and waiting. Sometimes it was artificial, with the worker literally whpping out a timer on her phone and saying she'd be available in 2 minutes. Hahaha. And sometimes it's real life, like waiting in line at the grocery. 

Edited March 15, 2021 by PeterPan

[PeterPan]

4 hours ago, Quarter Note said:

My son is really, really angry about having so much of his day taken up.

You can read about Collaborative Problem Solving. This is definitely an age to be collaborating and problem solving together, lol. 

Does he have friends? For my ds, workers become his friends. They're teaching him how to BE a friend and how to have friends. Don't tell him that, but it can be one of the nice side effects. If it goes well, this is something you transition off of. It's not like a forever thing. The goal is to build the skills so he can start doing them in the community and with his peers and not need this level of support. 

[PeterPan]

Wendy makes a really good point about the context with the number of kids. To get that ABA effect, you're giving full attention. So whether it's a worker or you or your dh or whomever, it's full attention, not split between other kids. It doesn't matter who does it, only that it gets one. And if you have only one dc at home (like I did for some of this) and you just want to go CRASH for an hour or clean while someone else is ON, that's fine. 

[Lecka]

Do you have any goals that would require him to be able to go along with a plan, for a day, that he would want or need to do, that he currently could not do?

That is the only obvious thing to me saying — he needs those hours so he can get used to that level of expectation.

If he is already fine with things like that — maybe you don’t need so many hours.

The BCBA could also have an assumption or impression that you desire that many hours.  If you say you aren’t interested, that should be fine.  

Other positives of more hours are:  more time for games or fun mixed in with more explicitly working on goals.  More time to go on outings.  
 

If you are not looking for that — I doubt it would be a problem to say you don’t want to increase hours.

 

If the BCBA thinks there is a “therapeutic” reason he/she can communicate it with you. 
 

Like — if you talk about some goal of going to day camp and he/she says “I don’t see it going well bc that’s 4 hours a day and if he’s only used to 2 hours a day of not doing what he wants when he wants on his own terms, I don’t think he will just go from 2 to 4 hours for the first time at camp” — that would be a “therapeutic” reason.  
 

Otoh there could be nothing like that, and doing fewer hours might be totally fine if that is your family’s preference.  
 

My advice is — look for a goal that would be meaningful for your son.  Like — would he like to go to an activity you don’t think he can handle right now?  Is there a problem that bothers him you think could be helped?  
 

Things like that are how you get buy-in.  Other ways of getting buy-in are just having the therapy have a lot of fun or outings, and just getting along with the people.  
 

If this BCBA does outings and you can say “on Friday someone is going to take you on this outing you want” — that is the kind of thing where more hours can help with buy-in.
 

That will just depend so much on personality, though.  But that is just an example of how more hours can allow time for that.  And if that would help with buy-in for your situation, that’s something.  If that wouldn’t help with buy-in for your situation, then — it’s not.   
 

At a certain point you are probably seeing some things you would like to be better — if there’s a way to tie that into your son getting to do something or having a more positive experience meaningful to him — that would be seeing ABA as something mostly on his side and not mostly against him.  If he sees it as something mostly against him, and it’s not meaningful to him, I doubt you would want to do much with it, unless as a parent you really thought you had an adult viewpoint that he could not appreciate as a child — and then looking for buy-in would be crucial.  

[Quarter Note]

Ladies, thank you ALL so much for all of these responses.  I feel like I'm drinking from a firehose.  The major theme that I'm getting from you as that I need much more specific goals than, "Please help my son not to destroy things when he's in a rage".  We'll spend some time coming up with smaller, more specific goals.  I really thought that ABA therapy would be more like PT:  you go in, they give you some exercises, you do them for a while.

So far, we still haven't heard back from the BCBA, so we have no idea who the therapist will be, and that gives us time to come up with some goals.

 You are all very helpful.  I know that inside my son there is a wonderful kid.  He just needs a lot of help.

I'll also write more this weekend. My internet time is limited during the week.

[PeterPan]

Your BCBA should be coming up with the goals.

Think about what is not going well and what you wish were going better.

Have you ever behavior logged? That book I first linked (Stop that Seemingly Senseless Behavior) tells how. Until you do that, you're not seeing the flow of the problems to even have good goals. Behavior logging is a key part of ABA=analyzing BEHAVIOR.

[PeterPan]

16 minutes ago, Quarter Note said:

"Please help my son not to destroy things when he's in a rage".

Btw, that's easy. (snort) Give him something else he's allowed to destroy.

You can also behavior log and see the antecedents and do prevention work. You can work on interoception and he'll begin to solve his own problems with time.

But the short answer is give him something he's allowed to destroy. Paper, a punching bag, unwashed fabric to pull threads, whatever. Practice it when he's calm.

[PeterPan]

Remember a lot of this work is not about the end goal but about differentials. What would be one step better than what he's doing now? We praise differentials. If he destroys paper instead of hitting, we praise him. Kwim?

[PeterPan]

Behavior logging gives them the data that helps them determine goals. ABA is data driven. Read the book and learn how to make data, because that's the first thing that BCBA is going to be doing, other than pairing. 

[Lecka]

I want to say this in the nicest way possible — destroying things can be considered an issue that warrants more time per week to address.  
 

I think that is your answer for why you were told “and move up to 25 hours per week.”
 

This is often considered something that will limit what your son can do, a lot of times it will mean that a lot of activities just aren’t done because of the risk of destroying something.

 

And then that means — there is considered a need for more time to address that goal, and less of a thought of a trade-off of what other meaningful activities or free time he might be involved in.  It is just going to be assumed his meaningful activities are constrained by the behavior issue. 
 

These are all broad assumptions.  
 

If in your case the behavior issue never happens in x, y, x situations that your son participates in with no problems, and only happens in situations a, b, and c, where it is a problem but is not limiting overall — then that would be a different situation.

I think the thing to keep in mind is — it is maybe just a slow and time-consuming process, to some extent.  It is probably not a quick fix or something where they could get results in an hour or two a week.

It is not very easy to change and your son is being asked to make a big change (in how he responds to getting upset), and what is there in it for him?  
 

As an adult it’s easy to see — some things are just not sustainable and will have all kinds of negative outcomes for a person, and simply must be addressed.  But to a 10-year-old?  They may not be able to see those things.

The “I Love ABA” website has information about ABA for new parents — it might have good information.

 

Supposedly a recommendation of hours is tied to the child’s needs and overall situation (aka sometimes kids are recommended more hours if they would be in a daycare that didn’t meet their needs if they didn’t get recommended for more time at an autism center, but if they had a parent or babysitter who would meet their needs they might be recommended much fewer hours).  
 

But it is always easy to think someone just needs or wants more hours in their schedule and aren’t basing things off of a child’s needs or situation.  Because I do think that happens!  And I think sometimes a therapist can not be clued in to what would work better for a family.  I do think those things.  I think it can just be a hassle sometimes to deal with.  But it’s like — I think something possible to deal with by asking for more explanation or saying there is a preference for something else and see what the reasoning is, and if it is strongly that something needs to happen, or if it’s more that either way would be fine.  

 

[Lecka]

I think goals should be mutual.

I think parents should have goals and then the therapist should come up with ways to address the goals, and share additional goals the therapist sees as needed, and explain how those fit in with the parents’ goals.

They need to get your buy-in, too, bc it sounds like you are going to be in a position of encouraging your son or requiring your son to do this thing.  
 

If you don’t have buy-in that it’s worthwhile and addressing your own goals, how can you stick with it?  
 

The therapist should be trying to address your buy-in and your child’s buy-in.  
 

However — also with an assumption that you basically do want to address some issues and have chosen ABA.  
 

But you have got to have buy-in and think its worthwhile if it is going to be something you do for very long.  

 

The way for that to happen is for you to see results.  Also if you find out more information and it seems like it makes sense to you.  
 

If those things don’t happen you are probably going to get more and more skeptical, you know?  
 

Basically, to some extent, you need to extend some openness and willingness, and they need to extend some results or some compelling information.  
 

Edit:  not that it could be fast to be 100% better, but something where it makes sense to you and there seems to be a path you understand and think will be helpful and seems to be helping so far, etc.  

Edited March 16, 2021 by Lecka

[Lecka]

Well I looked at I Love ABA and they don’t have a section.  But she does have articles about what to expect, etc.  If I think of another website I will share it.  
 

 

[Lecka]

2 hours ago, Quarter Note said:

"Please help my son not to destroy things when he's in a rage

I think this is a good goal for a parent.  For a parent -- I think it can be helpful to add in things like "because it means he can't do x, y, and z and it means he is missing out on things."  Or to add "because it causes a lot of stress in the family."  Or to add "because it has caused him to have a negative consequence I don't want him to have to experience anymore."  

For a parent -- I think it is good to look for things you would like him to be able to do.  

Some goals are to stop something, others are to start something.  They can't all be "stop doing this and that."  Those can be necessary, though.

For a therapist -- first of all, why is this happening?  They need to figure that out in order to have an idea for how to change it.  So first they have this idea of why it's happening.  

Then often there is both a missing skill and a current response.  

If there is a missing skill and the therapist thinks that is the missing piece ------ well, then that is going to have to be taught and learned and practiced.  This sounds like -- you have identified this as emotional regulation and stuff like that.  Well -- that is its own process.  

Then when the missing skill is learned and practiced to some extent, you have to change from the old response to the new response.  Well -- the old response is what has been practiced for so long, it is what is comfortable, familiar, instinctive, etc.  Meanwhile the new learned response is none of those things.  So then having the newly learned skill actually be used in a stressful or difficult situation ------- that is its own thing.  

So I think a lot of the time, parents' goals are big, broad goals with some small, specific goals mixed in.  

And then the therapist needs to be figuring out how to get there, what steps to take, what the idea is for what to do, and those things.  

 

[Quarter Note]

On 3/16/2021 at 7:30 AM, PeterPan said:

Have you ever behavior logged? That book I first linked (Stop that Seemingly Senseless Behavior) tells how. Until you do that, you're not seeing the flow of the problems to even have good goals. Behavior logging is a key part of ABA=analyzing BEHAVIOR.

Hi PeterPan.  We have years of logging his behavior, with respect to diet, sleep, social interactions, etc.  We've gotten some ideas for triggers (and unfortunately, they're not really controllable things like diet), and there may be more we could try to correlate, but we've certainly done a lot of it.  We'll share all that we've learned with the therapist.

 

On 3/16/2021 at 7:32 AM, PeterPan said:

But the short answer is give him something he's allowed to destroy. Paper, a punching bag, unwashed fabric to pull threads, whatever. Practice it when he's calm.

Oh, we've tried and tried and tried that!  The problem is that destroying something "approved" for destruction requires stopping rather than just grabbing the closest thing.  But I think the real reason is that if he's destroying something that's okay to destroy, there isn't that emotional vent of actually punishing someone - know what I mean?  This is an area where we really hope the meds will help.

 

On 3/16/2021 at 7:33 AM, PeterPan said:

Remember a lot of this work is not about the end goal but about differentials. What would be one step better than what he's doing now? We praise differentials. If he destroys paper instead of hitting, we praise him. Kwim?

This is GREAT to remember!  Thank you!

[Quarter Note]

On 3/16/2021 at 9:39 AM, Lecka said:

I think this is a good goal for a parent.  For a parent -- I think it can be helpful to add in things like "because it means he can't do x, y, and z and it means he is missing out on things."  Or to add "because it causes a lot of stress in the family."  Or to add "because it has caused him to have a negative consequence I don't want him to have to experience anymore."  

For a parent -- I think it is good to look for things you would like him to be able to do.  

Some goals are to stop something, others are to start something.  They can't all be "stop doing this and that."  Those can be necessary, though.

For a therapist -- first of all, why is this happening?  They need to figure that out in order to have an idea for how to change it.  So first they have this idea of why it's happening.  

Then often there is both a missing skill and a current response.  

If there is a missing skill and the therapist thinks that is the missing piece ------ well, then that is going to have to be taught and learned and practiced.  This sounds like -- you have identified this as emotional regulation and stuff like that.  Well -- that is its own process.  

Then when the missing skill is learned and practiced to some extent, you have to change from the old response to the new response.  Well -- the old response is what has been practiced for so long, it is what is comfortable, familiar, instinctive, etc.  Meanwhile the new learned response is none of those things.  So then having the newly learned skill actually be used in a stressful or difficult situation ------- that is its own thing.  

So I think a lot of the time, parents' goals are big, broad goals with some small, specific goals mixed in.  

And then the therapist needs to be figuring out how to get there, what steps to take, what the idea is for what to do, and those things.  

 

Lecka, I'll just quote you once but I want to say a big thank you for all of your posts.  They have been very helpful!  We're really, really working hard on getting some buy-in with my son, and your explanation of why all the hours may be needed was very helpful.  He knows that he wants to stop the destructive behavior - that may be where we get the most cooperation.  And you hit the nail on the head when you said that reducing the stress on the family is a major goal. It is!!!

Thank you so much!  I'm also reading as much as I can from the I Love ABA site.

[PeterPan]

1 hour ago, Quarter Note said:

This is an area where we really hope the meds will help.

Yes for us what you’re describing was chemistry