Applied Behavior Analysis (ABA)- What is it? by Sandi Rivers M.Ed. BCBA

We will be presenting a weekly series on ABA therapy and strategies to implement in the home, classroom or group setting by Sandi Rivers M.Ed. BCBA...

I. Applied Behavior Analysis (ABA) – What is it?


Applied-means that interventions are geared toward achieving socially-important goals, helping people be more successful in natural settings such as homes, schools, and communities. Behavioral means that ABA focuses on what people say or do, rather than interpretations or assumptions about behavior.
Analytic-means that assessments are used to identify relationships between behavior and aspects of the environment (e.g., screaming occurs most when Johnny is given a difficult task and allows him to delay or avoid that activity) before proceeding to intervention.

Popular practices based on the principles of ABA have incorporated some or all of these features. For example, reward systems, if/then boards, visual schedules, planned ignoring, and removing privileges are commonly used in the schools. When applied appropriately (e.g., making sure rewards are actually enticing to students), these strategies can promote positive behavior. Early intervention programs and programs for children with autism often emphasize arranging the classroom or home environments (e.g., using pictures, bins for items); these can be considered antecedent interventions.

Read more: www.autismsupportnetwork.com


II. Functions of Behaviors – Why do the children engage in the behaviors?

Remember EATS!!!

ESCAPE	ATTENTION	TANGIBLE	SENSORY
To escape/avoid an aversive task or situation	To gain attention from another person, usually in shared attention situations.	To access a desired item or activity	Automatically reinforcing themselves bc feels good or to avoid unwanted stimulation.
Jon is told to sit in a group, it’s loud, crowded, etc. He screams and is removed from group to go bounce on a ball	Tim is in group worship, starts to shake his legs, bump other kids, lay back on his back.  Teacher continuous calls on Tim and redirects him then staff come sit next to Tim and rub his back.	Sue is denied a ball she wants and screams then hits staff.  She then picks up the ball and plays.	Paul is in a classroom during free play, it is loud and child attempts to run outside of class continuously.  He receives small breaks from the time the staff are having to get him.

PT vs OT Who Does What?

Check out the video below to better understand the difference between Physical and Occupational therapy.

What is feeding therapy?

 My son doesn’t like green beans.  According to my husband, it is because he is smart.  But what happens when your child doesn’t like any food that is green…or orange…or too soft…or too hard?  Is your child just a picky eater, or could there be a bigger problem?

According to The American Speech-Language-Hearing Association feeding and swallowing disorders are described as “problems gathering food and getting ready to suck, chew, or swallow it.”  Signs and symptoms of feeding or swallowing disorders include failure to accept different textures of food, long feeding times (over 30 minutes), coughing or gagging during meals, less than normal weight gain or growth, and difficulty chewing.  If you notice these symptoms in your child, it might be time to discuss your concerns with your pediatrician. 

What happens next?  If feeding therapy with a speech-language pathologist is recommended, an evaluation is completed to look at movement and strength of muscles used during eating as well as an observation of eating to examine posture, behavior, and oral movements during chewing and swallowing. If therapy is then recommended, treatment may target increasing strength of mouth, increasing lip and tongue movements, improve chewing ability, accepting a variety of foods, and/or improving ability to drink from a cup or straw.

Our goal is to have happy, healthy kids who are able to enjoy the social and nutritional benefits of meals with families without the stress!

Is Screen Time Affecting Your Child?

Screen Time and the Young Child

Computers and electronic devices are a huge part of our daily lives.  They are a huge part of our kid’s lives as well.  But when should these items become a part of our lives and how often should they be allowed? Babies have a curiosity for the light and sounds of iPads and phones. One-year olds are getting tablets for their birthdays.  The 2013 Zero to Eight study commissioned by Common Sense Media showed that 38 percent of infants younger than age two use mobile devices like smartphones. What does this exposure mean for our little ones?

Recent studies have shown that screen time can have an impact on typical language development in small children.  It showed that the more television children under two watch, the less words they are able to understand and communicate. This includes televisions on as background noise.  Other studies have shown that when technology is used as “play”, the amount of expressive language used by the parent decreases as opposed to when they play using simple toys or books. With that being said, should you completely limit all screen time and media time?  Is that realistic in today’s world?

Up until recently, the American Association of Pediatrics recommended avoidance of screen time for children under 2 and 1-2 hours a day for older children. But they are currently changing their guidelines.  They have stated, “In a world where ‘screen time’ is becoming simply ‘time,’ our policies must evolve or become obsolete.” So what are their recommendations?

Current recommendations include:

·        Setting limits at every age. AAP has said that limited screen time continues to be best for children under 18 months.  FaceTime with Grandma? It is completely fine. For children 18 to 24 months, limit screen time to high-quality programing/aps. Children older than 2 should limit screen time to one hour or less a day.

·        Avoiding displacement.  Strive to maintain time for play, conversation, and creativity.

·        Address digital etiquette.

·        Engage in media use together. Adult interaction continues to be crucial for young children. Discuss what is seen on the screen with your children to model more language and joint attention.

·        Create media-free zones. Take time away from your devices.

·        Model media behaviors. It is amazing what children pick up from just simple observations.

Technology isn’t going away.  We just have to find a balance to help young children learn how to handle technology in their lives as well as encourage social and communicative development.

Please Welcome Carly Morris, MA CCC-SLP

Carly received her Bachelor’s in Communication Sciences and Disorders from the Pennsylvania State University, followed by a Master of Arts in Speech and Hearing Sciences from the University of Illinois, Urbana-Champaign.

As a practicing Speech-Language Pathologist, Carly has treated a variety of speech and language disorders and symptoms including autism, Down syndrome, genetic disorders, neuro-motor disorders, childhood apraxia of speech, brain injuries, as well as, stuttering. Carly is P.R.O.M.P.T., Beckman, and Kauffman trained. She is particularly passionate about feeding and swallowing disorders, sensory, behavioral, and oral-motor based disorders. Carly’s experience includes medical management of feeding disorders and coordinating teams to include a gastroenterologist (GI) doctor, nutritionist, dietician, pediatrician, and psychologist to improve oral feeding. She is also an orofacial myofunctional therapist who coordinates care with orthodontists to create programs to eliminate tongue thrust during swallowing.

Carly has over 8 years experience assisting the management of a pediatric private therapy practice. She has proven skills in leadership, management, and mentoring other clinicians in the field. Carly truly enjoys coordinating care with parents and teams to create goals focusing on daily independence and functioning of the child.

Help your child put their best foot forward...

Help your child put their best foot forward in the right pair of shoes. Check out this blog entry with top shoe recommendations for children of all ages.

Dinosaur Physical Therapy-Shoe Recommendations

My Child Has Autism…What Can Physical Therapy Do?

Nicholas S. Kelly, PT, DPT / Thursday, October 20, 2016 / Therapyland, LLC / Alpharetta, GA

“I thought you guys just worked on things like strengthening.”
Contrary to popular belief, pediatric physical therapists (PTs) work on A LOT more than just muscle strengthening for our kids. In fact, Autism Speaks denotes PTs as healthcare professionals who “focus on any problems with movement that cause functional limitations”. These movement compromises can occur in children with cerebral palsy, Downs Syndrome, orthopedic or cardiovascular issues, and even children with Sensory Processing and Autism Spectrum Disorders (ASD), as well as a host of other medical diagnoses.

“Does my child need PT?”
Children with autism frequently have challenges with motor skills such as sitting, walking, running or jumping; however, every child with ASD is different from every other child with ASD. Not every child with ASD will need physical therapy. If PT is found to be medically necessary and the child could benefit from physical therapy services, a program will specifically be designed for his or her needs. If you suspect that your child has problems developing appropriate motor skills or has low muscle tone, contact your child’s pediatrician regarding physical therapy services.

“So, how exactly will the PT help my child with autism?”
A PT will start by evaluating the current developmental level and abilities of the child. Once identifying the individual’s challenges, interventions can be designed and implemented to address the “physical therapy diagnoses” or issues like poor muscle tone, balance issues, and coordination deficits - all common in children with ASD. The Children’s Hospital of Philadelphia Research Institute outlines 4 areas of PT intervention:
● Gross Motor Skills – using large muscles for sitting, standing, walking, running, etc. 
● Balance/Coordination Skills – involves the brain, bones, and muscles in a coordinated effort for smooth movement; for example, as in climbing stairs and jumping.
● Strengthening – building muscles for support and endurance like for walking for a distance without becoming tired. 
● Functional Mobility/Motor Planning – moving through space, day to day, for independence and efficiency; for example, to climb onto the rocking chair and make it rock back and forth.
In addition, extensive collaboration with other professionals from whom your child might receive treatment (i.e., occupational therapists, speech-language pathologists, behavioral therapists, etc.) will help to maximize the child’s potential to reach the highest level of functional independence.

“What will a treatment session look like?”
Since children learn through play, licensed physical therapists use child-friendly, specially chosen toys and activities to motivate and encourage patients to participate in therapy. Typically, you will find balls, swings, puzzles, and slides in our therapy gym. Children are encouraged to have fun while they work hard to accomplish the tasks their therapists set for them. In our clinic, sessions are usually an hour, with frequency determined by the referring physician, parent/caretaker, and PT. The child’s health insurance may also influence the frequency of services. 

For more information, please follow the links provided:
https://www.autismspeaks.org/family-services/tool-kits/100-day-kit/treatments-therapies

https://www.carautismroadmap.org/the-role-of-the-pediatric-physical-therapist-for-children-with-autism-spectrum-disorder/?print=pdf

https://www.carautismroadmap.org/examples-of-outpatient-physical-therapy-activities/?print=pdf

http://www.everydayhealth.com/autism/physical-therapy.aspx

Tips for Picking Up Slippery Foods

Tips for Picking Up Slippery Foods by Coach Mel

New York Times-When Do you Worry About a Picky Eater?



Dr. Peri Klass sums up feeding difficulties perfectly in this article. We offer a dynamic team approach to combat feeding difficulties in children. This team includes a speech therapist specializing in feeding, an ABA therapist, a GI doctor, the child's pediatrician and dietitian. For more information, please contact Carly Morris-carly@therapyland.net.

Please Welcome Nicolas Kelly, PT, DPT Physical Therapist

Please Welcome Nick Kelly to our Therapyland Team! If you, or anyone you know is interested in scheduling Physical Therapy for their child, contact us now. Please share as we all know how difficult it is to secure therapy times, including after school hours. They won't last long!

Nicholas Kelly, PT, DPT Pediatric Physical Therapist

Originally from Alabama, Nick graduated from the University of Alabama with his B.S. in Exercise and Sport Science in 2013 and later received his Doctorate of Physical Therapy from the University of Miami in 2016. Nick is a pediatric section member of the American Physical Therapy Association (APTA) and has presented research at national conferences regarding serial casting for a child with hemiplegia. Nick has previous pediatric clinic experiences in outpatient care, early intervention, school-based therapy, and even hippotherapy and community sports in Costa Rica helping children with diagnoses of Down Syndrome, motor developmental delay, cerebral palsy, and autism. Nick hopes to become a pediatric certified specialist and later pursue his PhD in pediatric physical therapy. Nick works to provide a holistic therapy approach and maximize functional outcomes for children and their families.

Please Welcome Victoria Mitchell, M.S. OTR/L

Please welcome the newest member of our Team, Victoria Mitchell Pediatric Occupational Therapist. If you, or anyone you know has a child in need of occupational therapy we currently have openings, including after school hours. Please share!

Victoria Mitchell, M.S., OTR/L
Victoria graduated with a Master of Occupational Therapy from the University of South Alabama in 2011. During her time in adult rehabilitation, she was able to work with a variety of conditions, including stroke, dementia, amputations, and neurological disorders. In 2012, she was able to transition into pediatrics and has been working in out-patient pediatrics since. Vicky enjoys and has talent for working with children who have neurological, genetic, and sensory conditions and/or deficits. She also has a passion for handwriting and is currently in the process of becoming handwriting certified through the Handwriting Without Tears Program.

Toddler Talk

Speech is an important milestone in toddlers. Toddlers usually begin using one- two word phrases at this stage. There are several things that parents and caregivers can do to encourage speech.

Toddlers understand and say nouns before other parts of language. Identifying nouns with your child is the best way to start speech. You can build vocabulary in almost everything you do with children, simply by talking to them. While dressing them (or as they are dressing themselves) identify shirt, pants, socks, shoes, say left foot and right foot when putting on their shoes. While at the grocery store, identify common food items, apples, juice, crackers, etc. While driving in the car, ask your child “what do you see?” and model responses such as “I see trees and the road” or “I see a stop sign and a car next to us.” Descriptive words are important when building a vocabulary. When talking with your child, use adjectives. You can say, “I like your green shirt”, “Let’s get in the blue car”, “That tree is tall”, “The kitten is little”, etc.

In addition to working on receptive language, you can encourage talking by modeling words for your child. If they show signs of hunger, model “eat” and try to have them imitate the word. If they want to be picked up, model “up” and try to have them imitate the word.

Typically your child’s first words are simple. At dinnertime, say “Eee” before giving them food, withhold for a moment to encourage them to imitate the sound to request “eat”. When playing with a ball, say “ba” before throwing them the ball. The motivation of playing should encourage them to imitate the sound. Shortening words so that children are able to say them is important. Instead of encouraging them to say “fire truck”, first work on “tuck”. Simplifying words can be helpful so that children can more easily imitate. Shorten sentences as well. Instead of saying, “The baby is crying”, encourage your child to say, “Baby cry”. Instead of asking them to say “pick me up, please”, ask them to say “up peas”. Then follow up with a model of the correct production of the word or sentence.

Finally, reading is a great way to encourage speech and language. While reading books, describe the pictures and ask questions. In addition, ask them to identify and point to pictures in the book. This will keep children engaged during book reading.