ABA, Speech and OT therapies: what they are and what to look for in the therapists

Sensory input... Stevie LOVES his feet tickled!

Sensory input... Stevie LOVES his feet tickled!

ABA therapy stands for Applied Behavioral Analysis and it’s a scientifically proven way to improve the symptoms of many behavioral issues, including those often associated with autism.  Here is a link to autismspeaks.org that has a detailed explanation on what it is, how research has been done on this treatment since the 1960’s, and how it’s been successful in treating the symptoms found in those with autism and other disabilities.  

The most important lesson we learned from ABA is its main principle: positive reinforcement.  What’s funny is that most of us work like this.  Working for a paycheck is an excellent example of positive reinforcement.  Each one of us has a “preferred item” (ABA lingo), something that we will work for and do what we are asked to do to receive this item.  In the paycheck example, it’s money, but for a small child that loves to play with Legos, it’s getting another set of Legos or time to play with the Legos.

To find out what your child likes, you have to OBSERVE him or her.  Whatever they love to play with, eat, or do, you can use as a positive reinforcer. Take notes on what they do.  It takes a little time and effort, but it is priceless.

Will, our oldest, loves apples, but he doesn’t necessarily tell us when he wants one.  He just opens up the refrigerator door, looks at what he wants, looks at us, and leaves the door open. Sometimes, he’ll actually take the apples out and put them on the kitchen counter, but that’s about as far as he’ll go.  So, I have to remind him how to ask for something. “Will, what do you need?” “Apples.” “Ok, Will, look at me and say “Mom, can you make me some apples, please?” (Will looking at me) “Mom, can you make me some apples, please?” “Yes!  I like the way you looked at me AND asked me so nicely to make you some apples!  Coming right up!”  He likes them peeled and cut into slices.  These kids! (And I mean, all kids here.  That bit with Tina Fey peeling grapes for her kid? Fantastic!) Sometimes, I just look at the apples with him and wait.  And then I look at him and wait.  Then he actually asks me all on his own.  

Praising them for how well they did something you asked them to do is positive reinforcement in itself.  It works like magic.  “I like how you looked at me when you asked for Cheerios!”  “I like how you said ‘please’ when I gave you more.” “I like how you’re using your words.” If you catch them while they are being good and praise them for it, you will see the behavior you want to see more often. Our boys are sweet boys because we praise them when they do the things we expect them to do: put their things away, clean up their plates, say please and thank you, wash their hands, show empathy, etc.

In effect, with ABA you are training your kids in the behavior that is socially acceptable.  We don’t want to change who they are, but we definitely want them to function well in society.  For some kids on the spectrum, it is too much stimulation to maintain eye contact, but it is a social behavior they need to know how to do so they can navigate living with other humans. 

In Speech therapy, therapists teach clients exercises that help them with issues like articulation (the making of a specific sounds) and vocabulary expansion, among others.  In our personal experience, if speech therapy is done in conjunction with ABA, the results are amazing.  

Occupational therapy is for children that need help with their fine and gross motor skills as well as deal with sensory input issues. Therapists help their clients with their fine motor skills by teaching them how to hold a pencil, follow a straight line, or cut with scissors, and with their gross motor skills by teaching them how to jump, jump with one foot at time, or ride a bike, for example.  Sensory input is everything that has to do with how we perceive the world through the five senses.  Children on the spectrum have different needs when it comes to sensory stimulation. Occupational therapists have wonderful tricks to help kids by offering sensory input like jumping into a crash pad, having a weighted lap pad or blanket, or being spun around on a swing, before, during or after ABA and other therapies.  We all need to take a stretch or a walk after sitting at the computer for too long. They just need breaks more often and with stronger sensory input.

There are so many other therapies out there, like food therapy, for children who have a difficult time with textures in their mouth, or play therapy for children with emotional distress.  You just have to do your homework and work well with your therapists.

What to look for in places of therapy?  

Make sure that all the therapists have the right certification and they are well rated in the community.  Read reviews and again, do your homework.  

Look for Board Certified Behavioral Analysts (BCBA) for ABA therapy. They should be the type of people that really want your children to succeed and are about making life easier for the children and the parents. We were blessed that in each place of therapy, all of our BCBAs made sure to teach us how to implement these therapies at home. In one of our places of therapy we actually received six classes with Power Point slides and had homework on how to put these lessons in place at home.  We even had to record ourselves on video as we attempted doing what our ABA therapists did with our boys! 

We also had hour-long monthly meetings on the progress our boys made on each of their goals.  They always answered our questions, had suggestions and ways to attempt the therapies at home. We developed a GREAT working relationship with them and our boys improved immensely.

Our BCBAs were also good managers of the therapists working with them.  A BCBA can be a case manager of sorts for a group of clients.  They do an evaluation on your child and take notes on what would be appropriate developmental goals for the age of the child.  They create goals, ask our input on them and put them in place on a daily basis.  Some BCBAs have individual clients and work with one child all day.  But in the places of therapy we went to, our BCBA managed a group of what they call “behavior therapists”.  These therapists would then execute the exercises with the goals set in place by the BCBA.  So, although the BCBA was actively involved in the process and sometimes worked directly with our boys, they would actually work with different behavior therapists most of the day from 9am-4pm Monday through Friday.  (Yes, it was intensive therapy and I can’t recommend this enough!)

Just as an FYI, the behavior therapists don’t necessarily have a background in ABA or psychology.  Depending on the hiring policies of the place of therapy, their education background can vary greatly.  The most important thing is making sure your child is doing well, progressing in his or her goals, and is happy when he or she comes to the place of therapy.  

It was interesting that I fell in love with the first place of therapy and I didn’t want to let go.  I thought that what they were initially getting in a group setting, would turn out poorly in a one-on-one setting.  Turns out that it was exactly what they needed to clear the next hurdle.  So, it’s okay if you get upset because they can’t get something you think has been working perfect all along. If your insurance has changed and you can no longer participate in one place, trust that they will be where they need to be. If they are not improving, try to troubleshoot with your BCBA; he or she is your ally in this process.  And if that doesn’t work out, look for another BCBA until you find the one that you and your child can work with well.  Just like trying to find a good doctor, you need to do your research and find a good place for you and your kiddos.

We are blessed (or lucky, if you prefer) that our boys were born in the time and space they were born.  There are so many resources for our kiddos now.  The lesson I learned in all of this is to be flexible and have faith that everything will be fine. Every time I do this, things work out even better than I expected them to.