ABA

[chickypoo2468]

So O had his developmental testing with the neuropsychologist last week, and I'm glad I listed to you all when I was considering not going. He tested at 6 months for cognitive and fine motor, 2-3 months for speech, and 8 for gross motor. I feel like now I can pick more appropriate things to work on.

He also tested significant for autism, but she said you wouldn't give a 6 month old an autism diagnosis so he's not getting one at this time. But it's good to know/have this info bc if his WES comes back with anything we could be ahead of the game. Even if he doesn't have it, a lot of the genetic disorders we've looked at have autistic tendencies, having this all documented can help us later. She also said that even if he's not autistic he may benefit from ABA therapy because of his global delays.

Anyway, so we are just going to see her in 6 months unless the WES finds something and then we will just go when we get those results. But in the meantime she gave me the numbers of the three ABA locations and said that we should see about scheduling walk throughs and deciding which one we would want to go with. I think it's still not a definite thing, but the waitlist can be long so I guess that's why she wants us to start looking now.

I know absolutely nothing about ABA. I've seen it mentioned here and I've seen a blog post where an autistic adult was ranting about how horrible and inhumane it was. But from how the neuropsych explained it it sounded extremely beneficial. But like I said, I know nothing.

So is there anything I should know or be looking for? Anywhere I should look for info?

Thanks guys!

[greysonsmom]

This is how an old friend explained it to me, she is an ABA therapist. I'm still pretty new to it, DS just had his third session.

okkk so basically aba is applied behavior analysis. So we do an assessment on what the child can and can not do and what behaviors may affect the childs performance. bascially we base it off of 4 functions of behavior. This applies to everyone not just children with autism.

1. escape ( they want to escape what they have to do at the moment) 2. access to tangibles (so if they want something and they cant have it they may show a behavior)3. automatic reinforcment ( this can be a stim like hand flapping rocking back and forth or even if your itchy and you scratch.. that is automatic reinforcment because it makes you feso we look at the function of the behavior and then we go from there... so for example I have a client who is sooo smart but has a lot of behaviors when it comes to sitting down in the classroom and doing work, so in school he has been running away and kicking and punching the teachers... in school they let him run away and yell at him for punching and kicking them.. In our clinic when he starts to run we block and completly ignore the punching and kicking because he is trying to escape doing work, If you allow him to escape he will think every time he kicks and punches and runs away he wont have to do his work... which is pretty smart because then school just lets him sit there and not do anything.. IN the clinic we ignore all these behaviors and i was being kicked and punched for about ten minutes until he realized I was not going to let him escape from doing his work so I kept reminding him when your ready to go do your work we can go play after and about ten minutes later he realized nothing was working and sat down and did all his work better) 4. attention so we look at the function of the behavior and then we go from there... so for example I have a client who is sooo smart but has a lot of behaviors when it comes to sitting down in the classroom and doing work, so in school he has been running away and kicking and punching the teachers... in school they let him run away and yell at him for punching and kicking them.. In our clinic when he starts to run we block and completly ignore the punching and kicking because he is trying to escape doing work, If you allow him to escape he will think every time he kicks and punches and runs away he wont have to do his work... which is pretty smart because then school just lets him sit there and not do anything.. IN the clinic we ignore all these behaviors and i was being kicked and punched for about ten minutes until he realized I was not going to let him escape from doing his work so I kept reminding him when your ready to go do your work we can go play after and about ten minutes later he realized nothing was working and sat down adn did all his work for something like attention... sometimes kids just want the attention and it may be bad attention if they are not getting enough good attention.. so if someone is hitting and/ or screaming we dont give any attention to bad behavior but as soon as they were to stop screaming or hitting we will reinforce the good behavior by giving them an edible or crazy good praise and make them realize they will only get attention for good behavior.

We work on about 10 to 15 goals a day... it depends on the child and what they need to work on whether it be behaviors, educational goals, self help goals... we are always incorporating speech into our sessions especially if the child is young but usually speech is something different because we focus on so many different areas that we wouldnt hit enough on the speech

[greysonsmom]

Sorry for the wall of text

[zaraceligon]

For my kid ABA experience is one of the most amazing and useful therapy he has. It depends on insurance how many hours the kids need. For example my kid needs to completa 20 hrs a week including parenting consulting. His hours are divided with three different therapies and two supervisors. Most of his therapy is at school (ABA are allow to be in a private school or day care) they are helping him with self care etc, be independent on dressing, eating putting thing away focus on teachers, be able to answer questions and express him del as well socializing with his classmates.
The therapies will teach you how to deal with deferent tantrum it can be ignoring the behavior, redirecting the behavior, or find the best and most uses method for the kid. For example my kid is very good having a schedule written than me redirecting him all the time. As much I keep talking ether way he ignores or he avoid the situation is is written he will read it and understand what he has to do. The method so far is like magic he knows exactly what the schedule is telling him to do. Example morning wake up, said good morning, take a shower, eat breakfast, take the bus to school. It just depends of the need of the kids, you can start making a list of the needs the you want him to accomplish. Example learn to stand up, wash hand, play with siblings etc is all depends on his needs. Good luck MK

[freezorburn]

I think as you interview the different providers, you are looking for a good fit, both for O's needs, as well as in how they communicate with you as far as setting objectives and tracking progress.

We've been working with a practice that has assigned two people to DS. The program director is a BCBA and did an initial evaluation -- not a diagnosis, but about 2 hours of play activities to assess his behavior and determine what strategies might help him. The BCBA then designs his program. Second person is the actual therapist, who works with him 2x a week. The program director sits in on sessions one week per month to assess progress and determine if any adjustments need to be made to the program.

I also appreciate that this practice has their administrative practices in order. Fee structure is clear, they take care of insurance billing, etc.

[chickypoo2468]

Is there anything else that would set art one center from another? Besides actual staff of course.

[chickypoo2468]

I was speaking with O's OT and she said at they get no social interaction with ABA. Is this true? I would think social interaction would be a big part of it

[mamaturtle]

May 17, 2017 8:13:47 GMT -5 chickypoo2468 said:

I was speaking with O's OT and she said at they get no social interaction with ABA. Is this true? I would think social interaction would be a big part of it

What? Social interaction with the technician or other peers?

I think there is for the technician and the child to deliver therapies. If a child lacks the skill to social interact with peers, ABA has modules to cover that and have a play group to practice skills. You can express concerns with the ABA service you go with.

The ABA service DS does not provide this because I already have DS in daycare and Cub Scouts (well that is over until September). We live on an apartment complex and there are times DS requests to go outside to go to the playground during therapy sessions. If there are kids out there, the technician would encourage social interaction.

[mrsbuttinski]

WTAF?

Best case scenario? This sounds like one of those situations where when you only have a hammer, everything looks like a nail.

Worst case? She's either allowing professional jealousy to cloud her judgment or is worried about her share of the therapy pie $$$ being diminished by another, potentially more effective, practitioner.

Given your child's degree of delay, ABA is probably the single best method for teaching at this point in time. Behaviors- like engaging and attending- have to come before teaching social interaction for a child who is not already primed to engage and interact.

In practice one-on-one with an ABA person is very like one-on-one with any other therapy provider in terms of social interaction with an adult which is where a child who have the cognitive maturity of a 6 month old should start interacting. Over time, if the therapy is done in your home, siblings could possibly be introduced to offer more social opportunities. Am I wrong, weren't you lamenting your baby's refusal to engage with siblings who try to play with him?

Are you resistant to ABA? You seem to be seeking out negative opinions- the blog poster who said it was "inhumane" and now the unprofessional OT citing a lack of social interaction. I mean, how does she build social interaction into her therapy and is your kid actually improving in this domain under her instruction?

[zaraceligon]

Mmmm, I don't not what to say I'm speechless on the opinion. But some of the example the my kids ABA are this. If going out for a walk they are teaching him to who is ok to say hi and who isn't. Teaching to ask to his classmates to play with him, ask his teacher for materials the he may need, at the store teaching him to pay for his stuff, etc. It you can see ABA is not just apply behavior it covers and conbine a lot of different therapies together, like speech, Phisical and OT as well.

[greysonsmom]

My son works on proper socialization in ABA

[freezorburn]

Social skills absolutely can be part of ABA. Is it possible your OT is just misinformed?

Social communication is probably the biggest concern for DS, so once our therapist had some time to get to know him and assess how he was doing with his initial program, they suggested having DS work with another child or even in a small playgroup. They do try to set up sessions with other children in their practice, but sometimes it's hard to get schedules to sync up. What we have ended up doing is bringing in 1-2 NT kids who we know, whose schedules fit with DS's therapy schedule. At this time they practice taking turns, going in different orders, choosing activities, joint attention, conversation skills, and so forth. The next big thing will be helping him function within larger groups. He has probably only started to get comfortable at preschool this spring, after nearly 2 years there. So transition to Kindergarten is going to be something we watch and manage closely. I think there could be a scenario where our therapist or program manager goes into the classroom with him, but we are not yet at that stage.

[chickypoo2468]

May 17, 2017 10:12:35 GMT -5 mrsbuttinski said:

WTAF?

Best case scenario? This sounds like one of those situations where when you only have a hammer, everything looks like a nail.

Worst case? She's either allowing professional jealousy to cloud her judgment or is worried about her share of the therapy pie $$$ being diminished by another, potentially more effective, practitioner.

Given your child's degree of delay, ABA is probably the single best method for teaching at this point in time. Behaviors- like engaging and attending- have to come before teaching social interaction for a child who is not already primed to engage and interact.

In practice one-on-one with an ABA person is very like one-on-one with any other therapy provider in terms of social interaction with an adult which is where a child who have the cognitive maturity of a 6 month old should start interacting. Over time, if the therapy is done in your home, siblings could possibly be introduced to offer more social opportunities. Am I wrong, weren't you lamenting your baby's refusal to engage with siblings who try to play with him?

Are you resistant to ABA? You seem to be seeking out negative opinions- the blog poster who said it was "inhumane" and now the unprofessional OT citing a lack of social interaction. I mean, how does she build social interaction into her therapy and is your kid actually improving in this domain under her instruction?

Oh, no no no, I'm not resistant to it and I'm sorry if I came across like that. I was just saying that that's the only instance where I've ever heard anyone say anything about it. I wasn't looked into it, the blog was just something a teacher friend shared. I have exactly zero opinions about it at this point bc I've never seen it or dealt with it, but I've seen it mentioned so I figured that it was a positive thing. What the neuropsychologist said sounded good and so I'm looking into it.

You had said something about my OT and jealousies not too long ago, and since then I've been thinking about her reactions and I do think that maybe I should take her opinions with a grain of salt. I'm not looking for negatives, the social aspect was just something she said and I hadn't thought of.
The places I'm supposed to look into (not sure if it's everywhere) are 40 hrs a week. The neuropsychologist said they might do like 20 bc of his age. It's at a center, not in my home. And yes, it was me that was stressing over his lack of engagement.

I'm honestly just trying to find out what ABA actually is so that I can help decide if it's right for him. And I want to make sure I'm asking about things that I need to ask about.

[chickypoo2468]

freezorburn she could very well be misinformed.

[freezorburn]

As you are looking at places, you might ask if there is the possibility of doing sessions in a combination of places, not just at the center. It makes sense for treatment to happen in a variety of settings, because ultimately kids need to be able to learn skills that they can take into the real world.

DS has sessions at my home, therapist's office and at his dad's place. I think it's been very beneficial to have all these different settings as part of his program.

[greysonsmom]

My son's evaluation said up to 15 hours a week. He is currently only doing one hour a week at the center because of our/their schedule.

[zaraceligon]

You need to talk to you insurance. Insurance are the one the determin the hours, if they are digesting is 40 hours, they may think his case is very severe and needs to have those hours. Also check if you have to pay copayment, and if the therapy is going to be covered por hour o for day. As well check for the deductible of the insurance, for example my deductible was 3000 for each kid, but I don't need to pay any insurance copayment for the therapy, the insurance will cover all the cost for the ABA therapy. You can also ask the insurance to reduce the amount of hours, for now and when the time is right he can get more hours it he needs them.

[freezorburn]

Zara makes a good point. In our case I think number of hours was determined by a number of factors. Initial recommendation by diagnosing psychologist was in the neighborhood of 20 hours.

Then we did a few initial evals with the ABA therapists, and their recommendation was 4 hours. I think that was even before they started talking to our insurance. I think it was a combination of what they can realistically offer given their caseload, travel between locations, what they think they can do with DS without overwhelming him, and the fact that he was already spending 16 hours/week in preschool with NT kids and was also getting 90 minutes per week of social skills group with our local school district. And while his preschool doesn't have the same training as the ABA therapists, he culture of the school provided enough scaffolding for DS to work on his social skills at his own pace. So that's how it played out in our case. Obviously the process will vary depending on needs of child, how the therapy provider structures the program, and insurance.

[mrsbuttinski]

chickypoo2468,

40 hours of ABA is considered the gold standard; no other method of therapy has as much study or the kinds of results ABA has. Initial studies looked at outcomes with 40 hours. There is some research that shows progress for many children at 20 hours/week but below that there is no definitive evidence that it's helpful.

ABA is appropriate for both kids with ASD and those with intellectual disabilities; for a child at risk for both, this is likely to be a best option. You should also be trained on supporting the work at home; ABA isn't something his BA does with him and then you go back to business as usual. ABA becomes your lifestyle to some degree.

ABA has changed a bit over the years. Originally it was a very clinical approach with a child strapped into a chair and a BA right in his face drilling. They also used aversives in addition to rewards. These days, it can be delivered in a more natural setting using rewards as needed.

[zaraceligon]

This will happen ones you find out which vendor or clinic you like. The person how will do his evaluation will come to your house to observe him on his own environment,while at the same time will ask you questions. After she his needs she will tell you how his program will be. For the amount of hours he may need 3or 4 therapies +the supervisor of the therapies. It will be at your house it cannot be at the clinic because of his needs. Also in those hours they will give you PC ( parent training) in order to complete the hours and to report to the insurance the you are as well been training to help your son.

[zaraceligon]

After she observe his needs. I'm sorry,this's what I meant.

[chickypoo2468]

We've already met our OOP max so I'm not too concerned with ins at this point. They've covered everything else.
He is on the Medicaid waiver waitlist, I wonder if they cover anything. There's so many random programs I have trouble understanding what they actually are for.

The neuropsychologist said that this was instead of preschool, and then the plan is to transition into school later. It really sounded like it's 100% at the center so I definitely need to look into this and see if the different places offer different options. I guess our immediate area doesn't even have ABA (which isn't shocking) so we have to go like an hour away for it.

[zaraceligon]

One of my kid got in a program the they cover all the expensive of the therapies until three, and they registered him at the pre-k. The speech, and OT was at the clinic and the ABA was at home. After they turn three it depends on the case of the kid that they will continue providing service until the age of 21. For my older kid they denied the service just because he is improving on his delays. But here is another thing to know about those programs even if you o your DH makes a lot of money you have the right to apply for help with co-pay. You just needs to explain your situation and why having to pay will affect your family. Even if they don't pay the hall amount they will cover the insurance deductible and 50% of the co- payment.

[freezorburn]

Earlier this year I looked at moving DS to our state Medicaid system but they would only accept DX from a small list of providers (ours was not on it) and ABA from an even smaller list. Don't know how it works in other locations, but for the moment I am willing to pay for insurance that gives us more choice, so I don't have to deal with a gap while we sit on a waiting list.

[chickypoo2468]

He does get early intervention right now til age 3 but here's no ABA with that.
One of the places called me today and is sending me resources for places that are closer and might even come to our home. So maybe I have more options than I thought!

[freezorburn]

It occurred to me, since you and I share a distaste for talking on the phone, that it might be helpful to jot down a few things you could ask your insurance company at this point. Because I know I was nervous as heck making that first phone call.

And some of these things may seem obvious, but I know that I find it helpful to review bullet points in my head before I make a call to make sure I cover what I need when I am talking to someone. Sometimes I'll even script my explanation for why I am calling.

You might start by explaining where you are in the evaluation process, that you are anticipating that some amount of ABA will likely be recommended, and you would like help understanding the benefits that are provided under your plan. Even if you already feel very well-versed in your plan ... you never know if there are nuances that you might not think to ask about. You might ask about provider selection. How does the claims process work whether they are in-network vs. out of network. Is there any pre-approval necessary?

When I called and talked to a real person, they ended up referring me to another department where someone could specifically talk to me about the mental health benefit part of my plan. And I spent a good amount of that time with one lady who was able to answer all of my questions, and also gave me her direct line to call if I had any further questions. Which made it easier for me to call back, because I felt like I didn't have to repeat my story again.

Good luck --

[chickypoo2468]

Haha. Yes. How lucky we are that we have to make all the calls that our kids require.
Good points, thanks.