How Do BCBAs Individualize Treatment for My Child? 

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If you’ve received or looked into receiving ABA treatment for your family, it’s likely that you’ve read about individualization of care. The term “individualized” is used frequently in the field of applied behavior analysis, and refers to how Board Certified Behavior Analysts (BCBAs) tailor treatment to their client’s needs and the needs of their families.  

The role of a BCBA is to find the most impactful, evidence-based treatment tools for their clients that will create meaningful outcomes and produce lasting change. The range of tools used to create individualized interventions needs to be broad enough to meet every learner’s need. Finding behavior analysts who possess the training and knowledge of such a variety of tools is unfortunately rare. 

Nearly all ABA clinics offer treatment plans based on two major criterion-referenced assessments: the ABLLS-R (Assessment of Basic Language and Learning Skills- Revised) and the VB MAPP (Verbal Behavior Milestones Assessment and Placement Program).  ABA Connect’s services are unique in that their treatment plans pull from a wider variety of resources and tools than most clinics typically offer. This is largely due to their history with the community and the ranging abilities of analysts that provide services with the clinic. Below are descriptions of the assessments and curricula available as part of ABA Connect’s treatment. 

Essential for Living: 

Essential for Living (ESL) is an assessment and curriculum created for the needs of learners with moderate to severe special needs. It specializes in daily living/adaptive skills, fluent requesting, and community–based skills. The creator of Essential for Living, Pat McGreevy, created this criterion-based assessment and curriculum with the mission of ensuring all learners with moderate to severe special needs possess the abilities to live with the dignity they deserve. Learners who have access to Essential for Living will likely be practicing requesting, tolerating the removal of preferred items, waiting, tolerating medical routines, and daily hygiene/eating routines.  

Socially Savvy: 

Socially Savvy is a social skills assessment and curriculum created by BCBAs with the purpose of teaching subtle, nuanced social behaviors to learners on the autism spectrum. Creating and maintaining relationships, perspective taking, practicing fluid language use, and social problem solving are all part of treatment with this teaching tool. Learners who already demonstrate some back-and-forth conversational skills are a good fit for Socially Savvy.  

PEAK Relational Training System: 

PEAK is touted as being the “next generation” of ABA curricula. It includes nearly every skill and lesson taught within the VB MAPP and ABLLS-R (discussed above), but the bulk of its programming involves using receptive and expressive language to derive relations.  The creators of PEAK have produced copious amounts of research that examine and support its effectiveness. They explain that the curriculum involves “learning how to learn” instead of memorizing correct answers. The PEAK Comprehensive Assessment evaluates a learner’s ability to relate concepts in the six major Frames of Relation, and is the only standardized assessment in the field of ABA.  

As discussed, the VB MAPP and ABLLS-R assessments are regularly utilized by ABA Connect’s staff. These criterion-referenced assessments have been commonly used in the field for over a decade, and behavior analysts are typically well versed in these two tools. The staff at ABA Connect have spent the time and energy needed for additional training on more comprehensive tools to ensure clients receive the Gold-Standard in individualized care.  

If your family is seeking a treatment that is tailored just to your needs, reach out to ABA Connect to learn more about getting started! 

 

 

Transitioning to a New Bed! 

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From the Author, Caroline Roesel, BCBA, LBA:  

As a BCBA and parent to a young child who recently transitioned out of his crib, I wanted to share how ABA can help caregivers through this particular transition! 

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We’re in a new age of parenting – one filled with endless websites and books that tell parents how to help their child do almost anything!  Regarding transitions that occur in early childhood like toileting, eating solid foods, and sleeping in a “big kid bed,” some children have an easier time adapting than others. But regardless of a child’s disposition, ABA can give parents the power to create an individualized approach that can help their children sail more easily through these changes. Parents who are armed with a few ABA principles can determine when the transition is going smoothly, or if they need to make changes! 

Is My Child Ready? 

When considering a transition to a new bed, reflect on your child’s biological and emotional readiness. Many children are able to transition from a crib to a bed around age 3, but some can be ready at a younger age. Also, it is recommended that your little one has a well-established sleep routine and sleeps through the night on most occasions.  Night–time toilet training is not needed!  

There are other signs of readiness that may tell you it’s time to ditch the crib: 

  • Your child can leave their crib 
  • The crib has become an area of play instead of sleep, and it’s impacting their sleep hygiene 
  • Your child is too large to sleep in a crib 
  • Your child expresses interest in sleeping in a “big kid bed” 

 

A Few Behavioral Principles 

Below are few key principles of human behavior that are typically at play as children are learning to sleep in a bed. I will describe each briefly, and then tie them all together in a broad plan for parents to individualize as they see fit: 

–Pairing: Pairing, in lay terms, can be described as associating new things with things that are already well–liked. For instance, if you attend a get-together where your favorite brand of coffee is being served and one of your favorite musicians is being played, you’re more likely to think positively about the gathering overall.  

Before starting the transition to a bed, reflect on how your kiddo is feeling generally. Are they feeling stable and secure within the family unit? Have your recent interactions felt good to you both? Note that transitions of this type might be more challenging after a recent significant change in a child’s life, if the child is going through another transition, or if one or both parents have been less present than usual. Psychologists have postured that the type of attachment children have to their parents can impact behaviors. Learn more about attachment here.  

Pairing Tip: Make sure your kiddo is in a good mood and feeling happy with you before beginning this process.  

–Motivating Operations: These are occurring incessantly throughout our lives. Motivating operations determine the “why” behind everything people do. If you’re feeling hungry, you are more likely to engage in behaviors that have, in the past, resulted in you getting food. If you’ve been burned on a kitchen stove, you’re more likely to engage in behaviors that will prevent touching stoves. And, you guessed it, if you’re tired, you’re more likely to stay in bed and sleep!  

Motivating Operations Tip: During the first 5 days of the transition, make sure your little one is very active! Have them engage in more movement and exciting activities than usual. Take them to a swimming pool or children’s museum, for instance. It’s also a good idea to monitor for over-tiredness, as children who are overly tired will actually fight going to sleep. If you’ve ever observed your kiddo have a tantrum and then get a “third wind” right before bed time, you know about over-tiredness! 

–Reinforcement: Parents sometimes underestimate how valuable their attention is to their child. Attention is one of the most powerful tools parents have! After all, your child/children have felt a connection to you from the beginning of their lives!  

At the beginning of this transition process, your child will learn that they can easily have your attention by getting out of bed and coming to find you. There is no getting around this, and they actually need to know how to find you for when they’re feeling sick/hungry/etc. and need you at night.  To teach them to remain in their bed when they do not need you, tell them when they’ll be able to reconnect with you, which is in the morning.  

Reinforcement Tip: Explain the new night–time process to your little one. “I’m going to (describe your usual night–time routine), and then you’ll stay in your bed and I’ll close the door. You can see me again in the morning!” You can use signals in their bedroom to let them know exactly when it’s morning and when they can leave their bed! Many parents (including myself) have found success utilizing light alarms, which turn on and illuminate a gentle glowing light at a certain set time. If you don’t want to use a light alarm, you can go into your child’s room each morning to rouse them. Just plan to do this at the same time each morning; their little internal clocks will probably start waking around the same time.  

When your child remains in their bed for the entire night, plan to give them extra cuddles, big smiles, eye contact, 1:1 attention, and praise for doing so!   

–Shaping a Behavior: Shaping a behavior can be likened to shaping a ball of clay. Regardless of how it looks at the onset, certain maneuvers can be done to help determine its final shape. Your child will be learning a new behavior: staying in their new bed at night. In order to shape a new behavior, consistency is key. Note that you should not expect to see large improvements the first 2 nights of transitioning to a new bed (although it’s definitely possible). It can take up to the 3rd night or longer to see marked change in the direction you want to go. This is understandably difficult for parents! Remember that you’re putting in difficult work upfront so your child (and you!) will sleep well through the night. When sticking to the plan feels tough, think of how healthy sleep influences a child’s brain development and mood. You are setting your child up for success by helping them learn to sleep well in their new bed. 

Shaping Tip: Stick to the plan for at least 5 days. Remember that you already made sure they’re feeling safe and secure by doing the Pairing Tip seen above! 

 

A Bed Transition Plan Using Behavioral Principles 

A few days before starting the transition plan, spend some extra 1:1 time together doing what your kiddo loves. This is the pairing tip. If your little one is making more eye contact, snuggling with you more, or showing their own special signs of affection, you’re on the right track! 

The first day of the transition plan, arrange for your child to do one additional movement activity in the morning and one additional activity in the evening. Help them feel a bit tired so they’re ready for sleep when the time comes.  Blue light from screens and even florescent lighting can affect our internal clocks from working properly. Turn off screens and consider dimming direct lights two hours prior to bed-time.
These methods relate to the motivating operations mentioned above. 

Before starting the bed-time routine, explain that tonight they get to sleep in their big bed! (Just like big kids!) Tell them the order of the night-time routine, then add, “and then you’ll be in your bed until morning. You can see me again in the morning!” Doing so will remind them when they get to connect with you again (it’s likely that your attention is extremely reinforcing!). 

Move through the usual night-time routine calmly. They may ask questions about the new bed as it gets closer to the actual bed-time. Remind them that they get to sleep in the new bed, and they’ll see you in the morning. 

When the time comes, tell them “Good night,” in a soothing voice, then leave the room calmly but quickly.  

Plan for your child to immediately get out of bed and leave the room. This is completely normal and to be expected (here’s where the shaping tip applies!). 

When your child leaves the room, calmly but quickly guide them back into bed to lie down. Do not stay with them for more than a few seconds. Tell them in a soothing voice, “I can’t stay with you, goodnight, I’ll see you in the morning.” If you’re using a light alarm, you can add, “When your light comes on, you’ll know it’s time to come out.” Tuck them back in their bed, and calmly leave the room.  

Your kiddo may come out of their room many many times during the first night. They may remain in their beds only for a few seconds before leaving again. Know that this is not unusual, and they will learn to sleep in their bed if you are consistent.   

When things feel tough, remember: 1) you’ve been using pairing and having extra fun with them for the past few days, 2) they’re not hurt or hungry, but they are sleepy because you’ve kept them active and influenced their motivating operations, 3) they are coming out to see you because your attention is incredibly reinforcing, so be sure to save most of your attention for after they remain in their bed until morning! 4) Even though they may come out of their beds repeatedly, at some point, you will see this frequency drop off. Notice instances when they stay in their bed for just a bit longer. You’ll also likely notice that when they do come out of their room, their emotional response will start to be less intense as the night goes on. These are all signs that you are successfully shaping their behavior!  

How to Know When to Change  

If after 5 nights, you have not noticed a difference in the number of times your child comes out of their room, revisit the tips mentioned above.  

Other things to consider: 

  • When you return them to their room, are your lingering for a bit too long? You may be giving just enough attention to keep them coming back for more! 
  • Have you stuck to your plan, or have there been unexpected interruptions? As the old saying goes, “Consistency is key.” 
  • Is your child feeling afraid in the new bed? Do they need a new night-light or stuffed animal?  
  • Are they waking because of hunger, and can you give them a high-protein snack shortly before bed?  
  • Do they have bug bites that are causing them to itch and wake at night? 
  • If they wear a diaper at night, is it leaking and should they switch to night-time diapers? 
  • Are they tired enough to sleep through the night? Do you need to modify their day-time nap (if they’re still napping)? 

If you’re following these guidelines and things still seem to not be getting better, it’s OK to reach out to a specialist. Behavior Analysts are accustomed to creating individualized night-time plans for families that incorporate details that are too specific to be included in a blog! ABA Connect provides this service as part of a comprehensive or focused intervention.  Your BCBA can look at your family’s needs and tailor a plan to you.