Autism Spectrum Disorder (ASD)

1 Autism Spectrum Disorder (ASD) Autism Spectrum Disorder (ASD) is classified as a neurodevelopmental disorder in reference to the Diagnostic and Statistical Manual of Mental Disorders. The condition is referred to as a spectrum due to its multiple and varied symptoms. Moreover, ASD is majorly critical in children where it affects their cognitive and behavioral developmental processes. The neurodevelopmental disorder results in deficits of communication, social affective connections and differential in having normal intelligence. Applied behavioral analysis conducted by a professional therapist is one of the approaches that is intensively applied in the treatment and management of ASD. Additionally, the approach aids in improving ASD in individuals by teaching basic insights that increase independence and quality of life. Positive reinforcement through the application of behavioral modification and analysis is a gold standard in managing ASD conditions.

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Firstly, the treatment recommendations would require approaching and creating a good rapport with Kaitie’s parents where I will introduce myself as a professional behavioral analyst (BA). The sole reason is to build trust and faith as a BA for their daughter and the therapeutic intervention hence, a more positive outcome for Kaitie. Coming up with a convincing plan and agenda which is manageable will enable them accept the facilitated communication therapy.

Additionally, the weekly two hour parent-program is essential for them to voice their concerns and address issues affecting their daughter. More so, the program aids in getting deeper insights into the advantages of facilitated communication, thereby eliminating their preconceived ideas.

Secondly, asking questions about their daughter will be a great way to listen and learn from them. This will create a good rapport since they will be able to understand their valued opinions.

Finally, stating the advantages and benefits of the whole home program for Kaitie will help convince her parents (Barbera, 2017). Consider providing emotional support to Kaitie thereby making the communication process less stressful for her and physical presence helps in maintaining the attention on the task at hand.

Barriers to creating a good rapport may include factors such as adapting to the idea of a new program and well-being barriers. Adapting and accepting a new training program for their daughter would be a difficult hurdle to come to terms with. The various programs including DTT and the two Registered Behavior Technicians may seem enough for the four-year-old. However, it is difficult to convince the parents to introduce another beneficial program. This may be due to prejudgment of the initiated ideas. The lack of proper knowledge about the facilitated communication therapy may contribute to Kaitie’s parents reaching a decision without being fully informed. Prejudgment allows for making wrong decisions without considering the whole

3 perspective and various aspects of the therapy (Barbera, 2017). Therefore, it calls for great communication skill to try and convince them in the case of any preconceived notions since they were already having second thoughts about the program and developing a home training. As a result of the numerous interventions, the parents may question various approaches used in the new treatment. Although, understanding the fears they have heard about the ‘miracle’ of the Facilitating Program parents may feel they are moving too fast or it is too much for the fouryear-old to handle. Getting to know such fears about new intervention measures may help convince them otherwise and hence create a good rapport and overcome the barrier of applying new interventions.

The fostering of a therapeutic relationship involves developing mutual trust and faith. In the first session, I would introduce myself to her and be patient. She may take longer to process the information and adjust with a new BA. Moreover, I would slow down the conversation to her speed. This will be fundamental in the creation of a social connective relationship and fostering a good rapport. In any case she fails to respond, I will be resilient and persistent since she may have trouble responding to the smile or controlling her emotions. I would apply the negative reinforcement technique when she indulges in problematic and attention-seeking behavior (Barbera, 2017). Kaitie may try to display repetitive actions such as flopping the floor, hitting, kicking and making stereotyped actions. In such cases, negative reinforcement by ignoring her actions will correct her actions. Since she had been on the Discrete Trial Teaching program, rewarding the good behavior will establish a good beginning. Moreover, interacting through physical activity will aid in communication due to short attention spans. The physical activities create more social involvement hence, enables her to relax and adjust to the change. Similarly, being affectionate by showing love and interest will be a way of proving care and support, but if

4 she is resistant to physical affection, I will be respectful to her needs (Barbera, 2017). Spending quality time with her will help observe her preferences, the various physical activities she likes to engage in and expose her to varied activities.

Verbal Behavior Assessment and Intervention Verbal Behavior Intervention motivates a child to learn a new language through finding and pairing the value of a word and the word itself (Wilson et al 2018). Similarly, Kaitie will be trained to emphasize the function of words and language rather than the form. Various programs will be used to assess her behavior and appropriate therapy programs for her. The best method applicable in her case will be the Early Start Denver Model. Kaitie is four years old, and this model is a comprehensive, evidence-based and equally play-based learning therapy. It will help her develop social communication skills, relationships, improve her play skills and language through general day-to-day activities. The Early Denver Model combines developmental techniques with the Applied Behavior Analysis (ABA) approaches to achieve a maximized outcome (Barbera, 2017). This model will improve Kaitie’s interest in social activities and focuses on the communication and relationship skills that she has already displayed. Playing is a method that improves the skills gradually. It involves intensive and structural ways which create enjoyment for the child.

The Denver Model is a multidimensional behavioral therapy approach which focuses on playing as a way of boosting social, cognitive and language skills for a child with ASD. Consider, Kaitie has two Registered Behavior Technicians working with her, parents and a therapist. Working together alongside this team will help develop Kaitie’s tailored program to reach both the desired goals and objectives and all the activities targeting her verbal skill development. According to the Denver model, in my absentia, it is vital to teach the caregivers

5 and parents how best to execute the program to meet Kaitie’s needs. Furthermore, the Denver Model is applicable in different settings that are either therapy sessions or one-to-one intensive teaching (Leaf et al., 2017). In any case since it is a home tailored program group sessions are not necessary during training.

The expected results will be an overall improvement in Kaitie’s developmental trajectory.

Firstly, her language abilities by the end of the program should be better than her initial state.

This is because the model allows for interaction in an enjoyable manner therefore; play activities will increase her capacity of self-expression and verbal development. Her social and communication skills will be equally better since the model emphasizes teaching during natural play or what may be considered normal every day tasks. Improved social skills will mean better relationships with those around her. Brain activity is intensively heightened through both joint and play activities (Hassan et al., 2018). Thus, a child is trained and efficiently boosts their social, cognitive and language skills. Correspondingly, her parents will be encouraged to continue with the use of the model in natural environmental settings and at home in daily activities, thereby reinforcing the intervention method.

Verbal operants that will be applicable in her case include: testing Kaitie’s ability to request items or activities she finds of great interest. Since she uses aggressive behavior (hitting, throwing herself on the floor or screaming) to express herself or ask for something, manding will help improve her ability. Echoic involves repetition of sounds, phrases or words for her to promote speech development, and tacting entails the child’s ability to label the items they encounter in daily activities (Hassan et al., 2018). Labeling is beneficial in increasing her language and communication ability. The inclusion of receptive tasks is significant since the skill involves instructional learning in an allocated task. Learning motor imitation skills will

6 assist her to acquire both gross and fine motor control (Hassan et al., 2018). These targeted skills will be taught during her discrete trial training (DTT). DTT can be carried out at a table or the play room when manding and in progression of the natural environment teaching (NET) sessions. During DTT, I will work with Kaitie on the targeted skills at the table. The length of time spend on the activities will be dependent on her but a shorter duration would be more effective.

DTT applied strategies include positive reinforcement, correction procedures and prompting. I will conduct natural environment teaching and manding sessions in the play room rather than at a table. Natural environment teaching generally includes continuously working on her skills by making the whole learning process engaging and creative (Hassan et al., 2018). All the verbal operants discussed above will be taught by placing demands which are related to the target activity. Consider asking her to label or tact different foods while playing with a kitchen set or to imitate a stirring pot. The focus is to improve functional communication for the child.

Continuous engagement in such activities creates further opportunities to teach mands.

Therefore, programming has to be individualized because of the distinctive set of skills for every child. Taking note of her behavior will be recorded to help in the future if we incur any challenging behaviors (Hassan et al., 2018). Consider what occurred right before the action and what occurred after. Keeping these records and data will provide further insight into why she constantly engages in behavior such as throwing herself on the floor whenever she wants something.

For adequate supervision of the registered behavior technicians, I will apply effective and evidence-based supervision based on the knowledge of basic principles. These involve the application of ethical methods to meet the set goals and objectives (Bailey & Burch, 2016). On

7 the account that it is an evidence-based intervention training program, supervision will be critical and highly effective. There will be a need for feedback and reinforcement for the appropriate behavior technicians to achieve the desired targets and skills for the intended goal. Positive feedback implies that the mechanisms put in place are effective and friendly to the client, any negative feedback will call for change in strategies.

Naturalistic approach to teach the parents would be pivotal response training. It focuses on things which are ‘pivotal’ to the child’s behavior or what initiates the behavior (Bailey & Burch, 2016). The aim is to bring change in aggressive behaviors a child may possess or poor communication skills as in our case. Pivotal response training will allow them to elicit the target behavior and collect the data. This will involve initiating communication with Kaitie during playtime or engaging her in a conversation. Similarly, she will be rewarded for any attempt to regulate the behavior on her own. The approach is applicable since she gets to learn while undergoing her daily activities and without necessarily concentrating on the problem behaviors.

If the target for Kaitie is to initiate a verbal request, her favorite toys will be placed within her vicinity l but out of reach to motivate her to initiate the request. She will then have the opportunity to develop the skills necessary to reach the target behavior.

The performance management strategies to support and supervise the program by the registered behavior technicians would be effectively training them with the required skills as stipulated by BACB. If the supervisee does not have the skills necessary to perform safely, ethically and competently, behavior analysts should provide conditions for the acquisition of those skills (Board, 2014). This is because they lack the necessary skills required in Facilitated Training. Preservice training will allow learning of relevant skills and continued coaching and feedback. However, insufficient training may interfere with the quality-of-service provision and

8 negatively affect the integrity of treatment. The parents may be taught how best to implement a natural teaching environment for Kaitie.

Learning how to implement natural environment teaching is eased by understanding that instructional control is gained through pairing. Additionally, encouraging them to follow her lead using the materials available in her home or general environment facilitates generalization. For instance, this can be done by noting her motivation when taught a new skill. To improve her language skills, a situation may be arranged, for her to access her 'doll' that is out of reach, parents may model the word 'doll'. If she repeats the word, then it is given to her. However, the method is greatly dependent on the child's environment; therefore a need to change the environments for efficacy (Smith et al., 2017). A team approach among all participants is critical in the treatment of a child. As a behavior analyst, I would provide support during the occupational and speech therapy sessions. Preventive strategies such as visual schedules, token boards and point systems; would be efficient in reducing problem behaviors and increasing the productiveness of the sessions. The registered behavior technicians will guide the goals implemented during ABA consider writing and all the other strategies to promote independence.

The parents' involvement increases the intervention amount the child gets, and they too learn new strategies to apply while on their own with the child (Barbera, 2017). This is likely to result in positive changes since new methods of interacting with the child are taught and learned by the parents.

The legal and ethical issues to consider are self-care concerns. A behavioral analyst needs a higher level of concern for others, thus I have a duty to uphold my schedule commitments to benefit the client with consistency in my schedule. Building friendships with clients and their families is necessary. However, professional boundaries have to be set, and financial concerns

9 should be addressed. Furthermore, the provision of quality services and understanding how to make ethically-based decisions is vital.

Cultural awareness generally refers to understanding one's cultural characteristics, preferences, and values and knowing they are different from the client's (Beaulieu et al., 2019).

Conscious awareness of personal biases will eliminate situations where I compare my culture with that of the client’s. It also increases the probability of engaging in socially acceptable behaviors to people from various cultural backgrounds. Further problems may be prevented, such as expecting a client to conform to our cultures. Cultural values may often clash with a client's and cultural awareness helps alleviate this. On the other hand, social validity is the social acceptability, importance of intervening goals, and the importance of behavior modification (Graf et al., 2017). Through assessment, one is empowered to refine or revise the applied interventions with positive feedback. Reasonable intervention methods are selected, and the results are analyzed according to the client's satisfaction. Although a program may have been effective in a different setting, may not be applicable in an alternate setting; therefore, a need to research thoroughly on what best suits a client.

Conclusion Due to various intervention measures available for children with autism, challenging decisions are faced with parents about the best choices for their children. However, with the appropriate information, the best interventions can be reached to suit the child. Verbal behavior intervention applies different operants to help improve the cognitive, social, and emotional wellbeing of a child. As a professional, considering the cultural variations, legal, ethical and social validity is key in the verbal behavior program to achieve the best results for the client.

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References Bailey, J., & Burch, M. (2016). Ethics for behavior analysts. Routledge.

Barbera, M. L. (2017). The verbal behavior approach: How to teach children with autism and related disorders. Jessica Kingsley Publishers.

Beaulieu, L., Addington, J., & Almeida, D. (2019). Behavior analysts’ training and practices regarding cultural diversity: The case for culturally competent care. Behavior Analysis in Practice, 12(3), 557-575.

Board, B. A. C. (2014). Professional and ethical compliance code for behavior analysts.

Graf, W. D., Miller, G., Epstein, L. G., & Rapin, I. (2017). The autism “epidemic”: ethical, legal, and social issues in a developmental spectrum disorder. Neurology, 88(14), 1371-1380.

11 Hassan, M., Simpson, A., Danaher, K., Haesen, J., Makela, T., & Thomson, K. (2018). An evaluation of behavioral skills training for teaching caregivers how to support social skill development in their child with autism spectrum disorder. Journal of autism and developmental disorders, 48(6), 1957-1970.Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., ... & Waks, A. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior analysis in practice, 10(2), 154-163.

Wilson, M., Hamilton, D., Whelan, T., & Pilkington, P. (2018). A systematic review of factors related to parents’ treatment decisions for their children with autism spectrum disorders. Research in Autism Spectrum Disorders, 48, 17-35.