With the rise in rates of autism diagnoses, more people are becoming familiar with the field of applied behavior analysis.  What I am not so sure of is if the "behavior analysis" being introduced to people is an accurate picture of the field. I believe that this is partially due to the rise in professionals claiming to be trained in behavior analysis.  If you are truly working with a well trained behavior analyst, you will know it because behavior analysis is remarkably different than mainstream psychology (what most people know to be the field of psychology).

The first and most widely observed mistake I see made is referring to the field, applied behavior analysis (ABA), as a treatment.  ABA is not a treatment.  Applied behavior analysis is a science.  It is an area of psychology that has very different views than mainstream psychology.  Behavior analysis has separated itself from the rest of psychology because of it's different subject matter, philosophical beliefs, theories, and methodology.  ABA is the application of the scientific principles of behavior discovered during experiments.  ABA does not refer to a specific treatment or treatments.  ABA-based interventions are devised by behavior analysts trained in the scientific principles of behavior.  Each intervention is unique and created to meet the needs of the individual and each individual's specific situation.  All ABA-based interventions are based on scientific principles of behavior that are based on years of experimental research.  

So what makes behavior analysis so different from the rest of psychology?

1. Behavior Analysts Study Behavior-Environment Relationships, Not The Mind
A critical distinctive feature is the subject matter of behavior analysis.  Behavior analysts believe that the appropriate subject matter for psychology is behavior and it's interaction with the environment.  In contrast, the rest of psychology studies the mind.  This does not mean behavior analysts do not study psychological events said to occur in the "mind," such as feeling, thinking, dreaming, perceptions, etc.  Behavior analysts do study these events, they just don't give the "mind" special status and they consider these types of events as examples of behavior just like any other behavior.  As such,  behavior analysts believe that these type of events follow the same scientific principles as any other behavior.  

2.  Behavior Analysts Do Not Explain Behavior With Other Behavior
Unlike mainstream psychology, behavior analysts do not believe it makes sense to say that private behaviors are the cause of other observable behaviors.  For example, it is common practice for us to say something like, "I yelled at him because I was mad."  This is an example of attributing the cause of yelling to feeling mad.  While this does not pose a problem for mainstream psychology, it poses a big problem for behavior analysts.  If we are to say a behavior (feeling mad) caused another behavior (yelling), than we have not explained anything at all.  We still haven't explained how or why the behaviors occurred. 

3. Behavior Analysts Explain Behavior By Examining The Context In Which It Occurs
For a behavior analyst, the explanation or cause of behavior can only be found my looking outside behaviors to the environment.  Now, here is where it can get a little tricky.  For years, behavior analyst have been charged with being extreme environmentalists. The truth is there has never been a behaviorist that ever believed that biological factors did not have some role in influencing behavior.  Not Skinner, not Watson, not anyone.  The real issue here goes back to subject matter.  A behavior analyst takes the position that the subject matter for psychology is behavior-environment relationships whereas biological factors should be studied by biologists, neurological factors by neurologists, etc.  A behavior analyst examines the context in which behaviors occur to identify the variables responsible for the behavior.  This includes all the relevant information about the situation before the behavior occurs and all the relevant information about what changed in the environment after the behavior occurred.  If there are biological factors or other factors that are outside the scope of behavior analysis, the behavior analyst will consult with the appropriate professional. This is referred to as an interdisciplinary approach.  Behavior analysts are proponents of a multidisciplinary approach. 

4. Behavior Analysts Reject The Application Of The Medical Model To Psychology
Mainstream psychology uses the same methods to study, diagnose, and treat psychological problems as the medical field. Behavior analysts do not believe the medical model is the best way to study and treat psychological problems.  Instead, behavior analysts use different research methodology and focus on socially relevant behaviors to each individual that are targeted for change rather than clumping everything together into diagnoses based on symptoms.

 Critics often claim there is a lack of large clinical studies that support treatments based in ABA, and they are right.  The reason is because behavior analysts don't believe that this type of methodology is the best way to research behavior and have adopted alternative methods called time-series designs.  Time-series research designs allow us to answer the question "What treatment works best for for whom?" whereas the "gold standard" double-blind, randomized, placebo-controlled trial cannot answer this question.  Individuals who are not trained in time-series methodology often erroneously mistake the research published in behavior analysis for case studies because of the focus on individual data.  In mainstream psychology, case studies, typically involve the publication of information regarding the progress of one patient.  In general, case studies do not involve experimentation of any sort, but rely on descriptions of the patients progress.  Time-series designs are experimental manipulations that allow us to say with confidence that the changes observed in behavior were due to our treatment.  This is a stark contrast from traditional case studies published in mainstream psychology journals and furthermore, time-series designs provide more information than the revered "gold standard" group designs. 

Most of the interventions used in mainstream psychology have relied on the "gold standard" to support the effectiveness of the intervention, but this is what you probably don't know.  Most treatments barely have effects bigger than the placebo group (the fake treatment group).  The effects are so small they require a fancy statistical procedure to make sure that the changes were significant enough to say there was a change and because groups of people are being compared, the treatment protocol has to be uniform across all the individuals participating.  Behavior analysts reject this procedure for several reasons.  First, behavior analysts believe that psychology is best studied at the level of the individual, therefore, the methodology is based on individual data.  Second, behavior analysts are very concerned with clinical significance.  In other words, behavior analysts don't really care if the procedure was statistically significant.  A behavior analyst wants to know if the treatment helped the person and did it improve their quality of life.  Third, behavior analysts believe that treatments should be individualized to meet the needs of the individual and to work best for their current situation.  Last, behavior analysts believe in the scientist practitioner model and take ongoing data on all interventions and modify the treatment as needed based on the data. 

These qualities of behavior analysis do not lend themselves well to the "gold standard" methodology.  This does not mean that interventions based in ABA cannot hold up to the "gold standard."  There have been several studies conducted using group design methodology, in which, behavioral interventions are consistently demonstrated to be effective.   It is difficult, however, to devise these studies because one is forced to develop uniformed interventions that directly violate the emphasis on individualized treatments, but despite this flaw, behavioral interventions always do well when put to the "gold standard" test.  

5.  Behavior Analysts Define Concepts Based On Function, Not On Structure
Mainstream psychology's classification system is based on structural features or formal properties (what it looks like).  The entire diagnostic manual is made up of different disorders that are separated based on similar topographical behaviors (they look the same).  Behavior analysts believe that the best way to examine behavior is to look at it's function.  The function of the behavior is the effect it has on the environment or the consequences the behavior produces.  For example, I hit the button on my alarm and the effect that has is to stop the loud, annoying sound;  I study for the test and the result is to receive an A (or avoid a bad grade);  I take off my jacket and my body cools off.  Most of the behavior analysis literature (articles and studies in journals) are based on the function of the behavior and not on the structural features of the behavior.  For example,  an article may be examining escape maintained behavior (behavior that results in the escape from an unwanted demand or task, such as schoolwork or chores).  There may be several data sets with several individuals that engage in very different challenging behaviors and may also have different diagnoses (if any diagnoses).  One child may hit and throw items that has the function of escaping schoolwork.  Another child may repetitively bite his arm that has the function of escaping grocery shopping.  As opposed to mainstream psychology literature, in which a strong emphasis would be placed on the diagnoses (they have all been diagnosed with ADHD) and would be examining behaviors grouped together based on structural features (they all hit). 

This does not mean that behavior analysts do not believe in diagnoses or think that they are not important.  It means that they place less emphasis on the diagnoses and more emphasis on the function of the behaviors the individual is displaying. This is why it is difficult for those outside of the field to find research supporting treatments for specific diagnoses (e.g., autism).  Most of the research does not focus on the diagnoses of the individual because it is focused on the function of the behaviors.  Just because someone has a similar diagnosis doesn't mean that the cause of the behavior is the same.  Using the above example, all the children in the study have the diagnosis of ADHD and they all engage in aggressive behavior.  If we examined the same treatment for all these children, chances are it wouldn't work for all of them.  Why? Because the function of the behavior is likely to be different for all of them based on the circumstances.  This is why behavior analysts focus on individual data and individual treamtments that are based on the function of the behavior for that individual and his current circumstances. 

6.  Behavior Analysts Are Scientist Practitioners
In mainstream psychology, it is unlikely that you would visit a therapist who takes ongoing data and does experimental manipulations to ensure that the treatment he is providing to you is working.  Behavior analysts believe it is unethical to implement treatments that don't work for each individual.  Behavior analysts collect ongoing data and continually monitor the data to ensure that the treatment is working.  If at anytime the treatment does not work or stops working, appropriate changes or adjustments are made to fix the problem.  Behavior analysts are continually conducting experimental manipulations to ensure that the changes are due to the treatment on not any other outside factors.  Behavior analysts are known for loving their data.  Not because they are "mad scientists" but because most of them take their vow to ethical conduct seriously and want to make sure that the treatment they are implementing is working. 

How do you know you are working with a behavior analyst?

• A behavior analyst will discuss the behaviors targeted for change and will make sure they are socially relevant and important for the indvidual.
• All targeted behaviors will be clearly defined and a plan to collect data will be devised.
•  A behavior analyst will collect assessment data to determine the function of the behaviors based on direct observations.
• A behavior analyst will be thoroughly trained in functional assessment and functional analyses procedures
• A behavior analyst will be thoroughly trained in time-series methodology and the scientist practitioner model
  
• A behavior analyst will collect ongoing data, including a baseline (before treatment) and continue when treatment is implemented
• A behavior analyst will devise a treatment that is based on the function of the behavior.
• A behavior analyst will have a detailed written description of all treatment plans.
  
• A behavior analyst will base all of his treatment decisions on the data.
• A behavior analyst will modify treatments as needed based on the data and will not continue to implement a procedure that is ineffective.
• A behavior analyst will only recommend treatments that have been empirically supported.
  
• A behavior analysts will not support the implementation of eclectic treatments (multiple treatments from various fields of psychology or other sources that have not been empirically supported) but will support working with multiple disciplines (doctors, nutritionists, neurologists, etc).
• A behavior analyst will be dedicated to improving the quality of life of his clients by implementing programs that make long-lasting and socially relevant behavior changes.
  

Recent articles like the one from Alison Gopniks entitiled, Why Preschool Shouldn't Be Like School, suggest that children's creativity is stifled when they are directly instructed from teachers.  While, I agree that it may be partially true that using direct teaching methods with children may result in less novel responses, I do not agree that this type of research provides evidence that teachers should not directly instruct children in preschool.  In order to discuss this issue it is important to be familiar with 3 types of instructional methods that have been heavily researched in the science of learning. 

The first type of learning is referred to as trial-and-error learning or contingency-shaped teaching.  With this type of learning the child learns on his own via the consequences of his behavior.    The type of consequence present after the behavior occurs will shape or change the future behavior.  This type of learning typically occurs in the natural learning environment.  For example, a child will learn not to reach out for the roses if the consequence is being pricked by a thorn.  Or on a more positive note, a child will continue to twirl and dance when the consequence is an audience clapping and cheering.  Behaviors that result in unpleasant consequences will be less likely to occur again and those that result in pleasant consequences will be more likely to occur again.  This type of learning is referred to as trial-and-error because the child is not instructed to the right answer or given any hints or prompts, he must discover the right answer on his own. 

The second type of learning is referred to as errorless learning.  Errorless learning is similar to trial-and-error learning in the sense that the consequences shape or change the future behavior, but with errorless a cue or prompt is provided to help the student choose the correct answer, thereby, reducing or eliminating errors during the learning process.  Contrary to popular belief, research in errorless learning has shown that it is not necessary to experience errors in order to learn.  In fact, errorless learning has similar learning results as trial-and-error, with the added benefit of having less frustration with the learner.  As long as the teacher, quickly fades out the type of cue or prompt she is providing, errorless learning is a great teaching strategy with many benefits to the learner. 

The third type of learning is referred to as rule-governed behavior.  This is the category that I think most people are referring to when they are talking about directly instructing the child.  Rule-governed behavior is behavior that is taught by instruction.  Instead of directly experiencing the consequences of the behavior, an instructor gives a rule to follow, such as, "Don't touch the thorns, they will prick your finger."  One of the perks of being a part of a species that has language is that we can teach our young via rules so that they do not have to directly experience everything in order to learn. 

Now this brings us back to our original question.  Does too much instruction interfere with creativity?  If one is to measure creativity by the number of novel responses made to a toy after being taught one response using one of the three methods of teaching (see example in Gopniks article), then the child will make the most novel responses when taught via trial-and-error, a slightly smaller amount of novel responses when taught via errorless, and is likely to make very few, if any novel responses when told what to do.  The problem with this, is I don't think we are actually measuring creativity with this example.  We are measuring how many errors the child makes after being taught a correct response.  In the example, Alison Gopniks referrs to in her article, they demonstrated (i.e., used a modeling prompt) one of many ways to interact with a toy with one group of children, then instructed one of many ways to play with a toy with another group of children, then observed the children playing with the toy and measured how many ways the child played with the toy other than what was demonstrated or instructed.  Essentially, this is comparing errorless, with the teacher demonstrating the correct response and rule-governed instruction, with the teacher instructing the correct response.  They measured novel responses, which could also be looked at as errors, which in most learning situations novel responses would be errors because they are responses outside of the response modeled by the teacher or the instructions of the teacher. 

If one wants to compare instructions versus trial-and-error or errorless to measure creativity the initial teaching would have to teach all desired responses either by reinforcing correct responses during trial-and-error or errorless and compare that to directly instructing the child to all the responses, then one could present the child with a new toy and measure the number of novel responses to a novel item to measure creativity.  To my knowledge this hasn't been done, so I don't know what the results would be, but based on the principles of learning, I would guess that there wouldn't be much of a difference between the three groups in the number of novel responses observed to a novel stimulus.  Where a difference would be found, is the length of training (trial-and-error would take more training trials to teach the skill) and if the child were presented with changes to the consequences.  For example, if a part of the toy broke and no longer produced the desired effect, the children who were taught via trial-and-error and errorless will adjust their behavior (no longer play with that part of the toy) faster than the children who were taught via instruction.  The children in the instruction group would be more likely to continue to attempt to make that part of the toy work longer.  This characteristic of rule-governed behavior versus contingency-shaped behavior could be argued to be a case for creativity versus rigidity.  The children who were taught via instructions are more likely to continue engaging in the same response in the same way whereas children who were taught using contingency-shaped procedures (trial-and-error and errorless) will be more likely to try new things.   

Both trial-and-error learning and errorless learning result in more flexible responding.  What that means is that if there are changes to the environment or to the consequences, behaviors taught via trial-and-error or errorless learning will adapt and change more readily to suit the environment.  Rule-governed behavior, on the other hand, is more persistent and rigid in the face of environmental fluctuations or changes.  If this is used as a measure of creativity, then, yes, instruction based learning will result in less variability and flexibility of responses.   If your goal of teaching is to have variable and flexible responding, then a contingency-shaped teaching procedure (trial-and-error or errorless) should be used to teach the skill.  If your goal is to have rigid and accurate responding then instruction based teaching should be used to teach the skill. 

But, this doesn't mean we should throw instruction based teaching out just yet to teach creativity.  It is the case that creativity can be directly taught via instruction.  For example, you can tell a child he has to respond differently than his last response and as a result he will engage in novel responses (i.e., creativity).  He is likely to do so in a very systematic way, but this may be a useful teaching strategy for children who seem to struggle with creativity.  Some teaching programs, such as Fit Learning, have found success directly teaching verbal flexibility which is a form of creativity (e.g., saying increasingly abstract things about an item).  Curriculum for children with autism also focuses on directly teaching creativity using both instruction based teaching and contingency-based teaching methods with success. 

The decision to use instruction based teaching or play-based teaching methods (contingency-shaped teaching), really depends on the skill you are trying to teach, the child's learning abilities, and what works best for the learner in the situation.  A strong teacher should be familiar with learning literature and should know the characteristics associated with each teaching strategy so that he can modify the curriculum for each learner as needed.  

The first step to teaching your child to talk is to show him that communication is meaningful by teaching him to indicate his wants/needs.  It is useful to teach communication in simple steps beginning with nonverbal forms of communication (pointing/touching) and slowly shape the form of communication into verbal communication.  The tricky part is that it is sometimes difficult to know what your child wants.  That's okay.  If you don't know what your child wants, then you won't be able to use this teaching strategy for those situations.  The good news, by using this teaching strategy your child will learn to communicate better and will be more likely to effectively communicate to you what he wants in more situations thereby reducing or even eliminating those frustrating situations when you don't know what he wants.

Identifying Natural Teaching Situations
A natural teaching situation will be anytime your child demonstrates any signals that he wants something and you can correctly identify what he wants.  Some examples may include, reaching for a cup to signal he wants a drink, crying when he can't reach a toy, looking toward a toy or item. 

Teaching a Communication Response
When your child demonstrates a desire for something, teach your child to communicate this by withholding the item and gently guide your child's hand to point to or touch the desired item.  Give the item to the child after he points/touches it.  Slowly reduce the amount of assistance you are giving your child until he begins to point/touch independently. Continue this process until your child is consistently pointing/touching items to indicate his desire for the item.  Then, you will begin to teach your child the next step.  Here are some examples of teaching steps that may be used (you can skip steps or add steps if needed)

1. Pointing/Touching
2. Signing or Pictures (this step may be added for infants who have not developed language or for older children with language deficits)
3. Vocal approximations to the word (saying "buh" for ball)
4. Saying the name of the object ("ball")
5. Saying the name of object and please  ("ball please")
6. Asking or stating desires ("May I have ball, please?" "I want ball")
7. Adding details about desired object ("May I have the big ball, please?")
8. Requesting items by their function ("May I have something to write with?")

When teaching your child to talk, begin by demonstrating the response you want, then you will slowly fade out the demonstration as your child starts to respond correctly.  Here is an example:

Child reaches for ball
Parent grabs ball and says, "ball"
Child says, "ball"
Parent says, "That's right, ball"
Parent hands the ball to child

Child reaches for ball
Parent grabs ball and says, "b"
Child says, "ball"
Parent says, "Yes, ball"
Parent hands the ball to child

Child reaches for ball
Parent grabs ball and waits
Child says, "ball"
Parent says, "Yeah, great job, ball"
Parent hands ball to child

Create Multiple Learning Opportunities
We learn best through repetition, so the best way to teach your child to communicate is to set up the natural teaching situations so that you can provide multiple learning opportunities.  In most cases, you can do this by breaking the item/activity into smaller parts.  For example, if your child requests juice, give him a small amount to create the opportunity for him to ask again.  If he requests a toy, let him play with it for a small amount of time (e.g., 30-seconds), then remove the item and show him how to ask for it again.  Repeat this process until he is no longer showing interest in the item.    

Another way to increase learning opportunities is to set up your environment so that frequently desired items are out of reach from the child (but still visible) so that he has to have your assistance to get them.  If his favorite toys are readily accessible, the need to communicate his desire for them is removed. 

A few tips

• It's important to remember that this teaching strategy can only be used when your child has a desire for something, so if he does not appear interested in the item/activity do not force him to continue.  Wait until he shows interest again, or try to find something else he may want.

• Avoid teaching general words such as "more."  This will end up limiting his vocabulary because "more" will be used to indicate his desires across several situations.

• When using this teaching strategy, avoid asking questions to your child, such as "Which one do you want?" because this will prevent your child from learning to independently communicate his desires.  He will learn to wait until he hears you say, "Which one do you want?"  or some other question.  The cue for him to communicate should be the feelings of desire he is experiencing. 

• Your child may demonstrate some frustration (crying, tantrumming) when you initially begin the back and forth process of taking the item then giving it back for small amounts of time.  Don't worry. Keep at it, and it won't take long for him to figure out that all he has to do is communicate to get the item back. 

• If you continue to have difficulty getting your child to talk, you should consult a professional for help.

  

There is no doubt that parents play a crucial role in their child's behavior, but does this mean that teachers are off the hook when it comes to students behavior in the classroom? 

Let me first make sure I emphasize that there are many wonderful teachers that are great with their students and don't get the credit they deserve.  I do not want this to have the tone that I am blaming teachers or criticizing teachers.  My goal is to present a different way of looking at a pervasive issue that all of us working with children have to deal with when teaching children.  My concern is not as much with the individual teachers as it is with the underlying misconception that student behavior cannot be changed or managed properly unless the parents are involved too. 

I empathize with teachers who are working with children that do not have parental involvement in the home or even worse have parents promoting inappropriate behavior.  I understand the frustration of having to deal with this issue from both a personal and professional position.  I have a blended family and I have to deal with this issue with my own children and I work with children in their homes and in the classroom, so I am well aware of the issues that arise when parental involvement, or lack thereof, is interfering with educational and behavioral goals.  What I have learned over the years is that the child does not benefit from focusing on what other people are or are not doing.  When we spend so much time focusing on what others "should" be doing, we take away from focusing on our own behavior and our contribution to the child's life.  You can't change what's going on in the child's environment outside of your classroom, but you can change the child's experiences while he is in your classroom.  Each child is going to enter your classroom with different backgrounds and there really isn't much you can do as a teacher to change what happens outside of your classroom.  You can, however, change the environment you provide to them while they are in your classroom. 

There are many reasons why children may not be getting the support they need from home:  financial strain, single-parent homes, conflict in the home, cultural differences, medical conditions, mental health issues, etc.  The list could go on and on, so I think it is important for those of us who work with children to remember that it is not the child's fault and the parent's may not be capable of providing the support needed.  The best we can do, is provide the consistency and support needed while the child is in our care.  By doing so, their behavior will improve, even if it is only while they are in our care. 

Tips to Improving Child Behavior in the Classroom:

• Children of all ages (even high school) learn best with immediate consequences.  If the child is behaving well or misbehaving, it is best to provide immediate feedback.
• Children learn better with reinforcement.  Sometimes this seems especially difficult with a child who misbehaves a lot, but it really will change behavior if you focus on what the child is doing right instead of focusing on what he is doing wrong.
  
• Keep it simple and easy.  Children who are not getting support from home are very likely to have experienced a lot of failure.  Imagine how it must feel to be so far away from the rest of the class. If you are teaching reading and the child still doesn't recognize letters correctly, what reason does he have to try? Give him a reason. Start small.  Find little accomplishments to reward.
• Change your attitude.  You have taken on the task of managing several children at the same time for several hours each day.  This is not easy.  Do not expect it to be easy.  Do not expect children to behave like adults.  They are children that require adult supervision for a reason.  That reason is because they are not capable of behaving appropriately an entire day without adult guidance.  Expect that part of your day will be spent managing behavior.  Have a plan in place to manage behavior that focuses on reinforcing good behavior.  
  
• Don't give up.  If your behavior management plan is not working for some of your children, then it needs to be adjusted to meet them where they are at.  If a child continues to misbehave, then you can make some adjustments to your plan by changing the criteria to earn reinforcement (make it easier) or you may need to provide reinforcement more often.  Remember, keep it simple and easy to earn reinforcement, especially with children who misbehave often.
  

Heidi Eilers, Ph.D., BCBA-D
Family Coach/Behavior Analyst
www.positivebehavioralsolutions.com
 
       

"Don't worry, he'll grow out of it"
I have been working with children with developmental disabilities for several years and I would estimate that approximately 75% of the families I have worked with tell me that their pediatricians told them not to worry about concerns about their child's development. So, they waited to see if he was going to "grow out of it" and missed out on critical early intervention services.  It boggles my mind every time I hear the same story.  Why are pediatricians giving parents such poor advice? 

I asked my kids' pediatrician why this is common practice and he told me that it is because more often than not, it is the case that children will grow out of it.  What I don't understand about this logic is the huge risk of not getting early intervention when there is a problem? Yes, it may be the case that more often than not, the child will grow out of it, but I don't think it is worth the risk for those few children who do not grow out of it to just wait and see.

There is little to no risk involved with having your child assessed by a speech pathologist or psychologist if you have concerns about your child's development.  On the other hand, there is a huge risk when you wait to see if they will grow out of it and don't get early intervention services.  A specialist will be able to tell the difference between a slight developmental delay that is due to nothing more than different maturity rates and a real problem that requires intervention.  Most pediatricians are not trained to recognize these signs and often cannot tell the difference. 

As someone who has worked with children with developmental disabilities for several years, my advice to parents, is get your child assessed as early as possible if you have any concerns.  There are a variety of possible reasons for delays in your child's development.  The only way to correctly identify the problem is to have an expert that specializes in developmental disorders assess your child.  Early identification and intervention is key to getting your child the help he needs.

Many parents have expressed concerns to me about their child being labeled or stigmatized by a diagnosis as the reason they were hesitant to get an assessment.  While I understand the fear parents experience when something is happening with their child, the bottom line is, if there is a real underlying problem, it will be there whether they get it diagnosed or not.  It will only make the problem worse if you wait until they are older to get the proper intervention they need.  Also, most of the time, diagnoses are not given to small children.  They are often labeled as "at risk" for a particular disorder so that they can receive the specialized services they need and are not given a formal diagnosis until they are school age.

Here is the link to the Center for Disease Control's Developmental Milestones to Look For:
 http://www.cdc.gov/ncbddd/actearly/milestones/index.html

If you have concerns about your child's development, report it to your pediatrician.  If your pediatrician does not refer you for an assessment, take initiative and do it yourself.  If your child is below the age of 3, contact your local regional center.  If your child is over the age of 3, contact your local school district.  If neither of these options work, you may need to find a specialist on your own in your area.  Look for a psychologist who specializes in diagnosing developmental disorders with young children. 

If you've ever tried using a point system or a reward chart, then you are aware of the difficulty involved in keeping up with it. They usually involve a lot of behaviors, then you have to decide how often they get a point, then you have to figure out how often your child will be able to exchange the points, then you have to decide the price of items purchased with points, then you have to keep track of how many points have been spent, etc..  Before you know it, you are running your own little mini economy and that is no easy feat.

Here is an easier way to use a reward system.

Materials Needed: A small strip of cardstock (about the size of a bookmark), 5 small squares made out of cardstock -you can personalize the squares for your child with pictures of something they like, such as princesses or cars, or you can draw stars or happy faces on the squares, 5 small pieces of velcro, and a small plastic bag or envelope to store the items.

Place the 5 pieces of velcro (rough side) on the strip of cardstock.  Place the other side of the velcro (soft side) on the backside of the 5 square pieces. 

Before introducing the new reward system to your child, you will spend a few days establishing the earned rewards as part of the daily routine.  First, you will need to identify which activities or rewards you want to use with your child.  For example, if your child likes to play games, they can earn 15-20 minutes of game time.  For the first few days, you will establish "game time" as part of the daily routine.  Every day at 5:00pm your child will be able to spend 15 minutes playing games.  The actual amount of time, depends on your child's age and the type of activity.  Younger children may only need 5-10 minutes whereas older children may need 30 minutes or an hour.  The reward can be anything - access to a favorite toy, game, activity.  It should be something that your child really enjoys doing. 

This "reward time" will be given to the child regardless of his performance during the first few days.  Why? Because it is very important to establish it as part of their routine before you try to use it as a consequence.  This is a big mistake that is often made when introducing a new reward system.  If the child hasn't experienced the "reward time" then she doesn't know what she is working so hard to earn and if she doesn't earn it, she doesn't know what she is missing out on. 

After you have spent a few days establishing the new "reward time" as part of your child's routine, it is time to implement the reward system.  Sit down with your child and go over each rule that will result in a loss of a square and that keeping her squares will result in earning "reward time." 

Here is how it works:

Each day your child will begin the day with all 5 squares on the reward strip.  Each time your child breaks a rule, one of the squares will be removed.  If she loses all 5 squares, she will not be able to participate in "reward time" that day.  If she has 1 or more squares left on the strip, she will earn "reward time." The reward  strip is small enough to take with you anywhere, so you can use it while you are away from home too.

There are a few keys to making this reward system work.

• Focus on praising good behavior throughout the day (tell her what she is doing right). Each time she loses a square, make it a point to find 5 things that she has done right. This will help keep you focused on the positive things your child is doing.
  

• When she loses a square, keep it simple, state the rule that she broke, and tell her that she lost a square for breaking the rule. Do not yell. Do not lecture.  Do not say anything more about it.

• Do not allow your child to have access to the activities used during "reward time" at any other time.  Reserve those activities and/or toys for "reward time."  By doing this, you will increase her motivation to work hard to earn "reward time."  If she knows she can have it at other times, then why should she care if she earns it or not?
  

• When she earns "reward time" tell her all the things she did right that day and remind her that is why she has earned her special "reward time."
  

You can personalize your reward system for each child and work on the rules that she has trouble following.  You can also slowly decrease the number of squares that she starts out with at the beginning of the day as her behavior improves.  For example, if she goes several weeks consistently earning the reward, then you can start the day with 4 squares.  Continue to decrease the squares until she only has 1-2 each day. 

Another strategy is to keep all 5 squares, but assign an amount of time to each square, so that the more squares she has, the more time she earns.  For example, if each square is worth 10 minutes, then 5 squares = 50 minutes of "reward time," 4 squares = 40 minutes, 3 squares = 30 minutes, 2 squares = 20 minutes, and 1 square = 10 minutes.

It might also be necessary to modify the procedure by starting out with more squares, if you are targeting behaviors that occur several time per day.  The same procedure can be used, you will just need to add more squares.  The number of squares that should be used with your child, should be slightly less than the number of times she breaks a rule during the day.  For example, if you are targeting whining, and your child typically whines 10 times per day, then you should start out with 7-8 squares per day.  Then follow through with the above described procedure to slowly decrease the number of squares that are used. 

Heidi Eilers, Ph.D.,, B.C.B.A.-D
Board Certified Behavior Analyst
Family Coach
www.positivebehavioralsolutions.com

Fear is the main source of superstition, and one of the main sources of cruelty.  To conquer fear is the beginning of wisdom.  ~Bertrand Russell

When confronted with the news of tragedy like the recent Arizona shootings, it is natural to feel overwhelmed with painful feelings.  We feel sorrow for the victims, their families, and their tremendous loss.  It also triggers many of our own fears.  What if this happened to my loved ones, my child, my spouse, my co-workers, my friends?  What can happen next, is what we need to watch for? For many of us, we quickly begin to feel a strong sense of anger followed by an urge to find blame.  Why did this happen?  Why wasn't it prevented? 

Why is it so common to go from painful emotions to anger to blame?  It might be because we are more willing to experience anger and direct our painful experiences to an external source, then to willingly experience painful emotions such as fear and sadness.  In the clinical world, we refer to this as experiential avoidance.  Experiential avoidance is our tendency to try to avoid experiencing negative psychological experiences, such as unpleasant emotions, thoughts, memories, urges, and physiological experiences.   Another way of saying this, is it might be easier to feel anger and to find an external source of that anger (a source to blame), then it is to remain in the present moment with our current painful state of emotions. 

The first step, is to recognize that you might be trying to avoid experiencing painful emotions.  Anytime you have a strong anger reaction, it is a good idea to consider the possibility that you may be feeling so much anger as an attempt to avoid experiencing your painful emotions. 

The next step, is to learn to experience your emotions as they are happening in the moment.  An easy way to practice this is to take a few minutes each day and focus on the present moment.  Close your eyes and notice what is going on in that moment.  Try not to change what you are experiencing. Just notice it as it happens. Start with your feet and work your way up to your head.  You might notice the feel of the cold floor on your feet, the aching muscle in your back, the urge to move and adjust your position, several thoughts (they might look something like, Why I am doing this?, I am doing this right? Oh no, I forgot to call my mom back).  When you notice thoughts occurring, acknowledge them as just that, thoughts.  One way to do this is to label them as such.  I am having the thought (fill-in-the-blank).  You can do the same thing with other experiences. I am having the emotion (fill-in-the-blank), I am having the urge to (fill-in-the-blank).  Notice all the physiological experiences that occur when you are experiencing different feelings.  You might notice your heart racing faster, tension behind your eyes as they swell with tears, a lump in your throat, your muscles tightening.  Again, try to just notice these things without changing them.  Being able to stay in the present moment takes practice, so don't expect to be an expert over night.  Continually practice and it will get easier with time. 

Why is it important to stay in the present moment with our experiences?  Many of our mistakes, bad behavior, cruel behavior, or hesitancy to do something good, happens because of our unwillingness to have unpleasant psychological experiences. If you take the time noticing what is going on in the moment, then you will be in a better place to make good decisions.  Your decisions will be less likely to be clouded with our human tendency to avoid painful emotions at all cost.  Your decisions will be based on your values and objective information.  Your response to negative emotions will be less likely to be filled with misguided anger and blame.

In the case of the recent Arizona tragedy, it may be that some politicians need to reassess their behavior and make some adjustments.  It may be, that we need to have better policies.  It is likely that there are several variables contributing to the tragedy.  Some that we may be able to identify and make appropriate adjustments, but others we may not be able to correctly identify or may be out of our control and we may not be able to make successful changes.  It is certain, though, that if these changes are made out of anger and blame, nobody will benefit.  Anger, blame, rude remarks, character assassinations, and other inappropriate behaviors, are only going to lead to more anger and violence.

It is reasonable to expect that human beings treat each other with respect and love.  It is reasonable to expect that we even treat those with opposing views with love, respect, and gentleness with our opposing messages.  It is possible for us to live with opposing views and still maintain dignity and respect for everyone.  Spending more time being mindful of your own experiences that occur in the moment can create a space for you to offer your opposing views in a respectful and gentle manner that does not create more hate.  It also creates a space where you can more clearly see what your position is without emotionally based biases and come up with solutions to problems that are more likely to be successful.  

Heidi Eilers, Ph.D., BCBA-D
Life Coach/Behavior Analyst
www.positivebehavioralsolutions.com
       

I am sure most of you have either heard stories or know someone personally who is in a relationship with someone who treats them badly and think to yourself, "Why do they let that person treat them like that?  It just doesn't make sense. Why don't they leave? They deserve better?"  Nobody believes they will ever end up in a relationship like that.  Most of us think, we would never let someone treat us that way.  The women and men who do end up in abusive relationships, thought the same thing.  If you happen to believe it only happens to weak, insecure, women, you are very wrong.  It can happen to anyone. So, why is it so prevalent? And, how does it happen to men and women who are confident, successful, educated, and seem to have some much going for them?

Individuals who engage in abusive behaviors toward others are usually masters at manipulating other people.  They gain your trust, make you feel special, and slowly start to ease their way into abusive behavior.  Usually the recipients of abuse are so high on emotional bliss, they are blindsided by the first signs of abuse and are prepared to believe just about anything to make it not true, which leaves them wide open for the abusers manipulative behavior.  Abusive relationships are not just intimate relationships. They can also occur with friends, co-workers, bosses, and family members.  The only way to protect yourself from becoming a victim of an abusive relationship is to become familiar with the warning signs and learn how to respond appropriately and if needed, get out before the abuse begins.

I highly recommend reading, Noelle Nelson's book Dangerous Relationships, whether your single, in a relationship, or if you have older children who are learning relationship skills.  Dr. Nelson, outlines 7 warning signs of a dangerous relationship and provides recommendations for what to do if you recognize any of these warning signs.  The list is provided below, but I urge you to read the book because it provides many examples of each of these warning signs that might not be so easy to recognize.  That is how abusers are so good at what they do, many of the behaviors leading up to abuse are too subtle to notice, but if you know what to look for, you can get out before it starts.

7 Warning Signs of A Dangerous Relationship   

1. A Whirlwind Beginning: The other person comes on too strong, too quickly. He wants to spend all of his time with you. He gives you a lot of attention. Your put on a pedestal. If it seems too good to be true, there might be a problem.

2. Possessiveness: Monopolizes all of your time.  Remember, this is typically done in subtle ways, (not the very obvious, "No you can't have friends, you belong to me"). He might make plans that interfere with plans you already had, but acts like it was done on accident.  He may begin to make subtle remarks suggesting that your friends have betrayed you.  He will slowly chip away at your other relationships in one way or another.

3. The Switch: Look for overly emotional reactions to things.  In the beginning this is more likely to be directed at other people or events, but eventually it will be directed toward you.

4. Blame: Look for signs that someone else always seems to be blamed for his problems.  Again, this will be directed at other people first, but eventually it will work its way to you.

5. Verbal Abuse: Direct cut-downs are easy to identify.  Abusers will also, put you down by down playing your achievements and putting down things that you cherish.  The only acceptable source of happiness from an abusers perspective is from him, so anything else that makes you happy will be criticized or destroyed in some way.

6. Insensitivity: Very few of us can hear or see stories about human suffering without feeling some type of sympathy.  Laughing or finding pleasure in other peoples suffering is not normal and definitely a red flag. Indifference may also be something to be worried about. 
 
7. Past and Present Violence: I think most of us by now, know that if he hits you once, he is very likely to do it again.  Violence against others (bar fights, fighting with family members or friends), however, tends to go unnoticed. These however, are good indicators of future violence, so do not take them lightly.

I want to urge you again to read the entire book.  The book provides detailed examples of each of the warning signs and provides good advice on how to handle these situations.  It may be the case that all of us might do some of these things every once in awhile and that doesn't mean we are an abuser, it just means, we have either developed a really bad habit or we were just having a bad day and took it out on someone we care about.  In an abusive relationship these things are behavioral patterns that occur repeatedly.  More importantly, a very good indicator of a dangerous or healthy relationship occurs when you make your personal boundaries very clear to that person.  In a healthy relationship, the other person will respect your boundaries.  In an abusive relationship, your boundaries will not be respected and the other person will likely try to make you feel like there is something wrong with you for feeling like your boundaries have been violated. 

If you have abuse in your history, you do have a higher risk of getting into an abusive relationship.  There are probably two main reasons why individuals who have experienced abuse at some time in their life are more at risk for entering into an abusive relationship. The first is the more obvious, you are more likely to get involved in an abusive relationship when that type of relationship has been modeled for you as an appropriate relationship.  Even though it might be painful and scary, if it is what you are used to, it is likely to have a level of comfort that other relationships won't provide.  The second, is a less obvious, and a little harder to explain.  One of the side effects of experiencing abuse, is the constant fear of experiencing abuse again.  The endless suffering because we can't predict the future and know for sure that it will never happen again, drives many sufferers of abuse to engage in destructive behavior as a way of numbing the pain. Sometimes, it is in the form of drinking, using, and/or reckless sexual behavior or other unhealthy behaviors.  Often times, it seems the only way to get rid of the fear of our uncertain future is to make it certain. One way to do this, is to jump right into a dangerous relationship. Sometimes the peace of knowing what's going to happen seems like a better option than the constant fear of the uncertain future.  If you have experienced abuse at any time in your life, it is very important to see a therapist to help you sort through the effects of abuse.  Abuse hurts a person so deeply that it wounds us in areas we may not even know about.  It is very important to focus on your current behaviors and learning how to sit with your emotions in a healthy way and not let them drive you into another dangerous relationship. 


National Domestic Violence Hotline
1.800.799.SAFE (7233) 1.800.787.3224 (TTY)
http://www.thehotline.org/

It's that time of year again.  The pressure is on to renew ourselves.  Most of start out with the best of intentions, but very few of us actually follow through with any of our New Year's Resolutions.  One of the reasons resolutions are rarely successful is because they are not set for the right reasons.  Most New Year's Resolutions are made because we are experiencing guilt or shame over the fact that we are still doing something that we have sworn off a million times. 

Managing our own life takes a lot of planning and organizing, especially these days when most of us are playing multiple roles (mother, spouse, employee, house cleaner, taxi, etc.).  Life management could take a lesson from the business world.  And, why not? Big organizations have figured out how to manage multiple roles successfully, it only makes sense that we could use some of these techniques in our own lives.  How do they make it work? Successful organizations are designed to increase employee performance that is directly aligned with the companies values, which is usually described in the companies mission statement.  Now, I will say that most organizations value system is much more simpler than our individual value system.  A typical organization, has as its core value, making money.  We on, the other hand, typically have several values.  This does make identifying our values a little more complex, but once the values are identified, all we have to do is tie our goals to our values. 

Why is setting values-based goals so important? First, it keeps us from wasting our time on short-term goals that don't fit into the big picture.  Sure, losing a couple of dress sizes would be fantastic, but not at the cost of our health, creating huge expenses, increased irritability resulting in loss of quality relationships, etc.  If the goals we set are aligned with all of our values, then we don't get caught up in shortsighted goals that end up creating more problems and that take away from focusing on more worthy goals.  Second, goals that are aligned with our values are more likely to have naturally occurring reinforcers or rewards that will help us maintain the new changes in our behavior.  For example, if I value being a good role model for my children, spending quality time with my children, and being healthy, but I set up a goal to spend more time at the gym working out, I am likely to fail.  Why? Because the goal is not aligned with my values.  A more appropriate goal would be to increase the amount of physical activities I do with my children.  This goal is more likely to be successful and maintained because it is aligned with my values.  I get to engage in healthy activities, show my children how to maintain an active lifestyle, and I get to spend more quality time with my children.  There are also a lot of built in natural positive consequences to this goal, such as feeling better and having a better relationship with my children.

Many organizations have made the fatal mistake of spending a lot of time and money attempting to increase employee performance in areas that are not directly tied to the companies values.  We can and should learn from these mistakes.  Make sure that all of your goals are aligned with your values, so you don't make the same mistake.  This will increase your chances of success because your goals will be designed to take you in the direction of your core values. Take the time to identify your values in the following 10 areas before setting any personal goals:

*If you are having trouble identifying your values in these areas, try a little exercise where you close your eyes  and imagine that you are attending your own funeral, think about what you want to be said about you in each of these areas during your own eulogy. 

1. Marriage/Intimate Relationships
2. Parenting
3. Family Relationships
4. Friendships
5. Career
6. Education/Training/Personal Growth
7. Recreation
8. Spirituality
9. Citizenship
10. Health/Physical Well Being

My 3-year old son received a present for the holidays this year that I don't think he will appreciate until he gets much older (or he may never appreciate it).  He learned how to stop sucking his thumb!  This may have been the easiest intervention I have ever done.  All I had to do was paint a bitter tasting nail polish on his thumb. He tasted it one time and has never tried to suck his thumb again.  Of course, we have also used positive methods during the process.  He is reminded of what a "big boy" he is and we tell him how proud we are of him for learning to stop sucking his thumb. 

I think many parents are afraid to use taste aversion (using a bad taste to deter behavior) to stop thumbsucking.  While most experts definitely agree that positive methods should be used over punishment procedures, I think there are some circumstances when an aversive intervention might actually be the best choice.  Thumbsucking is an incredibly hard behavior to stop and positive interventions alone are not very likely to be successful.  I feel like I need to put in a disclaimer here to state that I am not saying positive interventions can't or don't work.  I am saying they aren't very likely to work unless you have the ability to spend an enormous amount of time working on teaching your child to stop sucking his thumb, including many sleepless nights.  This point, is exactly why I think it actually might be a nicer alternative to use a quick and easy-to-use taste aversion procedure.   

If you decide to use taste aversion, it is important to use a product that actually works.  I used Mavala Stop and I would definitely recommend it. It had the right amount of bitter taste to work perfectly.  It's not so strong that it makes your child upset or cry, but its strong enough to deter the behavior.  My son did not experience any anxiety or pain using taste aversion.  He tasted it one time, made a funny look on his face, asked for a glass of milk, and never tried it again.  From that point forward, the entire experience has been completely positive because he has received nothing but praise for being a "big boy" who doesn't suck his thumb anymore.  He is very proud of himself and announces to everyone that he is a "big boy now."