On June 8th, VFAAB hosted a presentation and Q&A session with Kathryn Ambion, a board certified behavior analyst, clinical supervisor, and regional director of Northwest ABA. This event was open to the public, and we had both families and professionals in attendance as we shared dinner and knowledge. Parents asked many great questions and Kathryn shared her expertise in behavioral intervention for individuals with autism spectrum disorder. See her presentation slides here and check out the Q&A below.
Q: What is Autism?
Symptoms of autism include:
Persistent deficits in social communication and interaction
- Deficits in social and emotional reciprocity
- Nonverbal Communication
- Deficits in developing, maintaining, and understanding relationship
Restricted and repetitive patterns of behavior, interests, or activities
- Stereotyped or repetitive motor movements
- Inflexible with changes in routine
- Abnormal intensity with specific interests, attachment to unusual objects
- Hyper or hypo reactivity to sensory input
Symptoms present themselves early in a child’s life
Symptoms cause a significant impairment in a person’s everyday functioning
**It is a spectrum, from nonverbal to highly verbal Microsoft engineers
Q: What is Applied Behavior Analysis (ABA)?
A: A therapy that teaches kid skills and helps manages behaviors. It is not specific to ASD but can be applied to ASD. ABA looks at environmental factors, reinforcing positive behaviors. It is individualized- each therapy is unique to the needs of the child. ABA takes a lot of time. It can take years to develop a child’s skills. Therapists work many hours per week with the child. The amount of time it takes depends on the needs of the child. We know that it works. There is a lot of research evidence that shows it works. ABA is an umbrella term- many therapies fall into this category. On one end of the spectrum is highly structured, discrete trial, adult led therapies. Those therapies work on specific skills like gestures, eye contact. On the other end of the spectrum is a more naturalistic, child-directed therapy. The child chooses the activity and focus is looking at underlying developmental issues, like joint attention.
Q: What is the difference between Speech, OT, and ABA?
Different skills are emphasized:
- ABA: Social skills and behavior
- Speech: Expressive and receptive language
- Occupational Therapy: Fine motor and sensory
Q: My son’s school did not allow an ABA agency to enter the schools. Why?
A: Sometimes the school feels they should be able to handle it. They don’t want others to see that they might not be able to provide the services. Another reason is confidentiality with other students at the school. For that reason the school may say it is not appropriate to provide one on one instruction in a group setting. Finally, liability might be another reason.
Q: Is there a conflict between the way speech and APA therapy instructs?
A: Because ABA is relatively new, people have misconceptions about what it is and its effectiveness. Washington ABA is currently advocating to have ABA specialists employed in school districts.
Q: Is there a cure for Autism?
A: There is no cure for autism. You can increase skills to provide a better quality of life.
Q: The cost of ABA is expensive. Is Medicaid accepted?
A: Some clinics will accept Medicaid.
Q: If the person is diagnosed with Autism, do symptoms get better or worse, as they get older.
A: Depends on the person, but often disruptive behaviors decrease, and positive behaviors increase. The key to that is therapy. Difficulties change as individuals progress.
Q; Is ABA only for young children and not adults?
A: I strongly disagree. There’s no reason why older children and adults would not benefit from ABA. Often times, the need for early services is emphasized because learning occurs most prolifically in the first 7 years.
Q: I saw a lot of change in behavior for the worse as my child reached puberty. Is that common?
A: It is common, especially because of hormonal changes and because they feel like they have more of a voice. Often families want to get rid of the autism/ASD label as quickly as possible. But that makes it harder to get continued services as they get older.
Q: One of my children has a developmental delay but not autism. Should we enroll them in ABA?
A: Absolutely, ABA can be used with a wide range of individuals. ABA is based on teaching principles.
Q: What can we do while we wait for ABA services?
A: While you are waiting for services, here are some strategies to use at home:
- Use short, concise instructions, with a gestural prompt
- Use visual supports as an effective way for a student to understand what you are communicating
- Imagine child dropped in foreign country
- A picture of a cookie that a child can point to communicate they want a cookie
- Visual schedules: helps individuals know what is happening and expectations; can make them with images from the internet, free schedules on the internet, or buy packages of them, special education teacher can give you copies of them.
- Make sure you have the learners attention before giving a direction
- Functional communication training
- Example: All done, Help, No, My turn, Gain attention
- Help to decrease behavior and increase communication via gestures, signing, pictures, iPad etc. – multiple modalities is better
- Environmental Modifications
- Change the environment to make it safer
- Sitting child next to instructor
- Accommodations to desk – wiggle seat, bouncy bands, yoga ball
- Have a “safe space” for when they feel overwhelmed
- IEP document should include those accommodations
Q: What can a family do to maximize chances to get services?
A: Persevere. The waitlist is often many hundreds of families. The families that keep calling and pushing get services faster.
Q: What are some alternative sources for funding for services for my child?
A: You can apply for Ben’s Fund and DDA to get funding.
Q: Is it true that people on Medicaid are on waitlists longer than those who are not?
A: Unfortunately, ABA companies may choose the insurances they accept. Since Medicaid is not accepted everywhere, the result may be longer waitlists.
Q: What are the environmental requirements of in-home ABA services?
A: We can adapt to all environments. We work in the child’s environment working on functions and routines most difficult for them. Example: bathroom routines, grocery store
Q: What does the ABA process generally look like?
A: Assess client, determine functions of the behavior, work on teaching replacement behaviors that serve the same function, Identify strengths and challenges of a child
Q: How many hours/days a week is ABA?
A: Evidence has shown that a lot of hours are helpful. We provide 9 to 15 hours per week at Northwest ABA. Some do up to 40 hours per week.
Q: Are there limitations to what insurance will cover?
A: Variable depending on insurance. Some allow unlimited coverage, while others only cover 10 hours per week. There is a day treatment option for Medicaid only – for children under 6 years old, include three hours of direct service per week, including 50 minutes of speech, parent training.
Q: Will you assess and work with the child at a store if that is where the challenging behaviors are?
A: Yes, we will work with the store manager to set up therapy times at the store.
Q: Do we need a referral from primary care provider to receive services?
A: Most insurances require having diagnosis.
Q: What should we do while we are waiting for services?
- Get a diagnosis
- Be sure to be on waitlist
- Continue to contact providers
- Utilize services in school
- Know what your insurance covers
- Get connected with other families with special needs
- Join support groups (in person and online)
- Be persistent to get the services your child needs
Q: Example case study: 13 yr old boy with ASD who touches his private parts often. What do you do?
- Using ABA principles, we would observe and record the ABCs:
- Antecedents: what happens immediately before behavior
- Behavior: the behavior
- Consequence: what happens after the behavior
- Analyze the function of the behavior
- 4 main functions of behavior (SEAT): sensory, escape, attention, tangible (access to something)
- Find replacement behavior
- Giving them appropriate behavior to get what they want before they do the inappropriate behavior
- Think: “If they had words to say what they wanted, what would they say?”
- Take data and be consistent
About Kathryn Ambion: Kathryn’s interest in working in special education began when she volunteered at the University of Washington’s Experimental Education Unit (EEU) while receiving her Bachelor’s Degree in Psychology. In 2010, she began the Master’s program at the University of Washington in Early Childhood Special Education. While attending graduate school, she worked as an assistant teacher in the preschool and Developmentally Appropriate Treatment for Autism (Project DATA) classrooms at the EEU. In these positions, she was able to design and implement individual programs, support children to generalize skills, and work collaboratively with families, teachers, and service providers to ensure that each child’s needs were met. In 2012, Kathryn served as an educational specialist at the University of Washington CARE at the Haring Center providing behavioral and educational intervention curriculum and consultation to individuals. In 2013, Kathryn became an behavioral and educational consultant at MOSAIC Children’s Therapy Clinic where she supervised therapists, led weekly social skills groups, and led a pre-kindergarten inclusion classroom. In 2015, she joined Northwest ABA to continue her passion for working with individuals with autism and related disorders and their families. In her free time she loves spending time with her son and husband, traveling, hiking, and running.