Sunday, March 3, 2013

Principles of Reinforcement

Reinforcers – in a nutshell, are necessary and effective when used correctly.  A common misconception is that reinforcement is bribery.  This is only true if used incorrectly.

Reinforcement is defined as an event that follows a behavior, which increases that behavior.

We all respond to reinforcement, or the lack of it.  We go to work, because we get a paycheck.  We clean the house because we enjoy the results.  In the absence of reinforcement, the behaviors that have usually produced them decrease.  I love my job, but if I didn't get paid to do it, I'd do it less, and other behaviors that did produce reinforcement (pay) would increase.

But reinforcement for children in therapy situations does not have to look like a trainer holding a Scooby snack in front of a dog, saying, "sit" (translate that picture into a teacher and a child sitting perfectly at a table, with the teacher delivering an endless stream of instructions and m&ms).  There are many different ways to deliver reinforcement effectively, such as variation in frequency and type. 

Another big idea -- reinforcers don’t have to be treats.  Sometimes an exaggerated “woo hoo”, high five, tickle or hug is all it takes.  The most effective reinforcement system depends on each child’s abilities and interests.  You need to know what is most interesting and desirable for the child, and remember that this can change, sometimes quickly.

Thursday, January 24, 2013

Why is Categorization Important?

I did the math.  I have 80% of my clients working on categorization at some level.  Why?

One of the ways people organize their world is through categorization. Typically, young children seem to absorb the concept of categorization effortlessly through play, talking with others and participating in everyday experiences. Children and youth with autism spectrum disorders (ASD) often have difficulty learning to use categorization strategies effectively and therefore may require systematic instruction to develop and use them effectively.

Effective categorization skills enable us to perform tasks efficiently. Daily life without categorization could lead to a situation such as the following. In order to make dinner, you need to get the meat from the freezer in the garage, a frying pan off the coffee table in the living room, potatoes from the bottom dresser drawer in the bedroom, forks from the box on the top shelf in the bathroom, knives from the TV cabinet, and then you need to cook the food on the stove in the basement before bringing it up to serve it on the table in the dining room. This sounds absurd but this situation could occur if categorization were not used to organize things according to how they are used.

Beyond using categories, we must use the correct categories. Imagine going to the dining room section of a furniture store to buy milk, or going to buy a bike or a horse at the car dealership. After all, they are both things to ride on. 

Why Is Categorization So Important?
The ability to group things according to a common characteristic and then name that characteristic is a basic concept that helps children form a basis for structuring and organizing their world. When you systematically teach categorization skills, you are not just teaching a single skill but a system for learning, problem solving and organizing.  You are also teaching the foundation for processing, remembering and integrating new information. Many of us marvel at and even envy people who are always able to put their finger on an object or piece of information when needed because they know where to find it. This would not be possible without having developed complex organization strategies that include categorization.  I like to explain it as a filing system.  As a child learns new words, he needs a place to put them, knowing how they relate to other words.  Think of how you retrieve a word that is eluding you momentarily -- "It's like ___", "It's a (category)", "Not a __, but ___".  You might even recall connecting details such as where you saw this thing, who you were with, etc.

How Do Children Learn to Categorize?
Matt is going for a walk in the neighborhood with his dad. He points to a cocker spaniel running after a frisbee and says, "Kitty." His dad corrects him saying, "No, that’s a dog." Matt says, "Dog." Further along on the walk Matt sees an Irish Setter. He immediately points to it and says, "Dog." His dad responds, "Yes. That’s a big red dog." Matt is beginning to learn the category of "dogs."
Through a variety of experiences that include seeing and hearing others talk about dogs of different breeds, as well as being corrected when he uses a different word for a dog, Matt is learning what does and does not fit under the category of "dog." Although this seems very simple, consider all the skills Matt needs to have in order to reach this understanding.  Matt needs to learn the common features of dogs, such as: fur, four legs, two ears, tail, two eyes, long nose, teeth, and tongue. But that is not enough, as obviously many other animals have those same features (cats, cow, horses, raccoons, etc.). Therefore, Matt must also learn what a dog is not. And then he must learn that there are many variations (color, size, shape, length of fur, size and shape of ears, differences in the sounds they make). Eventually, he will also learn there may be exceptions to the rules (no tail, pug nose).
Simultaneously, Matt will learn about many other categories of familiar things around him. He will learn that dogs, birds and fish all belong to a category called animals. He will learn that foods are something to eat, while cars, busses and bicycles are things people ride. Flowers, trees and grass are called plants, and plants and animals are living things. Rocks, water and rugs, on the other hand, are not living things.  Matt will learn that things can be grouped or categorized in many different ways. For instance, items can be grouped by what they look like, what they are made of or how they are used. For Matt, the ability to grasp the concepts involved in understanding increasingly complex categorization skills develops so easily and naturally that his parents and others around him are unaware that they are teaching him an essential skill for organizing his world. 
Why Is Categorization So Difficult for Children and Youth with ASD?
Categorization can be very confusing to people with ASD. To many, it can be a totally foreign, perplexing concept. Why is that?

Different Ways of Thinking
As a woman with very high-functioning autism, Temple Grandin says that she thinks "in pictures" whereas most typical people think in words. Words help people categorize. In Thinking in Pictures and Other Reports from my Life with Autism, Temple Grandin describes the way she thinks of dogs.
... my concept of dogs is ... linked to every dog I’ve ever known. It’s as if I have a card catalog of dogs I have seen, complete with pictures, which continually grows as I add more examples to my video library. If I think about Great Danes, the first memory that pops into my head is Dansk, the Great Dane owned by the headmaster at my high school. The next Great Dane I visualize is Helga, who was Dansk’s replacement. The next is my aunt’s dog in Arizona, and my final image comes from an advertisement for Fitwell seat covers that featured that kind of dog. My memories usually appear in my imagination in strict chronological order, and the images I visualize are always specific. There is no generic, generalized Great Dane. (Grandin, 1995)
Could you imagine how challenging it would be for most of us to have to go through a visual list in your mind when someone simply mentions the word "dog?"

Teaching Categorizations skills
General hierarchy:
  • Match identical objects and pictures
  • Sort a group of objects or pictures into two identical sets 
  • Sort a group of objects by one feature
  • Choose an item to match a given category description or name
  • Sort into 2 and 3 categories
  • Name categories
  • What doesn't belong and why
  • What goes together and why
  • Name multiple items of a given category
  • Express similarities and differences

Need some ideas, feel free to comment or contact me :)

 some information adapted from Academic Interventions

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Wednesday, January 16, 2013

Are you tired?

Sleep disruption in children with ASD
Sleep disorders may be more common in children with autism. Researchers estimate that between 40% and 80% of children with autism have difficulty sleeping. The biggest sleep problems among these children include:
                Difficulty falling asleep
                Inconsistent sleep routines
                Restlessness or poor sleep quality
                Waking early and waking frequently

A lack of a good night's sleep can affect not only the child, but everyone in his or her family. If you're bleary-eyed from night after night of waking up with your child, there are a number of lifestyle interventions and sleep aids that can help.
What causes sleep disorders in children with autism?
Researchers don't know for sure why autistic children have problems with sleep, but they have several theories. The first has to do with social cues. People know when it's time to go to sleep at night, thanks to the normal cycles of light and dark and the body's circadian rhythms. But they also use social cues. For example, children may see their siblings getting ready for bed. Children with autism, who often have difficulty communicating, may misinterpret or fail to understand these cues.
Another theory has to do with the hormone melatonin, which normally helps regulate sleep-wake cycles. To make melatonin, the body needs an amino acid called tryptophan, which research has found to be either higher or lower than normal in children with autism. Typically, melatonin levels rise in response to darkness (at night) and dip during the daylight hours. Studies have shown that some children with autism don't release melatonin at the correct times of day. Instead, they have high levels of melatonin during the daytime and lower levels at night.
Another reason children with autism may have trouble falling asleep or awaken in the middle of the night could be an increased sensitivity to outside stimuli, such as touch or sound. While most kids continue to sleep soundly while their mother opens the bedroom door or tucks in the covers, a child with autism might wake up abruptly.
Anxiety is another possible condition that could adversely affect sleep. Children with autism tend to test higher than other children for anxiety.
What kind of effects do sleep problems have?                                                                       
Not getting a good night's sleep can have a serious impact on a child's life and overall health. Research has shown that, in children with autism, there is a connection between lack of sleep and the following characteristics:
                Increased behavioral problems
                Poor learning and cognitive performance

If your child isn't sleeping, there's a good chance you aren't, either. One study showed that the parents of autistic children sleep less, have poorer sleep quality, and wake up earlier than parents of non-autistic children.
How do I know whether my child has a sleep disorder?
Every child needs a slightly different amount of sleep. In general, these are the amounts of sleep children require, by age:
                Ages 1-3: 12-14 hours of sleep per day
                Ages 3-6: 10-12 hours of sleep per day
                Ages 7-12: 10-11 hours of sleep per day
If your child regularly has difficulty falling asleep or wakes up repeatedly throughout the night, it might be a sign of a sleep problem. To know for sure, make an appointment with your child's pediatrician. The doctor may refer you to a sleep specialist or an ear, nose and throat doctor.
It can help to keep a sleep diary for a week to track how much and when your child is sleeping. You may include any snoring, changes in breathing patterns or difficulty breathing. You can share this diary with your child's doctor and any specialist involved in treatment.
How can I help my child sleep better?
Sleep medications are generally used as a last resort with children. There are a number of lifestyle changes and natural sleep aids that can improve sleep time and quality in kids with autism:
                Avoid giving your child stimulants such as caffeine and sugar before bed.
                Establish a nighttime routine: give your child a bath, read a story, and put him or her to bed at the same time every night.
                Help your child relax before bed by reading a book, giving a gentle back massage, or turning on soft music. 
                Shut down television, video games, and other stimulating activities at least an hour before bedtime.
                To prevent sensory distractions during the night, put heavy curtains on your child's windows to block out the light, install thick carpeting, and make sure the door doesn't creak.
                Ask your pediatrician about giving your child melatonin just before bedtime. This dietary supplement is often used as a sleep aid to help people get over jet lag. It may help normalize sleep-wake cycles in autistic children who have sleeping issues, and research done so far finds that it's safe and effective.

Adapted from WebMD

Thursday, January 10, 2013

Stop Trying to Get your Child to Talk

What?!  Speech therapist is saying to stop trying to get your child to talk?  Well, yeah, but here's what I mean.

For some kids, repeatedly asking him/her (just gonna use "him" from here on) to say words for you doesn't really help him learn language.  It can have the opposite effect because it takes the joy out of communication and triggers the "stubborn" in some kids.  The desire to communicate comes from having something to say and knowing someone will listen.  So, instead of making your child repeat words after you, let him lead the communication and then follow that lead.  If you need to remind yourself to take the pressure off, a good rule of thumb is "Don't say say."  Plus, some kids, especially those with ASD, may echo the behavior (adding "say" before they talk), or may learn to rely on the prompt instead of learning to communicate independently.

For example, prompting your child to say "hi" or "bye" to visitors. (Can you hear yourself doing it?  "Say hi, say hi to grandma, Johnny say hi, say hi.."  Don't worry, we have all been there!)


  • get down on the child's level, 
  • try to secure attention and eye contact, 
  • be very excited and expressive in your facial gestures 
  • and simply say "Hi!" 
  • Then WAIT expectantly (count slowly to 3 to yourself if you need to - sometimes kids need time to process).
Will your child respond immediately?  Maybe, maybe not, maybe over time... but I prefer this more natural way of teaching language and have seen it work.

Dawn Gummersall, M.S., CCC-SLP

some info adapted from It Takes Two to Talk, by Jan Pepper and Elaine Weitzman  -- a great resource for anyone looking for ideas on developing early language