Have you done behavior analysis? Opinions needed...

[blessedwithboys]

I'm not sure what to think of the analyst who has been assigned to us. 

A little background:  I was 17 when I had ds1 and he proved to be a superkinetic toddler/preschooler.  I had no idea what I was doing but I knew I wanted to avoid meds, so his ped suggested ABA and I gave it a shot.  It didn't work for us, but I do recall that the analysts (we went through several) would just coem and observe at first, for at least the first 4 sessions or so.  Then after recording the antecedents, they would target the behaviors with consequences, thus the "ABC" approach to behavior modification.  FWIW, this was more than a decade ago and the people we worked with all seemed to be childless recent graduates in their early to mid 20s.

Now, I have 17 years expereince as a mother.  I know the ABA approach goes against my gut.  (It reminds me of the NILIF dog training method.)  However, I have a 9yo ds who has all the sign of "childhood onset" bipolar disorder.  He has shown these signs since infancy.  We trialed meds for about 9 or 10 months but they helped not a whit.  Thus, his dr decided he did not have a mood disorder and recommended I take parenting classes. 

Ds has been in counseling for anxiety but his counselor left and we got a new one.  On her first visit to our home, she mentioned that she also had a background in ABA.  I mentioned that I had considered trying it just for the fact that I would have someone else's observations of his behavior, as the dr seemed to think I was exaggerating everything I told him.  She decided then and there to do ABA with him instead of CBT therapy.  Ok, whatever, I was fine with that since the CBT wasn't working anyway.

So if you made it this far, here is the issue:  She hasn't spent a single moment talking directly to ds.  She ignores him completely.  (I get that maybe she is trying to avoid drawing his attention to the fact that she is watching him.)  What she has done is decided we need a schedule blocked out in 15-30 minute increments!  WTH?  I tried to explain that ds reacts violently to any direction form me.  He is grandiose and arrogant and acts like he's too smart to be ordered about by an adult.  But this women who has now spent a whopping total of 3 hours in my home is suggesting that I re-direct him 2-4 times an hour, all afternoon and evening.  She admitted to me that she has no experience working with bipolar kids, just ADHD/ADD/ODD.  I spent most of our last session gently trying to explain why this is unlikely to work for our family.  My reasons range from ds's disposition all the way to my chronic fatigue.  What happens if I have a bad day and need to just lay on the couch and watch TV with ds?  TV is supposed to be the reward for him behaving appropriately all day!  And what about the fact that his "bad" behavior isn't a choice; it's a freaking brain disorder!

She has told me plainly that if I am unwilling to trial her micro-managed plan there is nothing else she can offer me.  WWYD?  Give it a try in order to have more ammo for the next psychiatrist we try out?  Or call her to thank her for her three hours and let her know she is free to move on down the waiting list?

[fizgig]

Eek, well I can only tell you my opinion and experience.  I have a VERY different situation so I'm not sure it will really help but I do generally think ABA therapy should only be used in cases where children lack intrinsic social motivation.

Everything I know is basically through my own extensive research and interactions with the team of experts working with my son so someone is more than welcome to correct anything I've gotten wrong.  As I understand it, there is a big, ongoing debate in the therapy world between behavioral versus developmental approaches. 

Behavioral approaches focus on altering specific, discrete behaviors with the idea that a child can then apply those new behaviors to their everyday life.  They usually require the child to sit at a table and attend to the therapist while they reward the "right" behavior and some therapists will punish the behavior they hope to correct.  There are some really powerfully positive results with this kind of therapy for people who are lacking social motivation.  So, for example, for some children with autism a behavioral approach provides them with the feedback they need to understand what is expected of them and modify their behavior.  For children with severe autism or other psychiatric problems, this kind of therapy can certainly help modify behavior and encourage skills that they might not otherwise get.  Major criticisms of this approach include problems with generalization.  So, you can drill a child on their colors and they might say "yellow" when you hold up a yellow flash card.  But then that same child might not know what you mean when you say "get me the yellow car" because the skill they learn is specific only to one context.  Learning a specific behavior is not the same as learning a broad skill and so the other major criticism is that behavioral approaches are not naturalistic.  They don't work on real forms of back and forth interaction, never let the child take part in directing the action, and can create a very unnatural way for children to interact.  They also get criticized because the parent is usually not involved (and is sometimes not welcome at sessions).  Finally, for some kids a behavioral reward/punishment approach can have the totally wrong result in that the structured, reward/punishment model can actually cause some kids to become less social, withdraw and begin to believe that people expect them to just "shut up and behave."  Obviously a lot of this depends on what each kid needs and what each kid is like.

A developmental approach is much more child-led, play based and tried to encourage children to learn in more "natural" ways while still directing attention to the specific skills or needs of a child.  Often the parents are expected to play some role in therapy and they are taught approaches to use at home (since a child is with a parent much more than the 45 min sessions or whatever).  Criticism of these approaches argue that this is fine for kids who want to interact but that it won't work for kids who are off in their own world.  Some also argue that it is much harder to teach specific skills when you let the child lead part of the time. 

For our son (who is a late talker but not autistic), I feel (and our developmental ped agrees) that an ABA approach would be disastrous in our situation.  That said, it can work in the right situation with the right therapist and the right child.

Even beyond methods, the fact that she basically ignores your child would send up HUGE red flags for me and I would not want someone like that working with my child!  I would send her on her way and find someone who can work with you in a way that doesn't go against your gut.

[kateber]

Let me start off my saying I am not a parent of a child with special needs. I'm a stay-at-home mom, currently on bedrest pregnant with twins, and before being a SAHM I was a teacher/consultant/behavior analyst who was in love with teaching children who have special needs. I miss working with families and children, and I'm crashing your forum so PLEASE let me know if you are not comfortable with me posting here...I will not take any offense I promise!!!

I have struggled with ABA because I do believe in at as an approach for some kids. I have seen ABA in the hands of exceptionally trained, child loving, child-centered therapists with great common sense/instincts who excel at what they do. I have also seen ABA in the wrong hands which is a truly horrible thing. I wish all the bad, poorly trained therapists could be fired so ABA wouldn't get such a bad rap...especially all the ABA people who just think in terms of theories and forget they are dealing with real live children. :-( 

Here are the things I would have done in a home ABA consultation and that the therapist should have done. If she did not do these things, you may want to have one final meeting with her to ask her these questions, or you may just want to get a different therapist. What were this therapist qualifications? Does she have her BCBA? 

1. I ALWAYS acknowledged the parent as the expert and started off with a parent interview making it clear that I believed that they knew their child best and had valuable information. I always told the parent that the only intervention that would work would be one that fit into their home and family, that I would start by telling them what intervention I thought would be most effective and work most quickly, but that they should tell me if this intervention didn't seem doable because there is almost always several alternative interventions. 

2. I talked to the parent about the challenging behavior they were seeing, when it was more likely to occur, what happened before, what happened after, and got as much detail as possible. 

3. I would have observed the child, but also taken time to talk with and begin building a relationship with a child. 

4. Before starting any intervention, I would have another meeting with the parent where I would discuss my recommendations/plan, explain the science behind the plan, ask what portions seemed doable and what needed to be re-worked. 

5. The therapist should be the one to start the behavior plan/intervention. A lot of times it needs to be adjusted based on the child's response. It concerns me that she was just going to have you do without modeling how to do it and tweaking it based on your child. I'm sad to say that some ABA therapists are one trick ponies and do not individualize programming as they should be. Seeing as she wants you to redirect him, it seems like she is basing her plan off of the antecedent of his challenging behavior being unstructured time. Did she talk to you about this to see if you also noticed this or to see if she was on the right track? Also, the behavior plan should always include skills to TEACH in addition to ways to decrease the unwanted behavior. 

It can be really, really difficult to find a good ABA therapist. Just like it can be really, really difficult to find a good AP friendly pediatrician. You might have the best results with doing some research on ABA and combining that with your mothering instinct and common sense. Is your son in school? Do they target his social-emotional learning in any way? If you feel comfortable sharing more detail I'd be happy to help in any way I can. 

[blessedwithboys]

fizzgig, I don't think we're thinking of the same thing.  Applied Behavior Analysis is essentailly, IME, a way of using rewards to change an undesired behavior, not teach new skills (like naming the yellow card).  But I totally agree with you about the red flag for ignoring ds!

kateber, I think you are right in saying she feels the antecedent is unstructured time.  I disagree though.  I think he has a brain disorder called Bipolar Disorder-NOS.  (He has already been dx with Mood Disorder-NOS, after several sessions with a pyschologist.)  I absolutely feel his behavior is 100% beyond his control, at least the worst of the bad behavior.  And one thing that is guaranteed to make it worse: asking ds to do something...anything.  He has low energy and an inflated ego and his refusal to do chores is a major maifestation of that.  His refusal to go outside and play is caused by an irrational fear of getting stung by a bee.  And when he's harming himself, calling me names, or trying to destroy other peoples' property?  It's manic rage, IMO.  But one thing is sure and that is that the quickest way to piss him off is to say anything that he perceives as me asking him to do any sort of work (or stop doing something he enjoys, which will happen if he's only alotted 15-30 mins per activity!)

[rainbringer]

We had some success with ABA.  But it doesn't sound like the counselor is very sensitive to your ds, or listening to you, so I vote for trying someone new.  I wouldn't necessarily write off ABA, it can look a lot different depending on how it is done and who is doing it.  I do wonder if play therapy might be a better fit?

[blessedwithboys]

Ds is 9  yrs old and extrememly bright and articulate.  I think of play therapy as being for younger kids.  I think I decided to go against my instinct and let her do her thing.  Then, if it makes ds worse, I can have one more proof that his issues go deeper than "brattiness".