ABA and reasonable adjustments: how do you decide?

[inappropriatelyemployed]

I'm interested in hearing people's views on how you decide what behaviour to change with ABA.

Obviously, you want to empower the child to develop skills, and moderate behaviour which is affecting a child's ability to function at home or at school.

But I always wonder about where you draw the line.

For example, we have a therapist coming into school. DS has various quirks and props which get him through the school day and some behaviours which cause problems. He also needs help with social skills and communication. The traditional LA OT/EP line is to accommodate things rather than give the child the skills to cope, but I think there are areas where DS is better off being accommodated than learning to integrate, for example it is important he is able to feel confident about saying he is stressed in assemblies and feels able to participate it he sits in a chair a distance a way.

This is a temporary measure specific to the school environment and it teaches DS to feel that he can participate, albeit not necessarily in exactly the same way. His peers don't care and happily accept this. HIs TA doesn't like him being different.

This is a learnt behaviour but it is so far down my list of problems, it isnt even on the list.

Am I right in thinking that ABA seeks to work on behaviour changes which are important to the child rather than the adults around him?

Don't know anything about ABA but I completely agree with you that targets should be set in line with a child's priorities and not their TA's or teacher's.

I feel we have the same issue with our TA, she doesn't get equality at all, I doubt she ever will, to her equality means same and where there is difference the child should be adapted to appear the same or if they can't adapt, excluded from participating.

It is frustrating isn't it? Our TA is determined to 'push' DS despite the fact this then means she ignores the things which require accommodations and has no strategy for changing behaviours save to force him!

ABA would be to keep all changes within the comfort zone of the child, but aim for as socially acceptable behaviour as possible, over time, with small steps that the child finds reinforcing.

Kicking him off his chair into the middle of a bunch of peers isn't likely to produce the best outcome for anybody. In fact it is likely to move him further away from the level of socially acceptable participation behaviour that comes with being there but in a chair. It risks him not being able to be there at all.

Ask the TA what she thinks the 'problem' is, and what she thinks the 'solution' is. Ask her why she thinks this will produce a better outcome than what you are already doing. Ask her to produce a 'plan' with full contingency, and support, with the outcomes defined. Insist she adds to it a whole load of irrelevant but labourious tasks like laminating stuff and penning lots of columns into a diary that will supposedly capture the data of her plan.

Then watch her leave it up to you!

Tis indeed frustrating IE, but hopefully direct payments may eventually enable us to source a child focussed TA with values more in line with our own rather than utalitarian views without compromise for difference, unless it suits the adults retain their power base of course!

My feeling is that if a certain behaviour or stim is going to really narrow down the child's life, because it is anti-social, then ABA should work to change it. Sitting on a chair in assembly doesn't affect anyone else, but bouncing up and down manically and shrieking (my boy, in the past) will eventually close down a lot of options in his life (cinemas, theatres, restaurants, shops, etc). In that case, I think a child-led decision is nonsense and the adults need to take a view. I have had plenty of so-called experts telling me "oh leave the poor wee boy to bounce if it makes him happy". I am willing to bet I won't see those people for dust when my boy is 6ft 5 , 19, and getting stared at (or much, much worse) on the bus by mickey-taking teens.

The programme should be what its most important for the child to learn next and whats important to you as parents eg if issues at home make life hard. Much of what happens at school is not very functional or useful.

Does your ABA person have a curriculum you could share with school. I took in AP 'work in progress' book once. i'm sure they never read it but I think they felt reassured there was a plan and hierarchy of skills and everything would be covered in time, it wasn't that we were choosing not to do certain things, just that skills had to follow an order.

If he is sitting in assembly and listening then I agree that would not be a priority because its not a barrier to learning. Over time ABA staff would be desensitising him to sitting in a large group situation because it would in future inhibit him eg from school plays, cinema etc etc. If they were going to make him sit with the others it would be gradual eg sit on the floor a distance away and gradually moved nearer; or start with small groups and build up. They might also backwards chain it e.g. take him into assembly for the last minute, then 2 minutes etc etc until he is eventually sitting through the whole thing with the others but in this scenario DS would be getting tokens every few seconds and know by sitting there he would get a reward at the end. But you would not just go and plonk him in with the others without a gradual plan.

I agree there is a conflict between OT and ABA approaches. I think it depends on your child. Some children clearly have very genuine sensory problems and anxieties. With others like DS its all behaviour and rigidity. Once we work through it and desensitise him to something then its done forever, it doesn't keep popping up again. So he used to sit on his own, then when got ABA moved to the edge of the group, then into middle and now he will sit anywhere. He went from being intolerant of sitting next to other children to holding their hands, leaning his head on them and twirling their pigtails!

I do think sometimes OT / outreach etc jump in with accommodating measures without first assessing if the child could be densensitised to something because its a quick fix, whereas desensitising a child to assembly a minute at a time could take months. Sometimes I do think that means children are given choices (to opt out / special treatment) they should not have and may not need. But I think you have to first assess whether something is behaviour or genuinely sensory - then you have to be prepared to put in the work and effort of a desensitisation programme. They might have to accept for him to sit on the floor means he will access less of assembly initially and have to build back up to sitting longer.

I think it's more a case of the school disliking ds sitting on a chair or that they want to feel in charge of the programme. Personally I would feign disinterest in this target and say that you don't see it as a priority but if they want to work on it fine. They are probably then more likely to lose interest in it themselves because as you say it is unimportant and it is highly likely your ds will resist and they will eventually realise it is better for him to sit quietly on the chair! It is obvious that the things to work first on are those that will make the most difference to him and his learning at school.

Thanks. This is really helpful. I think it can be difficult to separate the OT and behaviour issues as what starts as a sensory response can turn into a behavioural routine. I know DS has definitely done this with food. He used to vomit lots at food and smells but does so much less now. The problem is that it made him extremely cautious to foods so he will say he is 'allergic' to certain types of food when I think alot of it is a routine he built up to protect himself.

I agree completely - isolating those things which affect the child's ability to learn and be part of a group are important and that doesn't mean just following what a child thinks he needs. If DS sitting on a sit was causing a big problem and was disruptive, then I would understand more. But it doesn't and no one notices as they are so used to it. He sits there happily and is engaged.

I just think stuff like that is about the TA thinking her job is to make him be like everyone else when I am thinking what does he need to live a full and happy life and get through education. Him sitting on a chair in assembly seems neither here nor there whereas not being able to ask for a break or communicate his needs or focus on learning or understand/remember classroom routines or get on with his peers are much higher priorities.

DS also needs to feel that when he does make a massive effort to do things people value it. He stays in the classroom all day now and he does struggle with this and gets stressed but he does it to please. Yet as soon as he does it, everyone forgets what an effort it is and then starts piling on more pressure like taking away afternoon breaks.

The ABA guy said he will draw up a list of accomodations that are made and will then work through what is thought to be the most important to focus on.

I agree about the quick fix thing as well. Once the TA sees that the approach to changes will be to put in some work to achieve them rather than tell him off, she may be less keen to kick him off his chair!

I think there is a real divergence between what his problems are - social skills, acting appropriately with peers, coping in class and with change, routines and rigid behaviour - and what is seen, he sits on a chair or doesn't line up.

Yes call her bluff, get the consultant to give her a 10 week desensitisation plan and a data sheet! And a list of 1:1 work she can do while DS is only accessing assembly for the last minute or so to make sure his learning time is not wasted! She's probably used to having a break from your DS while he is sat on his chair, probably be less keen once she realises she will be doing extra.

The consultant did a brief observation a couple of weka ago but is coming back to do more.

He did point out that, if TA and CT felt DS was coping ok in class, this would free TA up to do some monitoring and recording.

He also suggested it for playtime when the response to how DS managed was 'he does really well' but no one was really able to say what he does or who he plays with.

Don't ge me wrong. School have been great and have no qualms about letting an ABA programme be set up but the TA does have her own ideas.

Sorry, another question occured to me.

Working with DS on his numeracy homework today reminded me of a concern I have and I'm not sure if ABA can help with this.

DS does not remember the 'rules' he is to apply e.g. all the 'chunking' stuff they get taught for division, multiplication grid for multiplication, nth rule for sequencing and so on.

You remind him and he can do it. But I bet tomorrow, it will be like grouind hog day like he's never heard of it again.

How can you move this forward? It means he is ok when he is taught something in the class but he doesn't retain it. Is this common?

Things don't stick in my boy's brain either - it is most frustrating. But I find if you teach and reteach, (overteaching, I think ABAers call it) then sometimes on the hundredth or even thousandth time, it will suddenly have stuck. Maths has been the hardest though - and words like "the"

Thanks. I will ask Mr ABA tomorrow. Another thing to add to the list of things to do at home.

I get exhausted with it all. I wonder how people manage if they work 9-5.

Phew what a stressful morning.

DS had a panic this morning and wouldn't go into the class. He does that sometimes when there is a transition back from weekend. However, ABA person was coming to see him in class.

On top of that TA is off this morning - no one seemed to know until she didn't show up.

So I ended up 'TA'ing' for DS while waiting for ABA guy.

DS then worked well with another little boy. ABA guy then tries to encourage him to do a bit of time in class so he can observe. DS wasn't having it.

Usually the plan is, when he has these sporadic days when he can't cope, that he works outside. So he was getting really angry about people trying to get him inside the class. I was probably making it worse because I was still there and trying to encourage him too.

Then I got really upset as ABA guy goes 'at least I get to see the non-compliance that his teacher and TA were telling me about'.

DS is compliant 95% of the time. He only has occasional days out of the class. He tries really hard all the time to cope. This is never noticed and generally being in the class is an end in itself. But he isn't properly supported in class as they just back off from him and leave him to it and he dislikes his TA. His teacher was helpful but is now really dismissive and it really got to me that an ABA intervention I am paying for seemed to be, again, about what the teacher/TA wants, particularly when they have bollocks all understanding of DS or ASD. His TA is particularly useless.

Anyway, had long chat to ABA guy afterwards and he agreed that accommodations had to be made but we had to balance that against lowering expectations of what DS could achieve. Understanding the difference was important. He also took on board everything I was saying about DS's lack of communication skills which makes his teacher/TA see him as rude and his lack of coping skills which then make these difficulties arise. He will try and address this.

He is going to do a list so that, between us, we can agree on behaviours that need changing or skills that need to be worked on and then only work on that so we don't have TA going off on one all the time getting into arguments with him. Why is it that teachers see only the bad things that need changing and not the good stuff to praise?

I feel sorry for DS as he tries so hard and when things go wrong, people come down on him like a ton of bricks. There is another TA in school who does an intensive ABA programme with a younger boy with autism and she is so fab. I watched them today and it made me cry! She had some very difficult behaviour to cope with but she always does it sensibly, calmly and is always up beat.

DS, a very touchy Aspie, has this moody, oversensitive, ex-teacher who gets upset when he says something rude to her and takes it all very personally. I had to sit and listen to the ABA guy tell me how kind the teacher and TA are. yet I have the prissy TA and the teacher who tuts when we want to speak to her in the morning. I tried to put forward a slightly alternative view without looking like an overprotective, criticising mum watching out for her precious but it is hard. The school and the head are wonderful, on the ground, with these two, it's like the blind leading the blind.

I sat in the car and cried today while waiting for the ABA guy to finish and I never do that.

inappropriately This probably won't be any consolation, but your boy is very lucky to have you fighting his corner like this. The effort you are puting in and yet you still feel you are climbing Everest etc makes me , but at least you are on the right mountain. Most children and their parents are not. God only knows what happens to them.

IA, you will never get anywhere unless you can work openly and honestly with the people who are with your son every day. Who is/isn't at fault is not relevant-it's obviously just not happening.

It matters not a jot how nice and kind the head is.
That is why I never post on your threads because you will never overcome this constant clash however much time and money you throw at it.

I am sorry you are so down.

Thanks. I appreciate your thoughts.

Moondog - this is such a difficult one. DS is generally happy at his school and has 18 months to secondary school. I could not find a head so accomodating. He is happy to have outside agencies in, like ABA consultants, to support us. The teacher and TA are ten times better than the last school but it is still a daily grind and I think they just dislike me and would rather dismiss DS as naughty.

I take your point, as, no matter how much training there is, you can take a horse to water but you can't make it drink.

My experience of schools is so poor. This is DS's third and by far the best. But he is always ambivalent to school in general. DS2 however loves it.

Our head is leaving in a month too.

Maybe direct payments for a TA would be a good idea!

LAs are fighting against DPs for education. They seemed to like to think that parents do not have the expertise to make decisions about educational provision, and that public money will get misspent on snake oil.

My personal take is that snake oil will be at least as effective as the status quo.

Is your experience of schools with your DD2 positive?

Only now that dd has started school, I find myself wondering if school is actually good for anyone really? It seems to be a bit hit and miss tbh, with children picking up a few excellent teachers and years on the way, but a lot of nonsense and rubbish too.

I have been very fortunate with DS2 who has a lovely, supportive, caring and engaged teacher who really knows the children and helps them develop their skills. She is very young but is flexible and sensible and really supports DS2.

BUT I know how rare she is and I too despair of the system. DS1 completely kicks against the nonsense that is pumped out from his teacher - pointless homework that she marks with a tick and no feedback when I have battled to get him to do it; lessons that seem to have no practical value; premiums placed on particular types of skills and types of children. It is one dimensional and uninspiring. I am not even sure some teachers understand the mechanics of what they are teaching - grammar etc.

We are churning out kids to all write the same 'perfect' essay at 18.

As for DPs, we have them for SLT, I want them for OT and I would love to employ my own TA but not sure that would be 'allowed'.