Family ECHO Autism - RUBI: Reduce disruptive behavior and improve adaptive behavior - Part 1

Summary

In this engaging and insightful session by Family ECHO Autism, Eric - the creator of RUBI - passionately discusses the revolutionary program aimed at reducing disruptive behavior and enhancing adaptive skills in children with autism. RUBI is designed for young children to pre-teens, focusing on teaching parents effective strategies for behavior management. The session spans practical approaches like developing behavior plans, understanding the function of behaviors, antecedent-behavior-consequence model, and reinforcement techniques. Through real-life examples, Eric illustrates how consistent routines and strategic ignoring of inappropriate behaviors can foster positive changes and open new opportunities for children. The presentation underscores the importance of community support and makes the RUBI techniques accessible and easy to integrate into daily lives.

Highlights

• Eric introduces RUBI, a program for managing disruptive behaviors in autistic children 🌈.
• RUBI is based on the ABC model - observing antecedents, behaviors, and consequences 🔍.
• Real-life scenarios illustrate the impact of strategic behavior management 🌟.
• The session highlights the importance of understanding behavioral functions for effective interventions 🧠.
• Parents are encouraged to keep behavior journals to track progress 📓.

Key Takeaways

• RUBI offers a structured program to help manage challenging behaviors, enriching both child and family life 😊.
• The ABC model (Antecedent-Behavior-Consequence) is crucial for understanding and reshaping behaviors 📊.
• Describing behaviors specifically and tracking them helps in creating effective interventions 📝.
• Positive reinforcements and ignoring undesirable behaviors are key strategies in behavior management 🌟.
• Consistency in routines and clear behavior plans enhance adaptive behavior and life quality 📅.

Overview

In this fascinating session by Family ECHO Autism, Eric dives into the depths of the RUBI program, a resource crafted over two decades to aid parents in managing challenging behaviors in children with autism. With an engaging tone, Eric shares his personal journey and the motivation behind creating RUBI, emphasizing its unique focus on supporting both the child and the family unit.

RUBI's foundation lies in the ABC model, focusing on antecedents, behaviors, and consequences. Eric vividly demonstrates through real-life examples how specific behavioral descriptions and strategic management can lead to substantial improvements. Listeners are encouraged to jot down and track behaviors methodically to tailor interventions to their unique needs.

Highlighting various reinforcement strategies, Eric elaborates on using positive reinforcement and planned ignoring to foster desirable behaviors. The session is infused with practical advice on establishing routines and understanding functional behavioral analysis, empowering parents and caregivers to embrace change and improve adaptive skills, ultimately enhancing life quality for the child and family.

Chapters

• 00:00 - 01:06: Introduction by Eric The chapter is introduced by Eric, who is also the author of Ruby. Eric is set to provide more information about himself and share videos that are expected to be impactful. He expresses his gratitude and enthusiasm for being present with the audience and gains the ability to control the presentation slides.
• 00:30 - 02:00: What is RUBI? The chapter titled 'What is RUBI?' discusses the development of a program designed to assist parents in managing challenging behaviors of children. The goal of RUBI is to enhance the lives of children and their families by addressing behaviors that may restrict a child's life and family interactions within their community. It reflects on more than two decades of commitment to creating this tool to support families and improve children's engagement in school and community programs.
• 02:00 - 03:30: RUBI Parent Training Program The 'RUBI Parent Training Program' chapter discusses the innovative nature of a pioneering program specifically designed for children with autism. The program's success partly stems from the fact that no similar program previously existed, which highlighted the need for such an initiative. The chapter outlines the extensive research and development efforts undertaken over the years to refine and perfect the program. Now, the program is well-established, allowing the creators to share their insights and results with clinicians and audiences globally through various presentations.
• 03:30 - 04:30: Importance of Having a Plan The chapter discusses the 'Importance of Having a Plan' particularly for parents dealing with children who have behavioral and emotional challenges such as tantrums, anger, and frustration. It introduces 'Ruby' as a clinical parent training program aimed at assisting parents in helping their children manage these emotions more effectively. The goal is to enhance the everyday experiences of both the children and their families by providing structured support and strategies through the Ruby program.
• 04:30 - 06:00: Learning and Unlearning Behaviors The chapter discusses the concept of learning and unlearning behaviors, particularly in the context of parenting and clinical advice. The objective of the presentation is to give the audience, which may include parents and clinicians, an overview of a parent training program. While detailed, individual advice is not feasible in a large group setting, the presentation aims to provide some practical ideas that attendees can apply. 'Ruby' and certain techniques are mentioned but not elaborated upon in the transcript provided.
• 06:00 - 07:30: The ABC Model The ABC Model, initially developed for children aged 3 to 12, can also be applied to teenagers and adults. Many principles from this model are used in everyday life for behavior management. The speaker mentions that they personally apply antecedent management in their own life, highlighting the model's versatility and practicality.
• 09:00 - 16:00: Understanding Behavior Functions The chapter "Understanding Behavior Functions" discusses strategies for structuring one's life to increase daily success and achieve personal goals. It highlights the potential improvements families can make and suggests that effective interventions might require collaboration with therapists trained in Ruby. It also addresses therapists interested in engaging with Ruby practices.
• 19:00 - 21:00: ABC Data Sheet The chapter discusses a discussion led by the chief psychologist at Nationwide Children's Hospital, who has extensive experience working with families and children with autism, spanning over 30 years. The chapter aims to share insights and experiences gained over these years in working with such families.
• 21:00 - 31:00: Prevention Strategies The chapter titled 'Prevention Strategies' begins with the speaker discussing their academic and professional background in Clinical Psychology. They pursued their undergraduate and doctoral studies with the aim of aiding families facing challenging situations. The speaker is currently a professor at The Ohio State University, working in the departments of Pediatrics, Psychology, and Psychiatry, and is actively involved in ongoing research.
• 36:00 - 43:00: Reinforcement Strategies The chapter titled "Reinforcement Strategies" delves into various behavioral interventions for autism, exploring both biomedical causes and genetic underpinnings. The research lab is described as robust, with a diverse range of activities. The speaker expresses enthusiasm to share the information, aiming to provide at least one new idea or approach to better interact with individuals with autism, ultimately considering the session a success if even one novel concept is imparted to the audience.
• 45:00 - 49:00: Ignoring Behaviors In this chapter titled 'Ignoring Behaviors,' the speaker begins by explaining the origins of the name 'Ruby' for their research unit. It stands for Research Units on Behavioral Intervention, which is associated with the National Institutes of Health, and specifically the National Institute of Mental Health. The name 'Ruby' was adopted because it was originally funded by the NIMH and also due to its endearing and memorable nature, reminiscent of a pretty and valuable gem.
• 53:00 - 54:00: Conclusion and Q&A The chapter titled 'Conclusion and Q&A' features the speaker offering metaphorical 'gems,' which are valuable pieces of information or advice. The focus is on providing insights that could aid in monitoring and potentially altering a child's behavior, though the speaker clarifies that this session is not a clinical program due to the large audience and limitations of a virtual platform. It's a session intended to provide helpful insights rather than in-depth clinical solutions.

Family ECHO Autism - RUBI: Reduce disruptive behavior and improve adaptive behavior - Part 1 Transcription

• 00:00 - 00:30 right Eric is our presenter today he is also the author of Ruby he's going to give you a little bit more information about who he is but I think you're going to be able to learn a lot and I think in the videos that he's going to share as well are going to be have a lot of impact so Eric take it away sure great thank you very much it's it's such a pleasure to be here with all of you um the next slide um there you go Johnny I I think I see the click button now so I'll be able to move this is really just an introduction to
• 00:30 - 01:00 me what is Ruby it's been a about more than a 20-year love affair for me and and and my colleagues we set out to develop um a program that could help parents manage um challenging behaviors that uh limit a a child's life and limit a family and what they can do in their Community maybe limit um a kind of school program that a child
• 01:00 - 01:30 can be successful in part because there was no program like it before and um when we were working on this and trying to design this program we realized that there was no one who really ever done this specifically for children with autism and then we embarked upon um years of research and trying to perfect the program it's now come full circle and we are in a position to be talking a lot about this to clinicians all around the world um and and also in presentations like
• 01:30 - 02:00 this to parents directly at its heart Ruby parent training is a clinical program that um is designed for kids who have you know challenges and behavior um times where Tantrums or um anger and frustration and just general problems managing their emotions might get in the way of their everyday experiences and and slow them down and slow their families down our goal with Ruby is to help parents help their kids
• 02:00 - 02:30 have a happier life um and one of the things that I'm trying to do in a presentation like this when we're talking to probably a large audience of parents but also I think there are some clinicians in the room um our hope is that in presentations like this you get a feel for what the parent training program is like you might walk away with some ideas that you can implement but of course in a large group like this I'm not going to be able to give you really specific and individual advice for your child you know Ruby was developed these techniques
• 02:30 - 03:00 that we we have tried to perfect in this program were developed for children as young as three years of age uh and and tested on kids up through age 12 and we know that they can still be applied to teenagers and to adults and to be honest with you a lot of these same principles are things that I use in my everyday life to manage my own Behavior Uh I for instance when we talk about antecedent Management in a few minutes I could probably give you examples of how I try
• 03:00 - 03:30 to structure my own life so that I'm more likely to be successful with what I want to do every day so there's there's room here for your every family to see opportunity in making some improvements but I also want you to keep in mind that the the intervention to really work and to be applied for your family um May mean that you have to work with a therapist who is trained in Ruby if there are therapists here today who have spent some time thinking about Ruby or
• 03:30 - 04:00 maybe trying to do it I hope you benefit from this discussion as well because you'll get a chance to hear how I've talked about this with families over the years um before I get into some of the specifics let me just highlight who I am I'm the chief psychologist here at Nationwide Children's Hospital um I've been doing this kind of work for a very long time um I've been working with families and children with autism um for gosh I gotta now say 30 years uh
• 04:00 - 04:30 it feels like odd to say that but um I started as an undergraduate student and pursued my doctoral degree in my training ultimately in in Clinical Psychology to to try to help families um uh with challenging situations like this I'm currently a professor at the Ohio State University I work in the Departments of Pediatrics and psychology as well as Psychiatry um and we still are doing research in in Ruby
• 04:30 - 05:00 as well as in other behavioral interventions for autism as well as looking at biomedical causes and genetic underpinnings of autism our research lab is robust and we do lots of different things um I'm excited to share this information with you here today and like I said I hope you walk away even which is one new idea or or one sense of how to try something different with a person with autism in your life then we will have achieved our goal
• 05:00 - 05:30 so let me get started oh I guess maybe just a a point about why we call it Ruby um and and so Ruby actually is a weird name it stands for research units on behavioral intervention and it's a Research Unit of the National Institutes of Health um who uh specifically the National Institutes of mental health um funded some of our research early on um and so the term just stuck we never changed it and it was kind of a cute term you know Ruby makes you think of a of a of a pretty
• 05:30 - 06:00 um uh ring that you might have on your finger with a nice Jewel on it right um I don't have any ruby rings but maybe other people do uh and then I I just call this gems where I'm trying to give you some gems some little nuggets of of of of of of information that I think can be helpful to you with the idea that it will help you monitor a child's behavior and maybe actually sustain some changes but again this is not meant to be a clinical program I can't possibly do that with 230 people um on a zoom call it's really just meant
• 06:00 - 06:30 to be me transferring some information to you some Little Gems of knowledge that maybe you could use and of course the the term is is meant to be sort of fun right ruby gems I think you get it um let me get started and I want to start just by setting the stage uh what do you do when you have a problem just in general I want to ask you to chat it in but maybe be thinking silently in your head what's the answer to this well the
• 06:30 - 07:00 answer is when you have a problem you need a solution right this is not rocket science um I'm trying to be a little tongue-in-cheek here but just keeping it simple if you are looking for a solution you're going to be best if you have support in both finding and then implementing that solution not doing this yourself it's hard to do this by yourself
• 07:00 - 07:30 ultimately a lot of families benefit from working with a therapist somebody who knows Ruby and can really implement it really well when you don't have that it's good to have a co-caregiver a co-parent a grandparent an aunt or an uncle a friend of the family who can help you think about these things once you have a solution and you have some support how do you know when and how to use them I'm pausing just to let your mind think
• 07:30 - 08:00 about a possible answer to this how do you know when and how to use the support that you've garnered and the solutions that you're coming up with well you have to have a plan so we have a problem we need a solution or it's going to be better a better solution if we have support and if we put that all together we end up with something we will call a plan so that leads me to one of the first pivotal foundations of trying to support
• 08:00 - 08:30 an autistic child's Behavior you need a plan and what does that really mean it means that whatever you're doing you're going to write it down even if what you did today didn't work it's good to keep track of it in some some way keep a journal um you know write it on napkins and put the napkins in a drawer that you can pull out and read later it doesn't matter what you write it on but write it down so that you have some records and some ability to to trace back what you've done what you've tried how did it work
• 08:30 - 09:00 keeping track of it is really important what it does it begins to create a road map for you of what strategies are are successful and what strategies may be things you should put away and forget about doing when you write it down you're more likely to be able to share it with your support system with your child support system you could say to a teacher we did X and it seemed to have this kind of impact it also allows you to update it
• 09:00 - 09:30 you know this worked really well on this day didn't work really well on that day and then on the third day what are you going to expect right well whatever happens on the third day you write it down too and now you begin to see a potential pattern of behavior if you're not writing it down if you're not keeping track of it in some way then uh your power your to really have a good solution to have a solution that you can work with and adapt and change over time isn't going to be there so I really like to start this conversation by just saying whether you're actually working
• 09:30 - 10:00 with a therapist or not it's good to keep track of what you're doing find a way to write it down I I I really value I'm just having a notebook as a good way to to keep track of these things now that you know that whatever you're going to do you're going to write down you're going to build a plan you're going to be doing it with other people you're going to be talking to other people in your child's life you're going to try to Garner some support for yourself um what are the solutions that the
• 10:00 - 10:30 universal solutions that we might come up with and that's what the rest of this presentation is going to be about and it starts with learning to think about behavior in a new way and the first thing to appreciate is that all behaviors are learned now this may um not be an easy thing to hear and it sometimes is misunderstood what we mean by this because who wakes up someday and says I'm going to teach my child to behave in a way that is counterproductive or disruptive or
• 10:30 - 11:00 challenging or difficult or that limits their world I mean that's in the end how I always think about this I don't want to make a child do anything they don't want to do I don't want to make a parent make a child do anything they want to do but there are things that we want children to be able to do we there are things that we want children to be to have available to them to be able to go to a friend's birthday party to be able to go shopping without having a tantrum to be able to go to the zoo
• 11:00 - 11:30 and and and not be afraid um of of animals when they're there there are things that we want kids to be able to do either things that kids want to do that would open up their world but yet maybe sometimes challenging behaviors get in the way of that and so we recognize that we want to change those behaviors and we have to start by recognizing that those behaviors are there because they're learned the good news about that is any time a
• 11:30 - 12:00 behavior has been learned it can also be unlearned or relearned a different way the thing to ask yourself is when you see a challenging Behavior happening when you're experiencing it you have to ask yourself why is this happening can I answer the why and it's okay if you come up with four or five or ten different reasons why you think it might be happening in fact the more answers you come up with the better there's never only one
• 12:00 - 12:30 possible answer there's more than one and chances are there's more than one that actually is driving the behavior but it's a good place to start by asking the question and seeing how many answers you can come up with I'm gonna now talk to you about some ways in which you could try to refine this process we tend to call this search for the Y the the Journey of Discovery as looking for the function of the Behavior now a lot of these words are clinical words
• 12:30 - 13:00 that a lot of people could leave behind and not use ever again in the future but this is one that I really like parents um to begin to use because it's a shorthand way of describing a whole bunch of stuff what is the function of the behavior and at the heart of it we're trying to figure out why the behavior works for our child what does it get them you know sometimes behaviors get us out of things we don't want to do they help us avoid doing things right
• 13:00 - 13:30 so we call that escape sometimes another thing that often Behavior gets us is it gets attention from people I make a post on Facebook or Instagram and I want someone to hit like or love all the time right I'm I'm making an effort to get some attention from somebody when I'm engaging in social media when kids behave in a certain way sometimes it's just to get our attention
• 13:30 - 14:00 a third and very common thing is tangible kids want to get something you behave in order to act on your environment to get something back from your environment to get a piece of candy to get a toy to get access to your iPad then the other thing that happens is sometimes we behave in such a way because just feels good you know I I sometimes like just to run my fingers through my hair because I I'm
• 14:00 - 14:30 losing it and I want to remember that it's there or I want to feel how soft it is and that just feels automatically rewarding to me to do that and a question I throw out to you is what other ways might parents explain s are there other ways that you think about this a common one is and this is probably
• 14:30 - 15:00 very true and I want to underscore it is that behavior is a communication attempt and that's very true and that's not inconsistent with what you see on the slides a child is trying to communicate that I don't want to do this anymore Escape the child is trying to communicate hey I'm over here pay attention to me or Charles trying to communicate I want that or a child's communicating this feels good right I like tapping my foot
• 15:00 - 15:30 on the table right it just feels good that's why I keep doing it it's it's a very common way we talk about functions of behavior is that it's a communication but the question is what are they trying to communicate and almost always you can derive it down to one of these four functions and it's important to keep it this simple you can make it more complex than this but in all the years that that I've been thinking about this and working with thousands of families I've never had a need to come up with a fifth or sixth or
• 15:30 - 16:00 seventh function it's really about Escape getting attention getting something I want or that it's just gosh golly feels good to me in the moment so another way to remember this is escape is trying to get away from something that a child doesn't want to do a task a person a place they don't want to be a tangible reward or a tangible function of behavior is some kind of reward it's
• 16:00 - 16:30 something they prefer it's a food a video I'm going to get what I want an attention function is a peer a caregiver a parent a teacher pay attention to me look at me look what I'm doing and I like the way that feels is another way to think about automatic functions it produces some kind of internal state that is pleasing to us
• 16:30 - 17:00 this is an extremely important foundation of wanting to change behavior is really knowing why it's happening and and and every single time we are confronted with a behavior problem that is difficult to change difficult to understand I always ask the parents that I work with well why do you think this is happening let's spend some time thinking about that maybe we don't understand the why if we're not able to change it if we're not able to help the child cope better we probably
• 17:00 - 17:30 aren't really understanding why they're behaving this way we developed something in the field called the ABC model a way of trying to help us get information to better understand the functions of a behavior the first step in the ABC model is actually the focus on the middle letter the B the behavior we want to make sure that we clearly are defining the behaviors that we're seeing in in our Ruby program we talk about behaviors have to be really clear actions if you're running a video camera
• 17:30 - 18:00 can you see this Behavior what does it actually look like can you visualize it can you close your eyes and see it I can't close my eyes and see happy but I can close my eyes and see someone smiling or hear someone laughing in my head if I'm thinking about what happy is right so the behavior is laughing the behavior is smiling another way to think about this is a behavior something you can count yes a behavior is also something you can
• 18:00 - 18:30 time I can count how many times I laugh today I can count how long I was smiling for right behaviors can be counted and timed they can be visualized and when you are able to describe a behavior like smiling or laughing or hitting or kicking instead of angry or mad or irritable or happy
• 18:30 - 19:00 or joyful right those are good words but they're not behaviors the behavior is instead something we can count in time and that's really the first step to thinking like um a person who's going to be able to support behavior in a child with autism one of the ways that I I try to instill this in in the people I work with is I say What's Happening Here and so look at this image can you think about feel free to chat in if you wanted but what do you see
• 19:00 - 19:30 happening what are the behaviors it's a static image right but it's this little girl is either a really good actress or she's at a tough moment in life but she has behaviors written all over this picture and it would be useful for a parent to say to me she's screaming
• 19:30 - 20:00 she's clutching the grocery cart handle really hard she's crying it's not helpful to say she's having a meltdown that may be true it's not helpful to say she's having a tantrum that may be true what is helpful to describe exactly what she's doing what are the things that I can count on time
• 20:00 - 20:30 it's really important to be very specific not just what you see happening not just what you can count in time but to be thoughtful about where it's happening who's around what's the location what time did it start what time did it end I I the the specificity that you try to provide can change from one Behavior to the next the specifics you identify might be a little bit different than what another parent identifies but if you force
• 20:30 - 21:00 yourself to be very specific in describing a behavior you and the people that you've put around you to help support a child's Behavior are going to have a much better shot of trying to change it specificity is really important the other way to think about this is a series of a few other questions and questions and questions don't stop asking questions most of us are comfortable giving advice what we should really do and what the
• 21:00 - 21:30 people who you ask the support you should do is ask more questions don't give me advice when does it happen Okay when else does it happen or how long is it happening does it ever happen longer than that what happens when it's shorter how's that different where is it happening where else does it happen who's around who's there who else is there who else is there who else is there it's okay to ask a whole bunch of questions just like you're a badgering lawyer in a courtroom on like Law and
• 21:30 - 22:00 Order or something right you want you you want to ask questions so much so much of yourself you want to your you want your partners to ask questions of you the people who are supporting you in this Behavior Support plan to ask you questions keep asking questions because the answers are going to help you decide if you have the right function of the behavior how often does it happen and then the question in red is my favorite question when does it not happen we spend so much time thinking about the
• 22:00 - 22:30 challenging behavior that is interfering with a child's everyday life interfering with the things that bring them Joy preventing them from building relationships and going new places we spent all this time talking about when and how and where and who around that situation that we stop thinking about Geo there were times where we're more successful are there ever times where these behaviors are not happening and your answer to that question is going to also help you understand the function
• 22:30 - 23:00 let's shift away from the B to the a in the ABC model away from behavior and on to antecedent what is happening right before the behavior happens and then we'll focus on the C the consequence what happened right after because by answering those questions you now are thinking about the whole Behavior stream the trigger
• 23:00 - 23:30 the behavior and the consequence antecedent Behavior consequence so we are very focused in this approach and the whole Ruby model has been based upon this idea of teaching parents to always think behaviorally this is the first session if you go to see a ruby therapist this is the first session that you'll get it'll the focus will be on teaching um really working with the therapist to
• 23:30 - 24:00 figure out how the functions of behavior are working in your child's life they'll focus on making sure that you are thinking specifically about the behavior in ways that it can be counted and timed and that you understand the idea that all behaviors have something that occur right before the behavior happens and all behaviors are followed by some kind of consequence this shows you that behavior stream just pictorially antecedents happen then behaviors and then consequences
• 24:00 - 24:30 let's practice I'm going to ask my tech experts to show the video can I have a brownie oh not right now honey all right it's lunch time but why because it's lunch time it's not time for brownies said it's not time for brownies
• 24:30 - 25:00 open it all right you can have one one brownie foreign that's it now now feel free to make any comments in the chat about this video one question is why is this child having a difficult time with his mom
• 25:00 - 25:30 right now some might call that a meltdown some might call it a fight some I call it a tantrum why is he having a problem and you can probably come up with a whole bunch of ideas and answers to that question but if you're thinking behaviorally you're gonna actually answer that question with more questions and I can see in the chat some people are already doing that the first thing I always ask people to do is what describe the behavior what is
• 25:30 - 26:00 he doing he's asking for a brownie he's stomping his feet he's starting to respond with a high-pitched voice he's starting to whine he might even you might even call that fighting with his mom he has a clenched fist he's pushing the brownies into her I mean you can again we can keep describing the behaviors very specifically but the end result is he wants his brownies asked her for it what did she do
• 26:00 - 26:30 she said no and what did his behavior do he stomped again he pushed the brownies right he kept he kept persisting ultimately what happened what's the consequence to his behavior mom gave him the brownie okay stop we didn't even look at antecedents yet of course the first antecedent was he asked for a brownie the consequence is
• 26:30 - 27:00 after his or he engaged in some Behavior stomping his feet pushing the brownie into her the consequence is she gave him the brownie stop and ask yourself what is he learning what is he learning I asked for brownie she says no I stomped my feet I pushed into her I get the brownie I've learned that an effective way to communicate that I want a brownie is to behave just like that right so when I said earlier all
• 27:00 - 27:30 behaviors are learned this one didn't wake up one day saying I'm going to teach my kid to stomp his feet and cry and whine and push to get what he wants but that's what's happening we have to recognize that that's what's happening and so to unlearn this we have to figure out a way to break it up but that's next right now there's still some things to think about I usually like to look at this case and in this case example we call this little boy Mason I've worked you know he's been in my life now for 25 years we've been working with
• 27:30 - 28:00 um these videos for a long time we had earlier videos that were less um uh fun than these ones that we did uh so this little character Mason um has been in my life for a long time and I I this asking for a brownie and not getting it and stomping his feet I've been thinking about it for a while and so I have a whole bunch of possible antecedents in my head of course the first antecedent is I want a brownie that's what he asked for but what else is there I saw someone in the chat earlier mentioned um how do you get access to the brownie
• 28:00 - 28:30 where was it exactly right right was it on the counter was it out in the open was it in a behind a cabinet door that he could open and reach right he somehow had access to that Brownie and he could walk out of the kitchen to the dining room table and and and and ask for it from Mom so that implies an intervention doesn't it it says gee we might wanna put those brownies in place where you can't access them the next thought that I have is
• 28:30 - 29:00 he hungry what time of day is it how far away from it is it when he had lunch or how far away from it is when he had breakfast how close is it to his next meal what did he eat at his last meal right I'm thinking about all those things too because that might influence this behavior and being annoyed to him actually just being hungry I know when I'm hungry I reach for the fastest quickest source and most fun food I can find right
• 29:00 - 29:30 another thing to think about is what was mom doing she's just sitting there at that table reading a book a big book maybe she's a law school student maybe she's a med school student maybe she just likes reading big books but regardless she's not paying attention to him maybe it isn't about the brownie at all right maybe it's about getting Mom's attention right now we don't really understand the function of this Behavior
• 29:30 - 30:00 other than the fact he got the brownie after he stomped his foot right the antecedents are unclear to us but might be driving the behavior but we do know the consequence is counterproductive for us so we know a lot more about this than you might have thought about just watching the video one way to keep track of all this is to use some kind of ABC data sheet this is an example of one of them I bet you if you put ABC data sheet into the
• 30:00 - 30:30 the Google The Google machine will give you back a whole bunch of different versions of this this is the one we use in Ruby you can also in your notebook just write down three columns and see Behavior consequence obviously we have a whole bunch of other columns on here for people to keep track of some data but this is one way that we ask people to do it it doesn't have to happen this way what does have to happen is as I told you earlier keep a journal keep writing it down because you need a few examples before you start to see a
• 30:30 - 31:00 pattern before you really understand while child why a child is behaving a certain way if we understand antecedents we can begin to think about prevention strategies we can think about antecedent management strategies that another way to say prevention strategies for instance in the video we just saw we've already identified a couple of these control the environment number two on my list that's exactly what I was suggesting right
• 31:00 - 31:30 just like someone was suggesting in the chat those brownies were available They Were Somehow accessible in his environment maybe we need to move them around put them someplace where you can't get them another prevention strategy on this list that I've already suggested for this case is all the way down at the bottom second from the bottom address setting events the setting event is something that just makes us set up to have a behavior problem
• 31:30 - 32:00 I might be hungry maybe that's why I'm asking for a brownie other kinds of setting events that people experience we all wake up on the wrong side of the bed sometimes sometimes we haven't saw him the other night before we didn't get a good night's sleep we're gonna be more grumpy that day right if I've missed my medication if a child has a seizure disorder and they had a seizure that day if I got into a fight
• 32:00 - 32:30 with my spouse or if my parents got into a fight in front of me last night I was getting dressed coming back from the gym I really don't like working out and I was excited about getting home and getting dinner and I broke my shoe string it just ripped I was so mad I had to walk with my shoes flopping around I put me in a bad mood and then when I got home I was in a bad mood and dinner wasn't as good as it could have been I
• 32:30 - 33:00 was set up by that little daily hassle breaking my shoestring right we can all be set up to have behavior problems and respond in different ways and when that happens it's good just to like maybe be low-key you know change demands change what you expect of yourself or in the case of your children expect what you're expecting of them to change too one of my favorites on this list is doing things in small doses it's really hard to ask a kid to clean up all his toys you know she has all her crayons thrown
• 33:00 - 33:30 out on the floor all her Legos around the floor or her dolls are on the floor you say you got to clean up this mess well maybe it's easier to ask a child to clean up if there's only one or two things left on the floor maybe you go in ahead of time and you clean up everything and then leaving one or two things out you ask the child to come in and clean up the mess it's not as overwhelming the next time you ask them to clean up it's clean up time maybe you leave four or five things out the next time maybe it's seven or eight
• 33:30 - 34:00 things you get my point you incrementally increase the amount of work you expect out of a child if maybe you have trouble on shopping trips and you ultimately want your child to be successful um going to the grocery store you may first make a trip where you just run in really quickly grab that half gallon of milk at the near the checkout line that they have these days and check out and and leave and so there's no time for there to be problems
• 34:00 - 34:30 but instead what happens is the next time you go you maybe add two more items to the list and then the next time you go you got three more items you get my point we do things in small doses or small steps and that helps us move toward more regular and maintained Behavior there are other ways in which we can prevent problem behaviors um the I'm just highlighting a couple of them here but this is really the way we we try to approach managing those antecedents that occur before a behavior problem happens
• 34:30 - 35:00 one of the most important things that I have found in working with children with autism is to focus on schedules sometimes just changing the time of a demand can be helpful you know for instance maybe doing your bath in the morning is is good for some kids maybe for other kids it's disruptive and it slows you down and makes you late for skull so instead we do our bath at night right we also use this strategy in green very often where we use fun activities to
• 35:00 - 35:30 reward the completion of more desired activities you've got to clean up your toys in your playroom before you go outside you got to hang up your code on the coat rack before you get to play your video game right the the do your work before you get something fun eat your green beans before you have your ice cream right this happens to all of us all the time it's the way we were raised another really important thing in Orange at the bottom of this slide is to be
• 35:30 - 36:00 thoughtful about building routines we all benefit from having structure and having routines I'm normally doing something else at 4 pm Eastern on a Tuesday afternoon I'm not in words Wednesday right on a Wednesday afternoon I'm not normally here this is out of routine for me I was really excited about being here it's novel it's fun but normally I'm doing something else and we all have schedules we all follow routines we know what our schedules are like it makes us feel good to know and
• 36:00 - 36:30 to have prediction to what we're doing it also makes us feel good to have fun and surprises too but most of us function on a routine and so will our kids and so it's good to have that the other thing to appreciate though about kids schedules is it's sometimes hard to keep track of your schedule anyone who works with me including this whole expert Hub team knows this I am really bad at managing my schedule it's a good thing it's written down otherwise I wouldn't know where I'm supposed to be at any point in time
• 36:30 - 37:00 and you probably have seen and maybe have used visual schedules like you see here on the slides there's lots of Internet Resources we have resources that we can share with you about how to build visual schedules for kids with autism but keep in mind we all use a visual schedule we all have calendars and planners and our phones that tell us where to be and what to do at any given moment and by having a visual schedule it helps us feel like we're more in control of our lives and and helps us be more
• 37:00 - 37:30 responsive to the routines that are available to us I'm going to show you a quick video here just how we use a daily schedule in Ruby and how we try to teach it so here you see a morning schedule for a kid these picture icons are all done brushing your teeth put it in the bag very good now what do we have to do put on coat okay take it all right let's go put in your coat come
• 37:30 - 38:00 on let's go so here you see Mom with Mason teaching him how to use this schedule you put on your coat let's put that in the bag a lot of helping support right now um backpack okay let's go come on let's go put it on now he's a Child Learning is how to use his visitor schedule very early on in the process eventually he'll get more independent with it my main goal here today is to help you realize and appreciate normalize that we all use a visual schedule and teaching
• 38:00 - 38:30 kids to do that earlier on in their development can be helpful daily schedules inform that we are communicating between caregivers and with our child about what they're doing and what they're doing next it allows us to potentially identify inconsistencies in our daily schedules and to help build those routines it highlights the importance of consistency and communication among family members because we're all focusing on on using the same visual schedule in some ways the visual schedule helps us be more
• 38:30 - 39:00 consistent for our child and then it also helps us identify those places and those times where we might more likely have some behavior problems it allows us to strategize where we can maybe fix some things that are happening in the day that are tough or difficult the next strategy that I'm going to talk about is a consequence strategy how do we reinforce good behavior how do we say good job how do we praise our children for the things that they're doing that
• 39:00 - 39:30 we want to see them do more of a reinforcer is anything that increases the chance of a behavior occurring again in the future so if I told you that Mom reinforced Mason's behavior for the brownie stomping you'd have to agree with me right because he's more likely to stomp to get the brownie in the future she is rewarding that behavior so we have to be thoughtful about this we have to make sure our rewarding behaviors we want to see
• 39:30 - 40:00 we want to make sure rewarding behaviors that open up a child's world and doesn't limit them it's good to think creatively about reinforcers make sure that you know what makes your child feel good the most effective reinforcement that we offer kids are going to be those reinforces that are offered when the child is actually doing a behavior we want to see right the thing to do is you don't want
• 40:00 - 40:30 to reward a behavior that is negative or counterproductive or disruptive the other thing to keep in mind is that a lot of kids have privileges access to things every day that they do and they have free access for it and it makes them feel good it might be that you turn those into reinforcers and as I was hinting at just a second ago the timing of delivering that reinforcer is really important if that Mom in that earlier video with
• 40:30 - 41:00 with Mason stomping his foot and asking for a brownie if if she told him you why don't you sit down in the chair and maybe I'll give you the brownie and then he says on the chair and she says okay you can have the brownie at least then instead of giving it to him for stopping his feet she's giving it to him because he did something she asked right that would have been a better outcome if she knew she was going to give him the brownie let's take a look at timing
• 41:00 - 41:30 cleaning up and I didn't even have to ask you the treat all right we're fighting wow I hope what you appreciate here is this Mom missed an opportunity right there there was some productive Behavior
• 41:30 - 42:00 happening but then the negative behavior started at that point she's lost her opportunity to reward but then she does and so again think about what is the function of this behavior of kids fighting in this case these kids have learned to fight because Mom rewards them to stop them not a good outcome here we actually have outlined an eight-step model for delivering reinforcement to a kid um this is a can be complicated uh and
• 42:00 - 42:30 maybe we've made it over complicated because it's eight different steps but you got to know what you're reinforcing what Behavior reinforce you remember behaviors are things you can count in time right you want to make sure that you're willing to reinforce an amount of the behavior that is potentially challenging for the child but it still may be very small right something that may seem really small to you might be worth reinforcing especially if it's hard for the child to
• 42:30 - 43:00 do you also got to decide on the frequency of reinforcement at first we want to reinforce the behavior that we want to see strengthened that we want to see more of we want to reinforce it every single time and the timing again is important you want to make sure you're reinforcing it right away you want to make sure you're reinforcing it right when it's happening I've missed my opportunity to reinforce Dr Barton for making a chat comment because she made it 15 seconds ago
• 43:00 - 43:30 I should have reinforced her right when she made it we use it contingently we we we use our reinforcement in a way that says you did a therefore I'm telling you you did a good job right we use it because you did something you have to maintain limited access and value to the reinforcer good job to our resources team for just
• 43:30 - 44:00 posting about the tip Andrew is highlighting something that Maddie did that he really likes and I'm reinforcing Andrew for doing that in the chat if it's contingent it's well timed it's specific I'm using social reinforcement right now that's all I'm using but sometimes with kids we have to use something more we have to give a treat we have to give access to a favorite activity or toy or electronic
• 44:00 - 44:30 but when still should use social reinforcement too because guess what that's how social reinforcement gets its value it gets value good job feels good to us because sometimes it's also paired with something else a more tangible reinforcer it's also okay to use visual reminders of your reinforcements if you do this then you get this and that can be depicted in a pictorial contract first this then that you probably have used first then boards like that before I bet let's take a look at catching them being
• 44:30 - 45:00 good hey guys you are playing so well together that's great I like the thing okay guys you're doing a really good job sharing it's really nice notice how she's coming in the timing is
• 45:00 - 45:30 good she's being specific it's contingent on what they're doing hey are you having fun yeah I'm proud of you you're playing really well together it's good this may seem artificial and awkward that's okay um it works and eventually we'll stop feeling so artificial and so awkward the other thing that we like to talk about is make sure you create positive time with your kids it's really important to spend special time with
• 45:30 - 46:00 your kids time where you are not necessarily putting demands on them and that time should be a time where you're just observing your child like the the play-by-play announcer during a football game or a basketball game who just describes what they see that's all you need to do with your kids to play with them effectively just describe what you see you're pushing the car you're moving that doll I mean again it sounds weird and sounds awkward but it is no Demand on the child and the child's feeling positive because you're present with
• 46:00 - 46:30 them and encouraging them if you want to do anything just imitate what they're doing if they push a car you push the car if they color the the sky purple you comment on it and say wow look at the purple sky I think I'm gonna make my sky green you don't tell them sky is blue right you let them be creative you in this special time you don't put demands on them because guess what when you're getting ready for getting them ready for school when you're getting them um to stop playing a video game to come eat dinner you're putting demands on
• 46:30 - 47:00 them all day long you have to have some time during the day where it's just you and the child having a good time describe what you see describe the play reflect on what they're saying praise play behaviors that are positive and really try to avoid any questions or demands when you're trying to create positive time with your child and so the last intervention that we talk about today is talking about what behaviors do we ignore there are some behaviors we pay attention to the
• 47:00 - 47:30 behaviors we pay attention to are the ones that are going to increase behaviors that we pay attention to that we don't want to see but we do pay attention to them they're going to increase too so the thing that we want to highlight is there are some behaviors that we just want to ignore now this isn't about ignoring your child this is about ignoring behaviors that your child's doing that are maladaptive for them that are problematic for them that are problematic for your family that are shutting down opportunities for your child
• 47:30 - 48:00 so that they can be replaced by more productive behaviors the last point of this slide is really important behaviors we initially ignore will always get worse and if we respond just like that Mom did in that first video stomped his feet pushed into her whined and cried at some point he kept escalating and she responded at that level guess what next time he's going to be comfortable going past that level to get what he wants right if we respond to
• 48:00 - 48:30 a child's Behavior they've learned that that's where we need to get and they'll keep getting to that level and they'll go beyond it to get what they want to get what they need to escape what they don't want to do let's take a look at training strong resistance like I've just described how do we teach kids to be really strong in their resistance to us peanut butter and jelly come on
• 48:30 - 49:00 sit up chicken nugget having chicken nuggets chicken nuggets chicken nuggets chicken nuggets yesterday chicken nuggets chicken nuggets chicken nuggets look at this chicken nuggets this is your favorite kind mommy chicken nuggets chicken nuggets again today chicken nuggets all right and chicken I hope what you saw here is the the sandwich came out
• 49:00 - 49:30 he started saying chicken nuggets she kept trying to coax him persuade him to eat the sandwich he kept saying no I want chicken nuggets I want chicken nuggets he was repetitive he was focused he was persistent and she eventually says okay I give up he wore it down and look that happens to all of us all the time these videos sometimes can be really silly but every parent I've ever showed them to has told me I do that I've done that and and we're not showing these to make anyone feel bad yes this is very much what happens in everyday life that's why we've made these videos like this the
• 49:30 - 50:00 reality of it is is that even though we do it and we all do it it also is causing the child to be more resistant let's take a look at this can I go to the park please no it's you know why it's really cold out today I want to go to another thing I said no I want to go to the park all right all
• 50:00 - 50:30 right do you want to go to the park all right you know what happened if I get how about you want some brownie yes all right all right here you got the whole brownie now notice here he didn't get to go to the park but what did he get instead pretty good consolation prize right obviously not a good idea let's answer the question on the slide it's not a good idea to do that but you saw what was happening she kept engaging him he kept escalating he kept throwing things and eventually she's searching for something God what do I
• 50:30 - 51:00 have here eat this brownie that was her strategy out of this and it's not a good idea because it's teaching him that he'll always get something good out of having a tantrum so we recommend ignoring we recommend making sure that you avoid eye contact when talking to a child that you do not touch a child when you're engaging with them that you use neutral facial expressions and that if your child's talking to you you're not talking back during this moment where they're asking or behaving in a way that you see as counterproductive to their
• 51:00 - 51:30 long-term success it's okay to make your ignoring obvious and exaggerated really literally you just look away and then as soon as your child stops the behavior you don't want to see you respond to them right away you show them the contrast between their behavior and your attention I have just another point or two to make let's take a look at this video but he yeah he did show up I know
• 51:30 - 52:00 I know I know they yep puppet yeah now I know I know yeah well she was she was talking about it the other day and she was saying that can you hang on one second I said stop it now go in the other room go in the other room stop it sorry
• 52:00 - 52:30 um mom you know what I'll give him a call and we'll find out what's going on Mom so what's really powerful here is they appreciate that she was trying to ignore but not completely doing it instead getting frustrated and responding intermittently and that's just making the problem worse too the reality of it is you want to plan ahead look when I'm on the phone it'll be really important for you to be doing something else and when I'm done on the phone I will come
• 52:30 - 53:00 do that something else with you and whatever the something else is you're playing with your child about what's fun but you have some kind of plan and you make sure that that plan is your child knows what you're doing and they know what they're supposed to be doing and then you ignore their attempts to get your attention and if they start doing the plan you might actually pull away from the phone and say good I'm so glad you're doing that I'll be off the phone in just a second right the best thing to do in these situations is to have some kind of plan that gets reinforced and other behaviors get ignored this doesn't mean
• 53:00 - 53:30 you don't love your child but responding to your child in the moment rather than having a plan ahead of time really does result in strengthening the behavior we're coming up close to the time that I want to break and make sure that we have an opportunity for you to wrap up with the rest of our team but I do want to just um make sure that everyone if you're going to use planned ignoring that you're prepared for the challenges Behavior will get worse before it gets better when you're ignoring it and some
• 53:30 - 54:00 behaviors just can't be ignored you know if a child's doing something dangerous you're going to have to prevent them from doing that you're going to break some of the roles like touching them but you still cannot talk to them not try to problem solve with them but you can prevent them from getting hurt or running away recognize that children can learn to be persistent if you're going to have to give in when you plan to ignore give in as early as possible actually don't persist and persist and persist and then
• 54:00 - 54:30 give in because all you're doing is making the behavior stronger and recognize when you're implementing plant ignoring it can take a while for it to work all right I think I'll stop there and give us an opportunity to wrap up and see if there are any questions that maybe are left unanswered in the chat that our team wants to address or wants me to address