Owning the Awesome

I'm pretty amazing. I've been a BCBA since 2009 and in the field since 2002. I get asked to be a Keynote Speaker at conferences, I have a great Trauma Informed Behavior Management Handbook, I give incredible webinars, and I'm an excellent clinician. I've been amazing for a very long time, but recently strangers are approaching me to tell me. I'm supposed to say it's humbling. The reality is it makes me feel great- and scared!

I've been on several podcasts recently and am starting to have people find me at conferences or emailing me to say they are a "fan" When I was at my last conference, I walked past a group of young people whispering "Is that Saundra Bishop?" "I think so" "Look at her name tag". I recently showed up at another conference and was walking with my mask and no name tag and 3 people recognized me. 

Being recognized for my hard work, skills, and experience makes me feel good. I'm a human after all. It also makes me feel grateful that my work will reach providers- particularly new ones who can start their careers doing ABA in a kind, compassionate way with a focus on self advocacy and reform. Being listened to means I have the opportunity to effect real change in the field. It also honors the fact that I am on the right track with my ideas. 

But, it's also scary. Imposter Syndrome pops in. I was literally on the phone with my therapist discussing my Imposter Syndrome and someone important in the field walked past me and interrupted my call to tell me they were a fan. My therapist said "ummm…if you are an imposter you're really good at it." It's also a big responsibility. People care about what I say, so I can't idly gossip or say things off the cuff. That's best practice anyway in professional settings- but extra true now. Please hold me accountable if it happens while we are chatting. 

As a little girl, I was always told I needed to be quieter, and be less of a know-it-all no matter how much I knew, and be smaller. I still battle that and I think it's important to buck that system and own the awesome. 

I still feel a bit nervous admitting I haven't always been an expert or the world hasn't always realized it. I feel extra vulnerable admitting I sometimes feel anxious about it. But, I think as leaders we need to take ourselves off the pedestal a bit. I'm honestly super great. I don't always remember that. And I can always be better. And it's the same for every leader in our field. 

You can learn more about this topic in my webinar The is No Old ABA

I'm Not Rude, I'm Right.

I'm not rude- I'm right

I have been presenting at conferences for 5 or so years. I often get marked very highly. One organization just told me I got the highest ratings they have ever had. I gave one workshop at an ABA conference and had roughly one hundred and fifty 4 and 5 ratings and eight 1’s. One review stuck out to me though. A very angry BCBA wrote a comment saying various things but continuously called me rude and ended with "Making rude statements to practitioners is rude."

The presentation was called "There is No Old ABA''. It addressed the notion that when people (especially Autistic people) criticize ABA the response is often "Oh! No! That's old ABA!" When, in fact, we still do a lot of the problematic and sometimes abusive things. The talk discussed the problems and tangible ways to fix them. It was spicy, but it was logical, backed up by evidence, and solutions were given. 

And 150 people out of 158 gave it a 4 or a 5 rating. 

But I was perceived as "rude" by this BCBA. And really, he's not the only one I'm sure. He was just bold enough to say it. 

It is so important to examine why we feel fragile when we are approached with challenging information. It is hard to consider the possibility that we have been causing harm, especially when we think we have been helping. 

These are steps that are helpful when confronted with information that may be hard to hear about our ABA practices:

1. Sit with the feeling: No one wants to be accused of abuse or doing harm. But sit for a minute and listen to the feeling before responding.

2. Consider if there is ANY truth to it. Perhaps you believe you do not do table work DTT- but do you do rapid fire DTT goals for behavioral momentum? Do you never block stims- unless it's interfering with a goal? 

3. Consider if the problematic thing is happening, how can you reduce it? Consider ways and implement. Do not expect Autistic people to tell you how.

4. If you aren't doing the problematic thing, no need to respond. It means the comments are not about you. No need to "not all ABA" the person delivering the message.

It is not a new thing as a successful and assertive woman to be labeled for just existing. It has become a joke now to say that I am being rude when I am saying innocuous things. But, this anger goes beyond that. As a field we need to listen and change- and that starts by listening to people, even if they are rude.

Why Using "Inappropriate Behavior" is Inappropriate

You may have noticed that we use the words "effective" and "ineffective" instead of problem, inappropriate, or even target behavior. There is a very specific reason for that. 

Years ago a few Autistic advocates looked at my website and, not so nicely, told me my use of appropriate was ablest. They pointed out that "appropriate" is a social construct, is culturally based, and centers on Allistic people. At the time my feelings were hurt but I didn't demand that they sugar coat their concerns- I listened. 

So, I changed the way I talked.  Now we use the terms "effective" and "ineffective". The purpose of supporting a client with a behavior is to get their needs met. We want to help teach them responses that are effective. Now, yelling to get a cookie is likely VERY effective right now for the 4 year old. But, in the long term when that person is 32 and goes to the grocery store, the behavior will be ineffective. 

Looking at behaviors as "appropriate" or "inappropriate" is arbitrary. Calling something appropriate is basing it on how society thinks someone should act. However, social norms constantly change and they are different based on community and culture. In DC, the clients are overwhelmingly school aged Black boys. ABA is a field dominated by middle class white women. I am a middle class white woman (mostly)  I'm constantly at risk of teaching incorrect social skills for the culture my students are a part of. Autistic Culture has their own social norms as well which is also ignored when we use the term "appropriate". 

When we label the a behavior as "problem" or "inappropriate" then the language puts the focus on how it affects the environment- how it affects others. When we focus on effective and ineffective, it puts the focus on the student. When you use "ineffective", the implication is there MUST be something “effective.” If you use "problem behavior" or "target behavior" there isn't a given that there is a replacement being taught. 

Its important to listen to Autistic voices about this. I've talked to Autistic people who like this language. There are also Autistic people who don't. Always be sure to ask your client about what language they would like. The disagreements on language are something we can discuss in another post. 

Sessions in School: How Providers can Interact in the Space

One of the most unique aspects of our jobs is that we don’t have a typical office setting. Our times are spent with the kiddos during their natural environment. This means that we’re mostly at the client’s home, in the community, or at their school. We typically will interact with a variety of people that we are not working with directly. When we see our clients at their school, the chance of us interacting with other people that aren’t our client also drastically increases. It is important to not only think about how clients interact with the space, but also how we interact with the space as clinicians. In order to have successful sessions with our clients at their schools, here are some tips/strategies that may help: 

Be aware of your surroundings:

When we’re at the client’s home, there are typically less people vs. when we’re at a school. So it is important that we are mindful of other staff members or children sharing the space with us. We have to remember that we are in a community setting, and whatever happens during our session may directly affect other people in the same area as well. Being mindful about where we leave our stuff, where in the room we are working in, and how we utilize the space is key. 

Be mindful of the teacher’s space:

This is something that I had to learn first hand even after about 7 years of working with children. Not every teacher will be comfortable with us being there. This is because the teacher may not fully know who we are and what exactly our role with the client is. A good portion of the time, our communications with the school is through a care coordinator or an admin person. So the teacher may not know who we are or haven’t gotten much details. This is why I like to think of myself as a guest in a classroom. Remember that it is always better to ask the teacher first. For example, if we need to utilize markers or paper, we should be asking the teacher or aide before getting them. We should also be mindful about whether or not the teacher is busy since they may be in the middle of a lesson. You may also need to refer the teacher to the supervisor since they may have other questions. When in doubt, refer to your supervisor and follow the directions of the teacher. Since we are in their space, we want to be as non-invasive as possible. 

Teachers are in charge of the classroom and the student you’re working with:

Even though we are hired to work with a single student, we have to remember that we are still in a space that belongs to someone else. Whoever is in charge is responsible for every single student in the classroom, and that includes our client. That’s why it is important to follow the rules of the school and the classroom. There may be times when the directions of the classroom teacher may interfere with a behavior that we are working on or goes against the plan for the student. Depending on the situation, correcting a teacher at this moment might negatively affect our relationship with them. For moments like this, I suggest you reach out to your supervisor and explain the situation, so they can follow up with the teacher. One of our goals when we’re at school is to ensure that teachers and aides are able to replicate our work in order to provide the most consistent behavior intervention for the student. So it is important for us to build that relationship with the teachers and provide them with resources at the correct time. 

Be mindful of other students:

We have to consider other students as part of the setting that we are working in. This is because our sessions can affect the environment in many ways. For example, we don’t want to hand our client a set of drums in the middle of a math lesson while there are other children around. One of my more vivid memories is when I first started working with a child at his preschool. There were other children there and in order to work on social interaction goals with my client, I decided to set up a game of tag and encourage my student to ask his friends to play. This is great because I was promoting that natural environment interaction for my client. However, I quickly realized that other kids were getting upset because they were “it.” So next thing I knew, I was managing behaviors of 5 different kids along with my client. Now, I’m not saying that you should never talk to other children that’s not your client. This is because during the right circumstances, your client’s peers may be a really good resource for promoting more learning and skills acquisition. For example, one of the children that I worked directly with had a few peers at his school that he enjoyed spending time with. By inviting them to engage with me and my client, I was able to provide a lot of positive interaction for my client. Based on my experience, I found that once you’re in the school setting for about a week, you’ll have a better idea of which peers are going to be more helpful during your sessions. However, remember we can’t force other children to “participate” or to help us run goals. Allow them to say no, if they want to, and don’t push if they are hesitant. You may be able to ask the teacher to help with finding peers for your student or get their thoughts on an activity that you’re planning. Always reach out to the supervisor as well for questions or clarifications. 

Lastly, every classroom is different:

I know this is the most obvious piece of advice, but hear me out. After going to many schools and working with teachers in various settings, I realized that I automatically assumed every public school operated the exact same way. Even though the schools are in the same district, their operational processes, what they can tolerate, what’s allowed vs. what’s not, and teaching styles may be very different. Even the same school may have different rules for the school day and the aftercare. So we want to be mindful every time we step foot into a different classroom. It also relates to the adult’s personality as well. Some teachers may be super talkative and want to know what we’re doing, while others are more reserved. It is part of our job to maintain a cooperative environment while still promoting best practices and scientifically supported methods. Everyone involved in a child’s care is there to ensure that this kid gets the best experience that promotes the most learning, so this means that compromises will be made. In order to be successful at teaching skills, we want to ensure that everything is doable and understood by everyone in order to provide the most consistent approach. 

Autism and Girls: Navigating Challenges in the School Environment

By: Yetunde Oladunjoye

School can be a difficult challenge for anyone. From learning new topics to meeting new people, there's a lot to navigate. However, in the case of people with autism, this struggle can be especially demanding. With the ratio of autism diagnosed in young children estimated to be 3:1 in males vs. females, girls are disproportionately less likely to be diagnosed early enough to learn supportive skills to aid them in the academic environment¹.

Why is School Challenging for Girls with Autism?

School comes with many rites of passage, such as prolonged periods away from family, interacting with peers, learning completely new concepts or building on previous knowledge, and many more.

With the amount of time educators spend on the children in their classes, identifying challenges should be less difficult with their training. But reality shows a different story. A study looked at how well teachers could identify children that may benefit from an autism screening. The results revealed there was a bias towards males and reported autism appeared differently in females².

For the social aspect of school, girls were observed to prefer non-verbal communication to supplement their verbal communication. This was generally considered not an indication of autism according to teachers and was, unfortunately, hiding the girls’ difficulties because of stereotyped generalizations of how girls communicate³. A common technique used to navigate these conflicts is called masking.

Why Masking is Important to Understand

Masking is a social tactic where an individual mimics or imitates what they perceive to be as "normal" in social interactions. A good example of this is when people applaud after a performance. It is perceived as "normal" to clap after the end of a performance, regardless of one's enjoyment, since this is seen as respectful.

However, masking can be a stressful endeavor to do since peer imitation is constantly occurring in tandem with all of the other processes someone has to think about when engaging in social situations. It doesn't help when individuals can hide the true meaning of their words, adding a new complexity to the situation⁴.

Masking is used as a coping mechanism for many neurodivergent individuals to make their way through each day of new interactions. Add the complication of the school years being a time where all of your peers are finding their own style of communication simultaneously, and it can be incredibly frustrating.

What's next?

Autism in girls is a topic in need of more research and awareness. Not only does the general public need to learn more about this, but educators need to acquire more knowledge in how it uniquely presents in young girls to help reduce the heavy bias in identifying the condition in boys. Without adequate support from those who spend a majority of their time with these children (besides their parents), girls with autism unfortunately have to exert more effort to just get through their school days with how confusing it can be in such a transitional time. All things considered, it is a positive sign to see autism in girls gain more recognition as a topic to focus in both research and educational studies.

References

¹Loomes, R., Hull, L., & Mandy, W. (2017). What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013

²Whitlock, A., Fulton, K., Lai, M.-C., Pellicano, E. and Mandy, W. (2020), Recognition of Girls on the Autism Spectrum by Primary School Educators: An Experimental Study. Autism Research, 13: 1358-1372. https://doi.org/10.1002/aur.2316

³Rynkiewicz, A., Schuller, B., Marchi, E., Piana, S., Camurri, A., Lassalle, A., & Baron-Cohen, S. (2016). An investigation of the ‘female camouflage effect’in autism using a computerized ADOS-2 and a test of sex/gender differences. Molecular autism, 7(1), 1-8. https://doi.org/10.1186/s13229-016-0073-0
⁴Tierney, S., Burns, J., & Kilbey, E. (2016). Looking behind the mask: Social coping strategies of girls on the autistic spectrum. Research in Autism Spectrum Disorders, 23, 73-83. https://doi.org/10.1016/j.rasd.2015.11.013

The Importance of Teaching Consent from an Early Age

By: Jordan Hoskinson, BCBA, LBA

Consent can seem like a complex topic to tackle, as both a clinician and as a parent to autistic children. What is consent? It’s defined as “permission for something to happen or agreement to do somethingᵃ.” This definition doesn’t seem to take into consideration where people are coerced or feel pressured into giving permission to be touched or to touch someone else. A much more inclusive definition of consent would be, “if the person agrees by choice and has the freedom and capacity to make that choiceᵇ.” The issue of who can be touched and how and in what context can be confusing for autistic children.

One way to avoid issues around these rules of physical touch is to teach children about consent. Physical touch, even something as innocent as a physical prompt to help someone hold a crayon, should not happen unless both people are on board with it. Our bodies are our own and we are the only ones who have the right to decide what we are comfortable doing with them.

As a parent, if my family is visiting my home and they wish to give my child a hug, my child has the right to say, “No, thank you” and to have that respected. By forcing my child into a situation where they might feel uncomfortable with physical touch, I’m teaching her that others have the right to make her body feel uncomfortable. Allowing someone to say no to physical touch should always be respected, whether it’s a family member, a peer, a doctor, or a therapist. 

As you teach your child about consent, be sure that you model what it looks like. Unless your child is in danger, don’t touch them unless you’ve received permission. If it seems as though they’ve had a rough day at school you can say, “Do you want a hug?” instead of just pulling them into your arms. This sort of consistency will help them learn what to do if they want to touch someone.

If you have a preverbal child, look for signs that touch may be unwelcome. This could look like backing away, pulling away, or engagement in ineffective behavior whenever you attempt to make physical contact.

Therapists and BCBAs at BASICS ABA Therapy are trained to ask all our clients’ permission before we offer any touch. This is one of the many ways that we teach self-advocacy. It’s never too early to teach your child about consent. It’s a lesson that every person—autistic and neurotypical—should be aware of and understand. When we learn about consent from an early age, we can grow up knowing how to give consent and also when to ask for consent from another person.

Footnotes:

ᵃhttps://bit.ly/3GGOYrJ

ᵇThe Code for Crown Prosecutors

Free Mini Trauma-Informed Handbook

I have posted about my Trauma Informed Behaviorism Handbook which lays out my unique approach using behavior analytic principles to create Trauma-Informed ABA treatment plans. You can purchase that here: https://www.basicsabatherapy.com/trauma-manual/trauma-handbook

I have created a free Mini Trauma-Informed Handbook which lays out Trauma-Informed consequence procedures. This is a great peek into our model! Check it out before you buy the full handbook. You can download the minibook here! You can purchase that here:

In case you missed the blog on the full handbook, it is pasted below:

When I first started in ABA, I was taught that if a kid threw a shoe at me, I should turn away from them because they wanted my attention. And you know what? As problematic as that approach was, it usually worked. When I became a foster parent, I was taught that if a child threw a shoe at me I should hug them because they needed my love. And you know what? It often worked. Over time those kids stopped throwing their shoes as their attachment became more secure. But, sometimes they didn't. And no one had answers for families who parented kids from hard places who couldn't be ignored or loved out of throwing their shoes. No one had any resources that addressed this issue.

That’s why I developed this model, started presenting webinars, and wrote this handbook. 

My Trauma Informed Behaviorism Handbook walks practitioners start to finish through creating a Trauma Informed Intervention using behavior analytic principles. It helps look at trauma events through the lens of setting events and walks providers step by step through creating an intervention that addresses this setting event.

In the full Trauma Informed Behaviorism Handbook: 

• Readers learn to recognize and define a trauma event.

• Readers learn how to apply trauma events as setting events.

• Readers will learn how to implement a trauma informed antecedent intervention addressing trauma event setting events (TESE).

• Readers will learn how to teach replacement behaviors and alternative behaviors that target the unique functions that maintain behavior for people who have experienced trauma events.

• Attendees will learn how to teach consequence interventions that address the trauma event setting event (TESE).

At the end of the handbook, providers have access to a template to use this model for their future clients.

I am super proud of this handbook and think this unique approach using behavior analytic principles and trauma informed ABA make this a must for all providers. You can purchase the full handbook here:

Trauma Manual

When I first started in ABA, I was taught that if a kid threw a shoe at me, I should turn away from them because they wanted my attention. And you know what? As problematic as that approach was, it usually worked. When I became a foster parent, I was taught that if a child threw a shoe at me I should hug them because they needed my love. And you know what? It often worked. Over time those kids stopped throwing their shoes as their attachment became more secure. But sometimes they didn't. And no one had answers for families who parented kids from hard places who couldn't be ignored or loved out of throwing their shoes. No one had any resources that addressed this issue.

That’s why I developed this model, started presenting webinars, and wrote this handbook which you can purchase here:

My Trauma Informed Behaviorism Handbook walks practitioners start to finish through creating a Trauma Informed Intervention using behavior analytic principles. It helps look at trauma events through the lens of setting events and walks providers step by step through creating an intervention that addresses this setting event. 

In the full Trauma Informed Behaviorism Handbook: 

• Readers learn to recognize and define a trauma event.

• Readers learn how to apply trauma events as setting events.

• Readers will learn how to implement a trauma informed antecedent intervention addressing trauma event setting events (TESE).

• Readers will learn how to teach replacement behaviors and alternative behaviors that target the unique functions that maintain behavior for people who have experienced trauma events.

• Attendees will learn how to teach consequence interventions that address the trauma event setting event (TESE).

At the end of the handbook, providers have access to a template to use this model for their future clients. 

I am super proud of this handbook and think this unique approach using behavior analytic principles and trauma informed ABA make this a must for all providers. You can purchase the handbook here!

https://www.beyondthebasics-dc.com/product-page/the-trauma-informed-behavior-management-handbook

Social Validity by Saundra Bishop

Social validity is looked at in research to see how the person experiencing an intervention feels about it. ABA often ignores that part of it. If social validity is considered, it focuses on the parent. It is important that we are always thinking about why we are doing an intervention and how it affects the student we are working with. 

We need to think about several things when we write goals:

1. Is this goal helping us/family/society or them? 

If the goal only serves someone else then it is not valuable. If a client yells out but that makes him feel calm, we need to support him. But the goal isn't to stop the yelling, it needs to be to find out why he is yelling. If it is a stim then why is he getting overstimulated in public? How can we create modifications? 

2. How is this goal creating increased opportunities for independence?

ABA is super focused on increased independence. We teach students how to go to the grocery store, write their name, and follow a hand washing checklist. But, does our client need those skills? Can he learn how to use Uber Eats instead so he doesn't have to spend hours and hours working on sensory goals, reading price tags, and finding tomato sauce that is in a different place at the same store every time? Can we teach him to voice text instead of writing his name? Or just use hand sanitizer? Sometimes our goals are so focused on our own version of independence that we forget that we can actually help people become more independent with other tools.

3. Will there be changes we can make to the quality of life of the person?

It is important to observe how the goal is actually valuable. We often make a goal that forces a kid to play trains with another kid because “all they do is parallel play” But, I “parallel play” with my partner all the time- he plays video games and I play on FB on my phone. How valuable is it to make the kid play trains with another kid? Maybe it is valuable but we need to be assessing it. On the other hand, teaching a student how to use social media safely could have a huge change in their life. 

4. Does the program honor the student as a whole person?

So many ABA goals work to change the student. Even ABA programs that don't have a goal of indistinguishability still work to tell kids they are wrong from a very young age. My favorite example is around restricted interests. Restricted interests aren’t wrong- it's that the person hasn't found the right conversation partner. 

When Pokemon Go 1st became popular, it was the best thing to happen to Autistic kids. They could walk around the neighborhood and people would walk up and they could just babble on about Pokemon. They didn't have to say hello or look at them. They just got to talk to each other. And it was awesome because the other person was excited to learn! 

Based on all of this we have created a paragraph that we put in behavior plans to try to communicate our values around social validity: 

The purpose of this behavior plan is to support the student in all areas of their life to be more independent and get their needs met. One way it does this is by creating accommodations to prevent the need for students to exhibit ineffective behaviors and opportunities for students to request the removal of aversive stimuli. This plan also includes opportunities to allow students to assent and dissent. This plan has also been designed to help students increase their access to reinforcement- both contrived and natural. With the goal of the student being able to access reinforcement naturally in the environment by ensuring the replacement behavior gives access to the original need. This allows the students to request reinforcers, and reduce student stress so they can learn new skills and reinforcers.

Please consider this when you write your plans- your clients deserve it.