Appled Behavioral Analysis (aba) Therapy for Autism


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Appled Behavioral Analysis (aba) Therapy for Autism

  1. 1. AUTISM DOES NOT FIT INTO A BOX… Presented By: Jamie Lynn Juarez, M.S. LMFT, PPSC, CWA
  2. 2. MULTIFACETED DYNAMICS IMPACTING CHILDREN WITH AUTISM  Variations in Family Dynamics  Variations in Behavioral Symptomology  Variations in Co-morbidity  Variations in Medical Symptomology  Variations in Treatment Methods
  3. 3. VARIATIONS IN FAMILY DYNAMICS  Different parenting styles: Authoritative (balanced), Authoritarian (strict), Indulgent (lenient), Neglectful (detached).  Array of coping strategies used by parents of children with autism: Fight, Flight, Frozen.  Diverse familial structure: Married, Divorced, and Blended.
  4. 4. VARIATIONS IN BEHAVIORAL SYMPTOMOLOGY Kanner, 1943 (Established DSM and ICD)  Social  Communication  Restricted Interest and Repetitive Movements Mukhopadhyay; Juarez, 2009 (Considerations to add Sub Categorical Types in DSM)  Visual  Auditory  Tactile  Kinesthetic  Olfactory
  5. 5. VISUAL  Matching Skills  Puzzle Assembling  Far Away Starring  Up Closing Starring  Side Starring  Waiving Objects  Rewinding Movies  Items Going Up  Items Going Down  Items Going Straight  Items Going Sideways  Catching Items  Spitting  Transferring Liquids  Spinning Objects
  6. 6. AUDITORY  Reception Skills  Echolalia  Nonverbal  Music  Toilet Flushing  Vacuums  Large Crowds  Showers  Other's Voices  Volume on TV  Volume on Stereo  Following Directions  Chalkboards  Dry Eraser  Loud Noises  Soft Noises
  7. 7. TACTILE  Affectionate  Aggressive  Soft Textures  Scratchy Textures  Liquid Textures  Sticky Textures  Wet Textures  Variety of Fabrics  Other's Skin  Hard Scratches  Soft Scratches  Holding a Pencil  Hot  Cold  Hitting Things  Touching Others  Banging Head  Non-edible Food
  8. 8. KINESTHETIC AND OLFACTORY  Writing Skills  Aggressive  Non Aggressive  Athletic Abilities  Spinning  Hand Flapping  Pacing  Jumping  Sitting Still  Clapping ______________________________________________ ___  Smell  Taste Sensitivity
  9. 9. VARIATIONS IN CO-MORBIDITY Autism is often accompanied by other symptoms warranting consideration of a dual diagnosis.  Attention Deficit Hyperactive Disorder  Oppositional Defiant Disorder  Obsessive Compulsive Disorder  Central Auditory Processing Disorder  Language Disorders  Sensory Integration Disorder
  10. 10. VARIATIONS IN MEDICAL SYMPTOMOLOGY National Institute of Health: Unusual Sensory Experiences Mental Retardation Seizures Regression Sleep Disturbance Gastrointestinal (GI) Disorders Neurological / Genetic / Metabolic Conditions Immune Dysfunction
  11. 11. VARIATIONS IN TREATMENT METHODOLOGIES CHILDREN WITH AUTISM OFTEN RECEIVE : EVIDENCE BASED VS. EXPERIMENTAL  Evidence Based: Medical (SSRI, Antipsychotic, Antivirals, Antifungals, Chelation)  Non-evidence Based: Biomedical (GFCF Diet, Vitamins, HBOT, Cranial Sacral, Laser, etc.)  Evidence Based: Therapies (Speech and Language Therapy, Occupational Therapy, Physical Therapy, Educational Therapy, Behavioral Therapy)
  12. 12. MEDICAL  M.D’s, D.O’s, N.D’s, D.C’s, H.D’s, etc… typically treat children with autism. Each have their own protocol.  Medical doctor’s using AMA guidelines to medically treat autism and those that are not using AMA guidelines to medically treat autism.  FDA approved medications for autism: Antipsychotic and SSRI  Off Label: SNRI, SNDRI, Antivirals, Antifungals, Blood Pressure Medications for example.
  13. 13. BIO MEDICAL  1. The "DAN! Protocol". The DAN! Protocol is not a clear and explicit protocol, per se, but rather a general approach to treating children that is being followed by a group of Doctors known as DAN!, or Defeat Autism Now!, Doctors. The best book to get a background in the DAN! approach is the book Children with Starving Brains, written by Jaquelyn McCandless, M.D., a DAN! Doctor. A complete list of DAN! Doctors is available here. DAN! is sponsored by the Autism Research Institute and DAN Conferences are held for parents twice a year. Yahoo discussion groups that include many parents working with DAN! Doctors include ChelatingKids2 and ABMD. 2. The "Cutler Protocol". Andy Cutler is a scientist who developed a protocol for removing heavy metals from the body. His protocol is detailed in his book, Amalgam Illness, and through the Yahoo discussion group Autism-Mercury. Note that many of the parents using the Cutler Protocol to remove toxins from their child’s body are also using a DAN! Doctor and many of the Dan! approaches to treatment. 3. Dr. Amy Yasko. Dr. Yasko's approach to treating children with NDs has many similarities to DAN!, but focuses treatment on the specific genes of the child, providing a roadmap that some parents believe is more customized. Her approach is also more focused on the removal of viruses and bacteria from the child's body. Learn more through her website, Holistic Health, her parent discussion group, and her book, The Puzzle of Autism: Putting it all Together. 4. Michael Lang's Natural Detoxification Program. Michael Lang is the founder of Brainchild Nutritionals, a supplement company serving children with NDs. Recently, he published a helpful guide with his own recommendations for how to detoxify a child with an ND safely and effectively. 5. Methyl B12 and Valtrex. A number of parents have experienced particular success using a combination of Methyl B12 (a vitamin) and Valtrex (a prescription drug that suppresses viruses). This approach has been spelled out by a parent who recovered his son from autism, Stan Kurtz. His discussion group dedicated to discussing this approach can be found here: mb12valtrex. 6. Homeopathy. Many parents report great results using homeopathy, the best description of which is available in the book by a parent, The Impossible Cure. Also, check out this discussion group run by the Homeopathy Center of Houston serving children with NDs. Adopted from Generation Rescue.
  14. 14. THERAPIES Speech and Language Therapy Co-Morbidity Associated with Autism: Dyspraxia, Apraxia, Expressive Receptive Disorders, Auditory Processing Disorders, etc. Methodologies: ASL, PECS, NLP, Augmentative Devices, Facilitated Communication, Rosemary Johnson, Linda Mood Bell, etc. Provider: Licensed Speech Pathologist
  15. 15. THERAPIES CONTINUED… Occupational Therapy: Co-Morbidity Associated with Autism: Fine Motor and Gross Motor Processing Skills Deficit, Activities of Daily Living Skills, Living Skills Deficit, etc. Methodologies: Sensory Integration, Handwriting without Tears, Money Math, Miller Method, etc. Provider: Licensed Occupational Therapist
  16. 16. THERAPIES CONTINUED… Behavioral Therapy: Co-Morbidity Associated with Autism: Attention Deficit Disorder, Oppositional Defiant Disorder, Mental Retardation, Expressive Receptive Disorder, Sensory Integration Disorder, Obsessive Compulsive Disorder, etc.. Methodologies: Typically referred to as Applied Behavioral Analysis (ABA). Functional behavioral assessments,” and approaches such as “Positive Behavioral Support,” “Discrete Trial Learning,” “Verbal Behavior Training,” “Pivotal Response Training,” “Fluency-based instruction,” “Shaping or Chaining,” and “independent work schedules/token economies,” and many variances of “Behavior Therapy.” Provider: Licensed Psychotherapist and, in some cases, Board Certified Behavior Analyst.
  17. 17. PROVIDER ISSUES?  All interventions for autism are provided by professionals…except ABA?  Common practice among current agencies providing ABA to our children is having uneducated, nonprofessionals facilitate therapeutic interventions.  Problematic on so many levels, especially considering the multifaceted dynamics impacting children with autism requiring such specialized standards of care.
  18. 18. WHO SHOULD PROVIDE ABA?  The field of behavior analysis is a scientific, evidence based methodology falling under the overall embarking scope of psychotherapy. Psychotherapy is the treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, changes in behavior leading to improved social and vocational functioning, and personality growth (American Heritage Dictionary).  Quality psychotherapy is provided by psychotherapist comprised of Doctoral and Master’s level behavioral health professionals. Skilled psychotherapists typically acknowledged are Psychiatrists, Clinical Psychologist, Marriage and Family Therapists, Professional Counselors, and Social Workers. All of these disciplines have gone through an extensive post-graduate training period to learn the many complex skills involved in practicing various psychotherapy methodologies. Current state laws included behavioral analysis as a licensed practitioner’s scope of practice. Insurance companies recognize these three professional licenses as an acceptable psychotherapy provider for behavioral health services to individuals with mental health disorders. Most insurance companies and professional boards do not acknowledge other professionals.
  19. 19. WHY IS IT IMPORTANT ABA IS PROVIDED BY A LICENSED CLINICIAN?  Doctoral and Master’s level clinicians must and should be the DIRECT provider of therapy. Hiring non-licensed, non-certified individuals to provide psychotherapy to children is illegal and unethical under clinical licensure laws for so many reasons. Other interventions like Speech therapy, Occupational Therapy, and Physical Therapy are not provided by inexperienced professionals. ABA must not be either!  State licensure is highly superior to certification for many reasons: quality of services, wider knowledge base, standards of practice, and legal and ethical accountability. This is why insurance companies will reimburse professionals.  The knowledge base and experience of a licensed clinician is much broader. Licensed clinicians have a minimum of a Master’s Degree and a minimum of three thousand post-grad supervised hours in multiple methodologies. Incorporating other psychotherapy methods when an ABA procedure isn’t working or supplementing an additional therapy to ensure better and faster results can only be done by a licensed professional.  More stringent legal and ethical accountability applies to licensed clinicians when ABA therapy is being received by an individual. The consumer is protected from harm related to practice standards, appropriate diagnosis and required therapy hours are regulated, consumer and trade boundaries are established, and quality of services are ensured.
  20. 20. CONCERNS ABOUT CHANGE IN STANDARDS?  The bigger concern is not changing the current standards of practice. Accountability is non-existent regarding a variety of issues: quality assurance, legal, ethical, consumer and trade, wasteful spending of governmental money, and intra-governmental deceit with contracted vendors to mention a few. All of these issues are rectified when licensure boards are overseeing providers of behavioral health. Consumers incomprehensively benefit!  If it continues on the way it is now, consumers will continue to benefit at substandard rates! The bottom line is change towards higher standards equates to higher benefits the consumer receives. Higher consumer success rates within the family, school, social, and occupational environment are achieved.  What will happen to consumers if better regulation standards occur? There are only approximately 4500 BCBA Certified individuals in our country as opposed to approximately hundreds of thousands licensed or working towards licensure behavioral health specialist. There are enough service providers to go around. My personal belief is BCBA clinicians are competent enough to provide ABA services (not other psychotherapy methods, however). The big emphasis here is BCBA clinicians should be the provider and NOT BCBA clinicians hiring ill equipped personnel to do their job! Remedying this aspect is the missing piece to the puzzle…  Many consumers currently rely on governmental funding that is exponentially dwindling to provide ABA therapy. Licensure regulations allows private sectors to be held accountable. Licensure boards are historical entities with heavy lobbying clout. This benefits the autism community immensely on so many levels!
  21. 21. WHY AUTISM DOES NOT FIT INTO A BOX  Comparative analysis against other disorders that do, so to speak, fit into a box; Inherited genetic disorders such as Down Syndrome or genetically predisposed with an environmental influence disorders such as Major Depression.  Autism’s behavioral and medical symptoms excessively differ.  The multitude of evidence based medical, biomedical, and therapeutic methods improve autism’s symptomology at varying degrees.  With all the above considered, Autism Does Not Fit Into a Box!
  22. 22. HOPE, INC. HOPE COUNSELING AND FAMILY THERAPY, INC. OFFICE: (909) 561-5466  Jamie Lynn Juarez is a Licensed Marriage and Family Therapist, Credentialed School Counselor, and Psychophysiologist. She is a respected, national lecturer for organizations striving to cure our world’s autism epidemic. Jamie is President of Hope Counseling and Family Therapy, Inc. (Hope, Inc) located in Ontario, California.  Hope, Inc. is composed of a Clinical Psychologist, School Psychologist, MFTs, a Credentialed Special Education Teacher, and a Special Education Advocate. The clinic offers Neuropsychological Assessments, Family Therapy, Cognitive Behavioral Therapy, Behavioral Therapy including ABA, Eye Movement Desensitization and Reprocessing (EMDR), Biofeedback, Neurofeedback, Brainmapping (QEEG), Special Education Advocacy and Educational Therapy. Many of these services are covered by insurance.  Jamie has been happily married to her husband Salvador Juarez, a Los Angeles Police Officer, for eleven years. They have four beautiful children: Danielle (10), Dominic (9), Devin (5), and Daliah (4). Their second oldest son, Dominic, is severely autistic.  Together they own a non-profit Hope for Healthy Families. Their non-profit educates other local Medical, Educational, Legal and Behavioral Health entities about autism and other special needs disorders. The book “Changing the Course of Autism” by Dr. Bryan Jepson is donated to these agencies along with other peer-reviewed literature about causes, therapies, and potential cures for childhood disorders.  For more information on how to help, please visit