Swethena is sharing how she discovered my Turn Autism Around approach and how she uses my programs. We discuss her previous therapy and what it looks like now, post COVID. She tells us how Richa’s diagnosis affected her and how the hope of ABA therapy turned this around.
In this episode, we are reviewing Richa’s assessments and discussing what to do next. We talk about the VB MAPP assessment and the one-page assessment and how we can make goals after completing them. Richa is verbal but non-conversational, so we are looking at behaviors and barriers for this child and discussing how these may change and what I would do when looking over her assessments.
Richa presents as a level 2 or level 3 VBMAPP learner, so we talk about programming for kids who have language but may not be conversational. I talk about many examples as we walk through the 4 steps of the Turn Autism Around approach when building plans for learners like Richa. Swethena and I talk about beneficial reinforcers and how to motivate kids like Richa.
Swethena is committed to helping her child and being a positive light in Richa’s learning. She reminds us that special needs children are put into the lives of such truly special parents and siblings. I am so thankful for Swethena for being generous with her child’s data and documents, making it possible to share information like this to help even more learners, parents, and professionals.
Swethana is a mother of two beautiful girls. Her youngest daughter was diagnosed with Autism Spectrum Disorder (ASD) at the age of 3 and a half and was later diagnosed with Epilepsy at age 4. She graduated with a Master’s degree in Computer Engineering from George Mason University and is currently working as a software developer. She resides in Kansas City with her husband and her two girls. She continues to support and advocate for her daughter as her family navigates through their daughter’s autism journey using ABA therapy. Her mission in the future is to spread awareness about autism and Epilepsy, especially to help spread awareness about ABA therapy, and would like to provide support and hope to other special needs families.
- Hot seat perspective from a mom of two girls.
- How to go over and score the VB MAPP and One-Page Assessments.
- Working with the VB MAPP level 2 and level 3 learners.
- Putting the 4 steps of the Turn Autism Around approach into action.
- Why programming for intermediate learners can be tricky.
—Turn Autism Around
—#28: Autism Medication with Dr. Michael Murray, Psychiatrist
—#104: Top 10 Best Autism Podcast Episodes of 2020
—#122: Putting It All Together – The 4 Steps of the Turn Autism Around Approach with Emily R
—A Major Autism A-Ha Idea: Dr. Carbone’s 3 Buttons
—Teaching Kids with Autism to Reply to Questions with Yes and No
—Tit for Tat Programming – Properly Programming for Autism Children
—Richa’s VB Mapp Assessment
—Richa’s Intraverbal Assessment
—Richa’s One Page Assessment
—Richa’s Planning Form
— Richa’s Self-Care Checklist
Transcript for Podcast Episode: 134
Programming for Intermediate Learners: Hot Seat with Swethana
Hosted by: Dr. Mary Barbera
Mary: Okay, Swethana so nice to have you here today.
Swethana: Thank you for having me.
Mary: So, first I would love to hear how you fell into the autism world.
Swethana: Yeah. So, my older sister's son, my nephew. He was diagnosed with autism and this was way back in like 2002. And I remembershe was, she was here, she's still here. And, I remember she brought him to India and I was back home in India doing my bachelor's. And I remember seeing him for the first time when he was 14 months old, baby, he was smiling, you know, just like a regular kid, just like have that social interaction andvery cute plump baby. But then she brought him back again when he was two and a halfright after his diagnosis. And I was like, is this the same baby? So was lack of response to the name, lack of eye contact or aloof.
Mary: And you didn't have any kids at this point.
Swethana: No, I was still doing my college, doing my bachelor's degree. So then fast forward, like 16 years later, I have my own kids. My younger daughter, then I was seeing the same symptoms in her, like right around 13, 14 months, she was happy, like making eye contact, you know, when we would click pictures, she was looking straight into the eye. Like she didn't have words, any words, but then around 16 months or so I did notice that she just stopped responding to her name. There's lack of eye contact. And, I remember one of our friendsshe asked us if we could come over for like a Thomas to train ride, and they have kids, same age as our kids. So their younger one, they have an older girl and a younger boy, and the boy is like one month older than my youngest one. And I could clearly see the difference. Between the boy and my daughter.
Mary: And you already had an older daughter who was four or five years older. So you had already raised, you know, gotten through the pres, you know, the toddler preschool years. And so you were well aware that something was different at that point.
Swethana: Right. My older daughter she's neuro-typical she's like, so we didn't have to go through all this. But yeah, younger one. Yeah. We were seeing all those symptoms, especially like lack of response to name, lack of eye contact. And so at two years of age, when we went for a pediatrician, well wizard and she recommended like infant toddler services. Since we are bilingual, she said, you know, it would help her with the social and communication skills. So we just went forward with that around like two and a half. We got a call from infant toddler services. We, we did that. Like, it was only like one hour per week.
Mary: It was about a year after you first noticed the symptoms.
Swethana: Yeah, yeah. I mean, I have to accept, we were in denial. I mean, because I knew my nephew, I know that so symptoms, so they were like two voices in my head. It's like one is saying, he's showing the symptoms of autism and the other thing, like, no, no, she was going to be fine. Right. So there's that denial there, but how will we continued with infant toddler services? But what I didn't know was there was hope for autism. That is something called an ABA therapy. I had no idea until we got, we received a diagnosis, like when she was almost three years and seven months. So a year later we got diagnosis, um, in July of 2019.
Mary: Did they say where she was on the spectrum at that point?
Swethana: She was diagnosed with level two.
Mary: So that's in between level three is the severe autism and level one is, is mild autism at this point, but those levels are very subjective, I think. So she was three years, seven months level two. And how were you feeling back then?
Swethana: It was all kinds of emotions, like grief and pain. And then, you know, anxiety, stress, fear, you name it. We had all, we were going through all those emotions. But then we didn't waste time. The psychologist who diagnosed her, she said, you know, there's something called ABA therapy. It would benefit her if she could get like 25 hours to 40 hours per week. She was, she already started going to preschool at public school when she was at age three. Said it would help her with like social skills and all that.
Mary: And those were like special needs classes?
Swethana: Special needs. . I mean, they had peer models too, um, with special needs kids and peer models. So, she was going through that. Then, so then a month later after diagnosis, we found this ABA center and then we started her on ABA therapy, like half days. Monday through Thursday, she would go half a day, preschool and half a day will be therapy and Friday full day ABA therapy.
Mary: So then, she also developed seizures. At what age did she develop the seizures? And what did that look like?
Swethana: So, three months after we started ABA therapy, she had an episode of seizures and she had her first seizure actually a little after her first birthday. So she had one occurrence of seizure. And we had to rush her to the ER and they just started on EEG a month later and they said, it's fine, normal EEG and all, and this was like in July 2019, we got autism diagnosis. And like five months later in December, we got the epilepsy diagnosis. Like she was sick, stuffed up and all. And then four days later she had seizures. She had multiple seizures. So we had to rush her to the ER and we were in the hospital for two days. So, and she was put on a seizure medication.
Mary: Is she pretty stable with her seizures now?
Swethana: Yes, she is stable with her, with her medication, but the medication is still going on. Yep.
Mary: Okay. So that brings us to December of 2019, and we all know what happened in 2020. So, um, and you, you were telling me before we started recording that you found me and my courses right when COVID hit. So when COVID hit, she was displaced out of her services. Is that what happened?
How Swethana Found the Turn Autism Around Approach
Swethana: Yeah, so because of our epilepsy, along with the autism thing, and our neurologist said she has like lower immunity to like cold viruses, right. If a virus attacks her, her susceptibility goes down and now we are like three months later, we are into COVID. Right. So as a parent, it was hard for us to make a choice. So we decided to stop the direct services. Because of all the COVID thing going on. And that's when I was little getting stressed out because I know she needs those, that ABA therapy. And then her preschool speech language pathologist, I was working on her, one of her goals, like yes-no questions. And she sent me a link to your video.
Mary: I have a video blog about teaching yes and no, which is complicated. So we can link that in the show notes as well. But, yeah. So you found me through that first video blog, but I have hundreds of video blogs and yeah. So, so then you started taking my courses. Six months ago or longer? Okay.
Swethana: after that, yeah, I listen to your podcasts. I watched more of your videos and I did your podcast survey. I was on a podcast with you and it's Monday take my courses and,
Mary: Yeah, we can link that one in the show notes too. So I did a podcast listener survey last year, right at the, towards the end of the year. Cause I was getting to my top 10 favorite podcasts for the year and I was coming up on, on podcast 100. And so we, you completed the survey and you came on a call and you asked a great question about intermediate learners, which is so complex. I mean, it's great that, you know, the SLP sent you that video and yes, no, but now after taking the early and the inner, especially the intermediate learner course, um, What kinds of things did you not know back before you took my course and then afterwards? Like what, what kind of things did you learn?
Swethana: So the first thing I think that I really learned from your free workshop or videos, like the demands are high reinforcement is low and that's, that's the thing that I did not know before. And it seems like that's, that's a very basic thing when you, you know, child, if you please demand and you don't have the right amount of reinforcement ahead of time.Yeah. She can just escalate into different kinds of problem behaviors. Yeah.
Mary: So any kind of problem behavior. Whether that's a child with autism, a typical child, an adult, if you have problem behaviors and all of a sudden I start crying or I start putting, trying to put my fist through the wall. The demands are too high, reinforcement's too low, and that is across the board. And so, and I think one of the mistakes that people make, especially with intermediate learners. And when I say intermediate learners, we're going to talk about the VB map a little bit, but level two, level three, VB MAPP learners, no matter what their chronological ages, are particularly difficult to program for. They're talking, but they're not conversational. And sometimes the more you push the weirder, the language can get and the more problem behaviors can occur. And so my approach. ABA, the science, then the verbal behavior approach, which was my first book. And my first, you know, I'm trying to give an overall view of how we parents end professionals should really put these things together. And now my new book turn autism around, is really an approach to look at the whole child, the whole family, and to look at prom behavior reduction at the same time we're working on the language and the right order and the self-care skills in the right order. And as you say, it is, as I say, is complicated. I'm sure you would know that now, but so, okay.So do my answer to, if you see problem behavior, the demands are too high of reinforcement is too low. What kind of other things did you think that you were. You know, what are you, what do you think about teaching skills? Like prepositions pronouns?
Swethana: Yeah. Yeah. I didn't know that there was certain order until I started taking your courses. And because I think for my daughter, especially she struggled with pronouns and prepositions and pronouns are still messed up. We are still working. That's one of her goals, pronouncing prepositions. She is like, I want, uh, I want mommy opened door for you. She's like, I'm open door for me. Yeah. So I, I realized that, that I didn't realize that there's a protocol. There's a certain method to teach those. So that's another thing that I've learned from your courses. Problem behaviors also. I mean, we got the basics for her when we started the ABA therapy, but again, with problem behaviors too, I didn't know. You know, you should work 95% of the time preventing problem behavior. I mean, you put it slightly in your courses like that is reactive, right? Yeah. Be proactive and reactive. And we were doing that unknowingly, but after taking your courses, it made it more clear sense to me like, okay, this is what we should be doing.
Mary: Parents and professionals has spent 95% of our time preventing problem behaviors. And those problem behaviors don't have to be a full-out tantrum or throwing things or property destruction. We want our kids to be happy. Um, we want them smiling. We want them having fun. We want them running to the work area, running to wash their hands, running to get dressed. And we need to think about reinforcement and keeping the demands as low as possible and the reinforcement super high. So, so it sounds like you've learned a lot. And the nice thing about this hot seat. So I did a hot seat several weeks ago with Emily, from she was a blogger from mama to Cassius voice. And so this is hot seat number two. And basically I I'm, I'm thinking that I'm going to do more of these.
Mary: And what I'm trying to do by doing some hot seats is walking either a parent or professional through my four step approach. Ideally the parent or professional should have read my whole book and, or taken one or all of my courses because. You know, if you just got on here and you had no idea, you just watched the yes, no video blog.And now all of a sudden you're like, oh, I'm having all these problems. I'm having problems with this and problems with that. And, you know, she talks like this and she's, her pronouns are messed up and you don't even have an inkling of the approach. It's going to be hard. So I think a lot of our listeners are in the position you in were six months or a year ago where you were kind of, you were doing ABA, you were trying to help your child reach her fullest potential. But at the same time, and not a whole lot of people in the whole world know how to program for intermediate learners. I happened to have a very vested interest in learning and creating my programs for intermediate learners, because my son who is 25 on July 3rd is, has been an intermediate learner since he's been four.
Mary: So. I would go to Dr. Carbone's clinic up in New York with my work, with the verbal behavior project. And I would go there and I would, I would pay attention. I would be like, okay, this is the way he's trying to do. Intraverbal categories are webbing, and this is the way he's teaching this or X, Y, and Z. Yes, no. And then I would go home and I would try it with Lucas and sometimes it would work.Sometimes it wouldn't and I have to adapt. And once I got him learning, um, it was, it was pretty magical to figure out how to help other kids and then eventually through my writing. So the plan is, you have submitted all of the documents that I've asked for, and we're going to just go through the four steps of the turn autism around approach.
Mary: Swethana. I always have to like, look at your pronunciation for your name. So, she has agreed to let us publish these, these documents, the VB MAPP, the one-page assessment, the one page plan. She's going to send the self-care checklist. We're going to the intraverbal subtests and she we're going to, we're going to put those in the show notes for you all.So go to Mary barbera.com/podcast, and you'll be able to get those, her actual documents. We've covered up, you know, the dates and, the confidential stuff that the professionals names who have done this, but I think it's a really good opportunity for us to illustrate how complicated it is to program for intermediate learners. How, we do have an approach and that is, able to be learned by motivated parents and professionals of any type, even power professionals. And you can really start turning things around. Your daughter was five by the time you got on the podcast listener survey and joined the course. And I mean, it's never too late. I mean, there's people listening with 15 year olds who are like, well, you know, it's never too late to make some progress and to turn things around, but it's also never too early. Like if you would have, would have had this information right out of the gate, even before she was diagnosed at 14 months, when she stopped responding to her name, you would have had more resources, a lot, probably half of the people that introduce themselves in our toddler preschool course don't have a diagnosis.
Mary: And so I really want to make this information accessible to you, to everybody listening, no matter what the age of your child. And, and there's no time for kicking yourself because you were in denial. I was in denial for a year and a half. Even if you're not in denial, it's hard to get services is hard to get in line for a diagnosis and with COVID, we all just basically lost a year and a half of our lives. Luckily you said your daughter Richa is in therapy now 40 hours a week of in-home ABA services. You're very happy with BCBA and the team and they haven't, as far as, you know, taken my courses or read my new book, but hopefully everybody out there will be able to. Because your of your generosity will be able to actually see what VBMAPPs look like and what one page assessment look like and the plan.
Step One:The Assessment
Mary: Okay. So the first, oh, before I get to the four steps and walking you through, this is not an actual consultation. I have not metthis child, I haven't looked at any videos. I haven't, you know, assessed her myself. And so I really can't give medical or behavioral advice. So this is just, and this is the way our courses run the way our workshops we're on the way the podcast run is we're trying to get information out to you all, but we can't, you know, if I give some advice, it may be wrong because I'm not a part of your daughter's case. So, know that and know that if you're out there listening and think, oh, well my daughter has seizures or, or we need to work on yes, no. And she told, you know, uh, to work on it this way. Not necessarily, although my book and my courses have a systematic approach to try to teach you how to fish, not feed you a fish so that we always go back to the four steps, which first step is assessment.
Mary: So, you had a VB MAPP for your daughter donestarting at, you know, the age of four or slightly before that. Um, so yeah, at the age of three, you, you had a VB MAPP. So for those of you that are listening, that don't know where the VB MAPP is. Um, so the VB MAPP is the verbal behavior milestones assessment and placement program. It was written by Dr. Mark Sundberg in 2008, and I was, had the opportunity to help field tests. The VB MAPP starting in 2006. My, when I was writing my book, my book was published in 2007. So my first book, the verbal behavior approach only mentions the ABLLS, which is the assessment of basic language and learning skills, which was initially written in 1998 by Dr. Mark Sundberg, the author of the VB MAPP, as well as Dr. James W. Partington.
Mary: So back in 2003, well, even for Lucas, back in1999, 2000, we had an ABLLS. When I started working for the verbal behavior project, we use ABLLS on everybody and that's, what's in my first book. So since 2006, I moved from the, from the ABLLS to the VB MAPP.And I feel like the VBMAPP is a really great tool. And so for those of you, and I know that the majority of you are listening, not watching, so I'm not going to really do anything where I'm holding things up or giving you a display, but the VBMAPP well, that was pretty big a co-op so we'll have to get that. Okay. So the VB MAPP has been field tested for kids with autism, but it's also, it was developed and field tested first with typically developing kids. And so looking at developmental checklist, what comes first, for level one VBMAPP learners, which is the lower columns and level one goes from a zero to 18 months typical development. Level two goes from an 18 months to 30 months typical development and level three goes from 30 months to 48 months typical development. So kids with, um, any kind of speech delays autism, typically developing kids, you could do a VB MAPP one, and if they are young, um, They should have, you know, all of level one complete if they're over 18 months of age, but a lot of our kids, if they have moderate to severe autism, my, what I've seen over the years is level one is like a peak with little to no manding or requesting, or tacting a co-ax and vocals are also low.
Mary: So as you move up to level two and level three, you get into things like requesting with more language and matching more categories and imitating more fine motor and more complex skills and things called intraverbals, which are the answer part of wh questions. So when you, and I've done some podcasts on conversational skills and intermediate learners, we can post those in the show notes as well, but intraverbals are a crucial part of conversations. And so if I say, what state do you live in? Your answer is actually an intraverbal response. And so a lot of our conversations, um, All of our conversations are advanced mans. I ask questions or you asked me questions and advanced intraverbals, which are the answer part. And you have to have a lot of ability, um, receptive ability and you're bilingual, you said. Um, and so if you think of it, this has really nothing to do with, with autism. It has to do with how we learn, how we learn everything, how we learn language, and it's very complex. And so normally, typically developing kids will pick up one language and they'll even pick up two or three languages pretty without a lot of effort.
Mary: But with kids, with delays and autism, that tends to be a really, um, much, much more difficult. The other parts of the BB map that a lot of people don't talk about. Oh, the other thing about the milestones, the first sheet of the VB MAPP is that you fill out these blocks and you get a score. And so initially Richa score was 60 and that was back in 2019.But the other problem is, or the, the other part, parts of the VB MAPP, which are really good are the behavior, barriers,VBMAPP barriers, because the part of the problem with the ABLLS assessment was like all the good behaviors you wanted at what costs. So the VBMAPP is all the good behaviors you want on the first page, all the barriers which don't include just throwing themselves on the ground or screaming or aggression or self-injurious, it also includes barriers like poor scanning or hyperactivity or self stemmed behavior or impaired articulation.Like you don't just want to keep going with language. You can't understand the child for instance. So the barriers is really important as well. Her very first VBMAPP, her barriers were, were said to be 24. However, we're going to talk about a recent VB MAPP, which showed, um, different scoring and, and just briefly talk about that as well.So the other,the other part of the VB MAPP is the transition assessment, which is really important too. And that is all your self-care tests. Like your potty training, your, your, how much reinforcement, like a range of reinforcers do you need, you know, a lot of reinforcement or are you good with just praise or how, how do you do with group, classroom responding, social skills?How do you retain new skills? Like how many trials does it take to teach new skills? And so. Overall, I'm just kind of going through what was presented to me too, as part of the assessment, which is the first step of the turn is around approach. And recently there was a VB MAPP done when Richa was five.
Mary: And, the last score was October of 2020 was one 18 on the, theMilestones, but the, the new BCBA who started the home program new to her case, she did it and got 80. And, the barriers went from 14 to 75, which is a big jump. Right. She had a lot more barriers on this more recent assessment. And then the transition assessment, which we want it to be high was 29 compared to 63. But let's just talk a little bit about over scoring and it's not anybody's fault. Like, it's not like, oh, whoever did this or these assessments, um, you know, didn't know what they were doing or whatever. Well, first of all, your child, the child could be different. The, the parent, like with I would do a VB MAPPon my own son and I wasn't a behavior analyst, I would tend to over score, [00:28:00] um, because you want your child to do well, but for any child you don't want to over score. Because what that does is you, you and the professionals keep pushing and making goals that are too high and then problem behaviors will pop, will come to be right.
Mary: So I would rather, and I also don't want to see someone like you sent me some, some assessment datathat shows that every day she's got some non-compliance, escape, she sometimes pushes and throws things and property destruction like tearing papers and you know, her tantrums can last an average of four minutes. That to me means the barriers are 75 or 80. Like, so that's why I said to you never meeting you never, never seeing a video. When I see data to show that we're having daily problem behaviors, pretty significant, the barriers are high. And, and that doesn't mean that there's something wrong with your daughter or wrong with the program. It just means that we need to do more things, like you said before up the reinforcement, lower the demands, make things easy, make things fun and not push in the wrong direction. So in addition to the two VB MAPPs that we're going to have permission to share in the show notes, also a big part of my turn autism around approach is to do a one-page assessment. Even if you have the VBMAPP done, you have reams of assessments. Why do we have to do this little one page assessment that Mary Barbera thinks is so great because it really is right. It is a snapshot. It can be done very quickly and like 10 minutes. And you know, where on here is, is showing that she's ripping paper or that she can say, I want to go back yard and wear shoes. I mean, those are the things that mom reported on here. It's, it's a quick glimpse and if you're a teacher out there or behavior analyst and you have multiple kids say you have six or eight students or clients, the, the having one page assessment on all of them day one. I would feel more comfortable.We have, we would know allergies, we would know medications, we would know safety concerns right off the bat. We would know, do they eat, do they eat off utensils? Do they drink out of a bottle? I mean, I've had kindergarten students who drink out of a bottle or they're only liquid, like that's important to know first day, right when the kids can't report.
Mary: So the one-page assessment is very key. We will link that in the show notes. And then also a part of the assessment is the self-care checklist. That's for everybody that's talked about at length in my book, we're going to, you can get all the book resources with or without book purchase at turnautismaround.com.So we can link that in the show notes as well, but we want to get all of these assessments done, read the assessment chapter for sure. Read the book in order. It was meant to be read in order. And you can also listen to it now, the other assessment, that's really only if the child is talking, which Richa is talking is the intraverbal assessment. And if I am going to try to tell how quote unquote high-functioning a child is, I am going to go up to them. I'll give you an example. And I don't know if I've said this in other podcasts or not, but, so I was with the VB project and I walked into my classroom with a teacher and she had eight students in the classroom and she said, oh, we just got a new teacher, Johnny and oh, he's really high functioning. And I'm like, oh, okay. You know, I don't know what that means. Uh, so I go up to Johnny and I go, Hey buddy, what's your name? And I, I forget what he said, Johnny or not, or maybe he ignored me and then I was just like, um, Hey, can you tell me some things that fly in the sky? So I'm asking a question just to see what he's going to say. And, um, he's like 3, 2, 1 blast off. And it's like, that's great. He's got language. I mean, we're not here to like, say your daughter is, you know, anything less. I mean, she's, she's got a lot of language. He has a lot of skills. This hot seat is strictly just to say how we might look at it. From the turn autism around approach and we might move her forward in the direction.
Mary: So the intraverbal subtests is really important part of the assessment as well. Um, we'll get into the teaching part in just a second. Um, so those are these, uh, the main assessments in my book. I also talk about getting a language sample, especially for kids that don't talk or only babble, or only say a few words. That's really important for somebody like Richa who has a lot of language that may or may not be, you might have to just do a 15 minute assessment or only track what they're saying for an hour spontaneously with you. Not really engaging with them, just to get a feel for it. It's not impossible. And then the other part of the assessment is, is, um, a couple of videos of them alone. And then, um, engaging with you. And if I were going to do like a real assessment where I would actually work with your child. Then I would want to see those, those videos as well, because you've provided so much information, but sometimes like getting a glimpse of things, you know, is even better, but I don't do any kind of one-to-one work. So this is, this is as good as we're going to get. But the nice thing is, is that you have a team that's supportive and is going to listen to this and help you kind of, make some gains, which is super nice. Okay. So, uh, Assessment. If you have a VBMAPP score that suddenly looks different, lower, or suddenly looks higher, you know, really make sure that the person doing it or you, if you're doing it are not over scoring and it's not a regression.The child could be doing worse. The child could be, you just don't have like the instructional control you need to, and, and really testing on the VBMAPP. Our level one is a piece of cake, um, level two and three. It could take days multiple hours. Like that was one part of field, uh, field testing, the VBMAPP in 2006, I remember getting like the best time to do a level one learner. I did it in 20 minutes, um, because he had hardly any skills, but once he has all these skills or your once your daughter has all these skills, it's, it becomes harder.
Step Two:Making a Plan
Mary: Okay. The next step of the turn autism around approach at first step is assessment. Second step is making a plan and that's the other thing that is, there's a whole planning chapter in my book. But, and there's a planningsheet and my book as well. Andsince I didn't really give you instructions, like is in my toddler preschooler course to literally take the one-page assessment and start working your way down the first column. So if I did that with Richa's one page assessment. I, as soon as I got down to safety concerns, um, she has concerns about laundering strangers, traffic, and water. So that would be my very first need on the planning form. Um, and then the next section down is she can feed herself and she, uh, with all kinds of foods, um, and she also sleeps through the night. Those are both strengths, especially to a five-year-old, uh, with autism. So I would, I would make those part of the plan and I would kind of go in that order. So your current plan starts with, you know, a lot of things, language. And so, um, that's one of the mistakes where it's, we're going to talk about soon, um, in the, um, chapter nine, but you know, when we get a child that's talking but not conversational, it seems like we put a lot of pressure on ourselves and all the child to how are we going to get to the next level? How are we going to get these boxes filled up on the BB map? How are we going to get our conversational yet pushing too hard in the wrong direction will often make issues. And I think that if we start more from the SA safety self-care, manding, you know, that's really answering wh questions. That's really where your conversational skills are going to come. Yet you have to do it so carefully. Um, so I would put on the strength column, the eating, the variety of foods with utensil, sleeping through the night, potty trained mostly, self care mostly independent. She, one of the things you wrote that she said on the one page assessment was, I don't want to do something that's, that's negation, that's a contraction. Those, those are things that I would put on the strength, power. I think those are big. And, uh, makes me think like we could probably get more of that, but the, and the more naturally the language comes in, the better she will do as well. And then on the needs column, in addition to some of the things you put, um, safety, uh, noncompliance at bedtime, uh, wiping after a bowel movement, um, needs assistance with dressing.
Mary: So that's, I think on there and thenintraverbal responding, especially with categories. So let's jump down here and talk about what I saw on the intraverbal assessment. Again, this is something that's free of charge as a supplement to the BB map. Think it might be in the book resources. We can link it in the show notes as well, but so the intraverbal subtests has eight groups.This was developed by Mark Sundberg and the eight groups are the first two groups are easy. They're kind of babyish, but yet again, some kids had zero on their intraverbals sub test scores, but you daughter has 10 and 10 on the first two groups, meaning she can fill in the blanks.
Mary: She can twinkle twinkle little. She can say star, uh, the itsy bitsy. She could say spider. Head shoulders knees. And she can say toes, happy birthday to you. Um, she could also answer what's your name, which is in group two and you wash your, she can say hair or hands or whatever. Um, and w for one of them is she is one, two, and we're going to put this in the show notes one, two, and she wrote buckle my shoe. And she didn't know whether to count that as correct. Yes. Anything nearly appropriate is good. Um, but where, what I look for with the plan, because I do have intraverbal responding on the plan as a need, um, is. She falls apart, basically in groups three and group four. Um, on questions, like name some numbers. What are some colors? Um, uh, what's your favorite movie? Um, and then, so those are all, um, intraverbal categories. So you're in my courses now. So, um, module four, the intermediate learner course has my whole category program. It's not about teaching it receptively or teaching the introvert will or teaching the TAC. It's a multiple control program. And I have found over the years, over the decades to be able to teach intermediate learners categories, which will eventually lead to webbing. And that I think is something that you should rewatch, and your BCBA and team members should learn how to do that, that protocol, the other place you fall apart in groups three and four is what's in the kitchen. What's outside. Where are trees? Um, where is a refrigerator? And so this isn't really talked about much, and I don't even think I have like, uh, program or, uh, video, but a rooms program. So what I would do is take pictures of the kitchen. Your kitchen, um, the garage, the bedroom, the bathroom, um, and, uh, outside, and then teach her and maybe take pictures also of the whole room. And then also the dishwasher, the refrigerator, the microwave in the kitchen, the bathroom, the sink, and the bathtub in the kitchen, also the sink. And so then we start teaching her like in the category categorization. Oh, sink. That goes that same cause in the kitchen. Oh, this sink is the bathroom sink. And you see what I'm saying? So I would say the big, the big things, uh, wherever the child gets stuck is you look not at, oh, I have to teach them. Who builds a web. She got a zero. I have to teach it. No, it doesn't matter. It's not important. No, but what is important is teaching categories, teaching rooms, teaching things in rooms, and you can do that with 3d items, like going around and saying, what's this what's this what's in a kitchen.Let's go to the kitchen and you can also do it with pictures. So that's the planning for how we're going to teach intraverbals.
Mary: And then, okay. So we have, um, the assessment, we have the plan. We have to really look at safety needs and the strengths and the needs, and make sure that, um, uh, you are working on getting her more safe, getting her more aware, uh, and getting her happier, um, because if she's throwing things or ripping things up or has four minutes tantrums. During therapy to me, that's not happy enough. Um, and, and I know that the ABA companies out there, um, that take insurance and everything, they do need to document, you know, these things. And, and, but at the same time, I think we really need to work hard to get kids. Doing better and better. Andreducing these things. I did do two video blogs, which I think we should. These are going to be very long show notes, but two video blogs, one's called the three buttons with Dr. Carbone, where the middle button is the button. We want them to be pushing everywhere at the table, away from the table during meals, during dressing. That is the right demands and the right reinforcement. If we don't have the right demands and the right reinforcement, we've got the, the pushing, the self-stimulatory button or pushing the escape button. I don't want to do this. This is stupid. I'm throwing paper to get out of things, whatever the situation is. The three buttons, I think we should really link in the show notes as well as a video blog, bye call tit for tat programming. And it can really happen quickly with intermediate learners is, you know, working on things like who builds a web and teaching remotely, where's the refrigerator. No, we're not teaching this. We're teaching kitchen and seek and refrigerator and, and all these things that are gonna matter, like go to the refrigerator and get the juice out of the, the bottom drawer. And then we also have to teach features of these things, like the drawer, the handle, the, the, um, shell. The freezer, the refrigerator, those are going to be so much more functional than even teaching. I mean, we can't really get to prepositions and pronouns, or I wouldn't worry about them much, especially prepositions until you've got a lot of features. Because if you say, go put that under the, the, on the bottom, you know, it it's confusing.
Swethana: Yeah. She needs to understand first.
Mary: Yeah. She needs to understand the world around her, more in the house and the rooms and the outside versus inside. And, I also have a bonus video called the book program, which is really all about how to get more natural environment teaching, going with books. So you can look at that.
Mary: Okay. The third step is teaching. Um, we take her assessment, her plan, we make sure the goals. If you're working on a preposition goal and pronoun goal, and there was another goal that I was like, eh, probably wouldn't work on that I'm working are getting her to tact on what she's doing to improve communication socialization. I don't really know that getting her to tact as she's doing something is really, should be a big focus at this point. However, I'm also not a part of the IEP team. I have no idea what her, what her goals look like. Just make sure the goals are meant for her and not meant for, you know, just kind of the goals that we put together for most intermediate learners. Make sure you also have goals in the plan to reduce, um, major problem behaviors to near zero levels and minor problem behaviors. I would, um, Get down to 20% or lower. That's usually my goal, but for teaching, the third step is you do have 40 hours of ABA, which is awesome. I'm wondering, does she have, she does have an older sister, but does she go to any preschool or anywhere socially now? Or is that still on hold because of COVID?
Swethana: Yeah, that's still on hold because of COVID. Yeah, she used to go to preschool and then once school with her too, it just, we just did a watch old school and just like zoom meetings with her special ed teacher and weeklyone meeting with her SOP and OD. Yeah. Like circle time meeting with her peers. And so it was all on zoom and so hard.
Mary: Yeah. So, I would try if possible to get her back into some kind of socialization next school year. But, you know, again, it's a very personal decision. She's got immune issues. She has seizures, you know, you just have to go with what you can. I mean, you're obviously doing a tremendous job. So for teaching again, I work on an intraverbal program, but it's gotta be really, in my opinion, multiple controlbased on what my findings are over the last decades. Teaching rooms. And I would, I would kind of hold off on the wholepreposition and pronouns, although I do have lessons in the intermediate course on that. And not the one final thing I'll say about the teaching part. The step is I really do think it's impossible for a very gung ho parent like yourself. To take the course take, especially the intermediate course. And to try to maybe read my book and, you know, and, and try to then tell the BCPA or your team or the SLP, what to do, especially with these complex programs, because nobody does it like I do it. And I have actual protocols that I've tried, not just on Lucas, dozens of kids in person I've done case studies, I've published a few, I've presented a few case studies on different receptive to tact transfers and those sorts of things it's complex and anybody can learn. But, I would just say, you know, if you're out there and you're a professional and you're like, well, that sounds like it's no, it really is, quite complex and you can attend a free workshop to see if it might, might be for you, whether you're a parent or professional, just go to Mary barbera.com/workshop. Attend a free workshop. If you like it, I would encourage you to join our online course and community.
Mary: All right. We are getting low on time, but I do want to point out one chapter in the turn autism around book. And that is chapter nine. It's on, it's called talking, but not conversational strategies to expand language. You got a chance to read this chapter. Did you, did you know everything in the chapter? Was it just kind of a review for you since you took the course?
Swethana: Some of it was review, but some of it, like, I think I missed some basics that I did not know in the course, like table time. I just started right off just bringing her to the table with her reinforcement, but I think in your book, you mentioned start with just reinforcements at the table. I missed that point. So I just, I just jumped into the program with the reinforcers. So she was doing well, but then it fell off and then she just got bored of table time. She's like no table time. Yeah. And that the big issue with my daughter is her reinforcements keep changing often. Which is a challenge for the BCBA and the team too. So the BCBA is doing a good job of bringing in your idea of reinforcements into our home and then keeping her busy and then, you know, trying to see which one she likes before placing demands or working on the goals.
Mary: And two reinforcers that I usea lot, especially for intermediate learners is the bears in the cup. Have you heard of that or seen my videos? So they're little plastic counting bears in a cup. And basically it's a token system. However, doing the bears in the cup, I find to be better because you could, you could put, you know, 10 bears by the cup and then you have to get 10 bears in every couple responses. You can put a bear in, so you can have 20 or 30 responses before you let your daughter watch a 20 second clip of a movie or give a piece of a cookie. And one of the things is the variable ratio schedule that the reinforcement rate needs to be a lot higher for intermediate learners. And so the bears in the cup, and then also a clicker or counter clickeris a really good reinforcer, especially for intermediate learnersthat you can go fast. All right, every time you tact, I'm gonna, I'm gonna count. Oh, we're up to 27. Now we can take, um, a little 30 minutes, minute break and watch a video or two minute. I also find this clicker to be really good at the grocery store or in typical preschool. And it's a really good reinforcer.
The Five Mistakes to Avoid When Working with Intermediate Leaners
Mary: So the five mistakes briefly in chapter nine onworking with intermediate learners and the mistakes to avoid is focusing on length of phrases and sentencestoo much.Mistake number two is not knowing how to deal with scripting.Scripting in itself isn't bad, stimming isn't bad. However, if you have a child who's scripting nonstop, and they have all this language to learn. They've got all this language, it can get even more tricky. And so, it's not bad, but if it escalates some kids, if you don't repeat what they're saying, they escalate to aggression or something worse. And so it can become really tricky. Mistake number three is not knowing how to prevent or correct language errors. Mistake number four is hyper-focusing on colors and other pre-academic skills. And mistake number five is focusing too much on talking while neglecting other areas like self care and problem behavior. And then we go through steps to kind of turn things around for those, those, um, kids that are talking, but not conversational. So you want to definitely check out the book and the book resources are free at turnautismround.com.
Step 4:Data Collection
Mary: And the fourth and final step of the turn autism around approach is data collection. We want to use easy data to help us evaluate if it's working or not. You did send me some rate data from the BCBA like out of an eight hour session. She has 0.5, you know, hour per hour of this or that. I find that rate data, especially on an ongoing basis for a smaller behaviors, isn't really all that helpful to me. I prefer partial interval data, which I don't talk about except [00:55:00] for in my courses. Cause it's, it's complicated. I mean, I may have mentioned it. I may have shown that somewhere, but um, I like partial interval data. I do talk a lot about my calendar system, which especially if your child has any medical issues, you could write down if she had a seizure or have her dosage of medication changes, you could write that down.And then for big tantrums, if it really the goal is to get rid of the big. You know, property, destruction and tantrums that last four minutes or 10 minutes or whatever they left. I might consider keeping calendar data in addition to, or instead of rate data. And like I said, your, your ABA team may need to use rate data because that's what the insurance approved or whatever.But we can also add a calendar. We can add ABC data. We can add partial interval data just to help, help us figure out, oh, she vocal protests when we pull potato head out or, oh, when we get to this prompt level for dressing, this is where she has a problem. And I think we want data. That's easy for you to complete, but also makes sense, like without our decades of calendar data, I don't know that Lucas would be in the, as good a shape as he is. And, because it really does guide me and keeps me on track, um, to figure things out. So that's the data I would take orconsider taking. There is a whole chapter on problem behaviors in my book with data collection. And those are described in the book resources as well.
Mary: So I know we went fast and we went long and all of these will be in the show notes, all of the things we discussed. But do you have any questions before we wrap it up about any of those steps or, or things that are lingering in your mind?
Swethana: So what about like the obsessive behavior?If she has, I didn't mention any of it. Oh, it's in the, in the like documents, but she had like a minor obsessive, like she had, she needs to have the cabinet doors and doors closed all the time. And I checked with the BCBA and we are okay to keep them closed. But we're also teaching her to wait, you know, if you have to take a spoon or fork or something from the cabinet, we, we put them high up, but we are teaching her. She immediately goes close the door, mommy, close the door, you know? Um, so she's kind of obsessive in that sense to keep all the drawers, cabinets or doors closed, but we're also teaching her to wait. Is that the right approach? What do you think?
Mary: You know, I'm not a big like fan of like, okay, now we're going to wait, fold your hands and wait for one minute and 20 seconds.Now we're gonna, you know, like I'm not a big. Waiting program kind of person. However, and you know, we have to look at like the whole picture, like if it's an obsessive thing, that's, uh, you know, driving everybody crazy or, you know, like say she wanted the cabinet doors open and you were like, I don't want to, or she wants, you know, to leave the door wide open with the, she doesn't like the screen door or something.That's like, no, that's not, you know, something our family can deal with. But if it's like, the cabinets are usually closed. I mean, even typically developing kids and people somehow. You didn't close the cabinet again, you know, like it's not obsessive, but that's something that I would do it. Yeah. Worry more about the major problem behaviors at this point. I would worry more about that. The tearing up paper, throwing things, uh, throwing yourself on the ground or crying for four or five minutes a day or a session. Um, those would be what I target first. The other thing about obsessiveness is it really could be, it could be a side effect of her seizure meds. I mean, I have no idea, but it could be a mineral vitamin deficiency, you know, if she's not eating right or, um, some kids have Zinc or magnesium deficiencies and, you know, you might want to look into that.
Mary: Just to make sure she's healthy. Um, some kids are obsessive and they need medication. Um, which I did a podcast episode with Dr. Michael Murray, which is one of my absolute all-time favorites and that's episode 28. And you know, I am not opposed to, you know, looking at that, it would become something, you know, if you're saying every time she goes to the kitchen it's 95 times an hour, she's saying close the door, close the door, you know, it's like, yeah, yeah. But yeah, I'm also not opposed to being like, okay, go sit down. Yeah. And, you know, write your name or whatever and, and, you know, go color for a little bit. I just have to keep it open for a little bit. And. And then, you know, have her do something or okay. Go get, um, you know, a snack and sit down and then once I'm finished this, I'll close it. So I would do it more like just naturally extend the time when you're reinforcing it.
Swethana: Than just telling her to wait or like having to, yeah.
Mary: I like it better than my first book too. And it took me like ten times longer to write it.
Dr. Cheryl: I mean, yeah. Yeah. I wouldn't do like a timer or anything. I might be like, Hey, go, okay you go put your shoes away and then, then I'll close the cabinet and even close it when she's not even there. And then that way it's not like she's demanding that you close it and that you're closing
Swethana: Right. Yeah. One of the things that we are thinking about is transitioning her to school. She is she's ready for kindergarten this year, this fall. And we were thinking about half-a-day school, uh, first of the day. And then second half ABA therapy. And I know I watched the advocacy video, uh, on, from your courses, you did mention about having a BCBA from the school districts, uh, you know, on the IEP. Do you recommend certain number of hours at the BCBA from the school? Because from, from the IEP meeting that we had with the school team and I included our BCBA too, we did not include the BCBA hours from their school district BCBA. I know the school district is very good. They have a BCBA, but I'm not sure if there's like one or two or three BCBAs for the whole school district. You know, do you recommend certain number of hours that she, that a BCBA would overlook her case and then collaboration?
Mary: I would worry more about who's going to be with your daughter one-on-one um, if that is a possibility, um, that hopefully could be also at home. So, so you could work at home on things, and then she would know how to, you know, ideally somebody should be taking my courses. So they're like know about reinforcement demands. And, you know, I just feel like the person that is, um, with your daughter, not just two hours a week or 10 hours a month or whatever. If the person next to your daughter, the power professional or one-to-one RBT, would be who I'd want to have training and oversight by somebody who knows what they're doing. Um, [01:03:00] so I do think that, if you are comfortable with COVID and all that, and she could push in to somewhere, I think it would be good because I think, um, she has a lot of language and a lot of skills, and I think going and trying them out will be good. I just worry about the, continuity and the, you know, the people that are with her that know her should be able to at least go in for the transition period. Not like day one, where you're going by yourself and she can't really get her needs and wants known
Swethana: Oh, I see. Okay. Yeah. Okay.
Mary: All right. So before we end, I always like to end the same way. Part of my podcast goals are for parents and professionals to be less stressed and lead happier lives. So any self-care tips or stress management advice you could give to other parents and professionals listening?
Swethana: Yeah. I mean, I've gone through all kinds of, you know, stages of grief, guilt, frustration from, from her diagnosis and, uh, feeling low and all that. But what really recently, I started doing meditation and that's really helping me kind of like positive thinking and all the people in our lives so far, like friends, family. Try to give moral support. And I would say the same to all the parents, especially special needs parents. My sister always tells me special needs kids are born to special parents and I feel that's true. And I feel even more special as the siblings of special needs children. We have to, uh, you know, understand that it's such a young age, but we have our low days with her, uh, you know, problem behaviorsescalating. Good days, very good days, bad days, very bad days. So, but we just, all three of us, my husband, myself and my daughter. You know, positive thinking positively, it keeps saying she's going to be fine. She's healthy, happy, and dependent. She'll get there. We'll just help her. And, and I do believe that that positive thinking creates positive situations that, that your thoughts will become reality. And I would just suggest all special needs parents, especially moms, because we go through that guilt, you know, did we do anything wrong for our children to get that diagnosis? Yeah. So it really helps to be positive.
Mary: You're doing a marvelous job and I think this is a really good, you know, your generosity with sharing your daughters, um, documents and being open and, um, with her, uh, situation, your situation being, um, able to, to help, uh, hopefully a lot of people out there who are struggling with similar things, with different things. But I think positive thinking is definitely the way to go and meditation is a proven strategy to really help. So thank you so much for your time and, hope to see you in the courses going forward. So thanks again.
Swethana: Thank you so much.
Sign up to receive email updates
Enter your name and email address below and I'll send you periodic updates about the podcast.