aba therapy

ABA for Autism: Why is it so Popular and Controversial?

What is ABA?

Applied Behavioral Analysis, or ABA as it is commonly known, is considered by most as the "gold standard" for treating autism. It is a system based on behaviorist theories. Simply put, the presumption is that desired behaviors can be imparted to the child by way of a system of rewards and consequences.

The idea of utilizing rewards and consequences is not new. However, carefully applying rewards and consequences to foster particular and quantifiable objectives is new. ABA enthusiasts point to its success in achieving specific outcomes. Alternatively, opponents argue that at best it's disrespectful and, at worst, can harm the child.

A Brief History of ABA

In 1987 a behavioral psychologist named Dr. Ivar Lovaas first applied ABA to autism. He believed that even profoundly autistic children could change their behavior through the ABA method. The idea was (and is) to extinguish or at least modify behaviors that children with autism exhibit.  The assumption being that the absence of autistic behaviors is equivalent to cure.

Initially, Lovaas didn’t hesitate to employ punishments for the non-compliant child. At times these punishments could be rather harsh. Over time these punishments have been eliminated in most ABA treatments. Punishment is often replaced by "withholding of rewards”.

Regardless of one’s opinion of ABA therapy, the axiom that Lovass set out to demonstrate turned out to be quite accurate. A considerable percentage of the children who receive intensive ABA training learn to behave at least some of the time appropriately, and some even lose their autism diagnosis entirely after years of intensive therapy.

However, the question remains as to whether exhibiting appropriate behavior is the same thing as "being cured."

What Children Can and Can’t Learn Through ABA?

Generally speaking, the intended consequence of ABA is to "extinguish" the particular undesirable behavior and replace it with more desirable behaviors and new skills. To illustrate the point, the therapist may use ABA to teach the child to reduce tantrums and outbursts and its stead to be taught to either sit quietly or make a request verbally while playing with other children on the playground.

However while classic ABA if successful will modify the behavior, there is no intention that it will build social or emotional skills. So, while the autistic child will be taught to greet someone with a handshake, that act won’t be connected with an emotional response toward the other person. The act is divorced from any internal experience.

Why some autism parents and advocates find fault with the therapy
Over the past twenty years or so, ABA, has morphed into a much broader set of techniques and approaches designed to treat autistic children. As ABA has expanded and become more common, there has grown along with it a long list of both advocates and critics. There are three main areas of criticism.  

1. Too Tough on Kids?

Initially, Dr. Lovaas treated people with severe impairments seeking to reduce self-injurious behaviors by using both positive reinforcement and punishment. Over the years ABA practitioners have eliminated the aversive reinforcement. Nonetheless, critics of ABA complain that ABA’s significant repetition is too severe for children.

2. Too Focused on Eliminating Behaviors?

Other critics point to the failure of some ABA practitioners to concentrate on skill development as problem behaviors are being eliminated. They ask, “What are the kids learning to do?” “Is there an alternative to throwing that tantrum besides just being controlled or trying to escape?”

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The objection of Ari Ne’eman, a leading autistic self-advocate, is its focus on transforming autistic people to appear to be “indistinguishable from their peers” — an expression he draws from Lovaas. Because of this, ABA promotes the disengagement of behavior from its emotional content. The child is being removed from his uniqueness.

3. Too Narrow?

Ne’eman is not opposed to structured interventions as a matter of principle. He believes that other forms of interventions that involve structure such as speech and language may be of more long-term value for the child. This would especially be the case for nonverbal children as it would meld behavior and communication into one intervention.

Ne’man argues that such kids could gain significantly from an SLP who could help them to gain access to alternative forms of communication to give them a new dimension of human interaction. The problem with ABA therapy is that while some children are indeed more controllable, they are worse off than before!

ADHD teletherapy

ADHD Myths and Facts: Do you Know the Difference?

There are a lot of myths out there about ADHD. If you have a child diagnosed with ADHD, you have heard more than one misconception that will make it all the more challenging to be of genuine help. After all, you want to know what is true so that you can best support your child. After all, he/she depends on you!

Perhaps the best place to begin is to filter between fact and fiction. Once you know the facts, you are bound to feel more comfortable and confident in your decisions. What is the reality behind some of the most common myths about ADHD?

Myth #1 ADHD isn’t a Medical Condition

Fact: NIH, CDC and the American Psychiatric Association all regard ADHD as a medical condition. The research shows that ADHD is genetic—that 25% of those with ADHD have a parent who has ADHD as well. What’s more brain imaging studies show differences in brain development between kids with ADHD and kids without ADHD.

Myth #2 Only Boys Have ADHD

Fact: Here is a real tricky one. It is true that twice as many boys as girls are diagnosed with ADHD. But this doesn’t mean that girls don’t have ADHD as well. It is just more likely that girls are overlooked and unfortunately remain undiagnosed.

Also, attention deficits among girls present differently than with boys which may account for the girls being overlooked. Whereas boys struggle more with being impulsive and hyperactive, girls are often more “daydreamy.”

Myth #3 ADHD Comes From Lousy Parenting

Fact: People who don’t know your child may think that your child struggles with certain behaviors due to your ineffective parenting, such as lack of discipline. They don’t realize that your child speaks or misbehaves as a result of a medical condition and has nothing to do with your success as a parent.

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Myth #4 ADHD Children Don’t Try Hard Enough to Pay Attention

Fact: What people don’t realize is that children who are suffering from ADHD often are working as hard as they can pay attention. Some of the time they are trying even harder than other children. It isn’t that these children are lazy or lack motivation.

Imagine telling a kid who is nearsighted to take off his glasses and see further away. Well, that’s precisely what you are doing when you say to a child with ADHD, “just focus!” The research shows that children with ADHD have different neural pathways in their brains responsible for focusing that work less efficiently than other children.

Myth #5 Kids With ADHD Will Outgrow it

Fact: Unfortunately most of the children who have ADHD in their early years never entirely outgrow it. That being said, some of the symptoms can either disappear or become less pronounced as the child matures. Besides as children grow older, they often learn management strategies that help them to cope.

Myth #6 The Only Way to Treat ADHD is With Medication

Fact: It happens to be that for around 80% of the children suffering ADHD the most effective treatment is medication. However, there are alternative treatments such as cognitive behavioral therapy. And some other more innovative approaches are being explored as well.

The Benefit of Enlightenment!

And the best part is that now that you know the difference between myth and fact, you are in a much better position to help debunk the myths that others carry around as well!

anxiety stuttering teletherapy

Does Stuttering Cause Anxiety or Does Anxiety Cause Stuttering?

At first glance, it seems to be the chicken and egg question. Which came first? But a closer look at the recent research reveals that there isn’t much of a question at all.

Stuttering: First a little background

Stuttering disrupts the way a person speaks which invariably makes it tough to finish a sentence. Those plagued with a stutter often find it difficult to sound out a word, or seem always to be interrupting their thoughts with an “um" or an “uh."

Research shows that stuttering generally begins in early childhood between the ages of two and five. Nearly 5% of those children who stutter as toddlers will carry their speech impediment throughout their life.

Does anxiety cause stuttering?

The question as to how stuttering and anxiety are related to one another had been the subject of debate in both the speech therapy and mental health worlds for years. Among the professionals, the prevailing opinion throughout the 20th Century was that the cause of stuttering in young children wasn’t physiological but rather was due to psychological factors such as anxiety. It was assumed that children who stuttered were more anxious than their siblings who didn’t.

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Or does stuttering cause social anxiety?

However recent research has shown this presumption to be erroneous. There is little to no evidence supporting that anxiety causes stuttering in children. Studies have shown that those children who stutter aren’t more anxious than other kids.  

In the June 2014 Journal of Fluency Disorders, Dr. Lisa Iverach published an article tackling this point. She intended to raise awareness regarding the impact of stuttering in children as they grow into adolescence and adulthood and their accompanying vulnerability to social anxiety disorder.

Dr. Iverach argued that it is a mistake to dismiss stuttering as a bad habit that children will outgrow. On the contrary, clinical studies have shown that stuttering is a direct cause of social anxiety throughout one’s entire life.

Getting more specific, Dr. Iverach writes that, “One of the main characteristics of social anxiety is the fear of negative evaluation or the fear of being judged. Children and adolescents who stutter may be the targets of bullying, not only as a result of their stuttering but also in response to their displays of anxiety and nervousness."

We all know that children will pick on each other for even the tiniest reason. And who could be a more inviting target to bully than the kid who is incapable of getting a sentence clearly out of his mouth? Sound like a perfect recipe for bullying?

And in some extreme cases, due to the almost guaranteed ridicule that will be suffered at the hands of the other children, the child who stutters may become too afraid to talk at all. Bullying may be too high of a price to pay for the child to express himself.

Dr. Iverach, in taking the problem to its logical conclusion has the following recommendation. She suggests that speech therapy to correct the stuttering while undoubtedly necessary, may not be sufficient — the child who stutters needs treatment for the growing social anxiety that will invariably be suffered as collateral damage.

In other words, the concerned parent must address the psychological facet of stuttering in tandem with the speech problem. In most cases, this will mean some type of mental health therapy as well to address the related psychological issues of the child.

helping children cope

Helping Children To Cope With Divorce and Death: The 5 Stages of Grief

Unfortunately, sometimes children are forced to deal with their grief when their parents get divorced, or one of them dies.  There have been many strategies put forth over the years. However, it is the landmark work of Elisabeth Kübler-Ross published nearly 50 years ago that has become the standard in the field giving grief counselors a critical structure for their indispensable work.

She has identified and explained the five main stages of grief, referred to as DABDA.

Denial
Anger
Bargaining
Depression
Acceptance

1. Denial

Denial is often characterized by such variant reactions such as avoidance, confusion, shock, and fear. It may seem counter-intuitive, but denial is the stage that very often is necessary to survive the immediate impact of the loss. By thinking that life no longer makes sense, or is too overwhelming, the psyche is shutting down and retreating into an unreal world that protects it from the frightening reality.

A child may harbor a false hope that none of this horror is true. Mommy or Daddy will soon walk through the door, and this terrible nightmare will abruptly end. Denial is crucial to help the child cope and survive the grief event. Denial shields the child from becoming completely overwhelmed with grief and thereby prevent its full impact to be felt all at once.

2. Anger

Once the denial and shock start to fade, the healing process begins. At this point, those terrible feelings that the child was suppressing rise to the surface. This next stage often involves frustration, irritation, and anxiety. Once reality begins to descend on the child, the questions arise, “why me?”, “is life fair?”, and on and on.

Because the child cannot comprehend that this could happen, she may direct blame and anger towards others in the family, or towards The Divine. Researchers and mental health professionals agree that although this anger is painful, it is essential for these feelings to be expressed. Anger is indeed a necessary stage of grief.

Experts in the field believe that although it may seem that the child is in an endless cycle of anger, it will dissipate. It has been found that the more truly the child feels the anger, the more quickly the anger will dissipate, and the faster the child will heal.

Whereas in everyday life, the child is instructed to control his anger, there is a different calculus regarding a grief event. Very often such profound loss is accompanied by the sense of being disconnected from reality, that the child is no longer grounded in this world. The child’s life is shattered, and there is nothing substantial upon which to hold. Strangely enough, anger is something to grasp onto- a necessary step in healing.

3. Bargaining

After the anger begins to subside, very often you will find the child attempting to make a deal with The Divine or some family member perceived to be powerful. Perhaps the child will say, “I will never be bad again if you just bring my daddy back!” This is called bargaining, and it is the way the child clings to a desperate yet false sense of hope.

The child feels that perhaps the pain and grief somehow could be negotiated away. So desperate is the child to rid himself of the pain that he is willing to commit himself to substantive changes in his life if that is what is what bringing back his home or loved one requires. The child is saying, “I am willing to do anything it takes to return life to normal.”

Based upon criticism over the years, Kübler-Ross acknowledged that these stages are not necessarily linear and some people may not experience any of them at all. Still, others may experience some of the stages and “skip others”entirely. Despite these qualifications, most who suffer grief do indeed travel through these five stages.

4. Depression

Once the child realizes that the negotiation isn’t going anywhere because no one can “make the deal,” she often feels overwhelmed, helpless and empty. These are the telltale signs of depression. Finally, the powerful realization that the person or the home that once was central to life itself is really gone, never to return.

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When this finally sinks in, the child may be seen to withdraw from life, walk around in a fog, feel completely numb, or even decline an invitation to get out of bed.  Being part of the world is overwhelming, there is no interest in being around others, and there is a reluctance even to talk. The “new reality” renders life utterly hopeless.

5. Acceptance

The final stage of grief is acceptance. However, acceptance doesn’t mean that it is okay that my parents are divorced, or one of them died. Instead, it is the felt sense that I am going to make it and be alright anyway. In this stage, as the child reenters reality, her emotions begin to stabilize. The child comes to terms with the fact that life will never be the same, but life can be lived nonetheless.

This is a time of adjustment and readjustment. Some days are good, some days are bad, and then the good days return. Don’t expect the child never to have another bad day – filled with uncontrollable sadness, but the good days will begin to outnumber the bad days.

The fog will leave and engagement with friends will begin anew. Perhaps most importantly, the child will start to understand that while the home will never be the same, nor can the loved one ever be replaced, there is the sense that it is possible to live a new reality.

Reaching his stage of acceptance completes the metamorphosis. This child is now a different person whose capacity to live and experience life is far beyond that child who suffered the traumatic loss that began the process.