World Mental Health Day: 10/10/2017

Today is World Mental Health Day. According to the Mental Health Foundation, one in six adults suffer from a common Mental Health issue (anxiety, depression, work related stress) and Mind reported that 1 in 4 adults will be affected by a Mental Health Issue each year. Unfortunately, many people who suffer from Mental Health issues feel isolated and struggle to discuss their mental health. Many charities and campaigns aim to support people with mental health issues and reduce the stigma and discrimination around mental health including, Mind, CALM, Time to Change, and Heads Together. They want us to start talking about Mental Health.

In the hope to raise awareness and help others who are suffering from a mental health issues, I want to share my story.

Two years ago (almost exactly), I was diagnosed with stress and depression. I went to my doctor as I was struggling with my mood and I was signed off work for a week. In my teenage years I had suffered from Post-Traumatic Stress Disorder (PTSD) and depression so I knew the symptoms, and understood the importance of getting support. The symptoms I faced were low mood and lack of motivation. I found it difficult to get out of bed some mornings and I slept a lot. I also wasn’t a very pleasant person to be around and when I was on my own, I cried a lot. I had a loss of appetite, began to lose weight and I wasn’t take care of myself. My GP was very understanding and I was referred for counselling. Looking back I think a year prior to that the symptoms began to appear, as I started missing days off work and became irritable with friends and family. I also had many issues with my sleep, but didn’t really pay any attention to this at the time! The symptoms slowly worsened until I received my diagnosis. There were several aspects impacting my mental health in the run up to that diagnosis.

I was in an unhappy relationship, and we were saving for a mortgage. The stress of this and the relationship did not help my mood. Unfortunately, a few months before I received my diagnosis this relationship ended, which was the final straw for my confidence. This was an important aspect that affected my mental health, although another main issue, was my work.

I was preparing for the BCBA exam. Which as many of you know or have heard is very hard. I spent a lot of time revising, which added stress to my relationship, and was hard on me. I failed on my first attempt so I was very anxious to do well on my second attempt. I had a very limited window to pass, as my Masters degree would no longer qualify me to do the BCBA exam, as the board had added additional hours of training to the curriculum. I put pressure on myself to pass so that I wouldn’t have to do additional work to obtain my BCBA certification.

I also lack a lot of confidence, generally and in my work. I wasn’t sure if I was ready to become a BCBA as I hadn’t had many years’ experience and was uncertain of my capabilities. It’s very hard when you look at your colleagues and peers and feel that they are more knowledgeable and confident in the field and you wish you could be more like that. Unfortunately, not focusing on your own strengths only knocks your confidence more. As my mental health deteriorated, my confidence decreased more and more. I got caught in a cycle of feeling incapable, and feeling unable to restore my confidence.

Even though I am better and healthier now, I continue to see a counsellor and am open with my supervisor about my personal struggles. I am lucky that she is very supportive. It’s important to recognise when you need support with your mental health. Ways you can do this is by speaking to your colleagues or supervisors (especially if you’re preparing for the BCBA or BCaBA exam). Also it is very important to take good care of yourself. Have a good work and life balance, exercise and find time to relax. You can also turn to GP for advice or a referral for counselling you feel that would suit you.

I also spoke to Jane McCready from ABAA4All to get her perspective on Mental Health as a parent

I was talking to another autism mum the other night who is under huge stress with her teenage autistic daughter and a marriage which has nearly broken down. We talked about her stress levels, day in day out. She looked tired, drawn and desperate. Her girl nearly broke mum’s arm the other day –  she was reaching for a phone to call for help and her daughter yanked back her arm violently. She is pretty sure next time she will actually break a bone, she is getting big and strong.

 I empathised with her as can remember a similar time, when Johnny was little, had only just been diagnosed, and I was still hoping for great things from his eclectic school (hadn’t yet started ABA). 

 I felt I must be a terrible mother. The worst in the world. At soft play centres and the like, all the other mums sat drinking coffee while their little ones scampered around happily and played with each other, safely and co-operatively. I marvelled that they could just let their kids run off. I needed to be with Johnny every single second, clambering one step behind him on the wobbly slide. Why? Was I an over-protective mummy?

 No. I knew from bitter experience the whole range of things that could go wrong if I left him to his own devices. 

 1) he would simply disappear, run away, maybe even out of the centre into the path of a car. He would not come back if called, did not even seem to know his own name. Had no idea that cars were dangerous. 

 2) he would hurt himself or others. Either by accident because, eg, he did not know it’s not safe to hyperactively jump off a 20ft piece of equipment. Or because he would bite, kick or headbutt other kids if in his way. Or headbutt a wall or punch his own head if some small thing did not go his way. 

3) he would destroy property or another kid’s toy or eat something dangerous (I lived in terror of him choking as he would eat everything, off the dirty floors, old bits of rubbish out of puddles etc.)

4) he would not be able to tell me if another kid hurt him, as was non verbal. Though not non vocal. All day long he never ever stopped a high-pitched squealing – sometimes happy, sometimes sad, but always very loud. People would stare and then complain. 

5) he wasn’t yet toilet trained and nappies could leak. 

 Oh I could go on. It was the same at home, only worse as he had developed a mania for trying to flood the house or post everything he could find down the floorboards or behind radiators. If asked to stop? Tantrums, headbanging on (concrete) floor, biting me. 

 I lived in fear he would break someone’s nose as he had a habit of suddenly headbutting violently forwards or backwards. I spent literally 18 hours a day (he didn’t sleep much) stopping him from hurting himself or others. His sister was only a bit older than him, and I had to protect her often from his rages or headbutts. 

 Mealtimes were another battle: he literally only wanted to eat chicken nuggets and chips, would throw all other food at me or all over the floor. I remember crying as I cleaned ketchup and peas off 100 soft toys in the toy box.

 I am a very strong person, I had come from a very challenging senior director role in an American investment bank. But I was on my knees living like this. I think I was close to a nervous breakdown. My husband too. 

When I finally decided to try this thing called ABA (which I was highly sceptical about as my lovely council autism experts had told me it was ‘very intense’ and even ‘horrid’) everything started to change very very rapidly for the better. I learned strategies to redirect his behaviours, and he learned to communicate his needs with words not his fists. 

 So when people ask about the stress of setting up a home ABA programme, I say yes, there were strains. Finding and keeping tutors. Having people trooping in and out of the house all day. Finding the money. Borrowing the money. Fighting the LA for a statement. Fighting the LA to say eclectic didn’t work and ABA did. Hiring legal help when they refused to look at that fact objectively. Writing a million reports. Keeping the house ever-so-slightly tidy. Day-long team meetings. Learning new techniques. Sticking to those techniques after an 18 hour day. Finding more money. More legal battles. 

Yes, all that was hard.

But compared to the heartache of watching your beloved, golden boy headbutt a concrete floor or his grandfather? Wondering if he would ever talk, or read, or put on his own socks, or use a toilet?”

I also asked her what helped her most to deal with her mental health and stress and she responded

In my early days (pre Facebook!) I found a lot of comfort and help on the Mumsnet SN Children board. Plus, I found comfort with friends willing to lend an ear as I ranted endlessly about autism – often on long, therapeutic park walks. I recommend Mumsnet and Facebook groups to share experiences. A problem shared is a problem halved – talking to others in the same boat can really help

I think there are so many supportive Facebook groups for parents now – my own page ABAA4ALL, Focus Autism UK, Autism Support UK, Child Autism UK.

Special Thanks to Jane McCready for her insight.

 

 

Further information/reading

 

Busy Analytical Bee Newsletter

Busy Analytical Bee: December edition – Depression and Acceptance and Commitment Therapy (ACT)

 

Mumsnet: Special Needs Chat

https://www.mumsnet.com/Talk/special_needs_chat

 

World Mental Health Day

http://www.who.int/mental_health/world-mental-health-day/en/

https://www.awarenessdays.com/awareness-days-calendar/world-mental-health-day-2017/

https://www.mentalhealth.org.uk/campaigns/world-mental-health-day

Time to Change

https://www.time-to-change.org.uk/

Mind Charity

https://www.mind.org.uk/

 

Heads Together

http://www.headstogether.org.uk

 

CALM: Campaign Against Living Miserably

https://www.thecalmzone.net/

Mental Health Foundation

https://www.mentalhealth.org.uk/

 

Statistics

https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/#.WbvjT8iGPIU

https://www.mentalhealth.org.uk/statistics/mental-health-statistics-most-common-mental-health-problems

 

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South East Association for Behaviour Analysis Annual Conference

I hope you have had a fantastic summer holiday reader! Before the summer holidays began I went to an amazing conference that I want to tell you about.

 

The South East Association for Behaviour Analysis (SEABA) formed in 2012 and is a non-profit organisation. They meet four times a year to discuss and share information about Applied Behaviour Analysis (ABA). There began offering an annual conference last year, which allows professionals and parents to come together and learn from one another and share information about ABA. This year the conference was held for two days in June in Tunbridge Wells. Unfortunately, I was only able to attend for one day, but it definitely did not disappoint!

seaba

The first speak was Tony Balaaz who spoke about ABA professionals working alongside other professionals, including Speech and Language Therapists (SLTs), Occupational Therapists (OTs), Teachers, etc.. Tony Balaaz is a parent of a child who received ABA therapy and now works as a Behaviour Analyst and is a Board Certified Behaviour Analyst. It was great to hear him discuss such an important topic.

The second speaker David Miland. David works in Positive Behaviour Support (PBS) and discussed the importance of teaching skills for children and adults to access community and included some real life examples. This is important for many of our clients so this was a very useful talk.

After that we heard from Rosie Crathern and Susan Tirella from Forest Bridge School. Their talk discussed incorporating language and ABA targets into a daily routine. Some parents find it difficult to support ABA therapy in the evenings and weekends, but Rosie discussed about how easily targets can be embedded in a shopping trip or other weekend events. These ideas were really helpful!

After a short break, Serina Tomlinson discussed the use of telehealth in delivering ABA training. Telehealth involves an ABA consultant connecting with a client via a video connection and giving feedback as they conduct a session or practise certain skills. This method has helped in very rural areas, in particular in America, when travelling to some clients can be long and difficult. This has shown great success in supporting consultants to support their clients deliver effective ABA therapy. It was interesting to hear about this development.

Tracy Mapp presented a case study after this. This case study was very interesting as it discussed supporting a young girl developing maths. The programme involved an audio recording that helps pupils learn to be fluent and accurate of multiplication. The girl reported that she felt confident following the programme. It was great to hear such positive results from this programme.

The last speaker before lunch was Sian Kelly, who is an Occupational Therapist. Sian works with children who are receiving ABA therapy and discussed how the team work together to achieve amazing results. It was great to hear how well the team collaborate to help support a child develop stronger motor control and balance.

After lunch, Sarah-Jane Scott, a teacher, discussed about developing curriculum targets that support her child’s needs and incorporate their ABA targets. She showed many of the wonderful activities her children get to do, including water sports and climbing. It was fantastic to see how much these children enjoy these activities and how much they learn during them!

Nick Barratt from Dimensions supports many clients with learning disabilities and Autism Spectrum Disorder. He also serves on the UK Society for Behaviour Analysis (UK-SBA) board.  Nick works with many other professionals delivering ABA services. Nick gave an interesting talk about developing ABA interventions and challenging behaviour.

The last talk of the day was from Amy Miland. Amy discussed a case study of a boy she had been working with. The boy’s parent, Laetitia Castle, joined her to share with us all the wonderful skills they have taught. It was great to hear such a positive story and also the parents perspective of ABA programme and her child’s progress.

As you can see there is a large variety of information available at this conference, including research, practical work and case studies! It was also a great opportunity to network with professionals from many backgrounds, and parents too! There were also stalls with further information at the back, where I picked up information about PECS, Blooming Tree, Step by Step School and Autism Partnership.

 

Thanks to SEABA for organising such a wonderful and informative event! I will definitely be returning next year for the 2018 conference, and hope to attend both days!

certificate

If you want to learn more about SEABA, you can check out their website, and their Facebook page.

The next event I will be attending is in Edinburgh on September 25th and is being hosted by Keys For Learning. The talk is by Bobby Newman and Daniel Mruzek, so if you want to attend this event too, check out the website and register online.

 

Happy Birthday Bee!

So yesterday was Busy Analytical Bee’s third birthday! Hooray!

Just a quick message to thank you all for your support for the newsletter. I am truly grateful to have so many people interested in the newsletter, without the subscribers I would not be able to continue producing it! I enjoy reading and learning about so many different applications of ABA and sharing them with you, so thanks for subscribing, and reading!

3645224092_aabc27e661
Taken from: https://flic.kr/p/6y7J8f

This  June edition is an interview edition and this month I got the chance to put questions to Robert Schramm MA, BCBA! Robert is one of my ABA heroes and has been working in the field for more than 14 years. This edition the article discussing safe driving behaviours, some playground games as Natural Environment Teaching (NET) activities and much more.

bees
THANK YOU

Teaching mands for information

Teaching mands for information can be a difficult task, but very rewarding. Ensure your client has a well developed mand repertoire, and they can request a variety of items and actions, using adjectives, adverbs and prepositions. Also ensure your client can also mand for attention (look, watch this/me, etc.) and appropriately use removal mands (Stop, let go, etc.). These prerequisite skills will be important before you begin teaching mands for information.

 When you are teaching mands for information it is essential that you give the information and that the information is reinforcing. If you give them access to an item, or perform the action for your client, your teaching will be ineffective. Ensure that you teach each Wh, in a variety ways, in a variety of sentences and with different toys, in different environments.

WHAT?

When teaching What, you want you child to use questions to find out what something is. You use the following ideas:

Put a toy in a black bag, look excitedly in the bag and say ‘WOW!’. When your client is motivated and wants to see in the bag (ensure they don’t or cannot look). If your client asks to look in the bag or hold the bag, you can explain that they can’t right now because you are holding the bag. You can keep looking in the bag and continue to be excited by the toy. When your client is motivated you can can prompt “What is it?” or “What’s in the bag?” and you can tell them the name of the toy and praise them for asking. If they then request for the bag or the toy, using the label you gave, then give them access.

HOW?

When teaching How, you want your child to be able to complete an action or access something, but not know how to do it independently. They must be able to complete the action physically (if you have to complete the action for them, teaching will be unsuccessful), but not know how to do the action. Here is an idea of an activity

Place a favourite toy inside a container, for instance a jar and give the jar to your client. If they ask for help, just encourage them, “You can do it, just open the jar”. It is essential that your client doesn’t know that a jar lid needs to be twisted, to make the information functional. When you client is motivated you can prompt them to ask “How do you open it?” and then you can explain “You need to twist the lid”. It is important that they are able to open the jar so this acts as a reinforcer for asking the question, as it leads them to accessing the preferred toy or item. You can also praise them for asking the question that helped them open the jar.

WHERE?

When teaching ‘where’ it is important you put a motivating item out of reach or in an unusual place.

If there is a favourite toy/item that is your client loves and has a regular place, move it before you session, for example, this could be colouring pens. Go with you client to get paper and then when you go to the place where the pen/pencils would be discover they are missing. You can exclaim “Oh no! The pens aren’t here!” and look confused and look around the area. When you client is motivated, you can prompt “Where are they/the pens/pencils?” and then you can respond “Oh I remember, I put them in the kitchen” and let your child go and get them.

N.B. Avoid putting things somewhere that the child can not access, for example your pocket. The information is reinforcing because it allows them to access a toy/item or action from the place.

WHO?

 This will have to be regarding a person or a character. The person would have to be hidden so the information is valuable to your client.

I like making pictures of people or characters your client likes (for example, Thomas the tank engine characters or Disney Princess characters) and making a fishing game with them. You just have to laminate the pictures and then place a paper clip or a staple on the picture. When you fish for the pictures you can show who you caught. If you want to increase motivation for a “Who?” question from you client, ensure they don’t see the person as you fish it, and then look at it excitedly. You can then prompt “Who do you have?” or “Who is it?” and then tell them the name of your character. Your client will need to request the picture separately if they want to see or hold the picture.

 

WHEN?

Depending on your child’s ability, you can give a specific time (2 o’clock, for example) or you can say that the activity will happen after another event or activity. The information is reinforcing because they know an exciting activity is going to happen soon. You can increase the time your client waits as the programme progresses. Here is an activity idea:

Baking would be a good idea for teaching this skill. You could bake some cakes and then let them cool. You can show your client the cakes when they are cool, but explain that you can’t eat them now. This could motivate your client to know ‘when’ you will be able to eat the cakes. You can prompt the question “When can we eat them?” and you could say “After we put icing sugar on them”. This information is reinforcing because they will know when they have done the icing sugar and put some on the cakes they can eat one of the cakes.

 

WHY?

The answer to this question will be a ‘because …’. You may have to act in a way that seems unusual to motivate your client to enquire about the reason behind it.

For example, you could come to your session with a lot of bed sheets and place them on the floor and look puzzling at the sheets. When you have the curiosity of your client, you can prompt them to ask “Why did you bring sheets?” and you could tell them “Because we’re going to build a fort! Come and help!”. Ensure that when you give them the information, it leads to a reinforcing activity so asking for the information was beneficial to your client.

If you have any other great ideas, share them in the comments section!

 

 

 

 

 

Interviews of 2016

Happy New Year Everyone!

 

I hope you have enjoyed the Christmas holiday and the New Years. As we entered the new year I wanted to look back at the interview editions I have released in 2016. It was a great year and I was honoured to have some fantastic Behaviour Analysts join me and tell the readers a little more about themselves.

First was March 2016, when I was joined by the fantastic Christos Nikopoulos. Christos has worked in the field for over 17 years and has published many papers. He has had a particular interest in the development and research into video modelling. He is also a BCBA working in and around the UK. To read the March edition in full, click the link below,

March 2016 – Christos Nikopoulos.

The second edition was released in June and included an interview with Georgiana Barzey. Georgiana is a colleague of mine and I have learnt a lot from her! She is a fantastic BCBA who works in and around London, providing private ABA consultation in a variety of settings. To read the June edition in full, click the link below,

June 2016 – Georgiana Barzey.

The third edition of 2016 included an interview with Lesley Love, and was released in September. Lesley Love has previously worked as a deputy head teacher and a head teacher at two well established ABA schools in London. She is now Board Certified (BCaBA) and working privately in and around London. To read the September edition in full, click the link below,

September 2016 – Lesley Love

The last edition of 2016 was released in December. This edition included an interview with Vincent Carbone. Vincent works in America, UK and Dubai. He previously had a clinic in America and now has one in Dubai. Vincent has over 35 years experience in the field, working with many children and families, publishing many research articles and presenting at workshops at conferences around the world. To read the December edition in full, click the link below,

December 2016 – Vincent Carbone

 

If you wish to subscribe to the newsletter, to ensure you receive all future editions click here. To learn more about Busy Analytical Bee, go to the home page now.

 

Task Analysis

When teaching a skill like “washing hands”, “doing a puzzle” or “making a sandwich” is difficult, you may want to break the task down into a task analysis. A task analysis looks at every individual step of the task and breaks into a chain. For instance, for washing hands, your task analysis may be broken down into;

  1. turn on tap,
  2. wet hands,
  3. pick up soap,
  4. rub soap in hands
  5. put soap down
  6. rinse hands
  7. turn tap off
  8. dry hands on towel.

Depending on your client’s abilities, you may want to add or lose some of the detail. This allows you to teach individual steps and assist with acquisition.

The best way to write a task analysis is to ask someone who is an expert in performing that skill, to observe someone performing the task, or to perform the task yourself. This will give you an overview of each step necessary to complete the task successfully. Here is another example in a data sheet. This is for completing a insert puzzle.

datasheet

The column on the left represents the five steps in this chain. The data is taken as the prompt that is required, FP (Full prompt), PP (Partial Prompt) and IND (independent). The respective data is circled.

Once you have designed your own task analysis for your client and the task you wish to teach, then you will want to begin teaching it to your client.

There are three main ways to begin teaching a skill in this way, backwards chaining, forward chaining or total task analysis. We will discuss these each in turn,

Backwards Chaining

Backwards chaining involves working backwards through the chain. The beginning of the task would be completed for the client, and the client would be required to complete the final step independently. As they begin to acquire the final step, the second from last step is introduced and the client will complete both these steps. The benefit of this is that the client will immediately contact reinforcement when the task is complete.

In the example of the puzzle, on the first four trials I completed the first four steps (red rectangle, yellow square, green oval and blue triangle), by inserting those pieces into the puzzle and then getting my client to do the last piece. I wait for my client to be able to respond independently three days in a row before introducing the next step. On the fifth day, my client is now required to do the blue triangle, and then the yellow circle before I deliver a reinforcer. Here is some fictional data:

bc-data

At the bottom of the data, I calculate the total number of each prompts used. So on day one there was 1 FP and 0 for PP and IND, on the second day there is 0 for FP and PP, but 1 for IND. I transfer these into percentages (number of prompts given ÷ total number of steps) and graph my data. This is what it would look like:(bc-graph

 Forward Chaining

Forward chaining involves working forward through the chain in stages. In the beginning the client would only do the first step and then receive a reward. After the require the first step the second step would be introduced. In this example the fictional data looks like this:

fc-data

On the sixth session the second step is introduced, following three consecutive days of accurate responding on the first step. On the twelve session the third session is introduced, and this continues until all the steps are being performed independently in the sequence. This is how this data looks when transferred into percentages and graphed:

fc-graph

Total Task

Total task involves the client completing every step of the task and the adult providing necessary prompts for each step.

tt-dataDuring every trial the client is expected to complete every step, and the level of prompting differs for each step. In the first session, on the first step a full physical prompt is required, but on the fourth step the client is able to do it independently. Here is how I graphed the fictional data for this total task chaining:

tt-graph

Remember to talk to your consultant or BCBA if you are planning to teach a complex skills, they may have some guidance and advice that will help you devise a task analysis and implement it successfully.

Good Luck!

Please keep in mind that the data used here is fictional, and should only be used as a guide to understand the concepts discussed in this blog. Thank you!

Ethical issue: Working too hard

This is an important ethical issue that I think doesn’t get spoken about enough. We usually discuss gift giving and exchanging therapy for other services (for example, the hypothetical situation of “my client has a garage, and will do my M.O.T for free, should I accept?”), but I have never heard this one being discussed and I think it’s important for people who are beginning their career in ABA know about.

Saying yes to extra sessions can have serious ethical implications. As a young ABA tutor, beginning my career, I was in a position when I was willing to do extra sessions and would accept extra sessions regularly.

I was collecting hours for my BCBA exams, I was saving for a mortgage and I am a nice person (I wouldn’t be a good therapist if I wasn’t). When I was asked to do extra session, I was usually very willing.

This is an ethical problem because sometimes when you begin saying yes, you find it difficult to start saying ‘No’. There can be any number of personal reasons why you feel pressured to say yes, or don’t want to say no.

But you can burn yourself out! You can become stressed, and you may spread yourself too thin. This can not only affect your health (in a number of ways, sleep difficulties, you might get sick more frequently, or worse), and it can affect your ability to provide a good quality services to your clients.

The following quotes are from the Behaviour Analysts Certification board (BACB), Ethical document, the Professional and Ethical Compliance Code for Behaviour Analysts.

“1.04 (c) Behavior analysts follow through on obligations, and contractual and professional commitments with high quality work and refrain from making professional commitments they cannot keep.”

You may be able to keep these commitments, or you may start falling behind if you take on too many extra sessions. Don’t let this happen to you.

“1.05 (f) Behavior analysts recognize that their personal problems and conflicts may interfere with their effectiveness. Behavior analysts refrain from providing services when their personal circumstances may compromise delivering services to the best of their abilities.”

You must be able to balance your personal life and your professional life. When you are finding it difficult to cope you must recognise this and prevent this from impacting your services. This may been cutting back on sessions until you are feeling better.

“2.09 (a) Clients have a right to effective treatment (i.e., based on the research literature and adapted to the individual client). Behavior analysts always have the obligation to advocate for and educate the client about scientifically supported, most-effective treatment procedures. Effective treatment procedures have been validated as having both long-term and short-term benefits to clients and society.”

It is the responsibility of the Behaviour Analyst to ensure the client receives effective treatment. You must first take care of yourself, this will ensure you are able to provide the best service.

Make sure you have a nice health balance between your personal and professional life. Work hard, but ensure you find time to see friends, catch up on your favourite TV series, or read a book.

If you are feeling concerned about your health, please speak to your supervisor or the families you work with. They will definitely be supportive and understanding. You may also want to speak with your GP if you have a recurring health issue.