Childhood Obesity

The incidence of children who are overweight or obese is a growing concern in Western societies, especially in the United States. Childhood obesity has many potential adverse effects on the socio-emotional and physical well-being of the child; however, early intervention & prevention are proven to be the effective reactive and proactive measures to protect from issues later in life.

Obesity and being overweight are considered in a child with a greater than 20% over healthy weight based on the body mass index (BMI). If the child has a BMI over the 85^th percentile they would be considered overweight, over 95^th percentile, they are considered to be obese. According to the World Health Organization, in the United States, 32% of children are considered overweight and 17% obese.

Aside from health concerns such as diabetes and heart disease, social-emotional consequences may occur. Unfortunately, when polled, other adults and children alike stated they disliked their obese peer and considered them lazy and ugly. Furthermore, children who were overweight were socially isolated, and report emotional, social and school difficulties, which led to low self-esteem.There are a host of risk factors that influence obesity in children some of these include: socioeconomic status; heredity; early malnutrition; amount of time watching TV; family eating habits; and levels of physical activity.

Now, for the good news, we can prevent and intervene! The most effective interventions for both preventative and reactionary interventions target the whole family. Even if not every member of the family is obese or overweight, if everyone eats healthy and exercises, everyone benefits. You can also create an incentive system of rewards not based on actual amount of weight-lost, but on time spent exercising, healthy foods eaten, etc. It is also important to note that research shows that children were better at maintaining their weight loss better than their parents in these systems, which is why early intervention is so important. Furthermore, restricting TV & computer access, removing TVs from children’s rooms, and reducing sedentary time in general can have a positive effect on achieving and maintaining a healthy weight.

There have been pushes at the national level. First Lady Michelle Obama’s Let’s Move! program and the NFL’s Play 60 are two resources to get us all up and doing to promote healthy lifestyles.

Book Recommendation - The Verbal Behavior Approach

This book definitely does not suffer from ample praise. And my sentiments about it are easily earned and not novel; however, after recently finishing the book, I figured I'd share out as a new type of post for this blog.

     The Verbal Behavior Approach: How To Teach Children with Autism and Related Disorders, written by Mary Lynch Barbera, Ph.D, R.N., BCBA-D, is a fantastic, easily accessible book for parents and professionals. The book explains the basics of Applied Behavior Analysis (ABA) and the Verbal Behavior (VB) approach used by clinicians to provide solid, empirical treatment for children with an ASD.

     Barbera’s informal, yet informative conveyance of the subject matter is welcomed. She manages to take complex concepts and explain them in applicable ways. For instance, in her chapter on ‘Developing Reinforcers,’ Barbera tactfully explains how all people, young and old alike, respond to reinforcement.

     In addition to providing valuable information on ABA, Barbera lets the reader into her world as a parent of her own child, Lucas, who has an ASD. She allows the reader insight into her own journey with ABA and her child. This extra touch – the insight from a parent who, in the beginning, was herself uninformed – gives the book a depth that is unseen in a lot of the literature. Additionally, at only 190 pages including data sheets and resources, The Verbal Behavior Approach is at the same time concise and thorough.

     Barbera stays away from being overly technical and she is able to make the language of ABA accessible to parents and professionals alike. As you read, you may find yourself having many a-ha­ moments. In addressing certain topics, she not only gets across the importance of certain teaching targets, but also the rationale behind why they are being taught.

     Parents and professionals, whether seasoned or novice, will benefit from reading The Verbal Behavior Approach. Barbera’s deep understanding of ABA from a clinical perspective and as a parent of a child with an ASD allows for some very insightful, yet down-to-earth explanations of VB programming as it relates to both therapy and parenting. A definite recommendation!

Some Basic Behavioral Principles (The Parent-Friendly Version!)

According to Cooper et al. 1987, a principle of behavior is “a description of a relationship between behavior and its controlling variables.”

Understanding the functions (reasons) why a child is behaving a specific way is important to achieving durable behavior change.  Additionally, there needs to be motivation to behave in a specific way. And lastly, we need to be far more concerned with what immediately follows (the consequence) than what precedes behavior. Seem a little overwhelming? Don’t worry -- we’re going to sparse it all out in under 800 words!

There are four basic functions of behavior. There are attention (e.g., I tap you on the shoulder and you turn and say “Yes?”), tangible (e.g., toys, iPad, play Duck-Duck-Goose), escape (e.g., to avoid a demand or delay a task), and automatic/sensory (e.g., it “feels” good and there is nothing particularly overt or observable happening – it happens inside the organism). Anyone of these (or a few at the same time) may be the reason behind why a child behaves in a certain way. Some children learn maladaptive ways to achieve outcomes (for example, I want your attention, so I cry). When we see this occurring, we need to find a replacement behavior that will serve the same function, but is more appropriate. The ultimate goal is to also teach an equivalent that works better and faster. When a child is crying to get attention it may be far easier – that is to say, requiring less effort – for a child to merely say your name when on the other side of the room. Thus, we may teach a child to ask for your attention by name as a replacement to crying. Figuring out the function (the reason(s) why) a child is behaving a certain way is one of the key principles that Behavior Analysts use to figure what replacement needs to be taught in an attempt to achieve the same outcome that the negative behavior does.

A second principle is motivation. The child has to “want” to do something. In the field, we have a few types of motivation, but let’s keep it basic and just say that if a child doesn’t want your attention at a particular moment, don’t expect them to cry if that’s their way of telling you they want attention.  We also need to look at what can be called satiation and deprivation. If you flood a child with attention (satiate) they may be less motivated to cry for attention. Additionally, if you have withheld (deprived) attention from the child for a long period of time, they may be more motivated to cry if that’s how they’ve learned to get attention.

Lastly, we need to look at the consequences – what immediately follows a particular behavior. So, for our crying example, if a child has learned in the past that if they cry, you start to attend, and they want that attention, you have potentially just increased the probability of crying occurring in the future when they want attention. So, if you were to ignore the crying and wait for an appropriate way for them to get your attention, you would potentially see a decrease in crying and an increase in whatever the alternate behavior is. Furthermore, while it is important to identify certain triggers that the behavior usually occurs after, Behavior Analysts look at the consequences – the reinforcing or punishing effect – to get at a more solid understanding of the behavior. Principles of reinforcement and punishment take time to understand or fully grasp, so they are out of the scope of this blog; however, an upcoming blog post will address this principle with more depth.

Understanding the function of a behavior, the motivation to behave a certain way, and what is following and maintaining a behavior are some of the key principles that Behavior Analysts use when developing interventions. Additionally, these principles hold true for the appropriate behavior as well and apply to all human and non-human organisms. If you want your child to say your name to get your attention, then make sure you are attending to them when they say your name. When we teach a new skill, we follow the appropriate responses with praise and something the child wants. Just remember that all behavior is learned and it serves a function.

That’s our brief, basic overview of some behavioral principles. For more information, feel free to send us an email!

Reference:

Cooper, J.O., Heron, T.E., Heward, W.L (Eds.). (1987). Applied Behavior Analysis. Upper Saddle River, NJ. Prentice Hall.

Sleep Tips

      For all people, sleep is undoubtedly one of the most important factors that contribute to being effective and available throughout the day. For children, a good night sleeps increase their ability to engage in learning tasks, and deprivation can hinder performance and make children more irritable. We are using our blog for this week to discuss some bed time strategies to help children get a great night’s sleep!

1) Limit the amount of day-time sleep. Napping has shown benefits in small increments, but extended naps can make night time sleep more difficult

2) Children need to learn to initiate sleep on their own – a crying child is difficult to ignore, but coming in when they cry condition an attention function & decrease a child’s natural ability to fall asleep

3) If you have been entering the child’s room when they are crying, and then you stop, expect a brief increase in intensity of cries for parental attention

4) If you are concerned with their waking, keep a sleep diary of how long they typically remain asleep and the duration of the crying

5) Keep bedrooms dark and cool

6) Be consistent with bedtimes

7) Using a slow, rhythmic object that your child can watch while trying to fall asleep may make it easier for them

8) If your child needs a snack before bed, make it early and keep it light

9) Create a bed time routine that your child can follow (e.g., bath then pajamas then brush teeth then a story then a hug then lights out)

     All people need a good, quality night of sleep to perform well the next day. If your child is experiencing some difficulties, the above tips may be helpful to get them to fall asleep and help them sleep through the night. Good luck and lights out!

Some Discrepancies Between Teacher and BCBA Prep. Programs at the Masters Level

So, I am one semester away from student teaching for my M.Ed/LBS I, and am getting ready to apply for a BCBA cert. program. Granted that I haven't started my BCBA program, but I've done a fair amount of research on programs, and work in the field --> therefore have met plenty of BCBAs. Had some thoughts on discrepancies between the preparing candidates for the applied fields of special education in the public schools and behavior analysis. I think that, at the end of the day, we are all actually more similar in that we are educators than different in the approaches we may take.

Specific Discrepancies:

1) SPED people get a lot of disabilities training and study, not so much in BCBA training. Counter argument that not all BCBAs want to work with children with disabilities -- fine, but for the ones that do, they need more. Shouldn't be news to an MA, BCBA that the brain of a child with autism has more white than grey matter...

2) SPED people get a lot of training in classroom environments and classroom management. BCBAs have a fantastic understanding of how environmental changes really impact learning and responding, why do SPED people get so much classroom environment stuff that says very little about specific environmental manipulations? Why do BCBAs not get more training on how to help teachers with this

3) BCBAs completely under trained to go into IEP meetings. Don't understand procedural safe-guards, teachers usually well trained, but not to work with BCBAs on an IEP team.

4) SPED folks get a lot of learning theory and pedagogy and assessment, have yet to meet a BCBA who knows the difference between formative and summative assessment. In this same breath, really difficult for BCBAs to evaluate academic curriculum and consumer progress. If BCBAs go into classroom, they should have at least a basic understanding of evidence-based content curriculum because, more so than not, the kiddos who are having behavioral difficulties are having them because of academic demands. Too many problems on a page --> hit staff, etc.

5) SPED folks get little to no formal training on behavior management from a functional standpoint. Additionally, they get no training on how to, in a class period, be able to identify potential functions at that specific time they are seeing maladaptive BX and respond with appropriate consequences/teach a functionally equivalent replacement behavior.

6) Where both camps need improvement -- Positive Behavior Supports. I am always shocked and saddened when I hear either a teacher or BCBA talk about how difficult it is to help one individual kid when they have 30 kids in their classroom. Tier II PBS interventions are fantastic classroom management systems, even when taken out of the context of a more broad School-Wide PBS system. Group those contingencies, make everyone pay into your token system, catch peers in appropriate behaviors and make it look so much better to be doing the right thing than the wrong. Additionally, I find it disheartening when I see small, clinic based groups of 3-4 kids that I hear are "unmanageable."

That's all I got for now. I'll use these thoughts and think of a follow-up for potential directions for the future.

13 Spookishly Simple Halloween Safety Tips

Halloween is a time of year that can create a lot of excitement for children; however, it can also cause some anxiety for parents about their child’s safety. Here are 13 helpful tips for making this, and every, Halloween safe.

1) It is always best practice to accompany your child as they go door to door, even in your own neighborhood. Also, even if you are with your child, try and get a group together – there is safety in numbers

2) Never accept items/candy if they look tampered with or are unwrapped

3) Make sure you bring a flashlight. Even if you begin trick or treating during daylight, the sun can go down quickly

4) Do not take “short cuts” or use alleyways to go between houses

5) Always remind your children to WALK, not run between houses. You never know when that unsuspecting hole, exposed pipe, or branch is going to pose a safety hazard

6) We know children will like to dress up as their favorite character, but try to make costumes as bright as possible, or add some reflective element to the costume if possible. The brighter the better for visibility at night

7) Make sure that masks fit well and properly to avoid obstructing your child’s vision, which can also pose unforeseen accidents

8) Limit accessories if possible. For instance, if your child is Luke Skywalker, they do not need to bring a light-saber and the phaser pistol, and drag along R2D2… It is cumbersome and can cause can trip up your child, causing injury

9) Keep a good distance from candles in bags and Jack-O-Lanterns, and make sure costumes are fire resistant

10) Have a brief talk to your children about speaking to and accepting items from strangers. Additionally, bear in mind that anyone can wear a costume and pretend to be friendly

11) Set a time limit for trick-or-treating. Do not allow it to be a free for all where we try to hit every house in the neighborhood. It’s unrealistic and can cause fatigue

12) Have your child carry some personal identification on them in case they got lost. Include name and adult contact information – and make sure they know where this information is in case they get lost

13) If your child wanders or frequently runs off, make sure you have a safety plan in place ahead of time. Review it, know it, and teach it to your child. More information on this can be obtained from the Autism Wandering and Elopement Initiative

And for our final tip, have fun and be safe. Halloween can be exciting and fun for all members of the family. However, safety is the paramount concern. Enjoy!

About Tooth Brushing

Tooth brushing is an integral daily living task that is vital to ensure dental and overall health. It is also one of the more difficult skills for children to learn and master. For some of our learners who need additional help, we wanted to provide you with some basic information and practical tips as they relate to tooth brushing.
Most developmental cusps are not set in stone in terms of age. Some skills take longer to learn and master, while others happen way before they were anticipated. There are, however, some typical ages when certain skills related to tooth brushing should occur. At 24 months or slightly older, the child should be brushing their teeth with assistance. At around 3-4 years, they should be brushing their teeth with a vertical and horizontal motion. Around this same 3-4 years old time, they should spit out the toothpaste when they’re done, rinse their toothbrush, and wipe their mouth and hands dry following tooth brushing.A little bit after this, we typically see that children are able to replacing the top on the tooth paste, and return their tooth brush and tooth paste to a designated area. And lastly, around 5 ½ years old, children can typically use proper brushing strokes. (Information adapted from the HELP for Preschoolers curriculum). Even if your child is not exactly where they ought to be in the realm in tooth brushing , you do not need to worry! Learning can occur!

Now, for some practical tips that you can use in the home!

- The first step is to desensitize the child to the sensation of having something in their mouth with an awkward feel and taste. This can be started by using a clean, wet piece of cloth wrapped around your finger to wipe the teeth (Please note, if a child bites,neverput your fingers in their mouth). You can start this as soon as you see the first tooth
- If your child is 2 and older, you can begin to introduce the tooth brush. Letting them explore the tooth brush (play with it, mouth it, imitate you using a tooth brush, etc.) is a great first step to introducing this new stimulus
 - Keep it short! A quick tooth brushing is better than nothing at all
- If it’s a matter of the toothpaste being aversive, start without toothpaste and gradually increase the amount
- For children who are presenting with more difficulties, do not hesitate to make brushing happen after every meal to create a routine
- If your child needs physical assistance, standing behind them, rather than to the front or sides, can make the assistance easier on you and less threatening for the child

With these tips in mind, and with appropriate interventions provided by trained and qualified personnel, you are moving in the right direction towards having successful and functional tooth brushing for your child!