Our First ABA session

We had our first ABA session on Monday (July 25th) from 530-830 pm. The BI (Behavioral Interventionist) - Ms. Ashley and the Supervisor - Ms. Yan both came over. Ethan said hi to both of them immediately as soon as he saw them. Ethan gets 12 hours per week of ABA therapy directly. The number of hours was determined based on the Vineland-II Adaptive Behavior Scales and the Functional Assessment Screening Tool (FAST) both from us filling out the forms and the evaluator observing Ethan. According to Ethan's evaluation report from ACES (the company that provides ABA services), the Vineland II has 4 domain areas: Communication, Daily Living Skills, Socialization and Motor Skills. FAST is an indirect assessment of behavioral function. The instrument yields summary statistics for four categories reflecting the behavioral functions of social positive (attention/preferred items), social negative (escape from tasks/activities), automatic positive (sensory stimulation), and automatic negative (pain attenuation). These are too technical for me to absorb! LOL 

For example, we have expressed mouthing as a behavior of concern. Ethan just likes placing an inedible object in his mouth (buttons, corners of shirts, fingers, etc). The frequency of mouthing is estimated to be 5 times per hour. Based on the results of the FAST, the primary potential source of reinforcement of mouthing appears to be automatic positive (sensory stimulation).

Potential Source of Reinforcement	TotalSummary-Mouthing
Social Positive (attention/preferred item)	1
Social Negative (escape from task/activities)	1
Automatic Positive (sensory stimulation)	3
Automatic Negative (pain attenuation)	0

Based on the results above, the treatment goal is to decrease mouthing – by December 2016, Ethan will decrease the frequency of mouthing behaviors to an average of no more than 2 per hour across a three month period. His baseline was 5 times per hour. What's the treatment plan? I don't know yet! Haha I have yet to talk to the Supervisor about it. As soon as I find out, I will share that information.

These are the approved hours:

Behavioral Interventionist-BI  (1:1) ABA Intervention	Direct	12 hours/week
Supervisor (Supervision and Parent Training)	Direct & Indirect	11 hours/month
BCBA Supervisor (Program Development)	Direct & Indirect	2.5 hours/month

Based on the above table, this is not just a therapy for Ethan but it’s also for us – his parents too. Parent participation is key to the success of all of this. We need to stay consistent with the program. The 12 hours per week doesn’t have to be at home all the time, we can have the BI go to the community with us like parks, groceries, restaurants, etc. ACES also offer WABA (Weekend ABA) which is a 4 hour program on Saturdays where we can drop off Ethan and it will be in a group setting along with other kids in the program. They also offer a monthly 4-hour outing with the families like going to the Jelly Belly factory, Tilden park, etc.

Anyway, going back to Ethan's first ABA session, the Supervisor prepared a binder (aka Workbook) for  Ethan with visuals. They went through several pages including matching the head and body of Mickey Mouse Clubhouse characters (which he loves by the way!). To my surprise, he was able to do it. They also introduced the token system, if he completes 2 activities whether it be completing a puzzle or matching, he gets a token. 2 tokens = reward. He was motivated to keep going because he gets 2 minutes of iPad or a fruit snack, etc.

Ethan's Binder / Workbook

Ethan completed this puzzle

Ethan trying to trace with Ms. A's help

His first day went really well and he responded to Ms. A and Ms. Y. He never threw a fit, no tantrums with them. He reacted very differently with them than me. When I was trying to take the iPad away, he was screaming at me but if it was Ms. A or Ms. Y, he never did. It made me think about our parenting skills. Ms. Y recommended for us to always talk to him first and set a timer before letting him use the iPad, a conversation similar to this:

Mom: Ethan, I’m setting the timer to 5 minutes, when the time is up, you have to return it to Mom OK?

Ethan: OK

Mom: What happens if the timer is up?

Ethan: Give it back to  Mom

I tried it, still it didn’t work. He still cried and held on the iPad until I had to take it away from him. I guess, we’ll have to just keep practicing. If he can behave with the BI, I know he is capable of behaving with us too.

Another thing too was the BI uses the iPad to collect data. Ethan has 23 treatment goals (8 from Behavior, 6 from Communication, 3 from Daily Living Skills, 6 from Socialization), Parents have 4 goals for a total of 27 combined goals to be met by December 2016! That is a LOT!!! Anyway, there’s an app that lists out all of Ethan’s goals and every time they have a session, the BI marks the goals whether he has met them or not which is great because we can definitely measure his progress or in which areas he needs help on.  This electronic form of collecting data is a distraction for Ethan because he’s into electronic gadgets! The BI was nice enough to just write down the goals in a piece of paper and record data from there.

This is a long post for me but just wanted to share our first session! ABA is not an overnight thing, it takes a lot of practice for us to succeed and I know we will get there at some point. I am optimistic about this program.