Every week in my graduate program, I’m tasked with completing online video content which culminates in an exam at the end of each week. It takes most of my weekend to complete the material so I will be able to focus the rest of the week on practicum work with clients, supervision and further study time. But folks, the video content is honestly some of my favorite hours spent because it is in the quiet of these moments that I hear Jesus speaking the most.
My first thought ~ I could listen to Dr. Patrick McGreevy talk for hours.
My second thought ~ His testimony brings tears to my eyes.
My third thought ~ This is the stuff Jesus is made of right here.
Dr. McGreevy was in the middle of stressing the importance of not responding (other than physical management if necessary) during disruptive, problematic or dangerous behaviors to self or others that can often be seen while teaching alternative more functional behavior. This would include not providing reactions such as directing attention to the person or allowing their ability to leave the situation.
This task of strengthening across the verbal operants is a super fancy term for teaching God given needs inherent in every living human person on earth. Because it is teaching a repertoire that allows us to fully and meaningfully connect with others including God. Without this repertoire or with lower functioning areas of this repertoire, we can exhibit a lot of inner or outward pain displaced as ugly hurtful behavior.
Behavior as believable to the person in their reasons for doing it as breathing is to staying alive. Yet along with it, a persisting void in the human heart.
You know what Dr. McGreevy said about this kind of behavior? Do not respond with attention but do not allow the person to get away from the more functional task either. Why is this so important? Because enough people have let them. Dr. McGreevy challenged those of us serious about behavior analysis to understand the urgency of staying the course. He used the words ~ Person up.
His strong words immediately took me back to my introductory coursework on ethics. Ethics…quite a loaded word right? I don’t know about you but I’m certainly not without human fault in the area of ethical perfection. As far as I’m concerned the only human who lived with perfect ethical conduct was Jesus. It is why Behavior Analysts have ethical guidelines a mile long because “person-ing” up can not cross the lines of other relationship.
Stopping the cycle means a person needs a human connection who will not leave. Only then can we ever begin to develop connection on progressively higher levels. Friends, this is why knowing Jesus is so important.
Person-ing up is to exemplify the character of Jesus and that is gigantic responsibility. For the purposes of my work, it is also the responsibility of a behavior analyst.
Testimony from Dr. McGreevy:
A boy he worked with named Stephen was in and out of special education programs who exhibited dangerous problem behavior when being taught to interact with others. Stephen had a diagnosis of oppositional defiant disorder. In the past the boy was left alone, allowed to stop activities with others or in some cases moved to an entirely different school setting when his behavior had become so dangerous that getting away from him seemed the only viable option. Dr. McGreevy worked with Stephen over the course of some time, not allowing him to escape the alternative functional tasks. In some cases it meant starting again the next day but the same task began again exactly as it had been before. Sometimes physical restraint was necessary when Stephen’s behavior was so dangerous it was harmful for those involved. The process was always the same, the alternative task did not go away and the dangerous behavior did not make it go away.
Over time, Stephen made so much progress that he was placed in a general education setting with his peers. Stephen would come back to visit Dr. McGreevy at times and on this particular day that Stephen visited he was working with a younger boy who also had behavioral challenges. As a matter of fact during this particular visit and in that particular moment Dr. McGreevy was holding the boy from attempting to stab peers around him with a pencil. Stephen approached the classroom and asked if he could talk with the boy. He didn’t ask to let him go from the restraint but simply asked if he could talk to him while he remained held. After having permission, Stephen kneeled down next to the boy and offered a statement. His advice…you can stop doing this now because he isn’t going any where.
What happens when children like Stephen become adults with dangerous behavior and unlearned connection? At best, protective equipment and/or numerous psychotropic medications. At worst, behaviors ending in death.
This is deeply important stuff. A void in human connection can and will create pain even a small child can recognize on some degree. In its absence we see destructive behavior in its place.
Because God created our hearts for connection.
There are days my job requires the very most of this truth and it is the reason why behavior analysts do this work. Last week one of my young learners did something similar to Stephen when instructed to do a task. She stood up from the chair, walked over to me, grabbed the top of my head with both hands and twisted her fingers around my hair. With hair in tote she pulled me up out of the seat laughing during the entire episode. If it weren’t for her BCBA in the room for supervision I would have needed more help. Once my head was released from the grab she continued to climb the partition up the wall to get to the exit. After a few minutes of scaling the partition she climbed down and tried to grab my head again. These attempts continued among other self-sensory alarming behaviors. All the while no reaction from us even during the most dangerous of the aggressive behavior which thankfully stabilized and physical restraint as was the case in the Stephen testimony was not necessary.
This momentarily delayed the task with behavior that has reliably gotten her out of situations because enough people have left her alone. In Applied Behavior Analysis, the alternative task may be delayed but it is presented again in its original form no matter how many times it takes to get there.
This is the same child who will throw herself on my lap and sit there in my arms asking for a hug so many moments of the day. At times it pushes me to the limits of my own humanness and every where in between.
It is where the magic lives. 💗
Love by Grace,
I wrote a previous blog post about one of the kiddos I work with each week who is learning to ask for a break. One of the most important things we do in her ABA programming are measuring and recording data.
I could talk all day long about the benefits of ABA but ultimately the data shows us the evidence.
You know that girl I talked about who fractured a wrist? This is her now. 💗
Reason #1: It is based on scientific evidence.
Some topics we teach along the way are coping skills, calming strategies and how to manage anger.
That 100% asking independently without prompting or reminder occurred this week and to say I’m proud of her would be understatement.
Loved By Grace,
I work with six year old identical twins both on the autism spectrum along side an ABA team for which we provide Center based early intervention therapy services several days per week.
One of the programs I’ve been writing and introducing with them currently has been focused on tolerating instruction that is aversive to them and/or accepting stimuli that blocks access to otherwise preferred items or activities.
If that isn’t a mouthful right?!!
Anyone who spends any amount of time with children on the autism spectrum may immediately understand the amount of chaos one can unleash with the kind of goals associated with the word no…not right now… wait… first we have to do this…or it’s time to do this activity you don’t want to do.
In our kiddos case it means sitting and participating in group instruction. An activity that can trigger all sorts of emotions and you might think their heads could explode. But seriously, if left to their own desires these two would be front and center in the middle of Bourbon street collecting as many shiny beads their little hearts could acquire. Our twinsies, they may very well be the future generation of bead manufacturing entrepreneurs in the heart of New Orleans. Love them. ❤️
But before we can get them to that dynamic duo multi millionaire bead making powerhouse we need to shape a tolerance to group instruction. Why you ask? Not because they need to sit still and be quiet for my sake or for ultimate survival in life but because they need to be able to attend to group activity. Doing so allows us to learn in a group setting and in order to learn we have to be able to tolerate activity that allows us to get an education.
This past week was none other than chaotic in the pursuit of twin sittings. Ha ha, get it? Twin cities, twin sittings. Okay maybe I just humor myself.
Day one of the week begins with running away from the teaching space delaying the activity. This was accomplished by continually taking off our shoes. All sorts of chaos with us messengers trying to put the shoes back on in order to get back to the seat. All behaviors that have most likely been reinforced in the past since it has essentially delayed the task of sitting in group instruction and successfully allowed us to escape the situation. More over the people around us keep putting the items back on our feet which provides all sorts of attention AND escape from learning. Bonus!
What do you think these littles are likely to do? Keep taking their socks and shoes of course! Until we stop reinforcing it.
Sure enough without attention for a period of time the lack of socks and shoes on the feet becomes uncomfortable. We now have their own motivation for help putting them back on. The messenger (that’s me) is still the bad lady at this point but will help with the shoes back on after sitting first.. We sit for a minute, help put shoes back on and we ask the messenger (that’s me) for a hug. I’m the all good lady now, Until we get back up from our seat and bite the messenger in the arm. I’m the all bad lady again and yes, being bit in the crack of the arm pit hurts like a mother!
This was all to successfully help the child sit through one education task lapsing approximately five minutes in time and then have the choice to leave the class. We finally sat through one task and could leave the class.
Follow through is the critical element here along with extinction of attention for problem behavior, extinction of problem behavior for escape followed by reinforcement for completing the task. Reinforcement immediately after the tolerated response. Snacks, beads, hugs, praise and encouragement. And we could be done with the task.
Day two of this week begins with a reminder we would be heading to group instruction along with a preference check of their preferred item. Which simply means using what is motivating or reinforcing for them at that moment for the desired response. For my super sassy kiddo this is probably a Little Debbie honey bun. A favorite most days.
Will work for honey bun. Will work even more for beads. Lord help us if they ever actually discover Bourbon Street. But seriously. Lol.
We are now heading to the class area without taking our shoes and socks off. Until we get to the hallway and throw ourself down to the floor. Crying and attempting to kick the messengers face (that’s me again). I’m the all bad lady again and my face is the target. I’d like to keep my face but there are definite moments we are close to losing it.
We see honey bun in sight. We stand up again and begin walking to our seat. We are asking for a hug clinging to my arm as we walk together to the seat. I’m all good lady again. We make it to the seat but throw ourself down to the floor again. This time pulling the messengers hair and hitting my face. Well crap, I’m the all bad lady again. We stop pulling hair and ask for another hug. We sit down in the seat and ask again for a hug.
Sitting down in the seat immediately gets the hug. We sit for the teachers instruction and get hugs AND the honey bun. Hugging tight to the good lady again.
You know what happened that day? She could choose to leave the class instruction after one task but she chose to stay for more and by doing so she got to pick the next song. It was Pete The Cat, one of her favorites of course.
We chose to leave group instruction after Pete The Cat but I could not feel more proud of this super amazing kiddo.
Eventually we will get to sitting through the full class but will do so in the right amount of time and on a schedule best for us. Small steps lead to big outcomes.
Parents or people who love them through the all good and all bad…Know that we see you. 💙
It is incredibly hard to bounce back and forth from good to bad and back again. It means we walk into the ever changing fire with them potentially getting hurt or watching them hurt themselves. And being okay with it.
But do not ever believe for a single second any child is not capable of achieving great things.
We are their calm in the chaos and it’s all good.
And please remember, unlovable human moments does not equal an unlovable person. That couldn’t be further from the truth.
Loved By Grace,
There’s a kind of love God only knows.
They are running around somewhere out there, still believing they are unlovable. But if they ever discover the real truth – how dearly and deeply they are loved by God, and how they sabotage it, that realization would be even more devastating. Eternally devastating. Which is why I pray something, somewhere makes it stop.
Because God thinks they are incredible, beautiful, intelligent, deep and has limitless potential. But pieces of a disorder sees something entirely different in the mirror, so the person it chooses may only scratch the surface of that potential.
At risk for always believing everyone abandons them and no one can love them. Even God. It means they may continue hurting those who try…or be hurt by those who confront those parts of them. Even God.
Spiritual strength they don’t have fighting against a disorder that takes from them and every person who can lose themselves trying – and as sad as that seems, I’m okay with it.
What I’m not okay with is an eternal soul at stake from a disorder that lies to the mind.
There comes a point when you realize God is the only one who can perform a miracle in a person’s life because He is the only one who will not get lost.
It is the most horrifying tragedy I’ve ever witnessed with the most beautiful souls I’ve ever experienced.
Loved By Grace,
I work with a fourteen year old girl with autism along side a team of ABA staff for which we provide in-home therapy based services several days per week. I could work on programming for this kiddo all week long because she is simply the best.
Which I had the chance to do this week. 💙
One of the projects I’m working on currently has been writing a program for teaching the differences between friendships, close friendships and romantic relationships. Additionally these teaching targets will help our learner be able to distinguish the difference in heathy/unhealthy relationships and between appropriate/inappropriate behaviors across social interactions.
It is not uncommon for children and teens on the autism spectrum to exhibit deficits in the area of social skills and therefore teaching programs in their ABA plans serve as an effective means for strengthening these skills.
From an essential living perspective, it is important for all children and teens to understand behaviors in social interaction and be able to discern healthy and appropriate circle of relationships into their adult lives.
Who can use these targets?
How to use these targets:
If you would like to download the index card materials you can find it here:
If you would like an electronic or app friendly resource of the index card materials you can find it here:
Note: Be sure to download the quizlet app on your mobile device before use.
* Tip: Many teens love their mobile devices. Use it to increase motivation for learning! If applicable of course.
* Tip: Star the cards you are working toward mastering OR star a few to break it down into smaller steps for them.
Feel free to reach out with any feedback or if you found this resource helpful. Email: firstname.lastname@example.org
And please remember…
Loved By Grace,
My thoughts this week have been gravitating to a time period in my life that molded me in many ways after walking away from the experience. It was the first time someone told me I had put to words the pieces of them that they couldn’t understand in themselves. It was the first time others recognized my spiritual gift.
About a year and a half ago, God reminded me of this gift and through gentle guidance called me deeper to it. It went like this:
Pay attention to your spiritual gifts; have the courage and faith to serve from them.
I’ve found myself reflecting on this memory from my past for several days but it seems rather fitting today, on World Mental Health Day. Naturally it is tonight, on #worldmentalhealthday, I have the quiet moment in the week to put these thoughts into words.
The first time someone recognized this spiritual gift in me was at an inpatient mental health facility where we were both patients. Both people who needed help. I don’t know all of the medical details of this other persons story and only vaguely remember what I had said to them in group support discussion but we shared a common thread. We were both in our late teens and admitted for suicidal treatment intervention. Whatever I had said hit them hard and the person immediately looked at me and replied , “How do you understand something I haven’t until now when you just said it? You should be the counselor.”
It was a profound moment and the first time I felt a calling to the helping profession. Which was slightly awkward because I wasn’t exactly a picture perfect person of health. Then here I was helping other people. After all, this moment happened at a mental health hospital because I was a beautiful hot mess.
It is no coincidence so many of us helpers have our own dark mountains we have climbed and because of it we understand mental health is a mountain we don’t have to climb alone.
The magnitude of my self-harm was absolutely serious and needed to be addressed in a treatment facility.
You might think an intervention program like this would focus on unconditional love, empathy and understanding for persons like me in so much mental pain. While this is true in totality of the experience, the actual process when it was happening is better described as tough love.
There was nobody there the first night holding my hand telling me everything was going to be okay or how sorry they felt for my pain. There was nobody telling me what I wanted to hear or enabling my unhealthy coping mechanisms. Far from it. All of my belongings were secured away from me. I could not have shoes on my feet with any laces or sleep with a pillow and blanket. I could not go to the bathroom without someone monitoring me. I could not shower without someone in the room with me and would have to dry off without a towel. I was assigned to a private room with no items that could be used to harm myself or others with sleep checks throughout the night. I could have water with supervision. Morning through bedtime was not to be spent in my room alone. The days were structured in group or individual treatment interventions, time with the psychiatric nurses or doctor and the rest of the time completing schoolwork.
At the time I remember thinking this was extreme. I didn’t actually do that much harm to myself and I had explained several times I just wanted a release from the pain I felt about myself. As sick as it sounds the release of attacking myself somehow served as a release of feeling everything so intensely. Albeit harmful instead of healthy release.
After the first few days I was gradually given opportunities back and allowed more independence but I stayed in this hospital for a full month before I was able to go home.
You see, tough love was necessary for all of us who were there to understand we can not be healthy individuals without facing hard truths about ourselves. Taking away all of the distractions, enabling, martyring, self loathing just to name a few in order to confront the distorted and/or delusional thought processes that got us to that point was necessary. This was unconditional love that an unhealthy person can not necessarily see. Allowing us to continue to escape a confrontation of our psyche would just bring us the same cycles repeating itself over again. Because the hard truth is that staying untreated would bring more unhealthy patterns, developing or intensifying more harmful behaviors and bringing with it more mental pain.
The experience taught me lessons about resiliency I would not have taken away without having been there. My World Mental Health Month lessons:
My spiritual gifts are unmistakably healer and teacher. There are times in my life when this has been confused with experiencing God’s love. Truth is it points to love but never in place of God’s love.
With that a picture of my puppy and the story about our encounter with Sam that night. Which will have to be a post for another day but another God at work in our lives and for lives story.
Loved by Grace,
My course opens for the semester today. Next up…principles of developing, strengthening and maintaining behavior.
In behavior analysis, we learn that these tasks often accompany its counterpart which is decreasing responses that are maladaptive, problematic or destructive to an individual in treatment. It is important to understand why we are trying change a problematic behavior but perhaps even more important is developing a new behavior in its place. In many cases this means teaching the skills needed in order to acquire desired change. It is even more important to understand we are not trying to change a person to something they are not but rather helping them achieve a meaningful outcome that is important to them.
I sat in on a continuing education class this past week on the topic of social skills training for individuals with ASD. It could also be useful for individuals with various other DSM-5 diagnoses in which there are disturbances within interpersonal relationships.
The presenter had us begin the class with an experiential activity. The class was divided in to three groups and told there were different types of candy hidden throughout the room. The goal was to find as much candy as possible when each group was instructed to begin the task. Group one was able to begin first. A minute later group two was able to begin looking for the candy while group one could continue in the search. After two minutes group three could begin the task if they could find any candy left.
It is probably not surprising to hear group one had found the majority of the candy and group two had gathered the rest. It is also not surprising that group three was not able to find candy. It was what the presenter instructed them to do next that was the take away to this experience. They told group three to approach the others and ask to have some of the candy.
The various types of candy represents all of social behavior elements important for interpersonal relationships. Group one represents neurotypical individuals without skill deficits. Group two represents individuals with mild deficits and group three represents individuals with severe social disturbances. Group three most certainly felt the limitation on some level before they even attempted the task. They could understand to some degree that this limitation impacted them in their environment. If that wasn’t enough they were then faced with improving their candy situation themselves by interacting with the group who did not experience this limitation.
I don’t know about you but if I was in this scenario over and over again after a period of time I would probably say something not so nice like give me some candy now damn it! You already have enough. Or I might just go up and take the whole freaking pile to hell with it. I have the candy now but I still don’t feel great. So I might throw the candy across the room or maybe just throw it all away because I don’t deserve it. Hopefully you can see the cycle going on here…
In order to be an advocate for individuals we must not forget the overwhelming task of learning behavior we have never experienced. More over begin to understand how problematic behavior has formed to serve a person in the absence of something else. All behavior is communication with our environment.
The primary professor for my ABA program shared a great testimony of this in my Foundations of Behavior course. Dr. Jose Martinez-Diaz spoke of an individual he worked with in this area of social development. He described an adult who had been referred to his care after a second suicide attempt with little to no improvement in his wellness goal. This individual had a history of chronic depression with little to no social interaction who self reported himself as withdrawn from the world. The person in this testimony may have had some type of DSM-5 diagnosis but a specific disorder was not mentioned in the testimony. What Dr. Martinez-Diaz did shared was that this individual grew up in a home with one parent who themselves struggled with severe mental illness. As a child the individual did not experience healthy parental attachment nor learned social skills for relationships from an early age. He came to Jose after several clinicians and having seen a psychiatrist with no improvement. Medication had not been effective, cognitive talk therapy not helpful and the now second recent suicide attempt. This individual stated they had never developed close relationships with others, was lonely, lived alone and felt an inability to connect with others. The meaningful outcome for them would be to experience a close relationship with a significant other.
After assessment Dr. Martinez-Diaz determined this individual had severe deficits in social skills. Assessment in the direct natural environment observing them attempt interactions with others. While many of us know how to initiate appropriate social interaction this individual did not. He literally approached an introductory conversation with hello I’m lonely, I want to get married and have sex with you. Seems self sabotaging right? But it wasn’t to him.
None of these other therapies had been effective because it wasn’t targeting the function of the problematic behavior, observing it directly and then teaching the behavior necessary for their desired outcome.
The intervention plan identified the deficits present and the goals for teaching these skills. The individual spent intensive time with the behavioral staff with training in conversational activities with contingency of reinforcement toward acquisition. He was trained on appropriate hygiene, conversational skills, role playing video recorded sessions practicing asking open ended questions and play back of inappropriate conversation examples. Play back of his improvement with making eye contact and active listening skills. These tasks were broken down in to small steps and as each element was mastered the next set of social skills was introduced. The final phase of the treatment consisted of the individual wearing a hearing device while walking through the college campus. Staff would instruct the individual to approach a trained volunteer and introduce himself. They would coach him on what to say next and so forth. Data was collected throughout the treatment on his progress. The final phase was to encourage him to generalize the skills learned to his natural environment.
Within two weeks of ending the final phase of treatment the individual reported that he had successfully scheduled a first date. Within a month he came back to Dr. Martinez-Diaz with a different problem. He had met two people and he now had too many dates for it not to conflict. Jose’s response was he no longer needed him!
This was a pivotal change in the persons life. He was able to overcome a limitation that was holding him back from meaningful connection with other people. Suicidal ideation was no longer present because he had developed behavior that he had not experienced without help. My professor and treatment team had quite literally saved a life.
Which is why he is so passionate about teaching applied behavior analysis.
Loved By Grace,
It is possible to control ones reactions and feelings even when one is faced with frightening hardships. The psychiatrist Viktor E. Frankl has been credited with the following:
Between a stimulus and a response there is space.
It is in that space where we find our power to choose our response.
In our response lies our growth and our freedom.
Many call what I do for a living the behavior super hero’s. I don’t know about super hero but I do know we hold this space mentioned as sacred. We are some epic space stalkers. Major ninjas and we wear black on Friday’s. Just kidding we wear flannel Friday, it’s almost Fall.
We are space stalkers because we will keep you in this space until you get it right. Whatever “right” might be that brings about meaningful change in the persons lives.
Not going to lie, sometimes people get super pissed. I mean, don’t we all want this space to ourselves? I know I do! Do not space stalk me and error correct me when I’m doing it wrong. WTF right? Then it means I have to change. That’s too much work. No thank you. Insert scar on the arm and bruise on my elbow from the past week.
You know what? Jesus space stalks all of us when we let Him. It might even feel like He put our sweet little selves on extinction when we aren’t getting it right. That is a fancy word for ignoring. Nobody there, yep crickets. But the minute we try it His way Jesus is right there beside us. Actually He never left. Perhaps we were just escaping the space stalking? Food for thought.
One of my kiddos learned this escape trick the hard way. Yes, the consequence was horrible. She was probably thinking WTF? If I don’t escape this space stalker lady it means I have to change and that is too much work. No thank you! I’m out of here.
You are probably curious what happened? Well…she stood up to run from the work, fell down mid escape over a chair, landed on her wrist to brace the fall and fractured it. All while we were trying to help her in this space with the different choice. This happened about six months ago and while her broken wrist healed quickly, the memory of it remains for everyone involved. Today she is learning to ask for what she needs by asking for a break instead of trying to escape. Which essentially is her learning that asking for help in this space can be life changing. At the very least it is a heck of a lot better than the six weeks in an arm cast.
Instead of broken bones she has healing.
I often think of the scars on Jesus when He chose the cross. Jesus also had a choice in the space and He chose to heal us. It takes work to let the space stalker change us. In fact we might escape to a few broken bones until we learn differently.
When we accept the help and no longer engage in the escape…Jesus will be our space stalker.
I don’t know about my super hero title in people’s lives with ABA but I do know the super power of Jesus. If we embrace our imperfections, I know love will do the rest. ❤️
Proud to be a space stalker.
Loved by Grace,