VOL.

3, ISSUE 1, 2013

December, 2012
Affiliated to Association for Behavior Analysis International-USA Volume 2, Pre-conferenc

MARCH, 2013 Volume 3, Issue 1

Presidents word
Sridhar Aravamudhan, BCBA., Bengaluru

The third annual conference of Association for Behavior Analysis India was held at The Park Hotel, in Kolkata on 8th and 9th Dec2012. The program received a tremendous response ,attended by over 200 participants, around 65% of whom were parents of children with autism and other learning disabilities. The rest of the participants were behavior analysts, special educators, mental health experts, occupational therapists, psychiatrists, students doing MS in psychology etc., Dr. Neil Martin, PhD, BCBA-D, Dr. Per Holth, PhD, Dr. Joyce C.Tu, Ed.D., BCBA-D, Ms. Smita Awasthi, BCBA, Dr. Geetika Agarwal BCBA-D and Mr. Corey

Robertson
MS,BCBA

conducted workshop s in the areas of Teaching Play skills, Teaching Social skills, Teaching Joint attention, Managing challenging Behavior, Power of positive reinforcement and Feeding disorders. There were 24 paper presentations supported by video studies on applications of the principles of ABA to teach skills to children on the autism spectrum. We thank the sponsors whose generous funding made the event possible along with the faculty from overseas and India who committed time for this event.

Plans are already afoot for the 2013 conference to be held in Chennai in December. And then there is the World Autism Awareness Day ( WAAD) which falls on 2nd April 2013. Do contact your regions representative ( see http://www.abaindia.org/executive-council.html#mis )

and find out how you can participate in raising awareness about autism. Id urge you to strongly consider becoming a member and supporting our ongoing campaigns and efforts. It only costs Rs. 1000 per year (parents and professionals) and will help us give you periodic updates and engage you in our efforts. Contact me at sridhar.a@aba-india.org. If you can further enlist support of corporates to raise funds for ABA Indias campaigns to help children and families with Autism itd be much appreciated too.

EDITORS MESSAGE
Dr.Geetika Agarwal, BCBA., Atlanta, USA

It gives me great pleasure to bring to you the second newsletter of India ABAI. The theme of the newsletter is the 3rd Annual India ABAI conference, Kolkata, India. I was fortunate to attend, present and also interact with fellow behavior analysts in India. It was especially heart warming to talk to the parents and therapists who are touched by this science. It was a testament to the universal nature of this science and its wide spread applications. This newsletter will recap some of the highlights from the conference. You can also visit the India ABAI website for more pictures and description. This newsletter is also packed with several articles. The opening article by Ms. Amanda Kelly, BCBA, focuses on selecting evidence based treatment, something very important for the parents and professionals to know likewise. Given the range of pediatric feeding difficulties experienced by children with autism and developmental disabilities, Ms. Dawn Berg, BCaBA, provided a great introductory article on the nature of feeding difficulties, some important signs and symptoms. We then tackled another area of significance- toilet training, by Ms. Tammy Frazer, followed by an article on childhood apraxia of speech, jointly written by Ms.Svetlana Iyer and Ms. Vani Rupela. Following our philosophy of

3rd ABA-INDIA CONFERENCE CONFERENCE , 2013

bringing the professionals and caregivers together, this newsletter will regularly bring caregiver stories and contributions in the section Parent Corner. For this edition, we have a grandfather writing about their journey in the field of ABA. Finally, we close with our ethics section and Ms. Sheela Rajaram, BCBA, provides an excerpt from the ethics talk during ABAI Seattle, 2012. To make this newsletter more user friendly, we have put together several resources in the form of websites, ipad apps etc. We invite your submissions and suggestion for the newsletters. Happy reading and hope to see you at ABAI, Minnesota, 2013

Smt. Mita Banerjee, State commissioner for the Persons with Disabilities, West Bengal (Chief guest) being felicitated at the inaugural ceremony

International guests (From left to right): Dr. Per Holth, PhD, Dr. Joyce C.Tu, Ed.D., BCBA-D, Mr. Corey Robertson MS,BCBA, Dr. Neil Martin, PhD, BCBA-D and Dr. Geetika Agarwal BCBA-D

Sincerely, Dr. Geetika Agarwal

ABA-India Founder Trustees and Executive Council Members

Toilet training is a critical life skill for individuals with autism and developmental delays. For a variety of reasons, individuals who have not yet been toilet trained may experience limitations in other areas of development including socialization opportunities, as well as educational, residential or vocational placements (Cicero & Pfadt, 2002). Additionally, individuals may experience a decreased quality of life with issues related to hygiene, irritation of the genitals, physical discomfort, and restriction from participating in typical daily activities (Cicero & Pfadt, 2002). There are a multitude of toilet training books, resources and interventions available to parents and caregivers. One of the most commonly cited resources includes Azrin and Foxxs (1971) rapid toilet training (RTT) procedure. Inherent in this procedure as well as most toilet training protocols, is the use of positive reinforcement in which a preferred stimulus (such as a preferred edible or item) is presented upon a successful elimination / void. Other procedures as cited by Kroeger & SorensenBurnworth (2009) that have been used in combination with reinforcement based procedures include, hydration (providing individuals with larger volumes of liquid to consume), scheduled sitting (individuals are placed on to or next to the toilet during regularly schedule times throughout the day), and elimination schedules or habit training (elimination patterns are tracked according to time of day and treatment is targeted during optimal elimination time periods).

Punishment procedures, although not always identified as punishment such as verbal reprimands, restitution overcorrection whereby individuals are required to clean themselves, their clothing or the environment or overcorrection / positive practice in which individuals may be required to walk from the spot of the accident to the toilet a specific number of times have been used; however, the trend for less aversive procedures appears in the current empirical literature more so than in the past (Kroeger & SorensenBurnworth, 2009). Prompting, (cues/assistance to elicit a target response), and prompt fading (decreasing the level of assistance needed to elicit a response more independently) are components in much of the literature on toilet training and caution must be taken when fading prompts to ensure that the removal of these prompts is not undertaken abruptly.

Toilet Training: A Diaper Fading Case Study

Tammy J. Frazer Ontario, Canada

Despite the number of strategies that are available for toilet training individuals with developmental disabilities, there are some individuals that present resistance to being trained. For some, traditional methods alone have not been effective and a more systematic approach is required to assist these individuals to demonstrate urinary continence Recent literature has incorporated the traditional toileting practices along with transfer of stimulus control procedures. As cited by Kroeger & Sorensen (2009), these procedures involve assessing the individuals tendencies to eliminate away from the toilet (e.g., in the bathtub or in a diaper)

and to gradually alter these antecedents /variables towards the terminal goal (eliminating in the toilet). Given the complexities that may come with rearing a child with autism, it is understandable that many parents may encounter difficulties in successfully achieving urinary continence with their child. The following case example is a demonstration of a procedure that combined both traditional toilet training procedures along with a procedure to fade diaper use and transfer stimulus control; a procedure that was necessary to teach urinary continence for a child with autism. Sarah was an 8.5-year old girl who was diagnosed with autism and lived alone with her mother. She was receiving approximately 20 hours of intensive behaviour intervention each week in her home for the past 3 years however her progress was limited. Sarah could ask for her basic wants and needs by leading others, gesturing towards items, or by using the Picture Exchange Communication System (PECS). She could perform some basic living skills with prompting, imitation and play skills were emerging and she could follow some simple one-step instructions that were paired with gestures. Most skills/targets that were introduced required extensive teaching; they were often not retained and re-teaching of a skill was frequently required. Although her mother and school personnel had attempted urination training on many occasions in the past using visual/picture task strips, first-then picture boards and seating her on the toilet at

various times throughout the day, she had not demonstrated any successful urinary or bowel eliminations while seated on the toilet. During the baseline assessment Sarah demonstrated the ability to remain dry when in a diaper for up to 3-hours at a time; however, there was no consistent pattern / time of day in which she eliminated. It was also observed that when Sarah had not been wearing a diaper she could retain urination and very soon after a diaper was put back on her, she would fully eliminate in the diaper. Initial toilet training occurred only during Sarahs scheduled therapy sessions; she was put into underwear (no pants / skirts) at the onset of her session (approximately 8:30 am) and remained in underwear throughout the session unless the protocol step stated otherwise. During all non-therapy hours, Sarah remained in a diaper. Training intervals during sessions were initially set at 30 minutes, and therapists were to ensure that Sarahs fluid intake was high during the first hour of her morning session. Upon the training interval elapsing, therapists prompted Sarah to request for the toilet using PECS and she was physically guided into the washroom. At this time, therapists replaced her underwear with a diaper pre-prepared initially with a 2-inch hole (what we will call modified diaper) cut into the area on the diaper in which urination would occur. This was introduced so that therapists could see that urination eliminations were occurring as well as to begin

the transfer of stimulus control / fading procedure.

Despite the number of strategies that are available for toilet training individuals with developmental disabilities, there are some individuals that present resistance to being trained.
Initially, Sarah was only expected to eliminate in the modified diaper while being anywhere in the washroom (e.g., bathtub, floor) she was not seated on the toilet at this time. Rather she was provided the opportunity to look at moderately preferred books, as identified by her mother, for up to 3-minutes. If Sarah eliminated in the modified diaper during this time therapists immediately delivered a highly preferred item / book for approximately 1-minute. This item was reserved solely for toilet training; Sarah did not get access to this item at any other time. If no elimination occurred within the 3-minutes, Sarah was put back into underwear and therapy sessions resumed. She was prompted to request toilet with PECS 15 minutes later in an effort to catch the elimination before another 30-minute time period had elapsed. This time schedule was repeated until an elimination success or accident occurred. Throughout the training and during sessions, therapists were to pay close attention to Sarahs

underwear at all times in order to observe the immediate onset of an elimination accident. Upon observing an accident, therapists were instructed to implement an interruption procedure in which the therapist rapidly clapped their hands together and stated pee pee in the toilet! in an effort to pause the flow of urine (similar to the startle statement as described by Cicero & Pfadt, 2002) and subsequently to guide her directly into the washroom to proceed with the current toilet target step. It was important to establish accidents in the beginning as teaching trials versus failed trials. As Sarah was more reliably eliminating in the modified diaper while anywhere in the washroom, therapists were instructed to immediately seat her on the toilet once the diaper was put on her. There was a decrease in the number of elimination successes throughout the next two weeks so therapists were instructed to step back to the previous step (eliminates anywhere in the washroom wearing a modified diaper); it was added that at the onset of any elimination they were to immediately guide / seat her on the toilet to complete the elimination. With this program revision throughout the next few weeks, Sarah began reliably eliminating directly into the toilet while wearing the modified diaper. Given her success, therapists skipped the progressive modified diaper steps four through eight as indicated in Table 1 and began immediately seating Sarah on the toilet without any diaper upon entering the washroom at the

scheduled time interval, which she tolerated without upset. With continued successes, time intervals were gradually increased to 45 minutes at which point Sarah was also beginning to independently initiate / request to use the toilet using PECS. She was also at times reported by her mother to independently walk into the washroom to use the toilet within their home during nontherapy time (unstructured time). Given her progress, timed toileting intervals were discontinued during therapy sessions; she continued to request to use the toilet to urinate and was experiencing zero to near zero accidents during therapy sessions. Sarah remained in underwear and pants / skirts during sessions; and generalization to non-session times was initiated with increasing durations of time in underwear while with her mother immediately following therapy sessions (e.g., 30 minutes, then 1hour). Further generalization occurred with school personnel to assist Sarah with toileting while in this environment and it was reported that she continued to be successful with requesting, eliminating and remaining dry both at school and as well as at home throughout her day.

When teaching urinary continence to individuals with autism and developmental disabilities it is important to examine variables, including both the antecedent and consequences, which may be impacting a clients performance. Subsequently, as in this case example, it is also important to individualize teaching, implement and revise procedures as needed so as to offer individuals greater opportunities to be successful.

Diaper Fading Steps

1. Modified diaper 2 inches client urinates anywhere in the washroom 2. Modified diaper 2 inches client urinates anywhere in the washroom and immediately seated on toilet upon beginning elimination 3. Modified diaper 2 inches client immediately seated on toilet upon entering washroom 4. Modified diaper 3 inches client immediately seated on toilet upon entering washroom 5. Modified diaper 5 inches client immediately seated on toilet upon entering washroom 6. Modified diaper 8 inches client immediately seated on toilet upon entering washroom 7. Client seated on the toilet upon immediately entering the washroom and underwear are removed

This case study illustrates that a combination of strategies can be used to effectively toilet train individuals with autism and that some individuals may require a more systematic approach to acquire this skill.

Paediatric feeding disorders

Dawn M. Berg, BCaBA, Feeding Program Supervisor, Florida, USA

A feeding disorder is identified when a child is unable or refuses to eat or drink sufficient quantities to maintain nutritional status regardless of etiology. Among children with autism, 45-80% experience mealtime difficulties that place them at risk for severe nutritional and medical issues. Furthermore, 33-80% of children with medical, developmental, or other special needs exhibit feeding problems. Typically, children with feeding difficulties exhibit strong preferences for certain foods (by type, texture, color and/or packaging) and consume a narrower quantity of food when compared to their peers. Additionally, mealtimes are often difficult due to elevated rates of disruptive behavior such as crying, gagging, vomiting, and throwing things when presented with nonpreferred foods. The cause of pediatric feeding disorders can be biological such as a cleft palate, reflux or allergies. It can also be the result of a behavioral learning history in which maladaptive behaviors allow escape from the meal or presentation of the unwanted food. It is not uncommon for the problem to morph from medical into behavioral. A child who experiences discomfort when

eating will cry when presented with food and the parents natural reaction is to remove the food,

Common signs and symptoms of a feeding disorder include:

Poor weight gain Feeding tube dependence Bottle or formula dependence Mealtime tantrums, or mealtimes exceeding 40 minutes Distress and anxiety with new foods Inability to increase textures Inability or refusal to feed oneself Extreme pickiness (eating fewer than 12 foods)

thus setting up a behavioral learning pattern that results in feeding problems. Several researchers have suggested that behavioral mismanagement (i.e., inadvertent reinforcement of inappropriate eating patterns) frequently contributes to the onset and maintenance of feeding problems (e.g., Babbitt et al., 1994; Palmer, Thompson, & Linscheid, 1975; Piazza et al., 2003). For example, as mentioned above, if a caregiver uses negative reinforcement by removing the food or discontinuing a meal following the child displaying inappropriate behaviors regarding

eating (e.g. crying, gagging, hitting the spoon), the child is more likely to engage in those behaviors again when presented with less preferred food items or behavioral interventions have been demonstrated to be effective for treating feeding problems in children. A multicomponent treatment package consisting of positive reinforcement and escape extinction is the most commonly used intervention for this problem (e.g., Ahearn, Kerwin, Eicher, Shantz, & Swearingin, 1996; Babbitt et al., 1994; Cooper et al., 1995; Kerwin, Ahearn, Eicher, & Burd, 1995; Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Non-Removal of the Spoon is a common Escape Extinction procedure in which the spoon is held at the childs lips until he or she accepts it. This procedure is often paired with positive reinforcement in which the child gains access to preferred stimuli for accepting and swallowing the bite of food. Antecedent manipulations are also common in the treatment of feeding disorders. The variety, texture or amount is often manipulated to increase acceptance or it can be blended with a preferred food and the

preferred food is slowly faded out over time as the child has success. Each child progresses at his or her own pace. Some children begin eating within a few days of admission to a program, other children progress more slowly and it takes many weeks before they eat.

A childs progress will depend on a number of factors, including, but not limited to (a) his or her feeding history; (b) the extent to which the child has oral motor issues, which impact his or her feeding; and (c) the extent to which the child has ongoing or emerging medical issues (e.g., vomiting).

While the incidence of feeding disorders is high among children with developmental disabilities, research has shown us that a behavioral approach to treatment is an effective way to treat food refusal and selectivity.
articulation errors, and atypical prosody. The American Speech Language and Hearing Associations technical report (ASHA, 2007) on CAS recognizes inconsistency of words in repeated productions as one of the important signs of CAS. For example, Say water may result in woo, tee, tah, aiy on consecutive trials. Thus, children with CAS may have a much stronger receptive vocabulary than expressive one. Another key symptom is choppy, segregated speech in which each syllable is produced as if it were a separate word. Symptoms change over time (Velleman & Strand, 1994), and response to treatment needs to be carefully examined in order to confirm a diagnosis of CAS. A challenge is that, the underlying social communication deficit in ASD may mask the motor speech difficulties which include problems with initiating speech, sequencing speech sounds to form words, and prosodic difficulties (Shriberg, Paul, Black, & van Santen, 2011). Literature findings regarding this overlap are heterogenous and a differential diagnosis is difficult due to lack of consensus in research. While it is important to diagnose children

Childhood
Apraxia of Speech and What It Means for Children

with ASD
Svetlana K. Iyer, MS Ed, BCBA and Vani Rupela, Ph.D.

Many children with Autism Spectrum Disorder (ASD) are non-oral communicators and have great difficulty acquiring speech despite adequate cognitive ability and communicative intent. This inability to communicate may create a high level of frustration and lead to aggression, self-stimulation and/or selfinjury. Some children with ASD may have certain speech characteristics that are consistent with a motor speech disorder called Childhood Apraxia of Speech (CAS).

The word Apraxia comes from praxis which means planned movement. The brain sends signals to the articulators (jaw, tongue, lips, palate) regarding the sequence and timing of movements for the accurate articulation of words. Children with CAS have difficulty with some or all of these processes despite having no obvious oral muscular deficits. Symptoms include atypical vocalizations, difficulties in syllable productions, persistent nondevelopmental and inconsistent

with ASD, one must be careful not to overly diagnose it either. There are currently no comprehensive prevalence data on CAS alone or the ASD-CAS overlap, although it is suspected to be rare (Shriberg et al., 2011).

How does knowing whether your child has overlapping ASD-CAS help?
Such overlap may mean that communication may take longer and be more difficult to acquire and one type of approach may not be sufficient. It is important to note that no two children with ASD or CAS are alike--they are an extremely heterogeneous group and different parts of a childs phonological and phonetic system may respond to various types of treatment approaches that target different aspects of speech production. (Dodd & Bradford, 2000). A well-trained clinician should, therefore, use their knowledge of motor learning the sound hierarchy, and have a good understanding of motivation and reinforcement (have a basis in Applied Behavior Analysis). A combination of techniques is often needed in order to create a treatment plan for a child with CAS-ASD based on his/her individual strengths and needs. It is vital to understand that, because the very nature of CAS, communication pressure (asking them to speak on command) can make it much harder for the child to speak. They are much more likely to successfully produce a word if it is:

a sound effect (e.g., animal or vehicle noise) rather than a real word accompanied by action (e.g., saying whee while going down a slide) embedded in a familiar verbal routine (a song, predictable book, etc.) produced simultaneously with another person produced simultaneously with another communication modality: sign language, gestures, mime, pointing to a picture, etc. produced without eye contact.

So, where does one begin?

Consult a qualified speech language pathologist for an assessment of the childs motor speech skills. He or she may suspect CAS initially and the diagnosis may be confirmed with time; CAS cannot be diagnosed until the child produces words orally. Traditional language therapy focusing on vocabulary and grammar fail to work with children having CAS. However, many of the techniques of speech therapy incorporate procedures of Applied Behavior Analysis (ABA). ABA is based on the principles of antecedentbehavior-consequence, which are translated into various procedures of reinforcement, shaping, fading, chaining, extinction, etc. that can be applied to change behavior, such as speech production. These procedures, if systematically

applied in conjunction with appropriately sequenced steps of motor learning and speech sounds, can lead to improvements. The childs interests, however, must be taken into consideration when selecting target sounds, words or their approximations to teach. If the activity (the production of a specific sound sequence) is not relevant to the childs interests, incorrect speech or none is likely as the motivation is lacking. Cooperation and repeated practice is likely when the therapist uses the childs current motivation and relevant reinforcement. For example, if the child enjoys blowing and popping bubbles at the moment, he is more likely to practice the bah (as an attempt to say bubble) sound over and over at that time. ABA therapists look for naturally occurring or contrived establishing operations (motivation) and utilize them effectively to enhance learning. In addition to ABA procedures, numerous treatment programs that are appropriate to CAS may be found. Children with ASD and CAS need intensive and frequent practice, as an important aspect of motor learning is repetition. Using multisensory and gestural cues help children understand the target speech movement. Target selection of speech stimuli is of utmost importance in CAS. One needs to begin with simple combinations of words such as moo, mow, ma etc. and then gradually increase the hierarchy of difficulty. Certain motor learning principles need to be borne in mind such as providing feedback to the child regarding the utterance. Its principles are rooted in theories of motor learning that

require knowledge of results and knowledge of performance as important prerequisites to learning. This means that the child needs to know whether or not communication has been achieved. For example, if the child says o non-meaningfully, one may sing a song that ends in o such as iyaiyao from a popular rhyme, thus converting it into an intraverbal response. However, withholding the desired object or toy until a perfect response is obtained is not advisable because this type of communication pressure will make speech productions more difficult and it will frustrate the child. Therefore, successive approximations are not only acceptable, but advisable. Repetitive practice will help the child learn a motor pattern. If the pattern is incorrect initially, it can be shaped gradually through feedback, cueing, practice, and reinforcement. Many treatment programs have been listed in the literature. One such program is P.R.O.M.P.T (Prompts for Restructuring Oral Muscular Phonetic Targets), which is a certified training program for therapists developed by Deborah Hayden in the 1970s. It is a technique used in restructuring the speech production output of children and adults with a variety of speech disorders (Hayden, n.d.). PROMPT incorporates specific tactile cues that tell the child what the movement feels like. Since many children with apraxia demonstrate reduced tactile and proprioceptive processing (Ayres, 2005), theoretically PROMPT should improve the childs ability

to make sense of the somatosensory input by adding tactile cues. These are also easier to
fade as the child becomes more successful. Oral Placement Therapy focuses on developing skills in the placement of articulators

and using approximations toward whole words (simple to complex) (Kaufman, 2012). For example,
word pasta may progress from approximations like ah-da, pahda, pah-ta, pas-ta, to finally pasta. The K-SLP incorporates

(Rosenfeld-Johnson, 2012). It progresses from exercises that bring oral awareness and reduce the tactile sensitivity of the oral mechanism to building adequate strength and stability through feeding, then onto functional sounds for speech clarity. It is important to note, however that strength is not an issue for children with CAS. Furthermore, while feeding activities may increase oral awareness to some extent, they will not directly improve speech (Watson & Lof, 2008). Therefore, one should not spend an enormous amount of time and resources on it and forget to focus on functional speech. Phonetic placement This is a method that uses verbal information to instruct the child where to place jaw, tongue, lip in the mouth to produce the necessary movement. Prosodic facilitation : This is a way to use melody and rhythm to provide more indirect input on movements, which is often more successful. Music also provides opportunities to practice varied and exaggerated intonation patterns, simple sound effects, and early developing sounds and words within the types of lowerpressure contexts that facilitate speech in children with CAS. The Kaufman Speech to Language Protocol (K-SLP) is a method to practice syllable shape gestures

ABA/ VB procedures, PROMPT techniques, and melody with successive approximations of words (Kaufman, 2012).

Speech is a highly skilled fine motor activity and it may take a long time to develop. In that time, children need to have a means of communication. Providing access to augmentative and alternative communication (AAC) systems may be necessary for some children in order to reduce the frustration due to lack of speech.
Note that correct models of words should always be given even though approximations are accepted. Children learn from what they hear (via implicit learning) and they will not learn the correct forms of the words unless they hear them consistently (Vihman & Velleman, 2000). Children with ASD are not as good at implicit learning as other children (Mostofsky, Goldberg, Landa, & Denckla, 2000), so this is especially important for them. Speech is a highly skilled fine motor activity and it may take a long time to develop. In that time, children need to have a means of

communication. Providing access to augmentative and alternative communication (AAC) systems may be necessary for some children in order to reduce the frustration due to lack of speech. SStudies (Waller, 1998; Morgan, 2007) show that children who have intact ability to communicate despite the lack of verbal speech have decreased frustration and increase their ability to communicate more effectively using some form of AAC. The use of AAC does not decrease the likelihood that the child will talk; in fact, it usually appears to result in increased speech (Millar, Light & Schlosser, 2006).In conclusion, it is quite challenging for parents and the child when confronted with CAS as well as ASD. As a parent, one must choose the therapy method by studying the evidence carefully and deciding what works best for their own child. However, with early intervention and the right combination of therapy, time, and patience, appropriate verbal behavior can be developed effectively. References:
American Speech-Language-Hearing Association (2007). Childhood Apraxia of Speech [Technical Report]. Retrieved from http://www.asha.org/docs/html/TR20 07-00278.html. Ayres, A. J. (2005). Sensory integration and the child: Understanding hidden sensory challenges. Los Angeles, CA: Western Psychological Services. Dodd, B. & Bradford, A. (2000). A Comparison of three therapy methods

for children with different types of developmental phonological disorder. International Journal of Language and Communication Disorders, 35(2), 189-209. Hayden, D. A. (n.d.). Helping children become risk-takers with their speech and communication. Retrieved from http://www.apraxiakids.org/site/apps/nl/content3.asp?c= chKMI0PIIsE&b=788451&ct=46417 1 Kaufman, N. (2012, April) The Kaufman Speech to Language Protocol: Observational Research Study. Presented at Teaching Children With Developmental Disabilities to Speak: Current Research and Best Practice, Philadelphia, PA. Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49, 248-264. Morgan, A., & Vogel, A. (2007). Intervention for developmental apraxia of speech. The Cochrane Library, (2). Retrieved September 23, 2007, from Cochrane database of systematic reviews. Mostofsky, S. H., Goldberg, M. C., Landa, R. J., & Denckla, M. B. (2000). Evidence for a deficit in procedural learning in children and adolescents with autism: Implications for a cerebellar contribution. Journal of the International Neuropsychological Society, 6, 752-759. Rosenfeld-Johnson, S. (2012, April). Oral Placement Therapy to

Accelerate Speech Acquisition. Presented at Teaching Children With Developmental Disabilities to Speak: Current Research and Best Practice, Philadelphia, PA. Shriberg, L. D., Paul, R., Black, L. M., & van Santen, J. P. (2011). The Hypothesis of Apraxia of Speech in Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 41, 405421. Velleman, S. L., & Strand, K. (1994). Developmental Verbal Dyspraxia. In J. Bernthal, & N. W. Bankson (Eds.), Child phonology: Characteristics, assessment and intervention with special populations (pp. 110-139). New York: Thieme. Vihman, M. M., & Velleman, S. L. (2000). The construction of a first phonology. Phonetica, 57, 255-266. Waller, A. (1998). Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia. International Journal of Language & Communication Disorders, 33(1), 45-70. Watson, M. M., & Lof, G. L. (2008). Epilogue: What we know about nonspeech oral motor exercises. Seminars in Speech and Language, 29(4), 339-344.

10

Guidelines for selecting evidence based treatment: Framework for Behavior Analysts
Ethical procedures originate from community standards (no shirt, no shoes, and no service), laws (no texting while driving), prevailing philosophies (liberal/conservative), individual freedoms (sexual orientation, religion), and a clients attitude and feelings (personal preferences and social validity) (Burch & Bailey, 2011; Foster & Mash, 1999). Though the phrase evidence-based treatment has recently become a catch phrase in medicine and psychology world, it has been standard procedure in behavior analysis for over 40 years (Burch & Bailey, 2011). Applied behavior analysis (ABA) owes no affiliation with a particular intervention; rather it is a scientific problem-solving approach aimed at producing socially significant behavior changes for the purpose of improving quality of life for individuals, families and communities (Kelly, 2012). As stated by the Executive Council for the Association of Behavior Analysis International (ABA:I), individuals who receive behavioral treatment services have the right to a) a therapeutic environment, b) treatment by a competent behavior analyst, c) programs that teach functional skills, d) behavioral assessment and ongoing evaluation, and e) the most effective treatment procedures available (2012)

Amanda Kelly, M.S Ed, BCBA., Boston, MA, USA

Selecting EvidenceBased Treatment as an independent Practitioner:

The combination of working in real-world settings with severe behavior problems certainly presents a unique set of ethical problems for behavior analysts (Burch & Bailey, 2011). So, how do we, as behavior analysts, maintain adherence to effective treatments? One recommendation for behavior analysts is to educate ourselves about treatments and to make it our mission to inform others of the research and support that exists (Zane, 2012). We should select research and literature whose effects have been published, that have been replicated by multiple investigators, and those which use an experimental design that controls for bias. Behavior analysts should also use clear operational definitions for terms, including the independent variable (IV) and dependent variable (DV), and

should assess and program for reliability within and across data collection measures. Interventions designed and overseen by BACB credentialed practitioners should also control and program for internal and external validity, by providing clear, technological descriptions of intervention details. Making the most ethically sound decisions on a daily basis can be difficult and grueling for practitioners. Following these steps can help guide individuals through the process:
Following are the steps that one can take to make ethically sound decisions: >Stay current within the field (maintain BACB certification) >Read professional literature >Interact with behavioral colleagues >Attend behavior analytic meetings >Obtain ethics continuing education (CE) credits >Maintain adherence to science and scientific decision making processes >Take data on effectiveness of procedures used >Adhere to ABA:I and BACB Ethical >Codes of Conduct >Communicate adherence to others and work collectively with other disciplines

11

Selecting EvidenceBased Treatment as part of a multidisciplinary team:

A question often explored is whether or not behavior analysts can participate in treatments with questionable empirical support. The short answer is yes, but under certain circumstances. Though behavior analysts always have the responsibility to recommend scientifically supported, most effective treatment procedures (BACB, 2010, 2.10a), we may be a part of teams that select alternate treatments. As long as no blatant risks or detrimental effects are evident, and after we have presented a behavioral alternative to other procedures or methods (BACB, 2010, 9.01), we may decide to be part of a team that employs alternate treatments. When encountering a situation where the treatment selected is not the one recommended, behavior analysts may agree to participate once they clearly define the goals of treatment, operational definitions of key terms, criteria for mastery, criteria for reevaluation, a measurement system and the dimensions to be measured (Zane, 2012). Individuals, who are affiliated with the delivery of nonbehavioral interventions, are strongly encouraged by the BACB to include a written disclaimer in materials in which both behavioral and non-behavioral interventions are recommended. The suggested description should read as follows: These interventions are not

behavior-analytic in nature and are not covered by my BACB credential (BACB, 2011) Remember, behavior analysts design programs that are based on behavior analytic principles (BACB, 2010, 4.0); and we develop treatment components with technological descriptions while collecting interobserver agreement (IOA) and conducting fidelity checks to assess and prevent procedural drift (Cooper, Heron, & Heward, 2007). Keep in mind that simply because something is accepted practice does not assure that it is right (Kitchener, 1980 in Alberto & Troutman, 1995). People have inevitably engaged in carrying out unethical interventions following orders from others. Even with ethical guidelines, no set of rules can encompass all possibilities. Educators and consultants must be prepared to engage in ethical and moral behaviors, even when their actions are in conflict with guidelines or instructions (Alberto & Troutman, 1999). In such

Executive Council for the Association of Behavior Analysis (2012, August 1) Retrieved from www.abainternational.org/aba/ind ex.asp Foster, S. L., & Mash, E. J. (1999). Assessing social validity in clinical treatment research: Issues and procedures. Journal of Consulting and Clinical Psychology, 67, 320-331. K Bailey, J. S. & Burch, M. R. (2011). Ethics for Behavior Analysts, Second Edition. New York, NY. 2011. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis, 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall. Kelly, A. N. (2012, August 28). Applied behavior analysis. Retrieved from www.behaviorbabe.com Kitchener. (1980). P. Alberto & A. Troutman (Eds.), Applied behavior analysis for teachers (5th ed.). Upper Saddle River: Merrill. Zane, T. (August, 2012). Maintaining Fealty to the Science: Evidence-Based Practice in the Delivery of ABA Services. Unpublished paper presentation at the Endicott Institute for Behavioral Studies Ethics Conference, Beverly, Massachusetts.

situations, it is important for us to remember that our best resource may be one another.
References lberto, P., & Troutman, A. C. (1999). Applied behavior analysis for teachers (5th ed.). Upper Saddle River, N.J.: Merrill.

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GRANDPARENT SPEAKS
Shishir Kant Mishra
Our story actually began when my second granddaughter Roshnee was born. By nature I am a child lover. I can handle new born with comfortable ease of a mother. I play with them and enjoy their company. In Roshnee I noticed that she wont look at the rattle, wont look at the light when pointed and whatsoever sound I make she wont look at me in the eyes. Simultaneously her mother [ a doctor by profession] will say this girl is hiding something in her and will reveal some times later we all laughed. Roshnee grew like any other normal child, all mile stones were age appropriate. Once when not even 2, when she first observed Cranes [Saras in Hindi] at a zoo she raised her hands high up and said Crow itte Bade (italic words in Hindi) [Crows are so big]. We also saw some unusual pattern in her behaviors. She would take 2 glasses and will transfer water from one to other without spilling a drop. We were amazed. She would walk for over a Kilometer [still below 3 yrs.] without asking to be lifted and we marveled at her stamina. On the pavement she spotted a metal knob head used by municipality to mark location of underground tap and would go round and round and we joked that she is mother earth going round the sun. In the house she hardly sat and always kept walking from one

room to the other throughout the day. We considered her a very active child. She however never responded to her name as if she didnt listen but she turned immediately on hearing just a faint crackling sound of the wrapper of some toffee or metallic sound of a coin dropping. She never cried if some other child took away anything she was busy with. [I wouldnt say she was playing with, because she didnt seem to play, let us say she was just handling it]. She wouldnt be attracted towards other children. Slowly it dawned on us that this was not usual pattern and something was terribly wrong somewhere. Her mother learnt it was Autism.

always wanted to with her younger sister and added that whatever be the case she was her daughter and she loved her and accepts her as she was. The importance of these words and total acceptance of my daughter of Roshnee and her Autism came to us thick and fast. Till then we--my wife and Iand my daughter, her husband and their two daughters were living nearby but separately. At that stage, we took some far reaching decisions. We decided to live together so that we could devote our full time to Roshnee. Roshnees parents would pursue their career which for doctors anyway starts late. I would wind up my business. Roshnees parents reposed full trust in us in the handling of Roshnee without which we couldnt have moved much ahead. We decided to

learn more about Autism.

By this time many more features of Autism showed up. Roshnee stopped speaking. She will only pull us towards what she wanted. Her sleeping pattern had gone haywire. She would not sleep till 1 or even 2 AM and would get up early say by 6 in the morning and still remained fresh like a lark. Early intervention was provided through those who knew what Autism was.When Roshnee was 4 years , we learnt that one Smita Awasthi from Dubai, frequently comes to Kolkata[ where we live]and provides input to parents having kids with Autism and that her next visit was due after about

What ? Autism ?? What is that?

Having gone round the world never heard what Autism was. But when it happened I took as something which will be set right with age. But her mother knew better. One day I overheard my daughter [ Roshnees mother]talking to her elder daughter that Roshnee had a problem and that she will not be able to play with her as she had

13

6 months and that then she was in Lucknow. We got in touch with her and rushed to Lucknow with Roshnee. In the train she was up as usual till 1 AM and making all sort of sounds which forced me and my wife to take turn in standing with her in the train lobby. At our first meeting with Ms. Awasthi we were impressed that Roshnee sat with her and enjoyed sitting there and after a long time she spoke bubble while working with Smita. After 6 to 7 days intervention for one hour each day we did notice some subtle changes in her which after so many years are difficult to point out but at that time appeared huge. Ms. Smita told us many things like a.This technique is called Applied Behaviour Ananlysis [ABA in short]. b.We should try to keep the child as happy as possible. c.Smita flattered me by saying [I dont know how she got it] that I was a natural child lover and that I should play with her as much as possible. d.We should always be in control and not the child, which meant that if we say anything to the child to do, then child MUST do it and we shouldnt give up till child doethat, even if it meant making child do it hand-on-hand way.It looked all very well and pleasing. However, real eye opener was during our return journey to Kolkata. Roshnee was still up till 1 AM but she kept herself confined to her berth and her noise level [babbling] was sufficiently low so as not to disturb fellow passengers.We then knew that

ABA was the route that we will take. I joined many yahoo groups dealing with Autism, learnt from opinions/experience of many mothers, and attended all workshops on ABA held in Kolkata by Ms. Smita and others. Having our own NT (Neurotypical)children and a grandchild prior to Roshnee we were practical enough NOT to see everything with the glasses of Autism and have been lucky that this has paid off. We did not attribute every action of Roshnee to Autism or sensory issues and compared any new behavior with that of our NT children. Like most children with Autism, Roshnee was a picky eater. She would eat only 3 to 4 items and nothing more. But we knew this was the case with our NT children, whom we cajoled, forced, and made them eat other things too. We adopted same method with Roshnee against the advice of many parents on Yahoo groups and NOT accepting it as sensory issue. We will put a new item in Roshnees mouth and she will spit it out. We will again put it and she will spit it out. We will continue doing it forcing it till she will gulp [remember Smitas advice---we should be in control not the child!!]. The result is today Roshnee eats every thing we give to her, perhaps is convinced now that we will not give her poison. Over the years we had our short stints with GFSF diet, which was perhaps effective but almost impossible to follow strictly with our North Indian food habits. We also had our weak moments when

we changed her name on the advice of a numerologist, visited some temples, prayed to God but never let go of the ABA based intervention.We continued steadfastly with ABA without wavering and believed that Race against Autism is a marathon and not a sprint, meaning thereby that results will come but slowly. Another advice Smita had given later on that we should keep Roshnee as busy as possible. We made it our endeavour to follow it inspite of our growing age. But writing on this subject will mean another article.

Our motive has been to make Roshnee as much independent and skillful as possible so that her quality of life improves. We believe that Autism is for life but with proper intervention and training, life of a child with Autism need not be a burden on the caregiver. It can be turned into an asset and a caregiver will be happy to have her around. This is our goal we wish to achieve before we [her parents included] close our eyes.

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Excerpts from ABAI Seattle

Sheela Rajaram, M.ADS(ABA), BCBA, Toronto, Canada

The symposium titled Behaviorists Behaving Badly was presented by a panel of accomplished Behavior Analysts, Dr. Mary Jane Weiss, Dr. Jon Bailey, Dr. Paul Dores and Dr. Thomas Zane. The crux of the symposium focused on the issue of Behavior Analysts (BA) using Fad or Pseudo scientific Treatments while steering away from scientifically supported interventions. The BA Code of Conduct and its relation to Evidence Based Practices (EBPs) was frequently referenced in the presentation. The somewhat strained relations between ethics and EBPs are particularly apparent in the intervention/treatment of Autism Spectrum Disorder (ASD), where many treatments lack empirical support. There seems to be a strong need, more so now than before, to adhere to ethical guidelines and evaluate the impact of non-behavioral treatments. Ethical challenges in the field of Behavior Analysis have impeded good quality behavioral practice and in the words of Dr. Dores, ABA has become a technique of its own rather than Applied Behavior Analysis.

As a Behavior Analyst, one cannot walk away from merely assessing the behavior, without proposing a behavior change plan. This leads into Dr. Zanes proposal for systematic and tangible change to minimize bad behavior among BAs. The proposed changes range from increasing course sequence criteria for BACB eligibility to mandatory Continuing Education (CE) credits on EBPs.

RIGHT

In concluding the content of this talk, it would be apt to infer that todays generation of BAs have the advantage of leaning on well-researched and within-context guidelines for responsible conduct. There is no excuse for not maintaining loyalty to the science!

OR

WRONG

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VOL. 3, ISSUE 1, 2013

RESOURCES FOR PARENTS AND PROFESSIONALS

A number of teaching materials are available for you. However choosing the right one can be a daunting task. We have handpicked a few for your easy reference

USEFUL APPS
Able AAC is a value priced, easy to use Augmentative and Alternative Communication (AAC) solution for iPad, iPhone and iPod touch designed specifically for individuals who have difficulty speaking or are nonverbal. Also built in to the application is a configurable home/school daily schedule list, reminder list, checkable task list,reward/motivational system, video and audio learning system. There are free and paid downloads available, check out more at www.ablevox.com

BOOKS
Lynn M. Hamilton, Bernard Rimland. Facing Autism: Giving Parents Reasons for Hope and Guidance for Help A Work in Progress: Behavior Management Strategies & A Curriculum for Intensive Behavioral Treatment of Autism by Ron Leaf, John McEachin, Jaisom D. Harsh, Ronald Burton Leaf - Very good information and is good to use as a compliment to the Assessment of Basic Language and Learning Skills Sundberg, Mark, L., Ph.D. and Partington, James, W. Ph.D. Teaching Language to Children with Autism or Other Developmental Disabilities Partington, James, W. PhD., and Mark L. Sundberg, Mark, L. PhD. The Assessment of Basic Language and Learning Skills (ABLLS) Maurice C., Greene G., Luce, S. (1996). Behavioral Intervention for Young Children with Autism: A manual for parents and professionals by 24 contributors. ISBN:0890796831 Lovaas, O. I. (1981). Teaching Developmentally Disabled Children: The Me Book, Austin, Texas 78757, 1- 512- 451- 3246 1512- 451- 3246 . ISBN: 0936104783 (paperback, 250 pages, University Park Press, 1981). Keenan, M., Kerr, K.P., & Dillenburger, K. (2000). Parent's education as autism therapists: Applied behaviour analysis in context. London: Jessican Kingsley Publishers.

CDs
"The Different Shades of Autism"video produced by the Veronica Bird Charitable Foundation Darold A. Treffert, M.D. In addition to being an exceptional resource for introducing educators, professionals and parents to Autism, "The Different Shades of Autism" is a terrific way to introduce Autism to family and friends.

http://www.______
http://www.helpuslearn.com/: A self-paced training program for ABA http://www.especialneeds,com/: An ecommerce website selling almost all teaching materials required for an early to advanced learner. http://appliedbehavioralstrategies.wordpress.com/author/applied behavioralstrategies/: The website of Missy and Rebecca contains information on a wide range of topics including inclusion, feeding, seizures to family related topics. http://www.behaviorbabe.com: Amanda Kelly, BCBA provides detailed information on a variety to topics related to ABA along with options to download datasheets and other materials.

UPCOMING EVENTS

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Upcoming events in 2013

ABAI 39th ANNUAL CONVENTION : Minneapolis, Minnesota
May 24-28 2013
th

ABAI SEVENTH ANNUAL CONFERENCE : Medira, Mexico

Sunday, October 6Tuesday, October 8, 2013

ABA-INDIA 4th CONFERENCE, 2013 Chennai, Tamil Nadu

December14- 15, 2013

RECENT EVENT: WORLD AUTISM AWARENESS DAY, CHENNAI APRIL 2, 2013

WeCan, an NGO in Chennai, Tamil Nadu
had partnered with city corporates, retail and media for Light It Up Blue campaign.

RECENT EVENT: WORLD AUTISM AWARENESS DAY, BENGALURU APRIL 2, 2013

ABA-India joined with a number of other organizations in conducting an awareness event in Cubbon park, Bandstand Lawns from 4-6pm.

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List of professionals in India

List of professionals and their contact information by City/State BENGALURU

Name

Certification Status

Email Address

Phone

Sridhar Aravamudhan Smita Awasthi Svetlana Iyer Radhika Poovayya Suruchi Sancheti Kinnari Bhatt Jeyameena Dhanabalan Tasneem Hegde Karuna Kini

BCBA BCBA BCBA BCBA BCBA BCaBA ABA professional ABA professional ABA professional

sridhar.a@aba-india.org smita.awasthi@aba-india.org svetimopsa@hotmail.com samvaadinstitute@yahoo.co.in suruchisancheti@yahoo.com kinnari.bhatt@aba-india.org jmeena975@gmail.com tasneem.h@aba-india.org karuna.kini@behaviormomentu m.com CHENNAI gitasrikanth@gmail.com shrups.sharada@gmail.com DELHI

9538001515 8600507070 9686509424 9845018302 9980135754 9945805019 9986687675 9900312067 9844043651

Gita Srikant Sharada Rajaram

BCaBA ABA professional

9840023867 9840049209

Alpa Mahansaria Priyanka Babu

BCBA BCaBA

alpagoel@yahoo.co.uk priyanka.bhabu@aba-india.org KOLKATA

09312142713 09873080117

Julianne Bell Sunetra Dasgupta

BCBA ABA professional

julseybell@hotmail.com sunetra.dasgupta@aba-india.org MUMBAI

9836941777 9903200581

Kamini Lakhani Razia Ali

BCaBA ABA Professional

kamini108@rediffmail.com razia.shahzadali@aba-india.org

9167512819 9987617616; 7666617616

For details visit: http://www.aba-india.org/professionals.html

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WRITE TO US
GUIDELINES FOR ARTICLE SUBMISSION
As an on-going process of ABAIndia to create a platform for parents and professionals alike, we invite you to send us your feedback regarding the newsletter. In addition, you can send across your article regarding behavior analysis or photographs promoting awareness of ABA to editor at the email id: geetikaagarwal@yahoo.com
1. Length: The submission should be between 5001000 words. If you require additional space, the submission can be divided into multiple parts and maybe presented as an ongoing series. 2. Format: For professionals we ask you to follow the standard APA format, 5th edition in your writing. 3. References: Please be sure to cite relevant sources in your article. The list of references should be included at the end of the submission. 4. Submission timeline: A member of the committee will indicate the deadline for your initial draft. After your first submission, you will receive edits within the 1 week from a committee member. Following this feedback, you have 2 weeks to address the comments and re-submit to the committee. Similar format will be followed for any additional and further edits. 5. Case studies: Please be sure to remove any identifying information of the individual included in your case studies. It is upon the authors to procure appropriate consents for publication from their clients/families.

SUPPORT ABA-INDIA
Become a member of ABA India (Affiliate members - Rs. 1000 per year) Making a one-time or ongoing donation Help with fundraising in campaigns across India Help in disseminating information about ABA to rest of the society Assist in organizing workshops in different cities and towns of India Volunteering time

Donations can be made to Association For Behavior Analysis - India, at Oriental Bank Of Commerce, Gurgaon, Haryana 122003 at A/c No. 51671131000593. IFSC code for direct transfer is ORBC0105167. Cheques made to Association For Behavior Analysis - India can also be posted to: Ms. Razia Ali , 407/408-H, Palm Court Complex, Link road, Malad west, Mumbai 400064, (Next to New Infinity MallMalad)

Team
|Geetika Agarwal,BCBA-D Chair of ABA-India newsletter, Georgia, USA| |Sridhar Aravamudhan, BCBA, Bengaluru, India |Sheela Rajaram,BCBA,Toronto, Canada| | Tasneem Hegde, MS, Bengaluru, India |

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