My son started ABA therapy this week. I’ve been working on getting this going for about six months, and as of this past week- it’s finally here! This means that the office visits and interviews are finally over, and now that the first week of therapy is done- I have to admit, it is a bit anticlimactic.
During the first therapy session we actually didn’t involve my son very much at all. That’s because the first session was really more of a meeting between myself, and the staff off the agency providing the therapy. There wasn’t that much paperwork really, however, we did cover basic ground rules and expectations for everyone involved.
What We Covered
- Statement of confidentiality – The standard paragraph stating that the therapists need my son’s information to do their job (which they already have), and that it will be used for his therapy plan, and nothing more.
- Reason for referral – Another short section where the reason I sought ABA therapy was described.
- Background Information – This section covered his current background more so than his history. Things like who he lives with, his age, and what the parents do for work.
- Medical History – This is the full gambit of what has happened in my son’s lifetime, and therefore goes on for a quite a few paragraphs in my son’s case. This section includes what has taken place in the hospital or doctor’s office, as well as the timeline for his developmental delays.
- Academic History – Discusses when my son started early on education, and follows through with describing the steps that have led to his current education plan.
- Assessments – A bullet point style list which shows what assessments have been done on my son. Basically, this is the proof that he is autistic according to multiple doctors and groups.
- Functional Behavior Assessment – This section gets a bit lengthy and starts covering what his current behaviors are, and how we initially plan to address them. Additional info about who is attending the meeting, and things of that nature are covered here as well.
- Definition of Targeted Behaviors – This section is a detailed outline of my son’s primary behavior issues including how they occur, how often they occur, the goal for the behavior, an analysis of the behavior, and what the plan is to address them.
- Parent Interview – This section covers everything that I discussed with the case workers in the months leading up to my son’s first therapy sessions. Basically, it’s a summation of everything I discussed with the various interviewers and case workers leading up to my son being approved for ABA therapy.
- Direct Clinical Observation – This section was a very detailed report of the observations that were made a few months ago when the ABA team came out for an initial in-home visit. They described what I talked with them about regarding my son, and how my son behaved while they were here. This did not cover the office evaluations, meetings, or interviews- only the initial in-home visit that took place a few months ago. This meeting took place so the ABA team could evaluate my home, and situation overall, to either support or deny services.
- Strategy – We covered that the method (or strategy) that will be used to address my son’s needs. More precisely, the Essential 8. In short, this is a program based on addressing his behaviors and developmental delays, based on 8 essential “domains” of being alive- basically. Things like caring for yourself, addressing social issues, etc.
- Treatment Recommendations – This section covers how many hours of therapy is recommended, that the parent agrees to the plan, and so forth.
- Treatment Authorization Request – This section provides bullet points that break down the agreement that is being made between the therapists, and the family receiving treatment.
- Amount, time, and length of sessions.
- Scheduled assessments throughout the years as therapy continues.
- Parent participation expectations during sessions.
- Who needs to be home during therapy sessions.
- That parents will support therapy goals in their everyday life.
- That other caregivers should be trained according to the goals of therapy sessions.
- The therapist is tasked with maintaining a high level of motivation.
- The family should seek counseling if they are too stressed.
- Treatment Goals (Parent Goals)- This section provides a bullet point list of objectives similar to the previous section.
- Condition for treatment – (in the home)
- Baseline – Where the process is starting regarding the parents awareness of ABA methods and training.
- Goal 1 – Learning about the “4 Functions of Behavior”, and to assist in ABC data collection.
- Goal 2 – Parent will learn 3 proactive and/or reactive strategies to implement when challenging behaviors take place.
- Goal 3- That the parent will implement the strategies from Goal 2.
- Targeted Completion date based on your case.
- Child Goals – This is a list of goals that will be specific to the child/individual being treated. The same format as the Treatment Goals with a condition, baseline (where the child is starting out), and a series of numbered goals to achieve over time.
- The number of goals are based on the condition, or behavior being addressed, in that specific goal set.
- Each goal has a targeted completion date, however, those are not in any way considered to be a pass or fail situation. Just a goal that should be worked for, which may change depending on the reactions experienced during therapy sessions over time.
- Discharge Plan – This is a section that looks pretty standard. It covers that the goals will need to be met before being discharged. Determination would be based on my son’s skills compared to that of the average person in his age group.
- Risks and Benefits – This area discusses the potential benefits, potential risks, agreements, that the parent has been informed of treatment plans, etc.
And that is it for the paperwork portion. More detail will be provided in future articles regarding the specifics of therapy plans, explanations of the acronyms used, and so forth.
Surprisingly, there wasn’t a very long list of policies. Basically, the therapist isn’t allowed to eat our food, or rely on us for much at all while they are here. Additionally, the relationship is similar to what you would expect from a psychologist and their patient.
You are not to spend time with the therapist outside of therapy sessions. This means you can’t invite them to babysit, or hang out as a friend during their off hours. The relationship is expected to remain professional.
Additionally, I am allowed to have the therapist go with us when we go to the store, park, or family gatherings so long as it is during normal scheduled therapy sessions. What I found odd is that they have to ride with me and not in their own car.
It sounded like there was more paperwork that could be done to allow her to transport herself, but I got the impression it was a hassle that was better left out of the process.
That really was everything we covered regarding policies and suggested guidelines.
Tools & Equipment Used
During the first week the following toys and training tools were used.
The toys are apparently selected based on the goals that are set for each week. Meaning they will rotate the toys and tools being used to best address my son’s needs from week to week.
The rotation is based on his needs, and how effective each toy is at gaining his attention during therapy sessions, in addition to the overall goals and plan that comes with his Essential 8 Therapy strategy.
As for my son’s response to the therapy, he seemed pretty open to it. From my experiences this is the honeymoon period. The therapist is still new, they’re also holding back during the first week to allow him to adjust to who they are.
Since they are hands off at this point, my son really didn’t get pushed too hard so he didn’t have many behavioral outbursts.
The slinky was used mainly to sooth him. He likes to flip it around in his hands while he is following instructions, or being asked to sit still.
So, despite the toy-like nature of what we all know a slinky to be- in this case, it is certainly a tool for sensory soothing and stimming behaviors.
The Topple game didn’t really do much for my son. Quite simply, he wasn’t interested whatsoever in playing along when they had it all set up.
The sticker activities were a little more interesting to my son. They used some pages that had people and animals all over them and then asked him to locate them based on their title. So, they would ask him to find the cow, then he would pick out the cow, remove it from the sheet, and then be asked to place it where it should go.
In this case, the cow went in the fenced area on the picture provided with the sticker kit. This lasted a little while actually, and gave the ABA therapist a chance to see what he does and doesn’t understand, and how well his motor functions are developed.
This week’s winner overall, was playing HI HO Cherry-o. This is a simple game that uses sorting, counting, and motor skills to play along. My son already likes sorting, so this was the naturally point of interest for him each therapy session.
The process of “playing” is fairly controlled, with the therapist doing her best to work her way into my son’s comfort zone. She would let him do it on his own, then request certain colors, or ask him how many apples there were, etc.
The overall goal this week was not to push him so much as make him familiar with the people that will be treating him each day. This game opened up communication and comfort very well since she could interact without really interfering too much.
Overall Responsiveness From The Patient (My Son)
My son wasn’t very responsive to breaking his normal routine this past week. As I mentioned already, he took to the sorting game pretty well, and didn’t hit too many tantrums really. However, he kept wanting to drift away from the therapist to do his own thing in his bedroom.
This makes sense as he likes his space and his phone after school. Since the therapist isn’t really pushing him quite yet, he was still allowed to start out with his normal getting off the bus routine.
After about 15 minutes of being home however, she would start trying to pull him away for different activities and basically, try and get to know him.
As I stated at the top of this post- this week was fairly anticlimactic considering all of the activity that led up to actually meeting for his first therapy session.
My son basically stuck to what he normally does, and the therapist would interrupt as much as she could, and then back off once he showed signs of being flustered.
His responsiveness was fairly good considering he normally doesn’t like people he isn’t familiar with. He even allowed her to play in his bedroom with him, which is fairly rare as well.
Overall, there isn’t much to tell for the first week. Most of the important factors were things like going over the rules, paperwork, and officially agreeing to the daily schedule.
I think the honeymoon will be over next week once the therapist pushes a little harder at getting him to comply with her requests and so forth.
Parent Opinion (That’s Me)
I think it’s too early to tell. The person that is acting as my son’s therapists has never done this before. In fact, this is her second job, and her qualifications appear to be that she completed some company training an not much else.
She seems to be dedicated to working with my son, however, it is the first week of working two jobs for this person- so the uncertainty and need to adjust is there.
I would be lying if I said I wasn’t concerned about whether she will show up for weeks to come, but in all fairness, I have no reason to think that she will flake out on the job. Time will tell.
I don’t blame the company for lacking experienced therapists. It is a simple matter of the supply isn’t there. So, the company providing ABA therapy is doing their best to use training, and weekly visits from a supervisor to ensure that things are going well.
Again, time will tell how effective all of this really turns out to be.
My initial opinion is that it deserves an honest shot at working. My concerns will become reality, or not, and for now I don’t think it is worth the time to speculate on how this whole process will go from day to day.
For now, I worked months and months to get this set up, and I am very hopeful that we can see some real progress in my son over the next six months.
In the meantime, I’ll be sure to provide weekly updates about how my son’s sessions are going.
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