As an ABA practitioner, you may be asked to visit the classroom of a child you are working with to conduct an observation. There could be a behavioral challenge going on, you could be conducting part of an assessment, or the school might request that you come in to provide recommendations to the teacher.

I have visited manyyyyyyyy daycares, camps, and schools over the years, and I've learned a few things along the way. Why don't I share some with you:

1. Always make sure that that the parents, teacher, and the school know when you will be visiting and the nature of your visit. If you work for an agency, make sure that you have contact information for the family, as well as the school, and inform them both of your plans to visit. If you work directly for a family, make sure they have informed the teacher and the school of your visit. I have been in situations where I was sent to a school by an agency who didn't inform the parents of my visit. Once I got to the school I was denied access to enter because no parent permission form was on file. I have also had the reverse problem, where a family told me it was okay to visit their child's school after a brief conversation with their child's teacher. When I got there the front office informed me all visits had to be approved by the principal, and promptly asked me to leave. Its always best to speak to as many people as you can before visiting a school and explain the nature of your visit. If you email the teachers or Principal, keep a record of these emails. Some schools can be quite welcoming to people coming in for the purpose of helping a child who is having difficulties. Unfortunately, I have experienced much more situations that were the opposite. Schools can make it difficult for ABA professionals to enter the classroom and observe. Talking to teachers, in classroom data collection, or actually working with your client on school grounds are often flat-out refused. Be prepared that you may encounter opposition from school administrators, and if the school does let you in then be super appreciative and courteous to help pave the way for the next professional who comes after you.
2. Be as unobtrusive as you can. Anyone familiar with Reactivity knows that the simple act of being observed changes the behavior of the subject. In other words, you are a new face in the classroom, you're obviously not a teacher, sometimes even the child you are there to observe doesn't know you.....you will absolutely stand out. As much as possible, minimize your disruption of the classroom. Enter the classroom quietly and find an out of the way location to sit and observe. Do not take timers into a classroom if you are taking data, take paper/notepads, and pens. Wear muted, plain clothing and minimal or no jewelry. Particularly if you are going into a pre-school with very young children, you will likely be sitting on the floor or standing so dress comfortably. Greet the teacher as you enter their classroom, and let them know you would like to speak with them 1:1 if they get the chance. Don't just walk into the classroom and start asking the teacher questions. If the teacher chooses to introduce you to the class, let them do so. Otherwise do not explain to other children why you are there.
3. Be polite and friendly with the staff, but also professional. Not every teacher will view you observing in their classroom as a positive thing. Sometimes the teachers will be cold or distant towards you. I have observed in classrooms where after the greeting "Hello", the teacher didn't say one additional word to me. Some teachers assume you are there because the parents aren't happy, or you are there to "tell them how to do their job". Enter the classroom with a smile and a greeting and make it clear that you are there to help, not to harm. On the flip side of a cold teacher, is the teacher who is so excited to have you in their classroom they want to chat with you non-stop. Many teachers have said to me, "I know you're here to observe child X, but can you take a look at child Y?? I think something's wrong with her". This has happened to me many times. It is not only unethical to comment on other children in the classroom, it is unprofessional. Let the teacher know in a polite way that you are there for child X, and you cannot make any statements or recommendations about other children. Which leads directly into the next point.....
4. Discuss confidentiality with the parents before your visit. Some of my clients receive ABA services at home, but their school does not know the child has a diagnosis. Or, the child is in a general education classroom and the teacher does not know the child is on medication. Confidentiality limits are things you need to know before you go to observe. The teachers (or other school staff) may throw crazy questions at you that you absolutely should not answer.  Determine beforehand if the parents want you to discuss their child's diagnosis, services, diet, medications, etc., with school staff. The reverse of that situation could be if the school hires you directly, and does not want you sharing specific information with the parents. As odd as that sounds, it does happen. Sometimes a school wants to try specific interventions or strategies before sharing that information with the parents. In a RTI (response to intervention) model that is allowed. Parents may not need to be informed of learning difficulties until after interventions have failed. Discuss with the school administrators what you can and can't say to the parents.

Remember that you are at the school to gather information about how a student learns and functions within a classroom environment, as compared to their typical peers. You are not at the school to chat with teachers, "hang out" with children, or antagonize school staff.  The way you present yourself during a school visit may impact how future ABA professionals who visit that school are treated.

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Tameika Meadows, BCBA, Blog Author

Today's post is about a program I usually write for children with impaired fine motor skills, motor problems, or difficulty with writing tasks.

'Fine motor' refers to using the hands and or fingers versus large (gross) motor which would be legs, arms, etc.

Problems with fine motor skills can show up in a variety of ways: The child might avoid certain activities, such as coloring, because they have weak fine motor abilities. The child might avoid, or be unable to, feed themselves, dress themselves, open doors, groom themselves, write, etc. Looking at it from a broader point of view, a child who is unable to grasp, point, make a fist, grab, or use a pincer grasp will struggle in a classroom setting, or during play and leisure time. Many toys require good fine motor ability to appropriately engage with the toy; the child must lift, push, pull, wind up, or shake the toy to get it to respond. This is why thorough assessment and evaluation are so important because skill deficits can "look like" challenging behaviors, if you don't know what to look for.

All of these skills can be worked on during ABA therapy sessions.

Typically, depending on the deficits a Fine Motor Imitation (FMI) program, or a Fine Motor Development (FMD) program, are a great place to start teaching.
A FMI program is teaching the child to imitate actions that the therapist must first model. The therapist can use shaping techniques to help the child get closer and closer to correctly imitating the fine motor action.  The program is more general, and teaches a variety of fine motor skills such as opening the hand, making a fist, making a peace sign, thumbs up, etc.

With a FMD program, this is more for a child with just a few fine motor tasks they struggle with, or cannot do. For example, an 8 year old who has difficulty writing his homework (homework is very sloppy or illegible), or a 6 year old who hasn't learned to tie shoes, and can only wear shoes that buckle or snap.

If you are a therapist or parent who has a relationship with an Occupational Therapist, they are a great resource for strategies to build fine motor muscle tone. Please see the list below for a few ideas to help your child with fine motor difficulties. Remember that if this is a deficit for your child, the skill has to be taught. You cant just buy these items and hand them to the child. Get on the floor and help them manipulate these items, encourage them to do activities they normally avoid (such as pulling up a zipper), and create multiple opportunities throughout the day for the child to practice:

 Toys

• Many simple toys can help to develop fine motor skills, including ring stackers, shape sorters and foam boards. These toys may have blinking lights, vibrate, play music or do all three as a naturally occurring reward when your child manipulates the toy correctly. This provides motivation to keep your child from becoming easily distracted. Many toys speak when certain buttons are pushed, helping your child to learn letters, numbers, colors and other concepts while also fine-tuning motor skills.

Play Dough

• Many fine motor skills can be developed with the use of play dough. Help your child mold large balls with her palms, small pea-sized balls with only her fingertips and long snake-like shapes between her hands or with her hands and a smooth surface. Many autistic children also enjoy squeezing things, which is great for improving forearm strength, so play dough is a perfect choice for this activity. Use tools to manipulate play dough as well. Cut with plastic knives or cookie cutters, make ridged designs with the flat side of a fork, press it onto buttons, fabric and other textures and show the child the designs he created.

Small Tools

• Teach your child to use tools such as plastic tweezers to pick up mini marshmallows, cheerios, and pennies. Use an eye-dropper to suck up colored water and then squeeze it out for painting.  Help your child use screwdrivers, such as those in an erector set, or give them undersized, silly items that require a firm grip, such as a small novelty pen.

Writing and Drawing

• Your child can begin to learn how to write and draw by finger painting, drawing lines, shapes, numbers and letters with their fingers. Use paints, or get out whipped cream and let your child have some fun. Magnet board drawing toys or large mats that change color with water-tipped pens can help your child learn to grasp and control a pencil.

Modified Toys and Activities

• If your child is easily frustrated by the toys she already has, consider creating similar toys with modifications so that she feels successful, then move on to the more difficult toys. Instead of a lacing board with many holes, make your own home made version out of cardboard, punching three to six holes instead of a dozen. Create your own peg board with plastic water bottles filled with water and glitter that fit into holes in a cardboard box. Fill some small boxes with sand and use these as blocks; they will be easier for your child to stack than regular blocks.

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Tameika Meadows, BCBA, Blog Author

To be or not to be? No, actually a very popular question I get asked is: "To stim, or not to stim??"

Sterotypy, aka "Stimming" (see my Glossary for an explanation why the term "self-stimulatory behavior" is misleading, and ABA professionals use "stereotypy" instead), can take many forms and can be frustrating or confusing to parents and caregivers.  These repetitive behaviors can be highly enjoyable and automatically reinforcing to the individual doing them, and many Autistics see any attempt to reduce their stims as harmful, ableist, and unnecessary.

 Some examples of stims can include:

• Rocking, spinning, hand flapping, mouthing items/objects, lining items up, spinning items, dropping items to watch them fall, vocal stims such as squeals, shrieks, or scripting scenes from favorite TV shows, visual stims such as staring closely at objects or flicking eyelashes, saliva play, tearing or ripping paper into tiny pieces

From a teaching perspective (either at school or during a therapy session), when children engage in repetitive sterotypy they may seem to completely shut out the outside world and may not respond to instructions or someone speaking to them. Some of my clients will engage in loud vocal sterotypy in group or classroom settings, that makes it near impossible for other children present to focus or learn.

So what's the answer here? What is the balance between personal rights to choose to engage in an enjoyable activity, and the rights of other people present to not tolerate this activity?

Not all individuals on the ASD spectrum have repetitive behavior to the degree that it interferes with learning or social interactions. That must be said. However for those that do, it can sometimes be a pretty significant issue, particularly in a school or work setting.

Many parents feel they don't want their child to "stim" at all. Other parents feel they want their child to know when to engage in sterotypy and when not to, and for some of the families I consult with this isn't even an issue (they do not want sterotypy reduced in any way).

Just imagine that your way of de-stressing after a long day is to have a warm bath and listen to music and everyday a therapist stops you right as you go to turn on the bathtub faucet and says "No. Hands Down". How would you react to that??

I don't recommend simply removing a behavior. You must remember, there is a function (need) involved. It would be better to teach a replacement behavior that is less disruptive and does not prevent learning/social interaction. To put it simply, teach the child what TO do instead of just focusing on what you DON'T want them to do. Consider redirection, Differential Reinforcement, environment enrichment, social interaction, or teaching toy play/hobbies.

I understand sterotypy can be very trying on a parent or teacher, can be intrusive upon learning tasks, and also difficult to handle in public.
A large step towards viewing "stims" as commonplace and not an annoying habit to extinguish is to realize that everybody engages in repetitive behaviors! Really, they do.

The next time you are standing in line at the bank, or waiting at a stoplight, look at the people around you. Do you see someone twirling their hair? (I do that one). Do you see someone tapping their foot? What about humming to themselves? So if you and I engage in repetitive behaviors at times, then what is the difference between that and your child engaging in repetitive behavior? Well, one big difference is the frequency/intensity (especially if the behavior causes harm), and the barrier to interacting or engaging with others while the sterotypy is occurring. So in other words, maybe think about ways to help your child choose better times and places to stim rather than trying to keep the child from stimming at all.

*UPDATE: After reading this post, a young lady contacted me to share her perspective. Her name is Tracy, and she is Autistic.  I think her words are valuable:

"I enjoyed your post on stimming. I like so much how you tell how everyone does it, and the analogy of a neurotypical person not being allowed a hot bath at the end of the day. 

Not being allowed to stim would sometimes be very much like this. Other times, it would be more like not being allowed to smile when I am happy. 

It's interesting to hear a neurotypical perspective: when we stim you feel we're in our own world. This is sometimes true....sometimes stimming helps me concentrate. Actually, stimming almost always helps me concentrate, just not always on the thing I am supposed to be concentrating on! :) When I spin around and flap, though, I don't feel like I'm in my own world. I feel like the I am surrounded by the world, held by the world, and my hands are moved up and down by what is the rhythm, the essence of the world. I stim to get the magical feeling of connection you might feel in the redwoods. True, this does sometimes require less being-with-people, but the world is just so magical and so wonderful and whole that- I don't know. 

As a spur of the moment choice, and as a conscious choice, I think my limited time is better spent spinning than small-talking. Stimming is also catharsis. You're right, it can be used when bored...... and it is a wonderful way to order the world in the midst of sensory overload."

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Tameika Meadows, BCBA, Blog Author