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Infant Development & Early Intervention

Red Flags for Autism

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Infant Development & Early Intervention

Red Flags for Autism

Roxana Rabadi, PsyD, LCP

There is no greater joy than watching your baby develop as a little person, hearing them laugh and babble, and seeing them explore their surroundings.

Some babies take a little longer than others to achieve expected milestones, from crawling to feeding themselves, and that’s not necessarily a problem; children develop at their own pace.

But there are specific behaviors that can be indicative of a developmental disability such as autism. Autism can be difficult to diagnose because the symptoms and severity are different for every child. There are a broad range of conditions within the autism spectrum that can impair a child’s development and have lifelong effects on their ability to thrive in our complex world.

According to The Centers for Disease Control and Prevention (CDC), “Autism is four to five times more common among boys than girls and 1 in 59 American children are on the autism spectrum.” It is important to monitor your child’s developmental milestones and bring up any concerns to your child’s pediatrician.

Could your child have autism? Review the warning signs to learn more about the red flags for autism

  1. Children with autism may exhibit delays in developing speech and language skills, and inability to understand meaningful nonverbal communication. There may be a problem if:
    • By 12 months, there is no babbling or “baby talk.”
    • By 16 months, your baby has not spoken a word.
    • By age 2, there have been no meaningful two-word phrases.
    • Your child is displaying jargon speech (made-up language), or is imitating what caregivers say, and repeating it over and over.
    • Your baby has poor eye contact and won’t look at you when you are feeding him or her or smiling at him or her.
    • Your baby seems unable to understand or use hand gestures, including pointing and waving.
    • Your baby does not imitate anyone else’s movement and does not seem to notice other people’s facial expressions.
    • Your baby does not seem to recognize or respond to their name being called.
  2. Children with autism tend to lack social understanding and interest in interaction. They may:
    • Appear disinterested or unaware of those around them.
    • Not know how to connect with others, seek out play, or make friends, or how to establish or maintain age-appropriate relationships.
    • Not show enthusiasm/enjoyment during interactions or do not display shared enjoyment.
    • Display aggression toward others.
  3. Children with autism may exhibit rigidity, inflexibility and certain types of repetitive behavior such as:
    • Insistence on following a specific routine.
    • Having difficulty accepting changes in the schedule.
    • A strong preoccupation with a particular interest.
    • Having an unusual attachment to a toy or other object.
    • Lining up or arranging items in a certain order.
    • Repeating the same actions or movements over and over again.
    • Examining objects closely or from the corner of the eye.
    • Fascination with spinning objects and his or her reflection in the mirror.
    • Rocking, hand-flapping, twirling and finger-flicking.
    • Self-directed aggression, such as head-banging.
  4. Children with certain types of autism also have a sensory hypersensitivity that is shown by:
    • Resistance to touch and cuddling – your baby doesn’t reach out to be picked up.
    • Unusual reactions to light, taste, smells, textures, and sounds.
    • Hypersensitivity to loud noise.

If you recognize any of these behaviors, know that there’s no need to despair. An early diagnosis and specialized treatment can help.

If you believe your child may need care and you aren’t sure where to start, call us at 833.227.3454, email us at info@360bhmail.com, or visit our website to Request a Consultation.

About the Author

Dr. Roxana Rabadi is a clinical psychologist who specializes in diagnosing and working with children and adults with autism and related developmental disorders.

Dr. Roxana Rabad
Roxana Rabadi, PsyD, LCP
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Evaluation & Diagnostic Services

Evaluation and diagnostics – also known as psychodiagnostics – is the first step necessary to diagnose and clarify concerns regarding behavior, personality traits, mood, emotional functioning,
and cognitive processes.

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Infant Development & Early Intervention

Our infant development and early intervention program helps babies and toddlers with developmental delays or disabilities learn key skills that typically develop very early in life. Early intervention can contribute to a child’s success at home, in school, the workplace, and community — and can make a positive impact on a child’s development and accomplishments well into adulthood.

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How Social Skills Training Can Help Children, Teens and Young Adults with Autism

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Telehealth Benefits for Autism

How Social Skills Training Can Help Children, Teens and Young Adults with Autism

Iris Chiang, M.Ed., BCBA

We all need to be able to socialize to be successful in life — to accomplish day-to-day activities of living, maintain a job, create friendships and intimate relationships, and build a family, if we choose to pursue one. These are core values of being happy for many people. They require a level of interaction and understanding between people.

But socializing can be challenging. It’s particularly tough for those with autism spectrum disorder (ASD) because some of the emotional and intellectual deficits typically associated with autism can make social interaction difficult.

Fortunately, those with autism can get help learning and developing social skills. The benefits are immediate and long-lasting: not just improved daily functioning but higher enjoyment and satisfaction, with lower incidence of isolation, depression and suicide.

Challenging Behaviors that Social Skills Training Can Address

Social skills training can help individuals with autism who:

  • Avoid other people and prefer to hang out by themselves
  • Prefer to be with adults, or with people who are younger
  • Have a difficult time making eye contact with others
  • Won’t engage in conversation with other people, or walk away from people who try to engage them
  • Get aggressive (loud, physical or violent) when approached by other people
  • Have a hard time sharing their stuff, who dominate conversation, who don’t follow rules of sportsmanship, or who are overly bossy
  • Have boundary issues — they get too close to other people or avoid closeness with others
  • Are too accommodating and may be taken advantage of, such as by peers who ask them to do their homework or give them their lunch money

If your child has ASD and demonstrates some or all of these behaviors, they could likely benefit from social skills training.

What Can Be Learned from Social Skills Training?

Social skills training most often is a complement to behavioral therapy based on principles of applied behavior analysis. The two go hand in hand.

Behavioral therapy with an individualized treatment plan identifies specific areas and issues that can be addressed through a customized program designed to modify challenging behaviors and improve functional living and quality of life. Social skills training offers the opportunity to put the skills learned in therapy to work in a group setting, while also developing skills that can only be learned in a group.

For younger kids, social skills training focuses on following group instructions, joining in group behavior, greeting group members, sharing and taking turns, conflict resolution, identification of different emotions, and initiating interaction; in other words, how to approach and communicate with other people in group settings.

For pre-teens and teenagers, social skills training focuses on joining a group, how to use verbal and nonverbal communication and behavior to determine if the group is open to being joined, how to start a conversation, how to be aware of certain behaviors that might seem unusual to others, problem-solving, conflict resolution, assertiveness training, and how to identify other people’s intentions. For young adults, social skills training can continue to further develop these skills.

A common thread in the training is teaching self-preservation skills including assertiveness, so kids learn how to stand up for themselves and, as they get older, how to recognize and respond to bullying including cyber-bullying.

Another Benefit of Social Skills Training: Support

Everyone responds to social skills training differently, largely based on their age and level of functioning. Some need more repetition (more practice); others learn more quickly.

For most, the training is actually fun because they experience the benefits in real-time … they get to engage with and form bonds with their peers. As a result, the learned behaviors become self-reinforcing and group members get support from each other. That’s the benefit of positive social interaction, which can be fulfilling in and of itself.

For more information about social skills training, visit our social skills information page or Request a Consultation for a complimentary 30 minute in-person or phone consultation to discuss social skills training available in your area.

About the Author

Iris Chiang is a Board-Certified Behavior Analyst (BCBA) with 13+ years of experience providing applied behavior analysis (ABA)-based treatment to children and young adults with developmental disabilities.  Her specific areas of interest in ABA include social skills training and staff training.  Iris also holds a school counseling credential and received formal training in PECS (picture exchange communication system), PEAK, ACT (Acceptance Commitment Therapy), CBT (Cognitive Behavioral Therapy), and PEERS.  Iris currently serves as the Director of Clinical Services for California Psychcare in Long Beach.

Personal interests include spending time with her husband and 2 daughters, with a third daughter on the way, practicing mindfulness, and trying new recipes as an amateur chef.

Iris Chang
Iris Chiang, M.Ed., BCBA

Director of Clinical Services
California Psychcare

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Social Skills Training

Our social skills training help individuals function more effectively in social situations and cultivates skills needed to create positive interactions with others. Delivered at one of our behavioral health treatment centers, we offer age-based groups for kids, preteens, teens, and young adults. Our groups are conducted in a comfortable setting where individuals with developmental disabilities can develop and practice their social skills with peers on a regular basis.

Telehealth Benefits for Autism

Benefits of Telehealth for People with Autism

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Telehealth Benefits for Autism

Benefits of Telehealth for People with Autism

Kate Sheldon-Princi, M.Ed., BCBA

Telehealth is used throughout healthcare, allowing patients to connect to many kinds of practitioners. Telehealth is rapidly growing in the field of applied behavior analysis (ABA) and may improve access to care for individuals diagnosed with autism spectrum disorder (ASD) or other developmental disabilities. Telehealth can be as simple as using a phone, tablet or computer to connect face-to-face with your healthcare provider, similar to how you may chat with family or friends who may live out-of-town.

California already had legislation in place that supported the use of telehealth – such as the Telehealth Advancement Act of 2011 – and support for telehealth was expanded in 2019 when Governor Gavin Newsom signed AB 744 into law.  This new legislation will make telehealth services more widely available to many Californians – including those needing behavioral therapy services. While the new law doesn’t mandate telehealth coverage until 2021, many insurance providers already offer the coverage — you may just need to ask for it.

Benefits of Telehealth in ABA-Based Behavioral Therapy

Expanding access to ABA-based behavioral therapy services through telehealth will benefit individuals with ASD and other developmental disabilities in many ways. The benefits of telehealth services for this type of care includes:

  • Increased Supervision and Communication
    In ABA-based behavioral therapy, a Board-Certified Behavior Analyst (BCBA) oversees treatment of a patient with autism or other developmental disability, with direct support typically provided in the home by a behavior interventionist (BI). The BCBA provides this oversight through in-home supervisory visits with the BI.  During these supervisory visits, the BCBA works with the BI and the patient to ensure that the treatment plan is being followed and that the prescribed therapy is moving the patient toward established goals.In some situations, the BCBA may only be able to travel to an in-home therapy session once a month, but by using telehealth, the BCBA can remotely join sessions more often. This allows the BCBA to observe the patient, speak with the parents or other caregivers and address issues, questions, progress and goals more frequently. When using telehealth, it’s important to note that this approach doesn’t replace the behavior interventionists who provide the hands-on care during in-home ABA sessions or the in-home supervision visits by the BCBA, but instead is a way for the BCBA to provide additional supervision hours to supplement the time they spend providing in-home supervision.
  • Expanded Geographical Areas Served
    Without telehealth, autism service providers often find they cannot accept referred patients who live outside of their BCBAs’ travel areas. Alternatively, some families need to drive hours from their homes so their children can access services. By providing BCBA supervision using telehealth, patients can receive care from local behavior interventionists with the BCBA supervision provided remotely most of the time. This is a major benefit to people who live in more isolated communities or areas underserved by BCBAs.
  • Improved Patient Outcomes and Satisfaction
    By increasing the frequency of supervision and communication with patients and caregivers, BCBAs can modify treatment plans and interventions more frequently, as well as regularly conduct trainings with direct-support professionals. As a result, the pace of treatment and progress may accelerate, with patient outcomes and satisfaction improved.

The Bottom Line

Before beginning the use of telehealth, a patient’s supervising BCBA must deem telehealth as clinically appropriate for the patient’s specific needs, and the patient and/or their family must give approval. Telehealth is not suitable in all cases. Protocols, procedures and technology that are proven effective and that maintain confidentiality and privacy are already in place. Success stories have been well documented, and service providers are preparing to expand the service to meet the needs of more patients.

If you think ABA-based behavior therapy services delivered via telehealth may be beneficial for you and you’d like to learn more, please request a consultation to schedule a complimentary 30-minute telephone or in-person consultation or visit our ABA-based therapies page.

About the Author

Kate Sheldon-Princi is a Board-Certified Behavior Analyst (BCBA) who has been a member of the 360 Behavioral Health family since 2012. Kate has provided and supervised applied behavior analysis (ABA)-based treatments to individuals of all ages and abilities, both in-home and via telehealth. Kate currently serves as the Director of Clinical Development for 360 Behavioral Health’s family of providers including California Psychcare and Behavior Respite in Action.

In her current position, Kate supports the development and integration of new services across the organization, which includes California Psychcare’s Telehealth services. Kate has been involved with California Psychcare’s telehealth program from advocacy for inclusion in legislation, to conducting trainings for clinicians, and the countless stages in-between. Kate, along with the rest of the 360 Behavioral Health team, is optimistic about the benefits that patients will experience as telehealth access is expanded.

Kate Sheldon-Princi, M.Ed., BCBA

Senior Director of Managed Care & Clinical Development
360 Behavioral Health

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Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays. This type of therapy is conducted one-on-one, is customized for each person, and is appropriate for individuals of all ages.

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How to Know When a Child’s Repetitive Behaviors Are a Problem

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How to Know When a Child’s Repetitive Behaviors Are a Problem

Jessica Robles, M.A., BCBA

Repetitive behaviors are often a cause of concern for parents who have a child with a developmental disability. There are many terms that are used to describe these types of behaviors. A clinician might refer to them as “stereotypy or stereotypical behaviors”. At the core, these behaviors refer to any repetition of physical movements and/or repetition of vocal sounds and can include the repeated moving of objects or the repetition of sounds or words that do not have a purpose. You might hear these behaviors referred to as “self-stim behaviors” or “self-stimulatory behaviors” but using these terms can be misleading because they can imply that the function of this behavior is for stimulation or automatic reinforcement – which is often not the case.

Everyone engages in some form of repetitive behavior.

Typical examples exhibited by people of all ages are shaking your leg when sitting, twirling your hair on your finger and clicking your pen repetitively.

People with a developmental disability often, but not always, exhibit repetitive behaviors. This is most prevalent in people who have been diagnosed autism spectrum disorder (ASD).

Although the list is endless, common repetitive behaviors demonstrated by kids with autism include:

  • Flapping their hands
  • Banging their head against the wall
  • Rocking their body
  • Spinning
  • Pacing back and forth repeatedly

A great example of repetitive behavior in a real circumstance would be a child with autism lining up his or her toy cars or dolls, and then — instead of playing with them — claps or flaps their hands repeatedly. The behavior we see may make the person feel better, have a soothing effect or be a way of expressing their frustration.

When to Be Concerned About the Situation

Repetitive behaviors become a concern when the behavior is a distraction, competes with learning opportunities, interferes with the person’s living activities, is disruptive to others or if the behavior is dangerous. For example, if a child is more preoccupied flapping his hands than paying attention in class, the behavior is problematic. The behavior also can be dangerous to the individual or others if it’s very physical or violent. An example of this is an individual who spins excessively to the point of throwing up regularly. If any of these situations occur, an intervention is needed.

Treating Problematic Repetitive Behaviors

Every case is different. It is important to conduct an assessment that yields a custom treatment plan to address the repetitive behavior of concern, but this general approach is recommended:

  • Contact a Board-Certified Behavior Analyst (BCBA) who has experience working with the type of repetitive behaviors your child is displaying.
  • The BCBA will observe the behavior occurring, assess the behavior, look at patterns, identify when the child most likely to engage in the behavior, determine how the behavior impacts the child’s life, and discuss with caregivers the significance and consequences of the behavior.
  • If it’s determined that the behavior requires change, the BCBA may recommend proactive strategies. These are tools and techniques that can be used to curtail the behavior or reduce its frequency. The BCBA may recommend reactive strategies that family members or other caregivers can implement when the behavior is happening.
  • The BCBA also may recommend that “replacement” behaviors be taught; that is, other, alternative behaviors that the child can engage in that meet the same needs of the repetitive behavior. If possible, the BCBA will help the individual identify the underlying cause — the trigger of the problem — to try to resolve it and prevent the problematic behavior from occurring.
  • Often an occupational therapist will work alongside a BCBA – as part of a multidisciplinary approach – to curtail or reduce the repetitive behavior so the individual can focus and perform everyday activities.

With appropriate intervention and support, behavioral therapy based on principles of applied behavior analysis has been very successful in reducing repetitive behaviors in people with autism and other developmental disabilities.

If you believe your child may benefit from behavioral therapy to reduce or modify problematic repetitive behaviors and you aren’t sure where to begin, contact us for a complimentary 30 minute in-person or phone. Learn more about ABA-based therapies.

About the Author

Jessica Robles is a Board-Certified Behavior Analyst (BCBA) who has provided applied behavior analysis (ABA)-based treatment to children and young adults with developmental disabilities since 2008. Jessica currently serves as the Regional Director of Clinical Services for California Psychcare. In her current position, Jessica supports local directors in providing quality services.

Jessica became interested in ABA when she was working as a direct staff providing in-home services to her clients. Through that experience, she realized how much progress a child can make when provided with a quality individualized treatment plan, and ABA became a passion for her.

In her spare time Jessica enjoys spending time with her family and cooking.

Jessica Robles
Jessica Robles, M.A., BCBA

Regional Director of Clinical Services
California Psychcare

aba home-based therapy icon
Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays. This type of therapy is conducted one-on-one, is customized for each person, and is appropriate for individuals of all ages.

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How to Prepare a Child with Autism for a New Sister or Brother

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little girl hugging mother's pregnant belly

How to Prepare a Child with Autism for a New Sister or Brother

April MacPherson, MA, BCBA

The arrival of a new baby is a joyful occasion for any family. Mom and Dad are bringing a new person into the world, and their kids are getting a new sibling.

The arrival of a new child also brings anxiety and maybe even some fear. How will family life change? How will the household be affected? What will be the demands of the new child? There is uncertainty.

The stress may be particularly acute for a child with autism spectrum disorder (ASD). What’s the best way to prepare a child with autism for the arrival of a new sibling? There is no one-size-fits-all approach because every child with autism is different. But there are some steps caregivers can take to prepare the child for change.

Before thinking about how to prepare your child with ASD, it helps to remember what his or her deficits or challenges are so you can plan to address those issues specifically. If you need help identifying your child’s problem areas and coming up with interventions to address these concerns, it’s best to consult a board-certified or licensed professional who follows evidence-based practices, including the science of applied behavior analysis (ABA). Then, you’re ready to prepare with these tips:

  1. If the child is particularly sensitive to changes in the home environment, check in with your ABA team to discuss changes you should start making before the new sibling arrives. For example, a plan might be put in place to introduce a bassinette and crib into the home, and potentially move the bassinette around so the child begins to adjust to the new furnishings and a constantly changing environment. It is never too early to introduce visuals that involve all things baby to your child so they can become familiarized with what babies look like and all the baby items that will soon be in their home.
  2. Some children may respond well to introducing a baby doll into the environment and treating the doll as you might a child — holding it, feeding it, pretending to change its diapers, and certainly have it sleep in the bassinette and the crib. This not only might give them a small glimpse of what to expect, but it can also increase pretend play and social skills.
  3. If the child has stronger verbal skills, explain what’s coming and how you feel, so he or she begins to understand that this is a positive development. You can read stories to the child about new babies coming home from the hospital. There are some good children’s books out there, and an ABA team can create specific social stories with visuals that are personalized to the child and the family’s unique situation.
  4. If the child is highly dependent on a particular caregiver such as Mom, consider having helping hands (e.g. friends, family, babysitters) develop a strong relationship and rapport with the child before the new baby arrives. This may allow the child to get more comfortable being in another person’s care, which could also increase their flexibility to new people or situations, as well as not require the primary caregivers’ full attention at all times.
  5. If the child is sensitive to noise, consult with a professional about how to effectively address this concern. Environments with babies can often have noises that a sensitive child may not be accustomed to. It would be ideal for the child to be more comfortable, relaxed and familiar with the sound of baby cries before baby comes. At the very least, it would be beneficial for them to have support systems in place to allow them to tolerate such noise – like special headphones – which should be established before the arrival of baby.
  6. Many children with ASD are highly sensitive to even the slightest changes in common daily routines. Taking a different route home from school or switching the order of an activity in a way that the child is not used to can possibly trigger an unwanted behavioral episode. This can be a challenging obstacle when a new baby is added to the environment, as babies are often unpredictable with their many needs. If this is concern in any household, it is important to receive professional support to ensure that a plan is put in place to gradually increase the child’s ability to adapt to unexpected or sudden changes in common routines. The goal would be to ensure the child is more flexible and adaptable to varied routines prior to baby’s arrival.
  7. Children who display aggression or other unsafe behaviors should have this concern addressed sooner rather than later. This is critical and will help minimize risk of injury. An effective behavior intervention plan that is tailored to the individual can make all the difference in the world. When seeking professional help, it is important that a Board-Certified Behavior Analyst (BCBA) is there to collaborate and create the behavior plan.

Remember that every child with autism is different, and each will react differently to a new sibling. At one extreme, some children will be affected by every change in the home, be it environmental or sensory. On the other extreme, some children may seem unaware and even oblivious to the new child, especially at first.

If you think you need help preparing your child with autism for a new sibling or would like more information about ABA-based therapy and how it might help, learn more about in-home ABA services or schedule a complimentary 30-minute phone or in-person consultation.

About the Author

April MacPherson is a Board-Certified Behavior Analyst (BCBA) who has provided applied behavior analysis (ABA)-based treatment to children and young adults with developmental disabilities since 2007. She currently serves as the Director of Clinical Services for California Psychcare’s Palmdale center. April spends her time supervising and mentoring her team of BCBA colleagues and staff who are looking to grow in the field of applied behavior analysis, as well supporting families in need in and around the entire Antelope Valley area.

April spent several years teaching kids how to ride horses and develop skills necessary for teamwork and equine-care before making the jump into the field of applied behavior analysis that primarily serves the ASD population.

Outside of work April enjoys spending quality family time with her husband and 2 kids in their home, which also includes 2 horses, 2 cats, and 2 dogs. Her family also loves to take hikes together whenever possible. April hopes to return to competing on equestrian drill teams and attending rock concerts again when her boys are a bit older and she has more time on her hands.

image of April MacPherson
April MacPherson, MA, BCBA

Director of Clinical Services
California Psychcare

aba home-based therapy icon
Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays. This type of therapy is conducted one-on-one, is customized for each person, and is appropriate for individuals of all ages.

Challenges with Children with ASD Who Are Growing Up Bilingual

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Challenges with Children with ASD Who Are Growing Up Bilingual

By Maria Sanchez, MA, BCBA and Crystal Herrera, MA

 

Growing up in a bilingual family can be a gift.

Children and parents all can benefit from the exposure to two different languages, cultures and family traditions — old and new — that accompany life in different places. It’s very apparent here in California, where so many families also have roots from different countries.
Over time, as family members become more proficient speaking English in addition to native languages, children and parents can help each other communicate, and understand and take advantage of different opportunities.

But for families with a child who has autism spectrum disorder (ASD), a bilingual home environment can also be a struggle. Language issues, in particular, can be a problem, especially since some amount of English is necessary to access many services and resources, and since so many healthcare and education professionals in the U.S. speak just English.

Language isn’t the only issue. Based on our experience providing healthcare services to people with autism, we’ve observed three challenges faced by many bilingual households.

Challenge #1: Culture
In many cultures there can be resistance to acknowledging that a child has a developmental disorder, be it autism or something else. Some family members may want to believe that the child is just going through a phase and will grow out of it, even when the evidence — such as challenging behaviors or limited language skills — persists. Some cultures have stubbornness or self-consciousness built in, which can delay or even prevent diagnosis and treatment.

In other ways culture can interfere with the delivery and follow-through of a treatment program. For example, if a child with autism is prone to tantrums, the therapy may advise that the child be left alone – if only briefly – while the outbursts run their course.

In some cultures, however, it is considered rude, disrespectful or uncaring to ignore a child who is acting out. In these cases it’s important that parents understand that often the most helpful response is the opposite of what they may think, because the “natural” response may be interpreted by the child as a reward for his or her behavior. The consequence is that the child doesn’t learn new or replacement behaviors and instead repeats the problematic behavior because he or she is rewarded for it with attention.

Behavioral therapists, including healthcare professionals trained in applied behavior analysis, can explain and teach this to parents as part of the program.

Challenge #2: Coordination of Care
Many healthcare providers and school teachers speak only English, so it can be difficult to access and coordinate care for a disabled child, especially when the predominant caregiver in a family does not speak English or when the child is very young and may not be able to speak.

Picture a situation where Mom speaks only Spanish, Dad works full time, and Mom is responsible for the child’s care. In this case Mom needs help understanding the situation so she can secure resources for the child. Explanations about how a treatment program works and what she should do to support the program with her child can be very beneficial and can help the child and parents get on the right track.

There can also be issues with doctors and medications. Imagine a situation where a child is not yet talking, and also happens not to be sleeping well. Mom and the child go to see the doctor. Because of language issues, the child’s health history is not fully explained to the doctor, who thus has a lack of understanding of the situation. In that case, the doctor’s treatment — maybe it is medication—may not be best for the situation. Or maybe Mom leaves the doctor’s office not understanding what a medication is for or how it works, so she is unable to fully support the child’s treatment because she doesn’t know what the medication is for and can’t explain the importance of it to the child.

Similar situations and outcomes can occur with other healthcare professionals, such as speech therapists, and at the child’s school with teachers and administration officials.

Challenge #3: Knowledge of Available Resources
Most communities have resources available for families, but not everyone is aware of how to gain access to these resources. Not being familiar with the predominant language causes a barrier to accessing the resources. For example, a family that is searching for speech therapy might not know where to apply, fill out the required forms or communicate the needs of the child.

Fortunately, there is help available for parents and children with ASD, including service providers who are bilingual and can help parents access care, coordinate care, and overcome some cultural obstacles to successful therapy and training. There also are resources for parents to learn English, which can help in so many ways.

If you think your child needs care and you are not sure where to begin, contact us to schedule a complimentary 30-minute in person or phone consultation. If you need a consultation in Spanish, be sure to add that into the notes in the “comments” section of the form.

About the Author

Maria Sanchez is a Board-Certified Behavior Analyst (BCBA) who is providing applied behavior analysis (ABA)-based treatment to children and adults with developmental disabilities.

Maria grew up in a predominantly Spanish speaking household and experienced, firsthand, the struggles of growing up in a predominantly English speaking country. At a young age Maria’s family depended on her to translate, navigate and communicate information about community events and resources. Maria started her career educating Spanish speaking families on proper nutrition while attending University of California Los Angeles. She currently serves as the Director of Clinical Services for California Psychcare and works with Spanish and English speaking families.

In her free time, Maria enjoys watching movies, hiking, and traveling with her family.

Maria Sanchez, MA, BCBA

Director of Clinical Services
California Psychcare

a boy and a girl doing a fist bump

Enhancing Sibling Relationships in Families with Kids with Autism

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a boy and a girl doing a fist bump

Enhancing Sibling Relationships in Families with Kids with Autism

Alfredo Arciniega, M.A., M.S., LMFT, BCBA

The relationship between siblings is significant in human development. The bond between siblings can provide love and support across a lifetime, and can reinforce social and developmental skills and positive behavior in childhood. Healthy sibling relationships can increase happiness and can contribute to a strong family unit.

Life for an individual with a brother or sister with autism is much like life in any other family. But siblings of kids with autism and similar conditions also face unique challenges. These kids experience a wide variety of emotions and experiences as a result of the situation. Younger kids are sometimes puzzled with questions such as “what is wrong with my brother or sister?” and “why aren’t the rules the same?” Teenagers may display a high level of concern about their brother or sister having a meltdown, especially in public settings. Young adults wonder if they will be the expected to caretake for their brother or sister in the future. All of these questions are important and should be discussed.

When parents are confronted with the intense demand for caring for their child with autism – along with all of the other family and life obligations – they may struggle with understanding when and how to address unique challenges that other children in the family may be facing. Parents can help siblings respond to their experiences of having a brother or sister with autism and can help them develop skills that build and maintain meaningful relationships that can lead to greater balance within the entire family.

Parents need to be aware that it is not easy for many children to express their worries about their brother or sister with autism, so it’s essential that parents foster an atmosphere of open communication, and that they initiate dialogue and provide support. Specialists trained in ABA-based therapy can help facilitate conversations and can provide resources and tools that can help develop strong sibling relationships.

Where to Start:

  • One-on-one time: Spending time with your child is a great way to make sure he or she doesn’t get lost in the shuffle of the daily routine and all of the appointments. Start with a few one-on-one activities, they will add up throughout the week.
  • Teach your son or daughter about autism: Depending on the age of your child, there are a variety of resources to help children understand autism, including books, support groups, movies, etc. A good starting point is to teach them the word “autism” and what it means. But don’t get caught up with limitations. Keep it short and simple.
  • Acknowledge his/her feelings: There has probably been a time when you felt frustrated or embarrassed about a meltdown. Your child may sometimes feel this same kind of frustration or embarrassment. Make it okay for your child to express his/her feelings about all of the ups and down they have with their brother or sister – without the worries of consequences.
  • Use positive praise: Don’t forget to praise and give your child attention . . . frequently. Start with the small victories and work your way up. If it doesn’t come easily, try using statements like “I like how you…”, “great job with…” or “it makes me so happy when you…”.
  • Have reasonable expectations: Are you perfect? None of us are. Be okay with things not always going according to plan. Kids are going to be kids, they are going to make mistakes, they’re going to misbehave. It’s is all part of the learning process.
  • Encourage family activities: Find moments throughout the week to schedule activities that are fun and safe for everyone. Promoting these activities can strengthen relationships with the entire family.
  • Support Groups: Sometimes it is comforting to know you aren’t alone or the only one with unique concerns. A sibling support group offers the opportunities for brothers and sisters with a loved one with autism to learn that there are other children they can share and connect with who “get it.” Find out where in your community you can connect.

If you think you need help with a child with autism or his / her sibling or siblings, learn more about in-home ABA services or schedule a complementary 30-minute in-person or phone consultation.

About the Author

Alfredo Arciniega is a bilingual Licensed Marriage & Family Therapist (114063) and a Board-Certified Behavior Analyst. In 2013, he started his career at California Psychcare working with children on the autism spectrum. This is where he discovered his passion to help and support children and their families. He earned two master’s degrees, which contribute to his skillset of providing an integrated treatment approach. His first M.S. degree is from the University of Phoenix and is in Marriage, Family and Child Therapy. The second M.A. degree is from Florida Institute of Technology and is in Professional Behavior Analysis.

Currently, Alfredo is a director of clinical services for the Laguna Hills | Orange County branch of California Psychcare, where he leads a team of behavior interventionists. He lives in Costa Mesa with his husky dog and partner. He takes great pleasure in spending time with his loved ones and enjoys hobbies such as hiking, surfing, and snowboarding. Alfredo hopes to continue to support families by utilizing his background in applied behavior analysis and providing a best practice approach.

photo of Alfredo Arciniega
Alfredo Arciniega, M.A., M.S., LMFT, BCBA

Director of Clinical Services
Laguna Hills | Orange County, California Psychcare

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Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays.

Toilet Training Your Child with Autism: Seven Tips for Parents

Toilet Training Your Child with Autism: Seven Tips for Parents 460 307 bh360

child toilet training

Toilet Training Your Child with Autism: Seven Tips for Parents

Shana Williams, MA, BCBA

Training your child to use the toilet can be tough. It takes patience and time. But it’s an important part of helping him or her learn about the body and develop skills necessary for life. It’s also needed to start school. Many pre-schools won’t accept children who are not toilet trained.

There are many books and websites for new parents to help teach kids how to go “potty.” For a child with autism or other developmental disabilities, toilet training can be more difficult because of how they may perceive or react to the different sensations related to toileting. Additional difficulties can arise if there are communication challenges or if the child requires more time to learn a new skill. A parent can usually toilet train their child, but sometimes professional help is needed.

Here are seven tips to help toilet train your child with autism or another developmental disability:

  1. Wait until the child is ready.

    There is no magic age or perfect time to potty train. Kids generally show readiness between the ages of two and four, but sometimes a child isn’t ready then. If that’s the case, wait. There’s no shame in waiting a little longer, and no reason for a parent or child to be embarrassed.

    You know your child is ready to be potty trained when they show some or all of these signs:
    • The child can pull up and down their pants
    • The child is hiding to poop
    • The child is showing discomfort when wet

    These signs indicate the child is capable of going potty on their own, and that they realize, on some level, that soiling themselves is not quite right.
  2. Get the diapers out of the house and get your child into underwear.

    Kids in general should be switched to underwear at the time of toilet training. For kids with autism, this is even more important because the shift from diapers to underwear may create different sensations for the child, and it may take a little time for them to get comfortable in underwear.

    If this is the case, accept it, and recognize that the child may poop or pee in their underwear at first, but that’s okay. Take time to allow the child to become comfortable wearing underwear prior to starting toilet training, if that works better. Then, once the child is comfortable in underwear, begin toilet training. Have the child pick out underwear that is fun and interesting to them – perhaps a style with cartoons or other characters. It’s also okay to target daytime training first and then target night time once the child shows more independence on the toilet.
  3. Set aside time, ideally a week, when you and your child can be at home together.

    Toilet training generally takes about a week if a parent and child are home together every day to do the training. This is important so you can monitor your child and when there is the urge to go potty or initial signs of wetness, you can run your child right to the bathroom so he or she understands that’s where they are supposed to go. You are literally showing your child what to do and teaching them a new skill triggered by their having to pee or poop. Some children require less time and some children require more time, and that is okay too. Just be sure to set up a system that allows consistency with the child’s new routine.

    If it’s not possible to be home with your child for a week, it may take longer to teach the behavior, or you may need to call a professional to help with the process.
  4. Make toilet training fun and rewarding.

    Have the child pick out a fun toilet seat with cartoons or other characters, same as with underwear. Make going into the bathroom a party: sing, dance, have balloons in the bathroom, celebrate being in the bathroom with your child. Make peeing or pooping rewarding for the child, perhaps with a piece of candy or cookie after they have peed or pooped. Cheer your child’s success!

    If your child fears the toilet, help them not to be afraid. This can be done by taking them to the bathroom and having them sit on the toilet or play around it, with the lid open or closed, with their clothes on — just to get comfortable around the toilet.
  5. Take peeing and pooping one step at a time.

    Usually a child pees first and then gets comfortable pooping in a toilet. That’s okay. If they keep having accidents, keep showing them the places where they had the accident and then walk them to the bathroom to reinforce the relationship between pooping and peeing and using the toilet. Have them say out loud at the spot of the accident “I need to go potty” and then take them to sit on the potty as well as do the toileting routine. Do this even if they have already gone at the scene of the accident. In some cases, repeating this process more than one time can be beneficial. The point is to demonstrate to the child that it is more work to be taken to the potty twice than to go to the toilet initially. This is an advanced technique that may require the help of a professional.
  6. If the child fears the flushing sound of the toilet or washing their hands after potty, avoid those triggers as part of the training.

    Don’t flush the toilet until after the child leaves the room. Don’t wash their hands in the sink — use hand wipes instead. Flushing and hand washing are behaviors that can be taught later on.
  7. If the child is not communicative, or not very communicative, use substitutions for some verbal instructions during toilet training.

    Depending on the age and functioning level of the child, you can use communication devices such as picture-exchange cards, bells or other different tools children can use to communicate non-verbally that they have to go to the bathroom. You can work with this.
Toilet training your child with autism or similar condition can be a little more challenging, but with time and patience you likely will be able to do it, and your child will learn the skills. If you need help, a licensed professional can provide individualized treatment delivered right at home.

If you are having challenges toilet training your child, learn more about how ABA-based behavioral therapy can help or schedule a complementary 30-minute phone or in person consultation.

About the Author

Shana Williams is a Board-Certified Behavior Analyst (BCBA) who has provided applied behavior analysis (ABA)-based treatment to children and young adults with developmental disabilities since 2008. She became interested in toilet training during her BCBA program through Florida Institute of Technology and working with many clients who had the need of becoming toilet trained.

Shana currently is the Director of Clinical Services with California Psychcare and is based in our Santa Barbara treatment center. She spends her time supervising and mentoring her BCBA colleagues, providing support to families in the Santa Barbara region, and running the social skills group held at the Santa Barbara treatment center each week.

Shana Williams
Shana Williams, MA, BCBA

Director of Clinical Services
California Psychcare

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Applied Behavior Analysis (ABA)

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays. This type of therapy is conducted one-on-one, is customized for each person, and is appropriate for individuals of all ages.

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Getting Comfortable: The Initial Sessions of Home-Based Behavioral Treatment

Getting Comfortable: The Initial Sessions of Home-Based Behavioral Treatment 460 307 bh360

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Getting Comfortable: The Initial Sessions of Home-Based Behavioral Treatment

Tasha Enriquez, MA, BCBA

Your child or another family member has been diagnosed with autism spectrum disorder (ASD) or a similar developmental challenge and is about to begin home-based behavioral treatment based on the principles of applied behavior analysis (ABA). Initiating this type of intensive behavior intervention is a great step forward, and everyone in the family has the potential to benefit.

Intensive behavior intervention is the most widely accepted approach to assess and intervene with people who have developmental disabilities. With treatment, problem behaviors and their triggers can be understood and addressed. At the same time, new skills can be taught to help the individual function more effectively in everyday situations.

Starting home-based behavioral treatment may feel a little intimidating. You may be wondering what it will be like or what to expect as treatment begins. Sessions are scheduled based on the number of hours recommended in the treatment plan, as well as family preference and availability. Your clinical team will guide you every step of the way and will work with you and your family to help you adjust to the new expectations of ABA services.

The initial sessions will focus on building “rapport” between the individual receiving the services and the interventionist. Rapport refers to cultivating a relationship based on trust and on developing a connection with the client and family. It’s about establishing a comfort level and simply getting to know each other.

Building rapport is critical to set up the treatment for success, as it establishes an environment where the interventionist is paired with “fun” and “access” to preferred items and activities rather than on requests or “demands” to complete specific behavior-modifying tasks. The amount of time it takes to build rapport varies depending on the situation, the individuals involved and other factors including the number of sessions conducted each week.

The Steps to Building Rapport

How does the interventionist work to build rapport? It happens in a very purposeful way:

  • First, ABA services are often initiated in the home because it’s the most familiar place and the most comfortable environment for the individual receiving services. Depending on the goal of the services, sessions may occur in other settings such as in a clinic, in the community or at school.
  • Second, the interventionist works to get to know the individual slowly, recognizing there may be some fear or anxiety about having someone new or unknown in the family environment. Initially the interventionist may appear to be just hanging out in the same room as the client or watching the client engage in activities – such as general play, watching TV, or engaging with cell phone games – from across the room.During the first few sessions, the interventionist seeks to determine the client’s preferred items (his or her “stuff”) — be it toys, games, entertainment or other objects — and preferred activities, such as drawing or building things. A lot of observation occurs during this phase.Direct interactions with the client increase gradually. For example, the interventionist may start by watching the client play with their cars from 10 feet away, perhaps while sitting on the couch. Then they may move closer, say three to five feet away, and make comments or car sounds such as “VROOMMMM, BEEP BEEP, Crash them together!” to engage the client. Next, the interventionist might ask if they can play with a car, too. Each step is carefully navigated based on the client’s response to the prior step, with the interventionist making adjustments as needed to accommodate the client.
  • Third, parents or other caregivers are always around during the sessions, either present and participating or acting as observers.The interventionist may request that a caregiver or other family members be involved in activities during session. If the client loves to play bubbles with dad, as an example, the interventionist will “pair” with dad and bubbles. If the client likes to go outside to race his brother on a slide in the backyard, the interventionist will join this activity. The interventionist also will ask about activities and interactions the client doesn’t like, so these can be known and avoided, at least initially, and about boundaries, including off-limit areas or activities at home.

After rapport has been established, there usually is a sense of trust and fun between the interventionist and the client. This means there’s a greater likelihood that as client goals are introduced, the client will want to participate and work together with the interventionist to achieve the goals of treatment, even when challenging. Over time, many clients come to view their interventionist as a coach — a helpful authority figure — and look forward to the sessions.

To learn more about our ABA-based services or how they may help someone in your family, please visit Applied Behavior Analysis (ABA). Or visit our Request a Consultation page to schedule a complimentary 30-minute phone or in-person consultation.

About the Author

Tasha Enriquez is a Board-Certified Behavior Analyst (BCBA) who has provided applied behavior analysis (ABA)-based treatment to children and adults with developmental disabilities since 2008. Tasha’s interest in behavior analysis started following volunteer work at a ranch where children and adults with developmental disabilities were taught to ride horses.

Tasha currently serves as the training manager for 360 Behavioral Health University, where she develops and provides training for new staff and current staff on topics in behavior analysis and clinical case management. Tasha is also a clinical supervisor for California Psychcare, where she provides direct supervision services for her clients and mentors trainees who aspire to be BCBAs.

Aside from her love of behavior analysis, Tasha also has 5 horses and enjoys spending time with her family. 

Tasha Enriquez
Tasha Enriquez, MA, BCBA

Training Manager | Clinical Supervisor
360 Behavioral Health | California Psychcare

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Applied Behavior Analysis (ABA)

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays. This type of therapy is conducted one-on-one, is customized for each person, and is appropriate for individuals of all ages.

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An Introduction to ADHD – Attention-Deficit/Hyperactivity Disorder

An Introduction to ADHD – Attention-Deficit/Hyperactivity Disorder 460 307 bh360

article

An Introduction to ADHD – Attention-Deficit / Hyperactivity Disorder

Lindsay L. Wray, Psy.D.

You may have heard the term attention-deficit/hyperactivity disorder, or ADHD. Maybe you have wondered what it is or what to do if you suspect your child shows symptoms.

First of all, it is important to know that ADHD is common among children. The percent of children with an ADHD diagnosis has changed over time and measurements can vary. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) that 5% of children may meet criteria for an ADHD diagnosis. Additionally, according to the National Survey of Children’s Health (2016), 9.4% of children between the ages of 2 and 17 have been diagnosed with ADHD. So, if your child is exhibiting symptoms or has been diagnosed with ADHD, you are not alone.

It is also important to note that most children grow out of ADHD, but for some, the symptoms can continue into adulthood. The behaviors that mark the disorder — namely having a limited attention span (inattentiveness) and / or being unusually active or impulsive (hyperactivity) — can occur in very young children, though in most cases the signs and symptoms become apparent when children reach school age.

ADHD is not a developmental disorder like autism but is a brain disorder influenced by a variety of factors including genetics, exposure to toxins during pregnancy and low birth weight. Medication is often appropriate to treat ADHD but is not always the only option available to treat the disorder. Behavioral therapy – with or without medication – may be helpful in eliminating symptoms that are significantly interfering with a child’s daily life functions and ability to adapt to different situations.

With behavioral therapy, which is based on principles of applied behavior analysis or ABA, a child can be taught new or different behaviors to replace problematic ones. Part of the appeal of behavioral therapy is that the benefits of modified, learned behavior can continue into adulthood, so the child is not just experiencing a better childhood, but is learning behaviors and skills that can last for a lifetime.

There are three types of ADHD:

  • Predominantly Inattentive Presentation. Common signs and symptoms include frequent daydreaming, lack of focus or poor concentration, making careless mistakes in schoolwork, not listening when spoken to directly, or being easily distracted or forgetful.
  • Predominantly Hyperactive Presentation. Common signs and symptoms include impulsive behavior, moving constantly with an intention to distract others, inability to stay seated when sitting still is expected, talking excessively when quiet is preferred, lack of patience and interrupting others.
  • Combined Presentation. Common signs and symptoms include a mix of the above. For example, one minute the child is daydreaming and cannot focus and the next minute the child is getting up and out of his or her seat.

All children have moments of inattentiveness and hyperactivity. It is only a problem when the symptoms impair every day functions, with the child having difficulty regulating and shifting behaviors to perform basic and necessary daily activities.

If you have observed inattentiveness and hyperactivity in your child that seems to be excessive, it is worth exploring further to determine if ADHD may be the underlying cause. Your first step is to discuss the situation and your observations with your child’s primary care physician or pediatrician, or with a psychologist or psychiatrist. These healthcare professionals may offer a referral to a specialist for an evaluation.

Evaluating a child for ADHD involves administering a battery of assessment tools used to evaluate thinking, reasoning and remembering (cognitive functions), as well as assessment tools used to evaluate functions of the nervous system (neurological functions). These tests are combined with interviews with caregivers and teachers and observation in a clinic or at school. The evaluation process, when conducted by a trained professional, is friendly and non-threatening.

Receiving a referral for an evaluation does not necessarily mean your child has ADHD. In many cases the evaluation will not indicate attention-deficit/hyperactivity disorder. But if there is a diagnosis of ADHD, a good clinician will help you identify an appropriate course of action and treatment that will help address the problem behaviors and that ensures your child is treated with care and compassion.

Learn more about our evaluation & diagnostic services or ABA-based behavioral therapy services available through 360 Behavioral Health.

About the Author

Dr. Lindsay Wray, a Licensed Clinical Psychologist (PSY 30954), received her Doctor of Psychology in Clinical Forensic Psychology from the Chicago School of Professional Psychology. She is a member of the diagnostic team at Willowbrooks Behavioral Health – a preferred provider for 360 Behavioral Health –where she conducts comprehensive psychological evaluations with children and adolescents facing a wide range of challenges. Dr. Wray is also a 4th Year Fellow at the Reiss Davis Child Study Center, a department of Vista Del Mar Child and Family Services, where she conducts comprehensive psychological and psychoeducational evaluations with children and adolescents. In January of 2019, Dr. Wray joined the Reiss Davis Graduate Center as an adjunct professor, teaching psychological assessment and dissertation courses in the Psy.D. program. Dr. Wray’s interest in the field of psychology and psychological assessment is driven by her desire to work with and improve the lives of vulnerable and underserved populations.

Lindsay L. Wray, Psy.D.

Licensed Clinical Psychologist
Willowbrooks Behavioral Health

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Evaluation & Diagnostic Services

Evaluation and diagnostics – also known as psychodiagnostics – is the first step necessary to diagnose and clarify concerns regarding behavior, personality traits, mood, emotional functioning,
and cognitive processes.

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Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays.