Thursday, December 10, 2009

ABA - the initial visit

On Nikko's progress report, Mrs. I said that I should pack along Nikko's other glove because they are practicing putting on winter outside clothes in the correct sequence at school. The only thing he's missing from his repertoire is boots, which he still won't wear. Perhaps I'll pack boots on Friday, but still include his regular shoes plus extra socks. I have to remember to try on the snowsuit at the back door of his room, but I think it's too small for him. *sigh*

Today at 1pm Maria, the director of MGB Services, came for a house visit. She was very nice, asked questions and told me all about how ABA would run out of our home. She emphasized cost a lot because she knows that ABA therapy is very expensive, but their services are probably the lowest rates around. It's true from what I've researched; an ABA center had therapists that charged $125/hr, whereas her fee for her services is $50/hr, for a senior line person around $25/hr, and for a line person between $10-15/hr depending on experience. Those are the numbers I have to work with, to crunch them and give us a rough idea how much this could cost over a few months to years. I was able to ask questions, but she answered a lot of them while we talked. The night before I had re-read up on ABA Therapy (Applied Behavioral Analysis, for those who don't know) as well as Verbal Behavior Therapy since that sounded like the route we'd like to take with Nikko. The whole premise of this kind of therapy is that it is rewards-based, using positive reinforcers to get a desired behavior. Pavlovian, sure. Effective? Yes, and proven. Some of my questions were:

Q: Nikko has really strong separation anxiety to me. How do the therapists handle that?
A: Linda H. will be consulted and have the final say on that, but all the therapists have dealt with this kind of behavior and can handle it. They'll most likely distract. Will physical restraint be used at times? I asked. She said that Linda would be asked, for sure. I'm not worried that they could hard Nikko by restraining him, but that they could be hurt by him because he's a strong fellow.

Q: Where would sessions take place? How long? Structure of a session?
A: We scouted out the house. She asked for a room where a door could be closed, a table and chairs accessible. We ended up in the basement which she said was ideal because it's a big enough space to do large motor activities, and a small space can be cornered off as well. I can listen in at the top of the stairs if I want. I am welcome to sit in on sessions, but things would be more effective if I didn't, and if the kids weren't around either. We would stay upstairs, basically. A session runs between 1-1.5 or even 2 hours. Nikko will soon welcome the sessions because it is 1:1 time with an adult and they will make it FUN. She showed me an outline of a structured session, starting with a snack, then ranging from 10-15 minutes of drills (perhaps matching or sorting or whatever the skill of the day is), then a 5 minute break of self-play, then 10-15 minutes of drills again, then a break to do a sensory activity or a motor activity, then 10-15 minutes of drills, then a 5 minute break of playing games, and he will learn how to take turns through ABA.

Q: How will a schedule be determined?
A: Linda H. will be consulted for her recommendations, but Maria said she thought Nikko would probably start at 3-4x/week for 1.5 hrs. Days to be determined. We'll work around his preschool schedule.

Q: Nikko is highly motivated by FOOD. How can we overcome this?
A: She was writing down the foods he likes, and mentioned that Linda has the final say on whether or not we'll start with food, but they intend NOT to use food as a motivator. She continued asking me what kind of toys Nikko liked to play with.

Q: How will I know ABA is working?
A: She said I'll see a difference within six months or sooner. As his parents, we'll also learn things from ABA that we can use with him in his daily life. I think they'll help us out with this part, because Maria suggested a training class that Linda offers as well.

Q: What should I NOT be doing with NIkko on a daily basis? (like TV)
A: Maria said I don't have to change anything. Keep doing what we're doing.

We're going to look over the contract, crunch some numbers, see where we can find some $$, and then formally move forward next week. I'll let Maria know.

Our day was out of whack because of Maria's visit. Ronin's nap was at 3:30p instead of 2p. Audrey also slept a little off. Nikko just wanted to watch Cars, and when prompted he said CARS to me after signing it. Now I've got to get him to label an actual car, not just the DVD movie. That would be called generalizing.

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