Circle Care Services

Effective pediatric ABA therapy in New Jersey

ABA Therapy

How Do I Find a Good ABA Service Provider in New Jersey?

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If you live in New Jersey and you have a child who has recently been diagnosed with an autism spectrum disorder, you might be wondering where to start to find the appropriate autism services for your child.

Physician Referrals

Starting with your pediatrician is the easiest way to get a referral to autism service providers and specialists serving families who have children with autism spectrum disorders.

Physician Referrals

Your family pediatrician may refer you to a developmental pediatrician who specializes in autism spectrum disorders. The developmental pediatrician is a great resource, and might even be your best resource for a comprehensive list of specialists who can provide services for your child. Many times, developmental pediatricians work in a hospital setting or with a team of specialists. These specialists work in various areas such as speech therapy, occupational therapy, neurology, psychology and other fields that are commonly utilized for treatment of autism spectrum disorders.

If your pediatrician or developmental pediatrician does not provide good referrals to specialist that will help your family to find autism services providers for your child, there are other resources out there to guide you on your search.

>> Read on to be guided in the right direction.

Referral Directories

One of the largest national organizations to consult for information is Autism Speaks (autismspeaks.org). This organization’s website is filled with a vast amount of information from “What is Autism?” to fundraising and partnerships. One of the most useful tools in the midst of all of this valuable information is the search tool for aba services. By accessing the directory and inputting your location, you can easily access a list of aba service providers for autism. This applies to any state, including New Jersey.

At the state level,  each state has a department of health registry. This registry tracks current statistics and trends in autism and uses the data to aid in research to help guide families toward early intervention services for autism services. The registry is also used not only to connect families with statewide resources that are available for aba services for autism, educational services, health services and community resources, but it lists local and county based health programs as well.

A quick internet search will yield some valuable resources in autism services and ABA services. Some of these resources include a comprehensive list of services in addition to autism services like the Autism New Jersey site (autismnj.org) which includes links to health, education, human services, workforce development, medical assistance, early intervention, eligibility for developmental disability and federal assistance with medicare, medicaid and social security.

In 2016, the number of children diagnosed with autism was one out of 54 children (age 8). Since the year 2000, the rate of autism diagnoses has nearly tripled.

The number of supporting organizations for families who have a child or family member with an autism spectrum disorder is also continually growing. Parents of children with ASDs twenty five years ago had limited access to medical, behavioral, educational and insurance resources. Now we have options and federally funded programs. Autism advocacy and the field of autism services and applied behavior analysis has come a very long way.

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What is the Best Type of Insurance for ABA Services for Autism?

The best type of insurance to pay for ABA treatment for autism is a preferred provider organization(PPO). In general, a PPO will have more options available for autism specific therapies that your child will need.

ABA Services for Autism

In addition to ABA therapy, there is the possibility that a child with autism spectrum disorder will benefit from speech and occupational therapy, physical therapy, psychiatric, neurology, and other specialties. Some of these are available in the school setting and covered by the school district. Some therapies aren’t covered at all and could be an out of pocket expense. It is always a good idea to call ahead and find out what is covered and what is not covered before starting a course of therapy. Planning ahead and finding the right insurance that covers the specialties that your child with autism will need is good.

Who are the therapists at Circle Care?

Getting ABA Sessions Started!

Of all the services that your child with autism will receive, the most predominant one will be ABA services for autism. ABA services is the most widely accepted form of therapy for autism spectrum disorders. Circle Care Services serves families all over New Jersey.

We deliver

  • One to one applied behavior analysis therapy in your home or in a clinical setting.
  • All encompassing compassionate care
  • Customized parent training that supports your long term and short term goals.

We take accurate data and monitor your child’s progress carefully along the way to make sure that your child is making positive gains in social, communication and behavioral skills.

At Circle Care Services we use positive reinforcement to teach your child and keep your child motivated to learn. We do all of this in your child’s own natural environment while keeping therapy sessions playful and fun. We hope to become a part of your family circle here in New Jersey.

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Best Therapies for a Child With Autism

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Which Behavior Therapy Works Best for Children with Autism?

Autism Spectrum Disorders have kept behavioral scientists and researchers busy for decades. We have learned so much and yet there is so much that we still can’t figure out. Consider, for example, the increasing numbers of children diagnosed with autism every year. Going back to 1997, SARRC (Southwest Autism Research and Resource Center) roughly estimated 1 in 2,500 children born in the United States were diagnosed with autism spectrum disorders. By the year 2000, the CDC (Centers for Disease Control) began monitoring these numbers and reported that 1 in 68 children born in the United States were diagnosed with ASDs.

Diagnosed with Autism

Currently we know how to identify children with ASDs at an earlier developmental age and stage- some signs start as early as 6 to 12 months of age. Still, autism is increasing at an alarming rate- 1 in 54 children born in the United States were diagnosed with autism in 2020.  Yet, with all of the research and all of the advances that have been made on behalf of autism in the field of behavioral psychology there is currently no known cure.

Autism is treated by various therapies depending on the severity of the symptoms and the specific needs of the child with autism. The most common therapy used to treat autism is applied behavior analysis (ABA) therapy. ABA therapy is an evidence based behavioral therapy that focuses on improving communication skills, social skills and behavioral skills while reducing socially undesirable or inappropriate behaviors. ABA uses positive reinforcement to accomplish these goals.

ABA is the most common therapy because it has been the most effective autism therapy for the last fifty years. However, there are some other types of therapies that are worth mentioning because they are either good supplementary therapies to ABA therapy or they provide excellent stand alone benefits for specific symptoms of autism.

What Therapies, Besides ABA Therapy, Also Help with Autism?

Speech Therapy is commonly recommended for children on the autism spectrum to help with communication and speech. A speech therapist can help children with compromised speech but they do much more than just help with pronunciation and teaching children how to speak. Speech therapy also addresses the misuse of language and helps those with autism to avoid misunderstanding language as they communicate with others. They teach their clients how to interpret body language and look for subtle physical signals. They also work with pragmatics in speech so that children know when, how and to whom they can say certain things to. Speech therapy teaches inflection or “prosody” which is the movement in a person’s voice as they speak. Children on the spectrum often need to learn this skill because many have a “flat” or monotone  pattern of speech that causes them to appear emotionless to others. Conversation skills, grammar, and social skills are also practiced with question and answer exercises as well as concept skills. Concepts can be difficult for some children with autism because concepts require abstract thought to make sense of some of the concepts. As you can see, there is much more to speech therapy than just learning how to speak clearly.

PECS is an acronym for Picture Exchange Communication System.

Picture Exchange Communication System.

Using single pictures, a child with autism can show someone what they would like to gain access to. This is part of the goal for Phase I of six phases. Phase II would work on generalizing the skills from Phase I, Phase III is picture discrimination whereby individuals learn to choose from a collection of pictures of their favorite things and ask (mand) for them. They can build a sentence to communicate by using sentence starters such as “I want” or “I need” and finishing the sentence with the rest of the pictures during Phase IV. Phase V moves on to responses so that the child will learn how to answer as well as ask. In the final phase (VI), children are taught to respond (comment) to questions such as “What do you see?” or “How do you feel?” They would use this opportunity to form sentences using starters such as “I feel” or “I see”.

Occupational Therapy is sometimes necessary for children with autism due to physical challenges that sometimes accompany autism. OT sessions can focus on:

*Gross motor skills to improve coordination

*Social skills to enhance physical activities with groups

*Fine motor skills to improve handwriting and activities that require small muscles and hand/eye coordination

*Play therapy to improve interaction and imaginary play skills with others

*Sensory skills to help children who have weak responses or extreme responses to sound, smell, touch, light or taste

The skills that are learned in occupational therapy improve daily living, the ability to perform academically and interact with others in social settings.

Nutrition Therapy- While there hasn’t been any substantial evidence that specific diets lesson the symptoms of autism, some parents believe that they see a difference in their child’s behavior when they add or subtract certain foods. Gluten and casein are hot topics with parents who report behavioral changes in their children when they are exposed to these proteins. Continued research is being conducted to examine the “leaky gut” theory which refers to the possibility of these proteins seeping through the intestinal tract, “fermenting” in the bloodstream and ultimately resulting in impaired behavior when the fermented blood reaches the brain. So far, this theory is unsubstantiated. However, nutritional therapy can be helpful for children with autism due to their limited preferences. Children with autism have a higher incidence of gastrointestinal problems and tend to have thinner bone density than children without autism. Working with a nutritional therapist can help to remedy potential health problems associated with limited food choices.

Art Based Therapy– This type of therapy refers to dance, music, drama and visual arts. The idea behind this type of therapy is that it provides an outlet for communication and expression that children with autism may or may not be able to express verbally or socially. Depending on what type of art form your child participates in, expressing themselves artistically can help with some of the skills that are being addressed in occupational therapy by exercising fine motor skills. Communication and social skills can also be improved by working with others in drama groups, or music and dance groups. Their senses can be engaged by color, art medium, and sound. It also provokes cognitive skills such as decision making, self awareness and perception and can also increase the chances of overcoming intolerance to certain stimuli like smells, sights and sounds that were previously unpleasant to them.

Social Skills Therapy– This type of therapy is specific to the improvement of social skills and communication. The focus of social skills therapy is to improve communication by developing the child’s communication skills so that they can carry a conversation, understand jokes and sarcasm, answer questions, read non verbal cues and improve speech overall. Circle Care Services has a great group of therapists who oversee a social skills group within the practice. (link here)

Horseback Therapy– Also known as Equine Therapy, this form of occupational therapy focuses on teaching attention, self control and sensory management. Riding a horse can also be beneficial to how a child with autism carries their own posture. During a ride, they will inevitably have to adjust to different movements from the horse and the children may move in different ways than they are normally accustomed to and widen their range of movement without even thinking about it. This type of therapy is credited with improved adaptive behaviors like responding to new challenges, coping with everyday life, communicating, resilience and mental flexibility. While equine therapy may still be in the early stages of research, what is known now is showing positive benefits and improvements in regulating behavior, sociability, irritability, lethargy and hyperactivity.

Yoga Therapy– Anyone who practices yoga for an extended amount of time will most likely express the benefits of yoga such as improved strength, posture, cardiovascular fitness, coordination, body awareness, focus, concentration, stress reduction, balance and flexibility. For children with autism there are additional benefits that are helpful. Yoga can help children with autism to self regulate impulsive, obsessive, aggressive and self stimulatory behaviors. If they attend a class with peers or other people in the community you can also expect to see improvement in social and communication skills, awareness and expression of emotions, reduced frustration and a positive self body image.

Relationship Development Intervention (RDI)– RDI is a type of therapy that is focused on building social and emotional skills by developing “dynamic intelligence” (the ability to think flexibly). Parents are trained by certified behavioral consultants to be the primary “therapists” in this program. RDI has six main objectives:

  • “Emotional Referencing: the ability to learn from the emotional and subjective experiences of others
  • Social Coordination: the ability to observe and control behavior to successfully participate in social relationships.
  • Declarative Language: the ability to use language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.
  • Flexible thinking: the ability to adapt and alter plans as circumstances change.
  • Relational Information Processing: the ability to put things into context and solve problems that lack clear cut solutions and have no “right and wrong” solutions.
  • Foresight and Hindsight: the ability to think about past experiences and anticipate future possibilities based on past experiences”.
I want to start with an evaluation

How do I make sense of all the different treatments?

These are just some of the many additional and alternative therapies that are out there for families to explore.

Making sense of all of these choices is a matter of what is best for your family. ABA therapy has proven to be the most effective therapy for children with autism. It is still referred to as the “Gold Standard” by which all other forms of treatment should be measured.

“The Maine Department of Health and Human Services (HHS) and the Department of Education (DOE) reviewed 150 studies with 43 different treatment approaches for people with autism. The meta-analysis used the evaluative method for determining evidence-based practice in autism to assign each intervention a rating based on the amount of evidence involved in the treatment process. The report found that ABA therapy was one of the few that met standards as an established evidence-based therapy.”

the different treatments

Knowing this, there still might be an area of a child’s life that could be served well by additional therapies or perhaps alternative therapies. There is nothing wrong with trying new things. It certainly wouldn’t hurt to enroll your child in a Yoga class with other children who have autism. Most children certainly wouldn’t mind spending time with animals if Horseback Therapy sounds like something interesting that your family would like to try.

Most of the alternative therapies have some cross-over elements of social, occupational or behavioral therapy that complements ABA, speech therapy, social skills groups or occupational therapy. Any combination of these could be a wonderful way of reinforcing the learning that is taking place in ABA therapy.

Who are the therapists at Circle Care?

What are the Costs for These Alternative Therapies?

Parents of children with autism are well aware of how costly it is for therapy services. Ideally, private insurance is the best option for autism treatment. However, some of the alternative therapies mentioned here, such as yoga or horseback, are most likely going to be out of pocket expenses. ABA, occupational therapy, and speech therapy are likely to be covered by private insurance. Social skills groups are also likely to be covered especially if it is part of the treatment program with your ABA provider.

Alternative Therapies

Here are some very rough estimates of annual costs for the therapies mentioned above- all of these are approximate costs and dependent on individual need:

  • ABA therapy can range anywhere from $20,000-$60,000 annually
  • Speech Therapy- Initial Assessments are approximately $250; half hour sessions are approximately $65 and one hour sessions- $130
  • Occupational Therapy- Initial Assessments $250; hourly $100- $200
  • Yoga Therapy is typically a private pay therapy; classes for children with autism range from a per class fee or a monthly membership at a yoga gym. Prices will vary with each facility or instructor
  • Horseback therapy is typically a private pay therapy ranging from $60- $250 per session
  • Art Therapy is a private pay therapy and will vary with each type of activity; private dance lessons, music lessons and drama lessons range from $60-$200 per month depending on whether your child receives group instruction or private lessons. Art therapy (paint, ceramics, and other various forms of media) are approximately the same cost.
  • RDI (Relationship Development Intervention)- may or may not be covered by private pay insurance. Initial assessments can cost approximately $250 and sessions can range $100-$200 per session.

It is roughly estimated that it takes $60,000 annually or more to support a child who has autism. It is a good idea to secure private insurance to keep out of pocket expenses to a minimum. Many of the therapies that are not covered by private insurance are the equivalent of what most families spend on extracurricular activities for their children who are involved in sports, drama, dance, theater or music. However, for the child that requires speech, occupational or behavioral therapy it is best to make sure that your insurance covers the cost. If it doesn’t, reach out to your local public health department, school district or state department and ask for assistance to find resources that are covered by government programs or the school district. There are plenty of resources out there.

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When Should I Consider Medications for My Child with Autism?

There are certain circumstances that may require making the difficult decision to allow your doctor to prescribe medications for your child with autism. This is not an easy decision and it is always best to take time to carefully consider all of the variables and seek another doctor’s opinion if there are too many questions left unanswered while trying to decide.

Generally speaking, it is always best to consider the full impact of deciding against medication. Will the child suffer adverse effects if they are left untreated? Will the child have difficulty with behavioral therapy without medication? Will they have difficulty in school without medication? If a child needs medication at an early age to help with academics or to sleep and they don’t receive it, the long term effects could be devastating.

Medication is usually reserved for symptoms such as aggression, insomnia, self injurious behaviors due to anxiety or frustration, attention deficits, and obsessive compulsive behaviors. Without medication, these types of behaviors can limit friendships, academic achievement, cause aggression toward others, harm to self and insomnia can cause a long list of problems including depression, obesity, irritability and attention deficit problems.

When considering medication, the benefits should outweigh the risks for the child. Earlier is better than later because some of these symptoms are harder to reverse after too much time has gone by.

Take your time when making life changing decisions for your child and your family.

The team at Circle Care would love to answer any questions about ABA, alternative therapies, medications or any other questions you may have about your child with autism. Our staff is dedicated to helping you make good choices for your child as you consider a course of treatment for your child with autism.

We hope to hear from you as you start your journey with your child. Give us a call and let us help you with a plan for the future that will benefit your child and your entire family.

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The Importance of Social Skills Therapy for Autism

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Most new parents have experienced a time when their own child or someone else’s child was that “one” child that was causing major disruption among all of the other children at a park or at a playdate. It’s hard to forget those humbling moments when your child is grabbing toys away from other children or randomly hitting others. When grocery store excursions become a flip of the coin between mom and dad to see “who gets to chase him first” or “who gets to sit in the car when she melts down” any parent will feel lost.

Social Skills Therapy for Autism

Parenting is not for the faint of heart and all children need to learn a host of “do’s and dont’s” as they mature. They need to learn table manners, how to ask for things properly, how to share and play with others and how to behave in public. We could add to this list of course, but the point is that all children need to learn social skills as they develop.

When you have a child with autism, social skills training needs to become more deliberate. The reason for this is that children with autism struggle to understand and succeed at understanding social interaction. There are a number of factors that cause this to be so.

➔  Speech Delays.

Children with autism have delays in speech that can make it difficult to maintain a conversation. They may repeat words or phrases over and over (echolalia), or they may answer questions with completely unrelated responses. This often pushes other children away because they don’t understand them and ultimately this leaves the child with autism isolated.

➔  Non-Verbal (receptive) Language Delays

Another reason that children with autism struggle with communication is that they tend to have difficulty reading non verbal cues. Non verbal cues are facial expressions or body gestures. For example, the look of boredom on a person’s face (facial cue) when they are no longer interested in a conversation might be obvious to most of us but to a person with autism it may go completely unnoticed. A person checking their watch and tapping their foot (body gestures) would give many people the idea that this person is either impatient or in a hurry. A person on the autism spectrum might fail to take notice of these gestures.

Similarly, sarcasm is difficult for children on the autism spectrum to understand. People with autism spectrum disorders tend to see everything in a very literal sense. So, to say something in colloquial language like “oh my goodness….you look so cute I could just eat you up!” might be a very frightening thing to say to someone with ASD. Jokes and teasing are no different. Something that is meant to be playful and innocent might sound scary and threatening to a child with autism who has not been taught about figurative language,  joke telling or sarcasm.

This doesn’t mean that you should change the way you speak and avoid telling jokes or using figurative language. What this means is that these are the things that need to be taught deliberately in social skills training for children with autism.

➔  Low Emotional Intelligence

Another common struggle for children with autism is that they often fail to understand the feelings of others. This can lead to the misconception that children with autism are unfeeling or uncaring- but this is not the case. The difficulty for those with ASDs is that it is nearly impossible to think from another person’s perspective and consider how they might feel in various circumstances. The job of identifying and expressing their own emotions is one of the main interventions in social skills training for children with autism because it is such a common deficit with children on the autism spectrum. It is important to teach children with autism to identify and manage their own feelings and emotions first because until they can do that, it is nearly impossible to recognize how someone outside of them might be feeling.

I want to start with an evaluation

What is the goal of my child’s Social Skills Training?

The first goal of social skills training for children with autism should be to bring their social interaction with other children up to the level of their same age peers who are not on the autism spectrum (neurotypical). This is especially true for young learners as it will set the tone for how well they succeed in school, work, community and other social settings that they will encounter.

Social Skills Training

When social skills intervention occurs early on, a child can build confidence at a much earlier age by learning how to make friends and get along with others. Getting along with others is a springboard for learning other valuable skills like sharing, taking turns, imaginary play and sportsmanship.

Speaking of sportsmanship, it is important to provide opportunities for children with autism to play games where they may win or lose. Children with autism “feel” the happiness and victory of winning and the sadness or frustration of losing with added intensity. This is a great opportunity to teach good sportsmanship or frustration tolerance in social skills training. One way to teach this is to model good sportsmanship. Play a simple game that you may lose, (suggestions- tic, tac, toe, Candyland, Tag or Hide and Seek) and thank the child for a fun game. Congratulate the child for winning. Modeling social skills is teaching social skills.

What Social Skills Should My Child Be Learning?

Playing with others requires social skills training that is focused on a few pivotal skills. These pivotal skills are the skills that make or break the ability for play to continue.

Talking with others is a pivotal skill that facilitates meeting, getting to know one another and building friendships. A child with autism who has social skills training will learn that it is much easier to join a group of children at play by saying hello and asking to play than it is to stand and watch. The more times that a child successfully communicates and interacts with others, the more likely it is that they will continue to communicate to meet their needs.

Once a child with autism begins to talk with others more often, learning how to share or take turns  becomes easier to teach. Teaching children on the spectrum how to share requires an opportunity to play with other children or siblings. So, you can see how important it is to get children with ASDs to talk with others first. Sharing requires a little negotiation, “first you have the ball for five minutes and then I can have the ball.”

In the midst of communication, play and sharing there is bound to be conflict at some point. This is why managing emotions is considered another pivotal social skill for children with autism. When children with autism have difficulties managing their emotions it can be tied in with their inability to express themselves verbally or it can be a deficit in any combination of social, communication, sensory or executive functioning skills (memory, self control, flexibility).

When a child with autism has difficulty managing emotions, they might react to aversive or non-preferred stimuli in any of the following ways. 

  • Run away from the environment.  (This can be dangerous in certain settings).
  • Experience a  meltdown similar to a tantrum that would be seen in a toddler. (this is true for some adolescents, even those with high functioning autism)
  • Become aggressive or self harming
  • Resort to self stimulatory behavior like hand flapping, rocking or pacing.

The far reaching impact of social skills training

Beyond the pivotal skills of talking, taking turns, sharing, and managing emotions, is the ability to extend those skills into imaginary play and problem solving. These are life enhancing social skills that will develop over time and with exposure to peers and problems.

Pretend play

Pretend play happens best with a group of children who take on various roles and create scenarios and banter back and forth with one another developing a story as they go along.

Problem solving

Problem solving is a life skill that is best developed in a social setting and through interaction with peers. It’s a social skill that requires a little prompting and teaching, but the more a child with autism interacts with other children the more likely they are to encounter situations that will require some negotiation. It could be anything from a small disagreement between two peers or it could be a puzzle that a group of children is trying to solve.

All of these important social skills can be taught in ABA therapy sessions and by inclusion in a social skills group for children with social skill deficits. These social skills intervention groups work the same way an ABA session would by using positive reinforcement and a natural teaching environment. The biggest difference would be that the social skills groups are  focused on the group interaction and improving social skills with each child by providing opportunities to respond to situations and resolve potential conflicts as they arise by guiding the children step by step as they learn.

The end goal of social skills training and intervention is to bring children with autism up to the level of their neurotypical peers in order to behave appropriately in public and to make connections with other people at the earliest opportunity possible. These skills will follow them into school, community and workplace settings as they get older.

Who are the therapists at Circle Care?

What Kinds of Strategies Are Used for Developing Social Skills?

Social skills intervention for autism should be fun while teaching necessary life skills. Luckily, social skills training is inherently fun because it’s all about getting groups of children together, playing and interacting.

Developing Social Skills

Some social skills training will be targeted for independent activities like going to the dentist or accompanying mom to the grocery store.

Whether your child is learning how to interact socially with peers in a group, one on one or independently in school or community these are some strategies that can be used for teaching social skills.

Role Play

Role Play is a useful strategy for practicing what will take place in a new situation that a child has never encountered before. If a child is going to the first day of school it can help ease any worries with a little first day of school role play. One child can pretend to be the teacher and another can be themselves. Practice introductions and finding a seat and starting the school day. Switch roles and allow the children to get creative and have fun with the role play. If imaginary play is difficult, a facilitator can step in and guide the role play.

Games

Games are always a great tool for teaching rules, turn taking and sportsmanship (as mentioned above). These social skills can be difficult for a child with autism and it may require time and patience to teach them. Some independent practice with a therapist or an adult at home is sometimes helpful to work through and talk through frustrations before getting into a large group setting. In the end, the social skills that are learned through game play are valuable.

Observation

Observation can remove fear of the unknown for children with autism. If a child on the spectrum is going to be exposed to a new setting (school, daycare, park) or a new situation (dentist, airplane, amusement park) it would be worth the time and effort to find ways to observe these new scenarios before the child experiences them.

If they are going to a new school, try stopping by to meet the new teacher, see the classroom, and watch the kids play on the playground.

If they will be visiting the dentist, try looking up some videos of other children during their visits to the dentist. Make sure (of course) that the videos are positive experiences and that there are simple explanations of what the dentist is doing in the video. The more the child knows before the visit, the less likely they are to fear the visit.

Social Stories

Social Stories are stories that help children with autism learn what to do and what not to do in social situations. Social stories are written in a specific format:

*They are constructed teach perspective

*They present opportunities for responses.

*They reinforce and support what they learn from the stories

*They teach the important role played by other people in situations and how they are handled

*They are reviewed by using partial sentences (fill in the blank) to encourage a child with autism to determine the ideal response to social situations.

Social stories are available in book and video formats and they are increasingly popular in social skills training.

ABA Therapy is the most frequently recommended course of treatment for autism spectrum disorders because it has shown the highest evidence based outcomes. Social skills intervention can be taught using Applied Behavior Analysis. ABA therapy uses positive reinforcement to reduce undesired or inappropriate behaviors while increasing socially appropriate behaviors. ABA focuses on improving specific behaviors such as communication, adaptive learning skills, academics and social skills.

Social Skills Groups

Social skills training can happen in just about any setting and there are opportunities throughout the day that can be utilized as teachable moments for children with autism. But, one of the best places to start is a social skills group that is specifically set up as a safe and accepting environment for children on the autism spectrum.

Kids Club is an after school social skills intervention group that is run by Circle Care Services’s ABA therapists.

At kids Club, children learn how to better

  • Talk to others
  • Take turns
  • Share
  • Manage emotions
  • Solve problems

This enables them to

  • Build confidence
  • Behave more appropriately
  • Make new friends

 All these skills are practiced and eventually mastered in a setting that is fun and free from any conflict or tension with peers. Parents need not  worry that their child is being bullied or isolated. Compassionate Circle Care therapists play with the children using activities and situations that ultimately teach them how to better navigate social situations in their everyday lives.

As your child breaks through barriers that previously kept him from joining in with activities that might be messy or loud or include a lot of friends, he will gain newfound joy.

Learn more form a new group in your New Jersey location or enroll now.

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What Is A Developmental-Behavioral Pediatrician?

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As a child grows from birth to adolescence, there are important developmental milestones that each child is expected to reach physically, cognitively and emotionally. When there is a delay in a child’s cognitive or emotional development that affects academics, social or family dynamics it might be time to become acquainted with a Developmental Pediatrician.

Developmental-Behavioral Pediatrician

A family Pediatrician is trained to monitor your child’s physical growth milestones and watch for any signs that your child might need to be referred to an outside specialist for issues outside of their immediate scope of practice. A Developmental Pediatrician is a subspecialty in pediatrics that addresses more specific issues that are related to delays in areas that affect development such as speech disorders, motor skills delays, sleep or eating disorders, attention deficit disorders, learning deficits, autism spectrum disorders, Down syndrome, cerebral palsy, Tourette’s and many others.

Developmental Pediatricians are trained to understand the effects of the medical and psychosocial aspects of the developmental and behavioral issues that their children are struggling with and how it affects the family as a whole. Developmental Pediatricians are trained to work with the entire family to evaluate, provide counseling and treatment.

In addition to working with families, Developmental Pediatricians work closely with school personnel and other organizations that are involved in the care and education of the child.

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Where Can I Find a Developmental Pediatrician?

If you are in need of a Developmental Pediatrician, you can find them at private practices, hospitals, clinics, rehabilitation centers, health departments, and community outreach programs. Children’s hospitals often have an entire department dedicated to developmental pediatrics.

Developmental Pediatrician

Due to the wide range of developmental and behavioral disorders that Developmental Pediatricians address, it is commonplace to find these specialists work with a team of professionals that specialize in various areas. These specialists might include a child psychologist, speech pathologist, physical therapist, occupational therapist, child psychiatrist, pediatrician, social worker, neurologist and even educational consultants or diagnosticians.

Send me a referral for a developmental paediatrician that can diagnose my child.

Who are the therapists at Circle Care?

What Do Developmental Pediatricians Diagnose?

Developmental Pediatricians are highly trained to be more specific when it comes to diagnosing behavioral and developmental disorders. General Pediatricians are somewhat limited in their training when it comes to learning disabilities, autism spectrum disorders and developmental disorders. There is a wide range of behavioral and developmental difficulties. Developmental Pediatricians can identify, recommend specific treatment options and provide options for the entire family.

Developmental Pediatricians Diagnose

Additionally, if there is a need for any medication a Developmental Pediatrician can also provide a prescription and monitor the child.

Over the long term, a Developmental Pediatrician is part of your child’s team of advocates that will support your entire family through the early years of childhood and throughout the years in school when the most help will be needed.

Our staff at Circle Care Services, New Jersey, joins up with that team of advocates to support you and your family through this time of growth for your child. Collaboration between our Behavior Analysts and the Developmental Pediatrician while working in cooperation with family, school and other outside agencies over the long term gives your child the best opportunity for learning and growing through the challenges they face.

Bring us into your inner circles, and get the supportive team collaboration you need anywhere in New Jersey.

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What is Positive Reinforcement?

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Your high school student brings home a report card with all As and Bs on it. As a reward, you and your husband decide to treat him/her to their favorite ice cream shop for dessert. You spend the time congratulating your child and sharing how proud you are of all of the hard work that they have been putting into their schoolwork. As an incentive, you and your spouse offer dinner at their favorite restaurant and some spending money if the next report card is just as good or better. They can even invite a friend. This is positive reinforcement in action.

Positive Reinforcement

Positive reinforcement consists of a stimulus that is added to the environment immediately after the desired response has been exhibited, increasing the likelihood that the response will occur again. The stimulus is simply something that increases the chances that a response or a reaction will occur.

In other words, if a teacher provides the right reinforcing stimulus immediately after a child performs an appropriate behavior it is more likely that the child will repeat that appropriate behavior and learn to use it more often. What does that look like? Well, if we say “touch tummy” to a toddler and the toddler touches their tummy right away, then the teacher or therapist would provide immediate positive reinforcement using something highly motivating or exciting for that toddler to reward them for responding correctly. This also encourages the toddler to participate with the therapist in the future because there is a reward for playing with the therapist and it is fun!

The reinforcement is going to be different for each child based on their personal preferences. Some children are happy with verbal praise and smiles while other children love to be tickled or chased. Some children enjoy bubbles as a reward and others just want a break with some free time to do whatever they want to do. These individual preferences will be discovered by our staff at the initial intake at Circle Care Services and they will evolve as ABA sessions progress.

The Role of Positive Reinforcement in New Jersey treatment for Autism

The number one benefit to using positive reinforcement is that it focuses on what the child is doing right. As a parent and even as a teacher, it can be a slippery slope when the focus is targeted on what is going wrong with a student. One reprimand or correction in behavior can lead to frustration which leads to more negative behavior and this can set the tone for the rest of the school day or the rest of an ABA session.

The role of positive reinforcement is to outweigh the focus on the negative behaviors with a greater focus on the positive behaviors. Positive reinforcement is a great motivator. A Harvard study of 60 strategic business unit leadership teams at a large information processing company briefly examined the difference between positive and negative feedback. The findings show that the top performing business teams were the ones who received 5.6 positive comments to 1 criticism.

The article beautifully sums up how positive feedback (reinforcement) affected the top performing teams:

“…even the most well-intentioned criticism can rupture relationships and undermine self-confidence and initiative. It can change behavior, certainly, but it doesn’t cause people to put forth their best efforts….Only positive feedback can motivate people to continue doing what they’re doing well, and do it with more vigor, determination, and creativity.”

If positive reinforcement works so well with typical people in the business world, imagine how effective positive reinforcement can be for a young child on the autism spectrum who is testing various behaviors in an attempt to figure out what is appropriate and what is not appropriate behavior. Imagine the satisfaction that the child might feel from the continuous praise, smiles, stickers, bubbles, tickles, iPad or whatever the reinforcing motivation (stimulus) might be for them. We understand these principles at Circle Care and we train our staff to create a highly engaging and motivating atmosphere during sessions so that your child will look forward to their ABA time.

Just as it creates more vigor, determination and creativity for business minded adults, it also does the same for any other human because that is how we are neurologically wired. We like praise and recognition because it triggers good feelings and it drives us to keep seeking those good feelings by repeating those events or behaviors which yielded those good feelings. The same is true for children on the autism spectrum. ABA at Circle Care Services uses these principles of positive reinforcement to teach and guide children with ASD toward socially appropriate behavior and effective communication skills in a natural teaching environment while having fun. Another benefit of using positive reinforcement in ABA or any other learning environment is that given enough time, it seems to be a long lasting method of teaching. “Learning accompanied by positive feelings and associations is more likely to be remembered, even beyond the end of the reinforcement schedule…”. This is important because in ABA we are teaching life-long skills that will serve these children well through their school years into adulthood.

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How Positive Reinforcement is Used in ABA Therapy

When positive reinforcement is used in ABA therapy, a behavior is targeted for change. If a child wanders around during meal times, the target for change may be “remaining seated during meals”. If a child is accessing electronic toys without permission at home, the target behavior may be “Johnny will ask a parent or teacher for access to iPad.”

Positive Reinforcement is Used in ABA Therapy

When the child with autism responds with the appropriate target behavior, the consequence for that behavior should be immediate positive reinforcement so that the child is motivated to change (repeat) the appropriate behavior. By using the principle that “behavior which is reinforced tends to be repeated (i.e., strengthened); behavior which is not reinforced tends to die out or be extinguished (i.e., weakened),” a behavior analyst will help to identify what types of reinforcers will work to change behavior for each individual.

Once a therapist knows exactly what will reinforce the target behaviors, the next important step is to implement a schedule of reinforcement that keeps the child motivated, interested and happy to comply with the treatment plan. Read our article on why positive reinforcement is so effective for the treatment of autism.

Types of Positive Reinforcement

There are four main categories of positive reinforcers:

  1. Tangible Reinforcers– are items that a child can touch, hold, taste, smell, or see. A child might be highly reinforced by having access to a tablet after displaying positive behavior. Or, maybe a child is reinforced by a certain toy, book or random object.
  2. Social Reinforcement- are positive social interactions that include actions such as high fives, smiling, tickles, verbal praise, or any gestures in a social setting that can increase the likelihood of positive behaviors in a social setting in the future.

One example of a social reinforcer could be the verbal praise of a teacher and thumbs up from peers in a classroom where a student fears reading aloud. This student is likely to read aloud again in the future because of the positive social reinforcement.

  1. Natural Reinforcers– are reinforcers that do not require any type of learning to become desirable. Food and water are natural reinforcers. Another example of natural reinforcement: a child asks for a ball that is out of reach and an adult hands it to the child. The adult handing the ball to the child is naturally reinforcing and increases the likelihood that the child will request “ball” in the future.
  1. Activity Based Reinforcement– is providing access to fun activities as reinforcers for positive behavior. For example, a child finishes a task in school at his/her desk and they are allowed access to a computer for ten minutes. Brushing teeth before getting a bedtime story would also be an example of activity based reinforcement.
Schedules of Reinforcement

Depending on how you want to teach a behavior, there are five main types of reinforcement schedules to choose from.

  1. Continuous Schedule– Reinforce behavior after every occurrence. This can be tiring as a teacher and it could also make reinforcers less effective.
  2. Fixed Ratio– Reinforce behavior after a specific number of occurrences. For example, you could reinforce a positive behavior every other occurrence or every third or fifth occurrence.
  3. Fixed Interval– Reinforce behavior after a fixed amount of time has passed. For example, if a child goes to bed on time every night for five nights in a row (school nights), then they are allowed to stay up late on the 6th night (non school night.).
  4. Variable Ratio– Reinforce behavior on a random schedule. For example, reinforce positive behavior after one occurrence, then after three occurrences, then after two, then after five and so on.
  5. Variable Interval– Reinforce behavior after a variable amount of time. For example, after five minutes, then after two minutes, then after twenty minutes and so on.

All of these elements together are all part of successful positive reinforcement in ABA treatment. Every goal is carefully planned and accurately measured by taking data during sessions so that progress can be monitored. By targeting the behavior that needs to change and using powerful reinforcers that motivate the child with autism to manipulate the consequences following the positive behavior, the chances of increasing the positive behavior are greater and ultimately the chances of long term learning are also greater.

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Weaning off of a Positive Reinforcement Schedule

Eventually, the child will start to respond more frequently and independently and in time the use of positive reinforcers to motivate behavior will not be necessary. At this point it would be appropriate to fade out the use of positive reinforcers and allow the child to enjoy natural reinforcement as their reward.

Positive Reinforcement Schedule

The goal is to steer away from criticism and to focus on positive feedback and reinforcement. As was aforementioned in the Harvard study, “…the most well-intentioned criticism can rupture relationships and undermine self-confidence and initiative. It can change behavior, certainly, but it doesn’t cause people to put forth their best efforts” But positive reinforcement can “…motivate people to continue doing what they’re doing well, and do it with more vigor, determination, and creativity.”

References:

  • Harvard study praise to criticism ratio

https://hbr.org/2013/03/the-ideal-praise-to-criticism

  • Ackerman, C. E. (2021, January 29). Positive Reinforcement in Psychology (Definition 5 Examples). Retrieved February 19, 2021, from

https://positivepsychology.com/positive-reinforcement-psychology/

  • Simply Psychology.

https://www.simplypsychology.org/operant-conditioning.html

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