Tag Archives: behavior

Mental Health Services for ASDs

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Sigmund Freud

Sigmund Freud (Source: Flickr)

Students with Autism Spectrum Disorders (“ASDs”), including Asperger’s Syndrome and Pervasive Developmental Disorder, Not Otherwise Specified (“PDD-NOS”), are often challenged by anxiety, which is an emotional health need. Many school districts contract with county mental health agencies or other providers for forms of individual psychotherapy services that may not be appropriate for some students with ASDs. Further, they may have no other service to offer to address ASD-related anxiety issues.

To add to the confusion, many county mental health agencies have recently re-identified themselves as county behavioral health agencies, yet they do not provide Applied Behavioral Analysis (“ABA”) or any other type of peer-reviewed behavioral intervention. ABA is supported by research to be effective in not only contending with undesired behaviors among persons with ASDs but also in providing explicit instruction to teach the skills these individuals lack.

Explicit instruction in social skills such as greetings, farewells, maintaining a topic of conversation chosen by another person, initiating conversations, and other aspects of human interaction have to taught to many children with ASDs as explicit, scripted procedures. Those procedures can then be generalized into real life by reinforcing them when they occur in natural settings and pointing out to the individual, in vivo, when he/she has engaged in the steps of the procedure so that he/she learns to recognize social contexts in which each script is to be applied.  Eventually, it becomes a learned, rehearsed strategy to deal with specific types of situations.

The degree to which persons with ASDs can master various scripted procedures, or even need this level of support, varies from individual to individual. The same for the degree to which someone with an ASD can generalize knowledge from one context to another, such as from the instructional setting to real life.  It’s called a spectrum disorder for a reason. The range of severity between mild and severe is quite broad and anyone can fall anywhere along it.

Traditional “talk therapy” that promotes developing one’s insight and insight into other people’s perspectives to sort out one’s issues is not necessarily appropriate for some individuals with ASDs. Because there are so many differences among people with ASDs, it’s not fair to say that no one with an ASD can benefit from traditional talk therapy. But, it is safe to say that there are a significant number of students with ASDs who truly cannot benefit from traditional talk therapy but still have emotional health needs that require mental health services as part of their special education programs.

The matter comes down to, “What form of mental health services are appropriate for students in special education who have ASDs and require mental health services in order to benefit from their IEPs?” Well, as with anything in special education, you can’t take a cookie-cutter approach and say one specific type of program will fix everything for everybody. For one thing, no such statement will ever be true; learners with disabilities, even within a population impacted by the same condition, are too diverse for one-size-fits-all programming. Federal law requires individualized programming for this very reason.

That said, there are certain approaches that are generally known to be more effective with students who have ASDs than others. These may work with many students with ASDs, but whether or not they will be effective with an individual student really depends on that student.  The following are possible methods by which effective mental health services can be delivered to some persons challenged by anxiety associated with ASDs.

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School-Wide PBIS & Teachers Who Bully

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Source: US Dept of Ed – Office of Special Education Programs

With all the public dialogue and experience-sharing regarding the prevalence of bullying in our schools, you would think the federal government’s push for school-wide positive behavioral interventions would be getting more attention. But, it’s not.

One reason, I suspect, is that people are so focused on holding bullies accountable that they’re not focusing on the real causes of bullying. But, that’s a reactive strategy rather than a proactive attempt to prevent bullying in the first place.

Additionally, people are primarily focused on other children as being the perpetrators of bullying when there is plenty of evidence that students are bullied by teachers and other school personnel, as well. This is one of those things that I wish it weren’t even necessary to talk about, but it is unfortunately one of the issues that fails to receive adequate attention but has such a negative impact on our students that it would be recklessly irresponsible of us to ignore it.

Our work here at KPS4Parents is about solving problems in special education and pretending problems like this don’t exist solves nothing. I believe that if teachers and administrators expect to be regarded with authority by their students, it behooves them to first devote themselves to their responsibility to create a positive learning environment that earns them their students’ respect.

In a recent bullying-related suicide in Japan, it has come to light that teachers were as much responsible as peers for the torment the deceased student experienced, who jumped to his death from his family’s 14th floor apartment. This just goes to show that the problem is not limited to the United States. But, it’s not rare, here in the U.S., either, and children with disabilities are more likely to be bullied than their typically developing peers.

A recent due process decision from Georgia shows just how bad it can get (not reading for the weak of heart – be forewarned) and there have been a number of cases in the news and/or in which parents have turned to social media to shed light on the mistreatment of their children with special needs at school by staff.

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Applying ABA to Non-Compliant LEAs

Positive Reinforcer ChartApplied Behavioral Analysis (“ABA”) has been around for decades, now. As one of the few scientifically research-based methodologies for providing instruction to individuals with autism, it has become regarded as an autism intervention. But ABA is not an autism-specific intervention at all. It is one approach to behavior modification that can be used with pretty much anybody.

Pure ABA has taken some criticism, and not necessarily without cause. Some practitioners have been overly reliant on Discrete Trial Training (“DTT”) to the point of training kids to be little robots without learning to understand or value?why social norms apply to them. The use of response-costs are also used inappropriately by far to many practitioners, particularly those who don’t really understand ABA. Response-costs are basically aversive consequences that are meted out when the individual engages in undesirable behavior.

From a purely scientific standpoint, response-costs can be delivered in a manner that facilitates the learning of more adaptive behavior. In our public schools, however, it far too often gets twisted into a justification to punish a kid for manifesting symptoms at school. (Of course, this presumes that there is any ABA being used in the school setting at all.)

Punishment is already epidemic and positive behavioral interventions are woefully lacking in our public schools. ?The idea of response-costs are far too appealing to school district administrators just looking for an excuse to punish a kid for displaying poor judgment or reacting to environmental antecedents because of a handicapping condition as though the kid is displaying willful defiance or misconduct.

These people don’t need any more ammunition to do the wrong thing. They can take the response-cost concept of pure ABA out of context and resort to reactive strategies in a knee-jerk fashion without putting forth the necessary effort to prevent the maladaptive behaviors and teach appropriate replacement behaviors in the first place.

In California where positive behavioral interventions are very regulated, there is at least some legal recourse for students who have been inappropriately subjected to reactive strategies, including response-costs, but the systems of accountability are far, far from perfect and way too many school districts still get away with harming children in the name of behavioral intervention.

But, like I said, ABA (including response-costs, when appropriate)?can be used effectively with anyone. I kind of look at our advocacy as behavioral intervention where the intent is to change the behavior of education agencies engaging in harmful, non-compliant behavior.

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Federal Seclusion & Restraint Info

USDOE Offices in Washington, DCThe U.S. Department of Education (USDOE) has made information available regarding the use of seclusion and restraint in public school and public school-funded settings for the use of educators, policy makers, parents, and concerned citizens alike. Click here to see this content.

All of it is important for parents and educators of special education students. I’m going to summarize a few key points here because it is so important, but realize that the federal info linked to above is far more comprehensive and includes additional resources that educators and parents can use that I’m not duplicating here.

First, USDOE has identified 15 key principles that it believes schools and parents throughout the country should consider when it comes to seclusion and restraint. Those 15 key principles are as follows:

  1. Every effort should be made to prevent the need for the use of restraint and for the use of seclusion.
  2. Schools should never use mechanical restraints to restrict a child?s freedom of movement, and schools should never use a drug or medication to control behavior or restrict freedom of movement (except as authorized by a licensed physician or other qualified health professional).
  3. Physical restraint or seclusion should not be used except in situations where the child?s behavior poses imminent danger of serious physical harm to self or others and other interventions are ineffective and should be discontinued as soon as imminent danger?of serious physical harm to self or others has dissipated.
  4. Policies restricting the use of restraint and seclusion should apply to all children, not just children with disabilities.
  5. Any behavioral intervention must be consistent with the child?s rights to be treated with dignity and to be free from abuse.
  6. Restraint or seclusion should never be used as punishment or discipline (e.g., placing in seclusion for out-of-seat behavior), as a means of coercion or retaliation, or as a convenience.
  7. Restraint or seclusion should never be used in a manner that restricts a child?s breathing or harms the child.
  8. The use of restraint or seclusion, particularly when there is repeated use for an individual child, multiple uses within the same classroom, or multiple uses by the same individual, should trigger a review and, if appropriate, revision of strategies currently in place to address dangerous behavior; if positive behavioral strategies are not in place, staff should consider developing them.
  9. Behavioral strategies to address dangerous behavior that results in the use of restraint or seclusion should address the underlying cause or purpose of the dangerous behavior.
  10. Teachers and other personnel should be trained regularly on the appropriate use of effective alternatives to physical restraint and seclusion, such as positive behavioral interventions and supports and, only for cases involving imminent danger of serious physical harm, on the safe use of physical restraint and seclusion.
  11. Every instance in which restraint or seclusion is used should be carefully and continuously and visually monitored to ensure the appropriateness of its use and safety of the child, other children, teachers, and other personnel.
  12. Parents should be informed of the policies on restraint and seclusion at their child?s school or other educational setting, as well as applicable Federal, State, or local laws.
  13. Parents should be notified as soon as possible following each instance in which restraint or seclusion is used with their child.
  14. Policies regarding the use of restraint and seclusion should be reviewed regularly and updated as appropriate.
  15. Policies regarding the use of restraint and seclusion should provide that each incident involving the use of restraint or seclusion should be documented in writing and provide for the collection of specific data that would enable teachers, staff, and other personnel to understand and implement the preceding principles.

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California’s Regulations for Positive Behavioral Interventions

UPDATE:  Effective July 1, 2013, the Hughes Bill, which described the FAA procedures, was repealed and replaced with AB 86, which offers fewer legal protections to students with behavioral needs.  Click here for more information about this change in the law.  The material below now only applies to those students who were eligible for an FAA and possibly a PBIP prior to July 1, 2013. These students may currently have PBIPs in their IEPs, which remain in force until their IEPs are replaced at their next annual due date. Students with claims arising within the last two years from school agencies’ failures to comply with the Hughes Bill during the portion of the statutory period in which it was still in force may still bring claims regarding those failures, in which case, the material below is still applicable.


Click here to listen to the podcast version of this post.

As part of a series of articles regarding seclusion and restraint practices involving special education students across the nation, we’re starting out with a look at the regulations already on the books in California. We’re starting with these state-specific regulations because California is one of the few states to have regulations this specific and, as one of the most populous states in the nation, these laws impact a lot of kids. So, this information can potentially benefit a lot of students by helping their parents in their efforts to achieve appropriate behavioral interventions as well as help their educators understand their obligations, thereby preventing a lot of costly litigation that takes money away from actual instructional costs.

There is federal legislation pending to address this very issue. The lack of consistency among the states as to what constitutes a lawful restraint or seclusion varies so widely that what is regarded as child abuse in one state is considered perfectly acceptable in others.

Because California has such specific language in its regulations about one aspect of positive behavioral intervention, we wanted to examine these regulations more closely. Plus, I’ve been involved in a due process case in which an 8-year-old with autism was unwittingly provoked into an outburst by well-intended special ed staff with the whole thing culminating in a DARE officer who happened to be on campus handcuffing the boy in an effort to protect him from hurting himself. That whole incident involved both restraint and seclusion with disastrous results.

So, this issue is vivid in my mind right now after having met this sweet boy and his loving family, as well as in light of other work I’ve been doing recently that has also involved inappropriate behavioral interventions in public school settings in California as well as Texas. As advanced as humanity has become, we can still be a savage species when it comes to children, particularly those with disabilities.

The thing about California’s laws relative to the minimum requirements under the federal regulations is that California’s laws are specific to serious behavior problems, interpreted by most school districts to mean violent behaviors, where the federal regulations only specifically mandate behavioral assessment when a student is at risk of expulsion for behaviors that may be related to his/her disability. In both cases, that leaves a lot of latitude for things to get way out of control before a school district takes action, particularly in school districts that are reactionary to student needs once they’ve reached crisis proportions rather than proactive in preventing these kinds of problems from arising in the first place.

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Smiling Assassins, Lawless Renegades, and Pseudo-Psychologists

Smiling AssassinConnecticut special education attorney, Jennifer Laviano, posted some excellent content on her blog, titled, “Unseemly IEP Team Members,” in an effort to educate parents about some of the negative types of personalities they can encounter from their local school districts at IEP meetings. As Ms. Laviano states in her post, these descriptions do not account for all district personnel; just those who engage in inappropriate conduct.

Even though the personalities she describes only account for a handful of “bad guys,” the non-compliant and/or substantively inappropriate actions of one district employee is often enough to derail the best efforts being made by the ethical district members of the team. To make things worse, most parents don’t know enough about the science or the law of special education to always know when they’re getting shafted. This makes it important for parents to educate themselves.

I want to focus on three particular personality types that Ms. Laviano describes in her posting because I’ve encountered individuals such as these relatively recently and have had to deal with each in a particular manner. One thing to note is that it is possible for a single individual to fit more than one of these negative personality types.
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“Velcro® Aide” vs. Learning Facilitator

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There is a realm of conflict surrounding the use of 1:1 aides in special education and many local education agencies (“LEAs”) have developed their own assessment protocols to determine when a child really needs an aide to try and rein in this issue.

Sometimes these assessments just turn into a means of justifying to the parents a decision against aide support that was actually made by the LEA for fiscal reasons, so there are still issues with these types of aide assessments that need to be worked out.

Because these are LEA-made evaluations that are not bound by regulation and they aren’t scientifically validated standardized tests, LEAs can make them up however they want and some are better at researching best practices than others. But, even if it’s the best aide assessment in the world, none of that makes any difference if the aide support a child is given isn’t used well.

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