Double-click here to edit the text.
Double-click here to edit the text.
Behavioral Health Services
Sensory Integration & Desensitization:
Compliance & Coping Skills
The reason children develop Autism Spectrum Disorder (ASD) is not yet known. Current research supports that ASD develops during pregnancy through a combination of genetic and environmental factors. Only increased risk factors for ASD are know. Increased risk factors for the development of ASD include:
There are currently no known preventive measures to avoid the development of ASD, aside from knowing the increased risk factors (in Question 1 above). Unlike some other disorders, ASD has not been linked with any known lifestyle habits. So, don't "blame" yourself. The science does not yet exist to know how to prevent ASD.
There is currently no known prevention or cure for ASD. However, depending on your child's level of functioning, consistent and intensive early intervention therapies have been known to significantly reduce the signs/core deficits of ASD. Such that, some children no longer meet diagnostic criteria for ASD upon re-assessment. However, because ASD is genetic (within your child's DNA), your child will always have the disorder, even though it may not be evident/observable to others.
If someone reports their child was "cured" from ASD, it typically means their child no longer exhibits the outwardly "observable" signs of ASD upon which an ASD diagnosis is based. Note: An ASD diagnosis is currently made based on the observable diagnostic criteria set forth in the DSM-5 (i.e., Diagnostic and Statistical Manual of Mental Health Disorders-Volume 5). Therefore, if a child learns replacement skills to compensate for their skills deficits, they may no longer meet DSM-5 criteria for the disorder if/when they are re-assessed in the future.
Before ABA treatment begins, your funding source/insurance carrier will authorize for a BCBA (Board Certified Behavior Analyst) to meet with you and your child to conduct what is called a Functional Behavior Assessment (FBA) to gather historical information regarding your child, conduct a Developmental Assessment, and observe your child on at least 1 (typically 2) ocassions.
From your responses regarding your child's behavors for reduction (e.g., Tantrums, physical aggression, self-injury, throwing objects, hand-flapping, eloping, mouthing/swallowing objects, etc.), the BCBA will identify your child's "Target Behaviors" for reduction and rates of occurrence (e.g., "Jimmy engages in 20 tantrums per day").
From the responses obtained from your child's Developmental Assessment, the BCBA will determine where your child stands in comparison to neurotypical children (i.e., children without ASD) of a similar age on skills such as Communication, Social Skills, Play Skills, Functional Academics, Fine/Gross Motor Skills, etc. If your child scores "Below Average" in particular skills, they will be identified as skills deficits to teach during therapy.
The BCBA will then create a Treatment Plan to address your child's core deficits. Based on the severity of your child's target behaviors and skill deficits (in comparison to other children your child's age), the BCBA will recommend the quantity of service hours needed to effectively address your child's target behaviors and skills deficits.
Depending on your child's needs, recommended service hours could range anywhere from 4 hours/week (e.g., for a high-functioning teen with just a few social defecits) to 30+ hours/week (e.g., for a 3 year-old who cannot speak, tantrums frequently, & does not acknowledge others). The FBA is then submitted to your funding source/insurance carrier to authorize the treatment plan and recommended hours. Once approved, you should receive a call from your ABA agency to finalize a weekly service schedule and setup an initial meeting with your ABA service team.
As mentioned, the greatest gains typically occur between 1 to 5 years of age, but benefits can be seen at any age (even clients upwards of 80 have benefited). Because the process of contacting your insurance carrier, having a FBA conducted, and getting Direct ABA therapy services authorized can take upwards of 3-4 months (or more), you do not want to delay services for your child once he/she receives a diagnosis.
After some parents have received ABA services for their children and completed Parent Training in ABA, they have chosen to "pause" services due to their children starting to catch up to their neurotypical peers (i.e., peers without ASD). These parents have stated that their child "is doing fine now," but wonder/worry if their child will fall behind again in skills at a different developmental stage and/or engage in different behaviors of concern as they get older (e.g., Not exhibit street safety, not be able to form friendships in junior high, curse in public, etc.).These parents often ask, "Will someone still be around to help if we need it?"
The answer is, "Yes." Most individuals with ASD (but not all) require some level of support/assistance (even if minimal) throughout life. We have worked with teens on "Phone and text etiquette," engaging in reciprocal conversations, engaging in small talk, store purchasing skills, and job interview skills. Because your child will always have the initial ASD diagnosis, they should always qualify for services if they continue to exhibit behaviors of concern or skills deficits. However, whether services are authorized depends on your funding source/insurance carrier ("Private Pay" is also an option). If; at some point in time, you feel you need advocacy for ABA (or other) services, you can contact one of the National ASD organizations listed in the "Parent Resources" tab in the upper right corner of this page.
In a nutshell, Applied Behavior Analysis (ABA) is a Science that looks at the relationship between an individual and their environment.
ABA therapists use research-based Principles of Behavior to modify "things" in the child's environment to decrease behaviors of concern (e.g., tantrums) and increase adaptive skills (e.g., teaching the child verbal language skills to express his needs instead of resorting to screaming).
Simply put, ABA therapists teach and encourage new skills so children no longer need to resort to behaviors of concern in an attempt to get their needs met.
ABA is not about "putting out fires" in the here & now. ABA therapy is about long-term behavior modification to change the overall trajectory of children's lives so they experience greater independence and access to more opportunities throughout their lives.
Functional Communication Skills:
Self-Help Skills: * That are appropriate for child's age
ABA is the science of Behavior Modification. Principles of ABA have been used in the
following areas (just to name a few):
Industrial Organizational Psychology - to increase productivity
Sports Psychology - to increase training, durability, & performance
Mental Health - to combat addictions and phobias, and decrease depression
Las Vegas - to increase casino guests' duration & frequency of gambling
If you can identify a behavior, there's a good chance ABA has worked on it in some capacity.
For children with ASD and other related disorders, Target Behaviors for reduction (e.g., screaming, physical aggression, self-injury, etc.) are those behaviors that significantly impair a child's ability to function. This includes behaviors that reduce their ability to interact with others, attend school, participate in other therapies, and/or restrict participation in age and socially appropriate tasks & events.
Target Skills addresed during ABA therapy are those identified as deficits in the Developmental Assessment conducted during your child's initial Functional Behavior Assessment (Note: New developmental assessments are typically conducted by your ABA service provider a minimum of every 5-6 months).
Target Behaviors to reduce, and Target Skills to increase, are based on your child's individual needs. Some of the types of skills addressed during ABA services have included:
Verbal language skills Manding (making requests), Intraverbals (answering/asking questions), and Tacts (labeling objects &/or making comments)
American Sign Language (ASL)
Picture Exchange Communication System (PECS)
Drinking from a (non-sippy) cup
Eating with utensils
Sneezing/coughing into elbow
Asking for help
Putting on shoes
Taking off clothes
Putting on a shirt/pants/socks
Picking out weather appropriate clothing
Shaving (e.g., for teens)
Nail hygiene (e.g., for teens)
Overall hygiene skills
Cutting food with a knife
Various age-appropriate household chores
Making a bed
Staying by/near parent during walks, community outings, etc.
Pedestrian Cross-walk, driveway, streetlight, parking lot safety
Learning emergency procedures (e.g., Recognizing when 911 should be called & calling 911)
Cooking simple foods/Cooking more complex foods (e.g., for teens)
How to respond if bullied
Stranger-danger/How to interact and respond with strangers
Pouring from a pitcher
Tolerance and acceptance of new/novel textures (e.g., wearing a damp shirt, stepping on sand, etc.)
Sounds (e.g., Vacuum cleaners, fire trucks, dogs barking, trains, air blowers, etc.)
Eating new Foods/Expanding food repertoire increasing types, textures, colors, temperatures of foods child will consume
Tolerating new clothes/different types of fabrics
Sensory Integration & Desensitization:
Being a gracious winner or loser during games
Displaying and respecting personal property, personal space, & personal privacy
Attending/participating in tasks
Appropriate classroom behavior (if services are provided at a school or child development center).
Identifying and calling others by name
Responding to and greeting others
Reciprocal conversation skills
Interacting with new people
Interview skills (for teens)
Age-appropriate small talk
Answering and asking Wh questions
Identifying and conveying emotions in self and others
Initiating play with peers
Functional play skills
Independent play skills
Parallel play skills
Interactive play skills
Playing board games
Playing with cars
Playing with trains
Playing dress up/superheroes
Playing pretend food
Playing pretend characters (e.g., doctor, policeperson, fireperson, etc.)
Blocks stacking/building structures
Outdoor Interactive Sports:
Learning First name
Guardians phone number
How to tell time
Prepositions of location (e.g., in, on, under, ect.)
Past tense words
Learning regular & irregular plurals
Using complete sentences/finishing a complete thought
Identifying and describing objects by function
Using correct pencil-grasp for age
Attending to less-preferred tasks
Listening to stories
Tolerating changes to routine
Tolerating transitions to less preferred activities
Fine & Gross Motor Skills:
Holding a crayon or marker (e.g., using a quadrupod or adult tripod grasp)
Drawing shapes/Drawing pictures
Using scissors to cut lines/shapes
Coloring within a shape
Using a pincer grasp to pick up small objects
Finger play to popular songs (e.g., Itsy Bitsy Spider)
Fasteners (buttoning, snapping, zipping, connecting zipper fasteners)
Throwing/catching a ball
Kicking a ball while moving & from a standing position
Walking up/down stairs one at a time, alternating feet
Riding a bike
Coping & Transition Skills:
Research has shown that skills are more likely to be maintained if taught and practiced in the environment where they will occur.
For this reason, ABA services are delivered in clients' homes and in community settings where target behaviors are more likely to occur and/or where new skills need to be practiced. Some services may be delivered in the community (e.g., to practice street safety, to work on peer play skills, or work on tolerance/compliance in non-preferred settings like the grocery store) or in-clinic, depending on your service delivery contract and the skills being addressed.
Services may also be provided in a client's school, private school, day care, or child development center if the parent obtains permission to receive services in these settings from the child's designated guardian in that setting (e.g., school or day care administrators) as well as their funding source (i.e., insurance carrier) and ABA agency. All Flourish ABA service providers have passed criminal fingerprint background checks and are eligible to provide services in these types of settings.
All services delivered outside of the child's home, or in setting not already approved, must be authorized by a member of Flourish ABA's Clinical Committee prior to services being provided in that setting.
It's normal to have concerns about a new person coming into your home and working with your child. The following information may help alleviate some of your concerns.
All Flourish ABA team members have completed criminal fingerprint background checks through the Department of Justice.
Flourish ABA only hires employees interested in maintaining employment in ABA or a similar field. We do not hire "seasonal" employees.
All 1:1 Behavioral Therapists are, at a minimum, Registered Behavior Technicians or the equivalent, through the Behavior Analyst Certification Board or other certifying entity. As such, they are required to follow strict technical and ethical guidelines to maintain certification.
You will receive regular Quality Assurance "Check ins" from our Quality Assurance Manager. You will also have direct access to our Quality Assurance Manager if you have praise (or concerns) to share regarding your services.
We have been in the field of mental health, behavioral health/ABA for a long time. There is little we haven't seen. It is highly unlikely we will see anything in your home or, in your child's behavior, that will surprise us.
We don't judge. We understand that having a child with special needs can be exceptionally rewarding and exceptionally challenging. Many parents, after trying VERY hard to reduce their child's behaviors of concern &/or teach their child new skills (e.g., language, acceptance of new foods, play skills, etc) feel especially overwhelmed because they don't have the training &/or time needed to address these challenges. This is WHAT WE DO. Let us help your child. Feel free to ask questions if you don't understand unfamiliar concepts or interventions. Keep asking until we are able to explain the answers in a way that makes sense to you.
We don't expect you to change your life for us. We want to work within your child's natural environment. If your family typically eats dinner at 6:30pm, then continue to eat at 6:30pm. Most likely your therapist can work on goals such as eating with a fork, drinking from a cup, taking turns getting food, not talking with their mouth full, taking small bites, trying new foods, etc. Therapists are not allowed to accept food from families. The exception to this is if your therapist is working on food selectivity with your child. If your therapist is introducing a new food to your child, they should request a small portion to "model" how "Yummy" the food is in front of your child.
If your ABA team requests that changes me made to your child's schedule or environment, then the recommendations will be in your child's clinical best interest to reduce behaviors of concern and/or increase your child's participation in learning skills, and/or increase your child's independence in performing tasks, activities, etc. Recommendations will be made in your child's best clinical interest. They will not be made for the convenience of your ABA team.
We don't expect you to clean up, dress up, or offer us snacks during sessions. Be yourself. Don't think of us as guests. We are in your home to provide a service to you & your child. We don't expect you to accommodate "our" needs. We do; however, expect you to accommodate needs that are in the best clinical interest of your child. These needs include keeping a consistent therapy schedule, participating in parent training and team meetings, and implementing the clinical recommendations of your ABA team to the best of your ability. If you cannot accommodate clinical recommendations, please be up-front regarding your challenges, so we can work with you as a team to find feasable work-arounds.
We understand. We don't know any parents who haven't felt the same way. It's important to not "blame" yourself or your partner, and to seek-out support. If you are considering taking your son in for an ASD assessment, you may want to ask a friend or relative join you for added support.
If you suspect he may have ASD, it's important that you do not delay the possibility of a diagnosis. As previously stated, the greatest gains can typically be seen in the first 5 years of life; however, signifant gains have been seen at all ages. Depending on your funding source, it can take up to 6 months from scheduling an initial assessment to receipt of services. If your son has ASD, it's best to know now and start the services he needs as soon as possible.
Keep in mind too; however, that we ALL exhibit some symptoms of ASD, but most of us do not meet DSM-5 diagnostic criteria. So, there is a chance your son may exhibit some symptoms, but not qualify for an ASD diagnosis. Or, he may be diagnosed with a different disorder with symptoms similar to an ASD.
Because ABA is used to reduce behaviors of concern and increase skills, it is not only used with children and adults on the spectrum. It is also used for children and adults with other developmental disabilities, as well as with neurotypical (non-ASD) children and adults.
IF your son has ASD, by getting him diagnosed, you can start getting him the help he needs ASAP. The earlier he starts learning language and social skills (if these are some of his core deficits), the fewer challenges he'll have as he gets older. Some of our clients, who were in special education classes when we started therapy, are now in general education-only classes (& no longer qualify for special ed.) because they no longer display the core deficits necessary for an ASD diagnosis.
As stated in the "Autism" section; however, ASD is considered a "spectrum" because each individual is different and has skills and deficits to varying degrees in many different domain areas. Once you begin services, your therapist can work on highlighting existing skills and teaching new skills to minimize or extinguish/alleviate your son's skills deficits (ID' d in the Developmental Assessment administered during his ABA Functional Behavior Assessment).
If you suspect your child has ASD...
1) Purchase and label a large binder to hold your child's future medical and diagnostic information
2) Fill out a notebook answering the questions found about your child's potential symptoms
3) Contact your child's pediatrician, your insurance carrier, or your Regional Center to make an
appointment for an ASD diagnostic evaluation
4) If your child receives an ASD diagnosis, attempt to obtain the following information from your
diagnostician if you plan to pursue Applied Behavior Analysis therapy for your child:
a) A documented ASD diagnosis
b) The diagnostic report/clincal evaluation that confirms the presence of qualifying ASD
c) A recommendation from your physician for ABA therapy based on "medical necessity"
- Preparing for your Childs Assessment (* The content in this section can be found on the Mayo Clinic's website). To access the Mayo Clinic's website, which will also allow you to print the information below, click on the Mayo Clinic link to your left.
Your child's health care provider will look for developmental problems at regular checkups.
What you can do to prepare for your child's appointment:
Bring a list of any medications, including vitamins, herbs and over-the-counter medicines that your child is taking, and their dosages.
Make a list of all the changes that you and others have observed in your child's behavior.
Bring notes of any observations from other adults and caregivers, such as baby sitters, relatives and teachers. If your child has been evaluated by an early intervention or school program, bring this assessment.
Bring a record of developmental milestones for your child, such as a baby book, if you have one.
Bring a video of your child's unusual behaviors or movements, if you have one.
Try to remember when your other children began talking and reaching developmental milestones, if your child has siblings, and share that information with the doctor.
Be prepared to describe how your child plays and interacts with other children, siblings and parents.
Bring a family member or friend with you, if possible, to help you remember information and for emotional support.
Make a list of questions that you want to ask your child's doctor. Questions might include:
Why do you think my child does (or doesn't) have ASD?
Is there a way to confirm the diagnosis?
If my child does have ASD, is there a way to tell how severe it is?
What changes can I expect to see in my child over time?
What kind of special therapies or care do children with ASD need?
How much and what kinds of regular medical care will my child need?
What kind of support is available to families of children with ASD?
How can I learn more about ASD?
Ask additional questions any time you don't understand something.
What to expect from your child's doctor. Your child's doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on.
Your doctor may ask:
What specific behaviors prompted your visit today?
When did you first notice these signs and symptoms in your child? Have others noticed signs?
Have these behaviors been continuous or occasional?
Does your child have any other symptoms that might seem unrelated to ASD, such as stomach problems?
Does anything seem to improve your child's symptoms?
What, if anything, appears to worsen your child's symptoms?
When did your child first crawl? Walk? Say his or her first word?
Does your child have delayed speech?
What are some of your child's favorite activities? Is there one that he or she favors?
How does your child interact with you, siblings and other children? Does your child show interest in others, make eye contact, smile or want to play with others?
Have you noticed a change in your child's level of frustration in social settings?
Does your child have a family history of ASD, language delay, Rett syndrome, obsessive-compulsive disorder, or anxiety or other mood disorders?
Tests and Diagnosis
Your child's health care provider will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you'll likely be referred to a specialist who treats children with ASD, such as a child psychologist, pediatric neurologist or developmental pediatrician, for a thorough clinical evaluation.
Because ASD varies widely in severity, making a diagnosis may be difficult. There isn't a specific medical test to determine the disorder.
Instead, a specialist in ASD may:
Observe your child and ask how your child's social interactions, communication skills and behavior have developed and changed over time
Give your child tests covering speech, language, developmental level, and social and behavioral issues
Present structured social and communication interactions to your child and score the performance
Include other specialists in determining a diagnosis
Recommend genetic testing to identify whether your child has a genetic disorder such as fragile X syndrome
Signs of ASD often appear early in development when there are obvious delays in language skills and social interactions. Early diagnosis and intervention is most helpful and can improve skill and language development.
Diagnostic criteria for ASD
For your child to be diagnosed with autism spectrum disorder, he or she must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
ASD includes problems with social interaction and communication skills and restricted, repetitive patterns of behavior, interests or activities that cause significant impairment in social, occupational or other areas of functioning.
Impaired Social and Communication Skills. To meet ASD criteria, your child must have problems across multiple situations with:
Social and emotional give-and-take in social settings for example, an inability to engage in normal back-and-forth conversation, a reduced ability to share experiences or emotions with others, or problems initiating or responding to social interactions
Nonverbal communication behaviors used for social interaction for example, difficulty using or understanding nonverbal cues, problems making eye contact, problems using and understanding body language or gestures, or a total lack of facial expressions
Developing, maintaining and understanding relationships for example, difficulty adjusting behavior to suit various social situations, problems sharing imaginative play or in making friends, or a lack of interest in others
Restricted, Repetitive Patterns of Behavior. To meet ASD criteria, your child must experience at least two of these:
Odd or repetitive motor movements, use of objects or speech for example, body rocking or spinning, lining up toys or flipping objects, mimicking sounds, or repeating phrases verbatim without understanding how to use them
Insistence on sameness, rigid routines, or ritualized patterns of verbal or nonverbal behavior for example, extreme distress at small changes, expecting activities or verbal responses to always be done the same way, or needing to take the same route every day
Interests in objects or topics that are abnormal in intensity, detail or focus for example, a strong attachment to unusual objects or parts of objects, excessively limited narrow areas of interest, or interests that are excessively repetitive
Extra sensitivity or a lack of sensitivity to sensory input or an unusual interest in sensory aspects of the environment for example, apparent indifference to pain or temperature, negative response to certain sounds or textures, excessive smelling or touching of objects, or visual fascination to lights or movement
We're sure this was not the news you were hoping for. Please know there is a lot of help and support available to you and your child. You are now a part of an understanding, helpful, and supportive community.
Autism Speaks & the National Autism Association (links are also availble through our "Parent Resource" tab at the top of this page) both offer excellent, comprehensive manuals for parents on what do to before & after your child has been diagnosed:
Length of treatment cannot be determined until your child starts ABA therapy. Treatment length typically depends on a number of variables. Including:
Whether you choose Flourish A.B.A. as your ABA service provider or another agency, please seek ABA services for your child ASAP. Having provided early intervention ABA therapy to children as young as 2, as well as consulted in state-run residential facilities with adults aged 50+ on the ASD spectrum (who never received ABA therapy), we can see what a life-changing difference ABA therapy can have on the quality of life and available future opportunities throughout the life-span.
Get help now. You will meet many kind, smart, and amazing people across your journey. It's scary right now, but it will get better for you, your family, and your child.
Boys are approx. 5x more likely to develop ASD than girls
Families with 1 child with ASD are at increased risk of having another child with ASD. This risk increases with each child diagnosed with ASD. It is also not uncommon for parents or relatives of a child with ASD to have minor problems with social or communication skills, or to engage in some behaviors common to ASD
Children with medical conditions like Fragile X, Tuberous Sclerosis, Tourette Syndrome, and Rett Syndrome (primarily found in girls) have a higher risk of ASD or ASD symptoms
Babies born before 26 weeks may have greater risk of ASD
There may be a connection between older parents and ASD, but additional research is needed
The age at which your child starts treatment. The greatest gains are typically seen in early intervention, when
children are between 1-5 years old
If your child has dual diagnoses, like an intellectual disability, severe ADD with hyperactivity, etc. &/or medical conditions
Your child's level of functioning within and across core skill domains at the onset of services
The frequency/severity of your child's target behaviors at the onset of services
The number and degree of core skill deficits at time services begin
The number of ABA treatment hours your child receives per week
How consistent you are in maintaining a consistent therapy schedule
The training and effectiveness of your child's therapists and ABA treatment team
Your involvement in your child's therapy (i.e., Are you implementing the recommendations made by your BCBA?)
If there are any "gaps" in your child's receipt of services
Your child's rate of learning
Your child's level of progress in meeting his/her treatment goals
If, upon re-assessment, your child scores "within average range" on core skills in comparison to his/her neurotypical
(i.e., non-ASD) peers, the Board Certified Behavior Analyst on your case may recommend titration (i.e., a gradual
reduction) in treatment hours.
Your child's level of progress in meeting his/her treatment goals
If your child maintains his/her skills after treatment hours have been reduced, and the general consensus among
parents, ABA providers, and other professionals (e.g., teacher, pediatrician, etc.) is that your child tests at, and appears
to be functioning at age-appropriate levels, and/or that you can make-up any remaining small deficits with parent or
school support, a recommendation will most likely be made to titrate and discontinue ABA services.
Toll Free: 1-833-FLOURISH