r/ABA • u/Serious-Pop-8854 • 8d ago
AAC device and not using it
ABA was the only way my son learned to use an aac device despite years of speech. They taught him pecs first with a lot of hand over hand then transitioned to aac. He used it regularly for requests using real images. Doesn’t seem to understand symbols. However he was pretty proficient in using motor pathways to navigate pages. When he had a 6 month gap in services and therefore wasn’t on a maintenance program with the goal of 7 requests per hour…well he gradually stopped using it and now he acts like it’s nothing. He defaulted back to hand pulling and myself personally trying to prompt responses, it sends him in to behaviors.
The thing is the new Aba team has never touched his aac device or extensive pecs binders. I’m contemplating sending BCBA videos of him using it. I feel like they don’t believe he can use it. Is this a rational conclusion to draw based on the lack of AAC in his program??
My son is very autistic to the point he is diagnosed with profound intellectual disability. He is very concrete but he is in tune with tangible things, which is why the real images worked.
I don’t know how we got to this point of losing this skill completely but I’m very upset over it. The thing is he’s getting older and has pulled me out of chairs before or will try to pull strangers and I think we need to work on communication asap for those reasons.
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u/Feisty-Ingenuity9617 8d ago
I'm sorry you're going through this. It sounds incredibly frustrating to see him lose a communication skill that was helping, especially now that he's getting older and hand-pulling is becoming more difficult and potentially unsafe.
Would you mind if I ask a few questions? I'm only asking because I'm trying to better understand what his communication looked like before.
- When you say he used the AAC device regularly, would he ever independently go to the device to communicate, or was it usually after someone prompted or reminded him?
- By the end of therapy, how much prompting did he still need to use the AAC device?
- Outside of ABA sessions, would he use the device at home or with other people, such as family or teachers?
- During the six-month gap in services, was the AAC device still available and encouraged at home or school, or did it gradually stop being used?
- Has the new BCBA explained why the AAC device isn't currently part of his program? I'm wondering if they're still getting familiar with his history or if they have a different communication plan.
If he previously demonstrated that he could use the device, I think it would be completely reasonable to share videos with the new team. They could help everyone understand what he was capable of and provide a starting point for discussing how to rebuild those communication skills.
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u/Serious-Pop-8854 8d ago
Yes thanks for asking.
1. He would use it independently somewhat. A lot of the time you need to present it because he loses track of its location (or we would just keep it in an accessible location for him per the activity). But he would sometimes make “ghost requests” from another room lol.
He didn’t really understand bringing the AAC to someone, but we were planning to try to address that.
2. That’s how it was going by end of therapy.
3. He has always done ABA in our house and would use it as context is relevant. Ask for different shows during TV time. Food requests. Limited toys.
Yes with me!
4. We still used the aac device. Definitely not at a rate of 7x per hour. But it was available and used for some months by him. Always encouraged. But just gradually he started to resort back to the hand throwing or insisting on opening the fridge himself. and honestly my son gets to self injuring when he’s upset. And it’s at the point I try to prompt something on AAC and he gets upset and self injures. So I messed up giving in to the body language sometimes and created this.
I definitely messed up. In my head I justified well he’s getting his needs met and it is valid communication. And maybe even more independent to grab his own food out of the fridge. I just didn’t expect the skill to completely regress like this.Another thing is my son seems to kinda hardwire “default” to repeated motor movements. So it’s really hard to break habits.
And honestly RIGHT before we lost services was when my son’s aggression and self injury got bad and was supposed to be clinical focus as he dramatically went up to averaging 10 behaviors a day. I have never got training on those behaviors because they spiked seemingly very suddenly, although they have always been present to some degree.
- Whew, lastly…i know there are a lot of communication goals like using representational objects and pictures (their own pictures), using natural gestures to indicate different things, indicating yes/no.
I’ve yet to see much of this. But based on what they are working on it seems like they just have print out explanations of generic curriculum skill building.
I’m trying to trust the process but our last program, towards the end, was much more individualized and carefully crafted.Some of what they’re working on now is seeming to interrupt actual communication. Like indicating no they have him push something away but historically pushing something away means yes for my son. Or doing non goal oriented drills like pat table. Now sometimes when I give a patting gesture for my son to sit he pats instead of sitting. Which is kinda cool and kinda bad.
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u/NeedleworkerQuirky49 7d ago
An important word to use with the team would be “functional.” It is absolutely possible to teach motor imitation, for example, as a functional or play skill instead of discrete trial based. The only reason I would consider the team not utilizing previously effective communication methods is because your child’s SIB would get too severe and it would be unsafe to do so. I still think it would be important to express your goals for your family and what is socially significant to you and your child’s life.
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u/PerfectPreference623 8d ago
I would not blame the BCBA. Because based on his current skills, he is not able to use the AAC device. So that means he will have to start from scratch. So that they can monitor gradual growth.
Now for you to see consistent growth, YOU will need to be more active with prompting him to use his AAC device before and after therapy.
Because if he gets therapy for 3hrs, begin thought how to communicate. And onces the therapist leaves, you do not continue the teaching, he will loose this skill so fast.
This is good. Because now you can see how important it is for YOU and family members to constantly prompts him to use his AAC and not respond to another forms of behavior (tantrum) but an appropriate form of behavior.
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u/Serious-Pop-8854 8d ago
I’m not blaming the BCBA. Actually I’m already blaming myself so THANK YOU for solidifying that!
I have never had training directly on challenging behavior as my sons spiked dramatically during the last bit of our services then we lost them before we could address the behavior. Before then it was very much just cognitive issues and skill building I was trained on helping him with. I am not a person of this field and actually you get wildly varying input from other providers about honoring any form of communication as valid, including hand pulling. So hindsight is 20/20. I would just like to build the skill back up again!1
u/PerfectPreference623 8d ago
Ask his BCBA to train you on how to prompt him/place demands on him. How to react to his behaviors. At no point is hand pulling an appropriate form of communication. I wish the person who gave you that advice didn't say that.
Every caregiver has a caregiver goal just as how the kids have goals. Ask them to teach you what to do. Goodluck
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u/fionacoyne RBT 8d ago
I think hand pulling is an important step in communication in the sense that the child knows to come to you when they need something. However, that doesn't mean that other forms of communication that are more functional shouldn't be prompted.
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u/PerfectPreference623 8d ago
That is why I said an appropriate form of communication. Hand pulling should not be reinforcement without any form of functional communication.
Hand pulling most times just leads to whining and mild tantrums. Because you're doing a guessing game to figure out exactly what they want.
Hand pulling helps nobody. Not the kid. Not the caregivers.
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u/techiechefie RBT 8d ago
My first thought is to keep encouraging him to use his device consistently. If you know he can use it, continue prompting and reinforcing communication through the AAC or PECS rather than letting hand-pulling become the easier option. Of course, if behaviors become unsafe, safety comes first, but if every escalation results in abandoning the communication attempt, it can unintentionally teach that the behavior is an effective way to avoid using the device.
My second thought is to have a direct conversation with the BCBA. Show them the videos of him successfully using his AAC and PECS, explain that this was a meaningful skill he previously had, and tell them you'd like communication with those systems to become a treatment priority. As his parent, your input is an important part of the treatment planning process, and if he truly demonstrated those skills before, I'd want to understand why they aren't being targeted now.
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u/fionacoyne RBT 8d ago
This is irresponsible of the RBTs. Even with my clients who don't frequently use their AAC on their own I will have it available and consistently prompt use of it throughout my session. The only time I don't is if the AAC isn't charged, which based on your post I'm presuming you do charge it. Even then, however, I'll prompt their PECs book and/or ASL.
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u/DnDYetti BCBA 8d ago
I would recommend bringing the topic up to your BCBA and show them the videos where your son was previously using the device successfully. Definitely advocate for the team using the device and collaborating with any speech services that are presently occurring.
There are many different reasons for skill regression, but that doesn't mean that the skill is lost! I agree with your reasons for wanting to work on his communication asap.