Intervention for Students with Special Needs

In this episode of Real Talk, KJK Student & Athlete Defense Attorneys Susan Stone and Kristina Supler are joined by Jaclynn Bosley, owner and executive clinical director of Thrive Early Learning Center, to discuss intervention and therapy strategies for children with special needs. In particular, they address Applied Behavior Analysis (ABA) and other therapy for students on the autism spectrum, as well as regression among students due to the pandemic. 

I am a licensed Ohio Principal, Board Certified Behavior Analyst (BCBA) & Certified Ohio Behavior Analyst (COBA). I started my career at the Lerner School for Autism at the Cleveland Clinic, Worked as a Special Education Supervisor for Riverside Local Schools, was a Behavioral Consultant and Director of Program Development at KidsLink and am now the Owner of Thrive Early Learning Center.  

Our slogan says it all: PLAY. LEARN. DISCOVER. THRIVE! Our mission at Thrive is to provide comprehensive, early intervention to young children on the spectrum, but to do so using a naturalized, play–based model.   

Students who attend our program are those who have an autism diagnosis, a related developmental diagnosis or those who are not yet diagnosed but are demonstrating symptoms that would respond well to this type of intervention model. 

ABA stands for Applied Behavior Analysis and it is the “Gold Standard” of therapeutic models.  ABA has the most research (over 70 years!) behind it and has proven to demonstrate improvements across all ages and levels across the autism spectrum. It is important when looking into interventions for your child that you look to only those that are based on research, and this is because being that autism is a language-based disorder, our children are often unable to report back to us (or report in detail) their thoughts/feelings/perceptions about what they are participating in. So, it cannot be overstated that we must use methodologies that we know have positive outcomes that are predictable and safe.  

Our early childhood program combines ABA, direct speech therapy, direct occupational therapy and direct behavior analytic services all in one. This is different than the traditional therapy models of clinic-based ABA in isolation, speech in isolation or OT in isolation. That model lacks the consistency and generalization that Thrive offers. Our Behavior Technicians are in therapy while the student is receiving speech or OT services, so that those skills can be taught to our behavior technicians to provide that intervention in those areas across all areas of play and learning throughout the day!  

Loaded question. Every child’s needs are so different that it is very difficult to just answer that with a solidified “yes” or “no.” What I can tell you is that children on the spectrum have very complex needs, and while much of what causes the complexities for our kids is speech/language related, this often manifests itself behaviorally (because of the communication frustration). So, while addressing the language needs is incredibly important, we also have to understand fully from a behavioral perspective why the behavior is occurring and how to address that need. That is where receiving ABA is so helpful, because children on the spectrum tend to demonstrate improvements when all areas are addressed, not just language in isolation. Also, ABA lends itself to “teaching the teacher,” not just the student. So, we often see that when the teachers are using solid behavioral principles, the overall responsiveness from the student so greatly improves. That part is something that cannot be addressed by speech services alone!  

An IEP is an Individualized Education Plan. The IEP is the document that guides the educational team on what services and goals will be provided to your child based on their individual learning needs. In order to get an IEP for your child, he or she must first be evaluated by the school team and identified as a child with a disability. This process is known as the ETR. The ETR identifies where the child’s deficit areas are (learning, speech, motor, etc.) and then the IEP is developed based on these results. So, the ETR identifies the deficit area, and the IEP documents how the team plans on helping your child grow in those areas. These are all completed through your local school district, and the evaluation can occur no earlier than age 3.   

The purpose of the transition plan is to work as closely with the incoming team from the school district as possible to create a plan that outlines how to transition the student from highly individualized and intensive instruction over to the public school model (and these models vary from district to district). It begins by reducing some of the more intensive supports that we provide in our setting and doing this systematically over time. For example, students will begin working with another student and one teacher (so 2:1 ratio) and working in larger classroom spaces that naturally have more distractions. Additionally, students are taught to be much more independent such as traveling throughout the building independently, and are able to unpack their belongings, get lunch items, pack up for dismissal, etc. Then, as the physical transition draws closer, we may make recommendations that the school personnel will either come here to Thrive to spend time getting to know and work with the student, or that we do the reverse and Thrive staff attend school services in the public school setting. This helps create a “bridge” of sorts so that the student can get adjusted over time and that the new staff learn the child and their needed supports. It makes it a more comfortable transition for everyone when we set the child (and the staff!) up for success!  

I would strongly encourage parents to request an observation of the classroom(s) well in advance of the IEP/transition. It’s very important for parents to physically see WHAT and HOW children are being taught. When an IEP goal/objective is developed, it will not list a curriculum or teaching methodology. So, while you may agree on the goal, as a parent you really don’t know how the child will get there. By physically seeing how the classroom is set up and functions, you can get a feel for how your child’s learning time will be spent. Take notes while you are there: who is providing the instruction (teacher or the aide?) How much free time do the students have? What are they doing in their leisure time? Are students working independently in work stations on file folders and TEACCH boxes, or is the intervention interactive and does it provide modeling, rehearsal of skills and feedback? The “HOW” (way in which it’s taught) is often much more meaningful than the WHAT (the goal/objective) alone.   

Unfortunately, yes – in academic performance, but more importantly there has also been regression in behavioral skills and life skills. Being at home all the time has created such difficulty for our students. It blurs the line between learning and leisure and has forced our parents to put on a whole new set of hats, which is stressful for parents and children alike. Students are not used to having mom or dad be their teacher, their speech pathologist, their occupational therapist, their classroom aide, etc. So, it is not uncommon to see the undesirable behaviors spike as a strong message of “NO, THANK YOU! School should not be my classroom and Mom should not be my teacher!” It’s hard for everyone. 

Compensatory services are provided when a child has missed a significant portion of services, usually due to absence. In a more typical year, compensatory services would be provided for a student who missed a lot of school due to medical issues, for example. This year, with services being unable to be provided (or at least provided adequately), it could absolutely be justified that additional services be requested by the family. Depending on the district, they may or may not be so flexible in discussing this as an option. They may say that they offered the services, but if your child has demonstrated an inability to benefit (or even participate) at all from the virtual services, then it should at least be discussed at a minimum.   

ESY refers to extended school year. ESY services are detailed in section 4 of the IEP. You and your child’s educational team will determine whether your child qualifies for extended school year. There are a few options for qualifying. One of them is compensatory services, one of them is regression and recoupment and the final qualifier is nature and severity of the disability. Many of my students qualify for ESY under this category, in that their diagnosis of autism and their presenting profile often justify the need for consistent services throughout the summer months. The majority of my students are on toilet training programs and participate in behavioral reduction programs for very interfering behaviors. Not addressing those for a typical 10 week summer would have significant negative impact on the child’s functioning and independence. 

In having done this over two decades and also having had the opportunity of working in both the private sector and in public school, I think that what really needs to be assessed in making that decision is this: Is the child’s time at school at a level of productivity that progress (albeit even slow progress) is continually being made? When progress is stagnant, other options need to be explored – even if the child isn’t highly behavioral. I think there is a false notion that the only children that should be placed out of district are those with severe behavioral needs, and that isn’t true. In both cases, it is important to have a highly qualified person (such as a BCBA) come in and assess the situation and provide recommendations on how to improve the situation so that progress can be reinstated. If, after that happens, the staff are still unable to demonstrate that progress is happening (and we assess this through the data), then it is time to explore other educational options.  

There is an automatic notion that individuals with a disability are always acting out on purpose – as a means to some self-serving end. This is just not true. This is why we need a thorough FBA conducted by a qualified BCBA. This process is to determine the function of why a behavior is occurring, and then to develop a behavioral intervention plan that addresses this behavior from a functional perspective. A quality FBA defines in detail what problem behavior is being demonstrated, the data that shows how often the behavior is occurring (this may also include how long the behavior occurs for, ex: refusal to work), what is likely to happen before the behavior is demonstrated (antecedents) and what happens during and after the behavior occurs as well (consequences).   

But a solid FBA also goes further. It doesn’t just list these things on a paper. Many times, I will get called to do an independent FBA and I review what the district has already done and next to the antecedents column, a teacher writes in “none” or the teacher writes “gave the student a worksheet- he got mad and had a meltdown.” A true FBA doesn’t include subjective opinions (i.e. “he got mad”) or use terminology that is vague (“meltdown”). A true FBA investigates further. It includes indirect methods such as interviewing staff to ask clarifying questions and interviewing the family to get additional information that can serve as a setting event such as poor sleeping habits, or familial relationships. All of these factors are so important in truly understanding the “why” and addressing it properly. An objective and quality FBA will help determine underlying or internal factors that contribute to the acting out behavior. When we understand those more readily, we can create behavior plans that address the whole person’s needs and identify the positive behaviors that we must teach in replacement.