ABA 101 for Autism Speaks - Kelly McKinnon & Associates, Inc.

advertisement
ABA 101
Kelly McKinnon, MA, BCBA, Kelly McKinnon & Associates, Inc.
Kelly McKinnon & Associates, Inc.
Why ABA to teach
children with autism?
• Research: * Lovaas study- Ivar Lovaas and his team at
UCLA conducted a study in 1987, where they compared
groups of children who received 40 hours of intensive
treatment, vs. children who received10 hours of intensive
treatment over 2 years.
• Intensive treatment occurred at home, school and in the
community (*summary of study only). Results summarized
that 47% successfully passed 1st grade; 42%-completed
classes for language-delayed, with substantial
improvements, but not enough for regular 1st grade.
• Note that 40 hours treatment included parental treatment
as well. Other research since this has stated that actual
Kelly McKinnon & Associates, Inc.
treatment hours are between 24-27,
due to lack of trained
professionals, but with still good success rates.
• CalABA 2003: Gina Green, Ph.D with the institute of
Effective Education: Behavior Analysts are ethically obligated
to base interventions on this scientific evidence. She noted
many current treatments for autism are NOT empirically
based. ABA, (when used accurately) has substantial
evidence of its effectiveness: 600+ studies since 1960,
Matson et al, 1996, and that treatment should occur at least
25 hours per week.
• Chapter three of the Surgeon General’s report on Mental
Health 1999 states, “Thirty years of research demonstrated
the efficacy of applied behavioral methods in reducing
inappropriate behavior and in increasing communication,
learning and appropriate social behavior”. ABA methods
clearly outline systematic programming when teaching new
Kelly McKinnon & Associates, Inc.
skills.
Applied Behavior
Analysis
Common misconceptions:
“Do you do ABA or Social Skills?
“ I do ABA”
“Only the ABA person can teach that goal”
Kelly McKinnon & Associates, Inc.
What is ABA?
• ABA: Applied Behavioral Analysis. An
approach that uses instructional technology
designed to change behavior in a systematic
and measurable way that is meaningful
• ABA is a methodology and set of tools. It
is not a curriculum in and of itself
Kelly McKinnon & Associates, Inc.
What is Not ABA?
• ABA does not mean “table work”
• ABA is not discrete trial: Discrete trial is ONE
method used in ABA, but does not stand
alone
• ABA does not mean a way to teach
academics
• ABA does not mean this is when you give
candy
Kelly McKinnon & Associates, Inc.
ABA: Applied Behavior
Analysis
• ABA is a “way of life”. We use it every day!
• We use “ABA” when we want to “make a
change” or teach something new
• Whenever you teach your child something
new, and praise them you made a behavior
change- and used “ABA”
Kelly McKinnon & Associates, Inc.
Let’s look at Behavior (change) and what it
means:
• Respondent Behavior:
Is unlearned. It is solely under
control of some antecedent stimuli.
There is an S-R response. Reflexive
behavior-automatic
• Examples
Kelly McKinnon & Associates, Inc.
Let’s look at Behavior change and what it
means:
• Operant Behavior:
Is at least partially under control of the consequence– we do it
because we get something for it that keeps us doing it again.
Learned behavior
• Many operands are under control of both the antecedent and the
consequences. S-R-C relationship– we do it because we have been
reinforced in the past, and the “conditions are right”
• The consequence is what is often the reason the behavior occursthink about this!
• Think about what motivates you to do things- these are the pairings
Kelly McKinnon & Associates, Inc.
S-R-C relationship
• S-R-C (or three-term contingency) has become known as
the way in which behaviors are learned. The way operant
learning happens.
• S: Stimulus (antecedent- what happens before you respond:
Example: teacher asks “who can tell me this word?”
• R: Response: the child responds (or does not respond)
• C: Consequence: what happens immediately following a
response (or no response). Teacher praises. (or ignores) If
child likes this, they will respond again (or if they don’t like
being ignored, they will respond next time).
Examples: happens all day in our life
Kelly McKinnon & Associates, Inc.
A- What happened first
events vs. assumptions
B- What was the defined behavior
C- What happened next
behavior vs. assumptions
Kelly McKinnon & Associates, Inc.
FunctionThe consequence: the stimulus that is motivating behavior
(what is reinforcing). Most behaviors are maintained by the
consequence:
• Social: attention, praise, eye contact, physical touch
• Task Avoidance: not wanting to complete, or keeping to
own agenda, escaping demands- *note, maintained by
negative reinforcement-if I escape, stimuli (demand)
removed
• Sensory: tactile, olfactory, visual, vocal sounds, etc. These
• feel good to the child- and often automatically reinforced by
the child
• Tangibles: access to favorite toys, favorite activities
• Examples:
Kelly McKinnon & Associates, Inc.
Function• Function is not to be guessed!
• It is in the data!
Bad Example
“The child is hitting the child next to him
because he doesn’t like him”
“The child is running out of the classroom to get
out of doing his work”
Kelly McKinnon & Associates, Inc.
Data collection
• Collect Data across situations/settings/people- sometimes a
behavior looks like something, but could be something else,
like an illness, or a means to gain attention
• Data sheets: can look different, as long as they note the
behaviors, sometimes the intensity and duration, and what
happens immediately after (consequence/what is reinforcing)
• Data is important: example: we may think a child is
responding to a situation due to escape behavior, but if we
take date, we realize that every time they act out to “escape”
math, the teacher gives them attention
• We also want times of day in the data, to look for trends
Kelly McKinnon & Associates, Inc.
Function drives
intervention
• A- student was presented with a worksheet
• B- student hit peer next to him
• C-peer screamed
Kelly McKinnon & Associates, Inc.
How to decrease that
behavior
• How to decrease that behavior: REACTIVE METHOD
• Goes back to your consequence: what did you determine as
the consequence the child was seeking:
• Now, stop providing access to that consequence for the
undesired behavior demonstration.
• In other words, if a child screams and runs around the room
when the teacher says “it is time to work”, and the child gets
a “sensory break”, which actually allows the em to escape
work, then the child if he wants to escape work, will do the
same response again under those same antecedent
conditions, because the consequence motivating him is that
he is allowed to escape work.
• Other examples:
Kelly McKinnon & Associates, Inc.
How to decrease
that behavior
• How to decrease that behavior: PROACTIVE METHOD
• We know what is motivating for the child, based on the
consequence we assessed: we determined what was
maintaining a behavior (desire to escape, attention, internal
motivators, access to tangibles) AND you stopped providing
access to those consequences when the behavior you want
to change is displayed
• NOW, be PROACTIVE, and teach a REPLACEMENT SKILL
for the child to gain access to that desired consequence
Kelly McKinnon & Associates, Inc.
How to increase a
behavior
• We now have new REPLACEMENT behaviors that
we want to increase.
• Remember: it is often the consequence>>what
happens after the response, that determines if a
behavior is likely to happen again or not>>that is
important in changing behavior.
• If you want a behavior to increase-happen more
often– then making sure to provide access to
desired consequences (REINFORCEMENT) is the
way to make an increase.
Kelly McKinnon & Associates, Inc.
Examples
• Problem Behavior: calling out: assessed: for attention
• Problem behavior
Replacement behavior
decrease
increase
Calling out
Function-access attention
attention
Ignore
(stop providing access
to this desired consequence)
Raising hand
Function-access
Provide exaggerated
attention—every
instance
Kelly McKinnon & Associates, Inc.
Reinforcement
• The C in the S-R-C
• Reinforcement: is a stimulus consequence: that serves
to INCREASE the likelihood that the response will occur
again
• Gives you a reason to do it again- a child will not
perform a new skill (especially that is hard or
uncomfortable) without reinforcement- a reason to do it
again
• Running a marathon example
• Reinforcement is NOT just giving candy
Kelly McKinnon & Associates, Inc.
Data Collection
Data collection let’s us know if what we are
doing is working!
It is important that you breakdown what you are
targeting, in a measurable way. Consider the
following:
Kelly McKinnon & Associates, Inc.
Frequency
How OFTEN does it occur?
* Frequency: Number of times a behavior occurs.
Count each instance. Generally looking for rates or
frequency of a specific behavior to go up or go
down; generally frequency looks at an instance of
behavior in isolation; total amount
Examples: Touching others, off-topic statements, hand
flapping, total number of play ideas initiated
Kelly McKinnon & Associates, Inc.
A-B-C data
A- (Antecedent)
B- (Behavior/Response)
C- (Consequence)
Kelly McKinnon & Associates, Inc.
ABC Data
• A- Teacher gave directions to the whole class
vs.
• A- Student did not pay attention to teacher
directions
Kelly McKinnon & Associates, Inc.
ABC Data
• B- Child ripped paper and threw pencil
Vs
B- Child became angry at teacher and threw his
pencil at her and ripped paper to get out of
doing work
Kelly McKinnon & Associates, Inc.
Percentage
• How often does a response occur
• Percentage looks at how often or many times a response
occurs, out of possible occurrence, generally frequency
addresses:
number of responses X 100
Total number of opportunities
Percentage often looks at accuracy of correct responses or total of
responses in general
Examples: number of times looked when responded; number of times
correctly answering questions when asked; total number of times
looked when listening
Kelly McKinnon & Associates, Inc.
Time samples
• Will also give you a percentage outcome
Partial Interval recording:
• Record responses occurring during some time of a
pre-determined period of time. Example, a student
looks at his teacher at least one time during a 30
second interval.
Whole interval recording:
– Record response that must occur for the entire time
of a pre-determined period of time. Example,
student remains on task, for a whole minute, for a
10 minute period.
Kelly McKinnon & Associates, Inc.
Time Samples
• Momentary Time Samples
– Record an response occurring when you end a
designated period of time. For example, if you set
a 30 second instance of time, record if a
response occurs right when that time ends. This
recording tends to give the most accurate
estimate of responses
– Examples: eye contact to teacher, engaged at
recess, attending to peer
Kelly McKinnon & Associates, Inc.
Duration
• Duration data looks at how LONG a response
occurs.
• Duration is helpful when you are looking to increase or
decrease responses. Examples: how long a child
sustains play. Determine appropriate duration, and
then use a duration data system to track how long until
you sustain for the criteria that you have set.
• Examples, duration for playing an activity, duration for
remaining seated in a circle time.
Kelly McKinnon & Associates, Inc.
Time of day
• Can be frequency data, or percentage
• However time of day is accounted for
– Medicine wear-off
– Fatigue
– Food
Kelly McKinnon & Associates, Inc.
Self-monitoring
• Is used to track a student’s own behavior.
• Generally looks at percentage: did a
response occur or not occur
• Measure this by total number of occurrence
opportunities
Kelly McKinnon & Associates, Inc.
Reinforcement
• Reinforcement occurs when an event
immediately following a response causes an
increase in the probability of that response
occurring in the future.
• It’s the C in A-B-C contingency.
• Reinforcement is used to strengthen
behaviors.
Kelly McKinnon & Associates, Inc.
Reinforcement
• It is NOT bribing. Bribing happens when you ask a child
to do something, they don’t do it, THEN you say “I’ll give
you this if you do it”. This teaches a child to ignore your
first comments, and hold out for the good stuff
• Reinforcement is NOT what YOU want it to be
• It is a consequence that increases the likelihood that a
response/behavior will occur again
• Ways to obtain reinforcement information
– Surveys, Observation, analysis through manipulation
Kelly McKinnon & Associates, Inc.
Reinforcement
• Reinforcement to increase responses:
• Reinforcement is to be given immediately after a
child has completed a correct response/desired
behavior
• This is to make sure the connection between the
desired response and the reinforcer
• Rule of thumb: when you are trying to
increase/strengthen a new behavior, you want to
reinforce it continuously—every instance (CRScontinuous reinforcement schedule)
Kelly McKinnon & Associates, Inc.
Reinforcement
Does the list look familiar?
“Reinforcers” can consist of:
• Sensory: tactile, olfactory, visual, etc.
• Social : attention, praise, eye contact, escape from
attention
• Tangibles : edibles, favorite items, favorite activities
• Breaks: opportunity to escape, “take a break”
Kelly McKinnon & Associates, Inc.
Reinforcement
• As often as you can, match the reinforcement you “put into
place” (arrange as the consequence of the responses of
your child) to be the SAME as the desired consequence of
the child’s previous behavior (what was maintaining their
behavior before)
• Examples:
• Fair Pair Rule: make the intensity of the reinforcement the
same as the intensity of the behavior change you are looking
for. Example: Don’t expect that a child that has jumped out of
their seat 20 times in a class, to sit in their seat and raise
their hand for 1 small piece of candy, or a coupon that they
may or may not win something next
week.
Kelly McKinnon & Associates, Inc.
Reinforcement
There are 2 types of reinforcement:
• Positive Reinforcement
• Negative Reinforcement
Kelly McKinnon & Associates, Inc.
Positive
Reinforcement
An increase in the future frequency of a
behavior due to the addition of a stimulus
immediately following a response.
**It is only a true “reinforcer” if it increases a
response/behavior
Kelly McKinnon & Associates, Inc.
Examples of Positive Reinforcement
• Giving sweets to a child after he completes a
worksheet independently (assuming this increases
the likelihood that the child will complete a
worksheet independently in the future).
• Providing tickles to a child that looks at you
• Providing praise to a child that completed a task
• If spanking a child after he spits increases the
frequency of spitting in the future, the act of
spanking is a positive reinforcement.
Kelly McKinnon & Associates, Inc.
Negative
Reinforcement
An increase in the future frequency of a
behavior due to the removal of an aversive
stimulus immediately following a response.
Kelly McKinnon & Associates, Inc.
Examples of Negative Reinforcement
• Turning off the computer to have a child
attend
• Husband cleans garage to stop wife from
nagging
• Itching your skin after you got bitten by a
mosquito. (The itching behavior removes the
itchy sensation.)
Kelly McKinnon & Associates, Inc.
Schedules of
reinforcement
• A schedule of Continuous Reinforcement
(CRF) provides reinforcement for each
occurrence of behavior.
• Examples
• Intermittent schedules of reinforcement (INT)
provides reinforcement in some, but not all
occurrences of behavior. Stronger R+
* Examples
Kelly McKinnon & Associates, Inc.
Token economies
(Positive
reinforcement)
Definition:
A behavior change system which involves the identification of specific
behavior to be reinforced, a medium of exchange such as tokens or
points, and back-up reinforcers which are purchased with the medium of
exchange (Malott, 2000)
Summary: 1) Clearly defined behaviors
2) Medium of exchange
3) Backup reinforcer
Token=Generalized Conditioned Reinforcer:
A conditioned reinforcer that has been paired with a wide variety of
backup reinforcers.
(Conditioned reinforcer: an event, object, stimulus that is not initially
reinforcing but acquires properties of a reinforcer after frequent pairing or
association with another reinforcer)
Kelly McKinnon & Associates, Inc.
Effective: research shows effective with those behaviors resistant to
instruction
• Tokens can bridge time gap (teaches delay of R+), and may be
undesirable to stop lesson plan to deliver an immediate reinforcer
• Tokens can bridge setting gap (example: tokens for assembly behavior
can be for exchange later in classroom)
• Management of satiation, and deprivation become less critical
• Provides versatile means of communication—behavior that earns tokens
can be varied among individuals
• Provides structured interactions in a consistent manner—requires
positive R+ in a timely, consistent method
• Provides representation for student progress- can see accumulation
Kelly McKinnon & Associates, Inc.
Reinforcement
Making reinforcement “natural”
Be creative~ reinforcement must match as
closely as possible to function
Reinforcement should closely match the
situation
Increase sociability by having peers reinforcing
Examples:
Kelly McKinnon & Associates, Inc.
Teaching new
skills
• Teaching a new skill generally involves
showing, breaking down.
• Teaching a new skill generally involves
teaching, via PROMPTS
Kelly McKinnon & Associates, Inc.
Instructional
Control
• Developing attending and instructional control
• Developing good attending skills and pattern of responding
is often the first step when working with a child with ASD.
This involves the systematic pairing of yourself with
reinforcement and then generating a stimulus transfer. If
you are reinforcing to be around, a pattern is developed.
Now, slowly build in demands-pairing continuous
reinforcement for each demand. Again, you develop a
pattern of responding. Now, slowly thin your reinforcement.
We cannot say enough about this. It does not mean forcing a
child to sit—it means making your teaching fun! So they are
motivated to respond!
• Examples:
Kelly McKinnon & Associates, Inc.
Prompts
Information/assistance added to the SD that helps the
student perform the target behavior.
•
•
•
•
Purpose: Reduces frustration (few errors) and
speeds up correct response-thus learning.
Consider your prompt hierarchy needed for child to
respond correctly-to reduce errors and frustration;
thus need to include a fading process.
Prompt dependency is due to lack of proper fading
and reinforcement,
Watch for accidental extraneous prompts
Kelly McKinnon & Associates, Inc.
Prompts
• Prompt hierarchy
–
–
–
–
–
–
–
–
–
Full physical
Partial physical
Gradual guidance
Touch cue
Gestural cue
Modeling
Direct verbal
Visual cue
Indirect prompt
Kelly McKinnon & Associates, Inc.
Types of
Prompting
General rule of thumb:
Least-to-most prompting
Errorless teaching is opposite:
Most-to-least
Kelly McKinnon & Associates, Inc.
Other antecedent
variables
• Environmental modifications—rearranging
the environment or setting to allow target
behaviors to occur more easily and/or more
naturally. This could mean changing where
the student sits, where materials are kept,
access to games to take to recess,
modification of schedule to minimize
transitions, etc.
Kelly McKinnon & Associates, Inc.
Prompts
• Indirect prompts—this technique is generally best used if a
child has previously had an experience with the expected
response, and can be used as a prompt-fading process. For
example, if you have taught a child to walk over to you when
you present markers, and the child is not looking at you, you
may knock on the table or make a noise that prompts the
child to look at you, and then realize they should walk over to
initiate interaction.
Kelly McKinnon & Associates, Inc.
Why we use peers~ peers go first!
• Modeling— demonstrating exactly what the
correct or desired response is for the student.
Keep in mind, the teacher, a peer, sibling, or
parent
can do modeling. It is a prerequisite that the
student has imitation
skills and understands that he/she should
follow/imitate the behavior just observed.
Kelly McKinnon & Associates, Inc.
Behavior chaining
Teaching Behavior Chains:
• Construct a task analysis
• Assess the level of mastery of each
behavior
• Teach the individual to perform the
behaviors in order and in close temporal
succession (quickly upon completion of
each step)
Kelly McKinnon & Associates, Inc.
Planning:
• Define the behaviors
• Establish value of behavior/rules for tokens
• High priority worth more/or 1:1
correspondence
• Determine criterion for success (how many
tokens by what)
Kelly McKinnon & Associates, Inc.
School Setting
Scheduled
Play
activities as
part of day
Teaching play in the classroom
1) Use the play skills checklist, according to appropriate level, to determine
play needs. Then set up stations in your class, addressing each level of
need, and placing your student at the level that they need. With success,
move them through to the next play station.
Station #1
Play 1:1
Teaching
Station #2
Station #
Independent 3 Play
Play
w/peer
Station #4
Play with
trained
peer, no
adult
(with
success
from # 3)
Station #5 Play
with more then
1 peer
Kelly McKinnon & Associates, Inc.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Here is one sample of how we took a school’s “theme” and broke it down:
Teaching Social Skills
Lily Elementary School
School Theme: Be Safe
Our breakdown:
-Being nice to others/complimenting others
-Recognizing teasing/dealing with a bully
-Keeping your hands to yourself
-Dealing with peer pressure
-Recognizing a stranger and what to do
School Theme: Be Respectful
Our breakdown:
-Definition of respectful
-Look/Listen to your teacher
-Look/Listen to adults & friends
-Use polite words
-Following school rules
-Waiting your turn
-Sharing/trading
-Being a good sport
-Joining into conversations/not interrupting others
School Theme: Be Responsible
Our breakdown:
-Bring materials to class and be prepared
-Complete all assignments
-Help a teacher/Help a friend
-Avoiding fights/trouble
Kelly McKinnon
& Associates,
-Recognizing another’s feelings
& helping
them Inc.
-Keeping yourself neat & clean
Analyzing
Behavior:
Key Factors to Consider in
Autism
• Core deficits in autism affect behavior:
–
–
–
–
Language processing problems
Social communication issues
Cognitive dysfunction
Sensory processing concerns
• How do these factors influence behavior?
Kelly McKinnon & Associates, Inc.
Child with ASD:
Language Processing:
• Difficulty with receptive language
– Does your child understand the spoken word?
– Using visual supports can help
• Difficulty with expressive language in order to
be understood by others
– Can your child communicate his wants and
needs?
– “Language” is more than “words”
Kelly McKinnon & Associates, Inc.
Child with ASD:
Social Communication
Issues
• Does your child recognize the need to
communicate with others?
• Does he want to communicate but lacks the
necessary skills to engage others?
• Does your child have problems
communicating appropriately in social
situations? (pragmatic language)
Kelly McKinnon & Associates, Inc.
© Nancy McGovern , PhD - 2004 to 2011
Cognitive Issues
• Difficulty generalizing to new situations
• Inflexible thought processes: “rule bound”
behavior
• Concrete thinking
– Difficulty with abstract concepts: (becomes more
evident as child ages)
Kelly McKinnon & Associates, Inc.
The Role of Anxiety
Contributing Factors:
• Inaccurate understanding of others
• Difficulty effectively communicating
wants, needs and desires
• Feeling overwhelmed
– bombarded by sounds, task demands or
sensory stimuli
• Change in comfort zone may result in…
“problem behaviors"
Kelly McKinnon & Associates, Inc.
© Nancy McGovern , PhD - 2004 to 2011
Behavioral
Principles cont.
• Behavior that is reinforced is repeated
• Behavior that is not reinforced is
extinguished…….It disappears
Kelly McKinnon & Associates, Inc.
So…
• We should reinforce the behaviors we
want to see again
• We should ignore the behaviors we
don’t want repeated
• Simple? Not quite!
Kelly McKinnon & Associates, Inc.
When Focusing on
Problem Behavior…
• Pick your battles
• Make a plan:
– clear the deck…make time and space for
change
– when you change behavior, it gets worse
before it gets better
• Don’t try to change everything at once
– Identify one or two target behaviors
Kelly McKinnon & Associates, Inc.
Identifying
Antecedents
•
•
•
•
Observe behavior
Recognize triggers
Keep a log
Look for a pattern
– Look at what proceeded the behavior
• Develop instinct for problematic situations
– Trust your knowledge
Kelly McKinnon & Associates, Inc.
Clear Communication
• Keep your language simple and
concrete:
– use as few words as possible
– Tell your child exactly what you want or
expect him to do
• Identify consequences ahead of time
• Don’t expect your child to be able to
generalize behavior to new situations
• Break information down into small steps
Kelly McKinnon & Associates, Inc.
Make It Visual and Concrete
• Use pictures, schedules, concrete examples
• Anticipate problems
– think ahead to potential struggles
– Think: Is what I am asking tangible?
• Begin with structure.
– Then introduce small variations to promote
flexibility
Kelly McKinnon & Associates, Inc.
Set Limits
• Setting limits is an act of love
• Be kind but firm. “Stick to your guns.”
• Negotiate before, not after the behavior
occurs
• Don’t be too sympathetic and don’t give
in “just this once”
– If you give in this time, she will try twice as
hard next time
Kelly McKinnon & Associates, Inc.
Reducing Anxiety
Your child’s and your own
• Avoid situations your child is not ready for:
– don’t set your child up for failure
• Use “Social Stories”
– They help your child become comfortable with a
new situation
• Use rehearsal and role playing
– Repetition makes “new” become “familiar”
Kelly McKinnon & Associates, Inc.
Reinforce the
Positive
• Shape behavior by reinforcing small positive
changes
– Reinforcers should be meaningful to your child
– Your attention is a powerful reinforcer
• Change reinforcer when it no longer works
• Short term reinforcement works best at first:
– your child may not be ready for delayed
gratification
– Set your child up for success
Kelly McKinnon & Associates, Inc.
Do not tolerate
behaviors that are
intolerable
– Parents often accommodate to
unacceptable behaviors to avoid conflict
– Be understanding but firm
– Autism is not an excuse for bad behavior!
Kelly McKinnon & Associates, Inc.
Remember
• Recognize that changing behavior takes
time and patience
• Set realistic goals
• Re-enforce good behaviors
• Celebrate each small step
• Keep a sense of humor
• Utilize your support system, take care of
yourself
Kelly McKinnon & Associates, Inc.
What you can do
General “Rules of Thumb”
1) Reward what you DO want~ be happy!
2) Ignore what you DON’T want
3) Remain calm- say what you mean~ be a
presence with your child- you are the boss!
Kelly McKinnon & Associates, Inc.
• Good bye!
• www.difflearn.com
Kellymckinnon@kellymckinnonassociates.com
Kelly McKinnon & Associates, Inc.
Download