Behavioral Pearls for
Therapists
Judith Aronson-Ramos, M.D.
www.draronsonramos.com
Overview
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Perspective
Resources
Pearls
Questions and areas of need
Factors
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Child
Family
Child-Family-Therapist Triad
Socio-economics
Environment
Child
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Disability
Temperament
Cognitive Skills
Self Regulation
Sensory Challenges
Family
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Limit Setting
Heirarchy
Culture
Resources
Supports
Child-Family-Therapist
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“I have the best…”
“I have the worst…”
Clash of cultures and values
Goodness of fit
Socio-economics and
Environment
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Control what you can
Get around what you can’t
Teachable moments and exposure
Working within boundaries
Assess for competing needs – food,
shelter, abuse
Archtypes
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The angry parent
The defeated parent
The overwhelmed parent
The defensive parent
The eager to please parent
Angry
• Begin and end therapy session with a
positive statement
• “Jonny was so full of energy today”
• Give a specific example the parents
can build upon
• This may help positive relationship
between parent and child
Defeated
• Therapists shine here
• Strengths based perspective
• Providing specific examples of
improved skill or ability
• Rare source of support for parents
Overwhelmed
• Therapists as sitters
• Still an opportunity to connect
• Be specific and narrow in the skill you
want the family to work on and
reinforce
• Refrain from judgment
Defensive
• Use specific observations
• Be a “safe” confidant
• Avoid direct conflict it will always be
perceived as judgmental
• Disarm by not reinforcing negative
interaction styles
Eager to Please
• Hyperfocus on an insignificant
problem can be unhealthy for child
and family
• This may be a red flag of a more
serious problem
Techniques to Redirect
Negative Behaviors
• Distraction – bubbles in every
treatment room, balloons if you don’t
like the mess, spinning tops (use
caution)
• Anticipation – preempt before you
see the behavior, look for patterns
Negative Behaviors
• Redirection – timing is everything
• Vapor Lock – the moment before the
explosion
• Address Sensory needs
• Identify Triggers
• Effective Rewards
Autism Red Flags
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No social smile and back and forth exchanges with caregivers by 2-3
months.
No notice of when caregivers leave or enter a room by 6-9 months of age.
Not responding to his or her name when called once or twice at nine months
or later.
Lacking in back and forth play with teachers, caregivers or other children.
We call this skill joint attention and it is a critical component of engaging
with others.
No pointing or babbling at nine months or later.
No functional words at 15 months or later.
Repetitive and non-purposeful play – dumping toys, lining things up, stacking
– at the expense of creative and imaginative use of objects.
Limited or no eye contact.
Red Flags
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Repetitive body movements or posturing – can be hand flapping, finger
twisting, spinning, rocking, all of these are done to an excessive degree.
Unable to be redirected at 15 months or later due to an intense fixation
with an object or interest; we sometimes call this “sticky attention”.
Unable to sit or engage in expected activities for age from 12 months on.
Prolonged difficulties with separation from caregivers, or extreme upset at
changes in routine.
Viewing or inspecting objects from unusual angles – laying down to look at
spinning wheels or objects, using peripheral vision, fixating on moving
objects that are not toys such as fans, wheels, washing machines etc. All of
these things are done to excess not just in an exploratory way.
Not comprehending instructions, directions, or tasks that are clearly age
appropriate.
For more information on red flags visit www.firstsigns.org
Autism Resources
www.draronsonramos.com
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www.autismspeaks.org - This site has the most comprehensive and up to
date information for parents about autism spectrum disorders. The Family
Services tab will take you too directories of local services and tool kits on
a variety of helpful topics. For immediate help to speak to someone about a
new diagnosis or ASD issue call 1-888-autism2
http://autism.yale.edu/ - Yale University Child Development Center's
Introduction to Autism Seminar
www.autismresearchnetwork.org - Comprehensive review of Autism
research efforts.
www.autism-society.org - Official website of the Autism Society of
America.
www.firstsigns.org - Focus on early diagnosis and intervention for Autism.
www.autismlink.com - Nationwide listing of Autism resources.
www.udel.edu/bkirby/asperger/ - Online Aspergers Syndrome Information
and Support. (O.A.S.I.S.)
Autism Resources
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www.nichd.nih.gov/autism/ - National Institute of Health information
relating to Autism.
www.maapservices.org - Information for individuals with high functioning
Autism, PDD-NOS and Aspergers Syndrome.
www.umcard.org - Main website for The Center for Autism and Related
Disabilities (CARD) serving Dade and Broward counties.
www.coe.fau.edu/card/ - Website for the CARD Center serving Palm Beach
County. This is a state funded information, education and advocacy group
for individuals and families with Autism Spectrum Disorders.www.aap.org American Academy of Pediatrics online interviews with Autism Experts for
parents and caregivers.
www.aacap.org - American Academy of Child and Adolescent Psychiatry
Resource Center on Autism.www.bestpracticesautism.com - A listing of the
most up to date books and resources on ASD including diagnosis and
treatment, it covers the spectrum from all ends and angles, a MUST VIEW
SITE
Local Referral Options if
you suspect ASD
• Early Steps
• Child Find
• University of Miami/Nova CARD –
free mobile screening van
www.umcard.org
• ARC of Broward
Parenting Resources
• Triple P Parenting Program - Evidence
based parenting resource with specific
materials parents can use to manage
problem behaviors and encourage optimal
development in young children.
• The Increbile Years - A comprehensive
parent training series for behavior
management an optimal emotional
functioning of young children.
Disorders of Young
Children
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ADHD in the Young Child: Driven to Redirection: A Guide for Parents and
Teachers of Young Children with ADHDby Cathy Reimers PhD and Bruce A.
Brunger (Paperback - Oct. 1, 1999)
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Teaching Young Children With ADHD: Successful Strategies and Practical
Interventions for PreK-3 by Richard a. Lougy, Silvia L. DeRuvo, and David
Rosenthal (Paperback - Mar. 28, 2007)
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Emotional and Behavioral Problems of Young Children: Effective
Interventions in the Preschool and Kindergarten Years by Gretchen Gimpel
Peacock PhD and Melissa L. Holland PhD
Oppositional Behavior
• Parenting the Strong-Willed Child:
The Clinically Proven Five-Week
Program for Parents of Two- to SixYear-Olds [Revised and Updated
Edition]by Rex Forehand and
Nicholas Long
Autism
• Check titles on the Best Practices
Autism Bookshelf, with the lastet
publications backed by evidence
based research.
Comprehensive Listing of
Websites by Disorder
www.draronsonramos.com
• ADHD
• Autism
• Syndromes
• Learning
• Child Development
Medication and Nutrition