Archive for the ‘treatment’ Tag

Useful Things I Learned from Being an ABA Therapist   Leave a comment

Before I start, I want to be absolutely clear that this post is not meant to condone ABA as an autism treatment. It is merely an attempt to find a tiny bit of good in my past career. (The biggest good was getting to know the children I worked with, and many of the families were delightful people doing what the “experts” had told them to do.)

Applied Behaviour Analysis (ABA) is still a hot-button issue in many parts of the autism community. I used to do ABA, primarily Lovaas-style. The type of ABA I did is heavy on table time and progresses through a specific set of programs designed to teach everything from speech to academic skills to self-help skills. It was touted as being scientifically validated and able to “recover” autistic children, or at least make them indistinguishable from their peers.

There are all kinds of problems with that, and with the ABA industry as a whole, but other people have written about that far more eloquently than I ever could. So today I want to talk about the useful things I took away from my time as an ABA therapist. Because there are some helpful techniques and attitudes I learned.

If the student isn’t learning, it isn’t their fault. My first ABA consultant taught us that if the child wasn’t learning what we were trying to teach, there was something wrong with our approach. Maybe we weren’t consistent enough from one therapist to another. Maybe we needed to present the material differently or change the way we requested the behaviour. Whatever it was, we were the ones who needed to adjust.

Breaking tasks down into steps and chaining behaviours. As someone who has ADHD and the accompanying executive dysfunction, it can be helpful to break down a large task into smaller steps. That way I can focus on one small piece at a time instead of getting overwhelmed trying to figure out where to start. Chaining tasks is also a really helpful concept that has helped me change my routines (and develop them in the first place).

I know my A-B-C’s. Not my alphabet (though I do know that as well), but a way of figuring out how to help my two-year-old, non-autistic child behave appropriately. When he does something I would rather he not do, I look at the antecedent, or what happened before he did the thing, I look at his specific behaviour, and I look at the consequence, or what happened afterward (i.e., what he got out of it). This is most beneficial when I remember my developmental psychology, since that tells me that a toddler doesn’t yet have the executive functioning to control his impulses (and as an ADHDer with impulse control problems, I understand this intimately). Understanding the reasons why he does something helps me find other ways for him to get whatever it is he needs, in a more acceptable fashion. It also usually comes back on me: a lot of his behaviour happens because I didn’t put something out of his reach, or I wasn’t supervising closely enough, or I was ignoring his attempts to get my attention.

I don’t over-react to things. One of the things I learned as an ABA therapist was to keep my cool at all times and to be neutral when correcting responses. This translates to my kid having a mom who responds to things like refusing to come for a diaper change by asking if he can come on his own or if he needs help. This gives him power in the situation that is appropriate for his developmental level but still gets the job done.

Some of the teaching methods can also be useful, but it depends a lot on the person and the thing you are trying to teach.

But there you are, a list of the positive practical applications of ABA techniques. Note that understanding child development is important (it wasn’t needed when I was working), as well as respect for the individual’s particular needs and desires (again, not necessary in my work). As with so many things, intent and attitude matter.

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Acceptance III   Leave a comment

As promised, I’m going to talk about the treatability of ADHD.

Russell Barkley says that ADHD is the most treatable mental disorder. He’s sort of right, but there are problems with that statement. There are actually problems with the concept of treatment as it currently stands.

So let’s look at the concept of treatment and then we can talk about whether or not ADHD is actually treatable.

Society has taught us that it is best to be neurotypical. We should be neurotypical, we should live our lives as though we are neurotypical, and any difficulty we have achieving that goal is a failure. Treatment is meant to bring us “back to normal” – that is, it’s supposed to make us more neurotypical, so that we can live like neurotypicals and have a better quality of life and be happy. Because the assumption is that you can only be happy if you are neurotypical, and your quality of life must be horrible if you aren’t living the same way as neurotypical people do.

There are so many things wrong with this that I don’t really know where to begin.

Let’s start with the assumption that you have to be neurotypical to be happy and to have a good quality of life.

I know lots of people who have mental disorders and developmental disabilities that affect their cognitive functioning, and most of them are happy and have good quality of life. Obviously neurotypicality is not necessary for either happiness or quality of life.

So if that assumption is incorrect, then it must also not be true that we need to live like we’re neurotypical in order to be successful, to be happy, and to have a good quality of life. Which means that treatment in order to be “more normal” is ableist and unnecessary.

Now, that doesn’t mean that treatment itself is unnecessary. If a condition is causing difficulty in an area that really matters to you, and you want help with that area and there is something out there that can help, treatment is a great thing. But the goal of treatment should never be “change my brain and my life so that I am neurotypical,” because not only is that impossible, it’s ableist and an incredibly negative way to approach something that is so pervasive and intrinsic to your life and your identity.

So that’s why the current concept of treatment is a bad one. And I know this is what people think, because I get questions from people all the time asking why they still have trouble with particular things even though they’re taking medication. I get questions asking if medication is going to change their personality. And I get these questions because people are told that medication is the most effective form of treatment for ADHD, and they think that “treatment” means “no more ADHD,” and that’s just plain wrong.

So how treatable is ADHD, really?

Well, in the current concept of treatment (as sort of a cure), it’s not treatable at all. There are no treatments out there that will make a person suddenly have a neurotypical brain. The best medication can do is make it so that our brains function more like they’re neurotypical, so it’s easier to do certain things while it’s in our system, but it doesn’t actually make us neurotypical, and we still have to work at things that neurotypicals find easy.

There are a lot of treatments for ADHD. I’ve listed a lot of them here:

Medication – This is the first-run option. A lot of people never get past this component of a treatment plan, and that’s not great because you need to be prepared if you have to stop taking medication for some reason.

Diet – A good diet that has lots of protein (not like ridiculously high, just higher than average) is important for good brain function. Other important components here include Omega-3 fatty acids (found in eggs and fish, for the most part) and plenty of vegetables, as well as complex carbohydrates (e.g., whole wheat bread and pasta, beans, potatoes).

Exercise – Regular exercise (especially cardio) is amazingly good for your brain! It wakes up your entire body and keeps dopamine in your system, which is great since dopamine is one of the primary neurotransmitters involved in ADHD.

Sleep – When we sleep, our bodies do a bunch of things like healing and rejuvenating. Our brains do that, but they also work through all of the events of the day, committing things to long-term memory and stuff like that. We need to make sure we’re getting at least eight hours of sleep per night to make sure our brains are functioning at their best.

Supplements – Krill oil (or other fish oil), rhodiola, reishi, and other supplements listed here (my father-in-law’s business) can be helpful in promoting optimum functioning. Dr Amen also has some suggestions in his book Healing ADHD.

ADHD Coaching – ADHD coaches help you learn, develop, and implement strategies that work for you, so that you can better manage your ADHD symptoms and be able to do well if you have to stop taking medication.

Talk Therapy – Sometimes you have a lot of stuff you need to work through, so this can be very helpful, whether you see a counselor, psychologist, or psychiatrist.

Cognitive Behavioural Therapy (CBT) – This is a type of behavioural therapy where the practitioner (a psychologist or social worker with training in CBT) helps you think through your behaviours and come up with better ways to react to different situations.

Meditation – If you’re able to meditate, this can be really helpful in getting your mind centred and teaching your brain to actually concentrate or focus on what you want it to.

Mindfulness – This is something I’ve been hearing more about lately, and it seems to be about getting us to focus on the actual now and the immediate future, rather than dwelling on the past or thinking really far into the future. Being truly present in the moment instead of jumping ahead in conversations or tuning out because something else caught our attention.

That’s rather a lot. And not one of these things is going to make you neurotypical.

But I don’t think that’s necessarily a bad thing.

Why should we try to live like we’re neurotypical, when we aren’t? Rather, shouldn’t we be working towards living the best life we can, as people who have ADHD? Yes, some of my symptoms cause me distress and those need to be managed somehow, but other than that does it really matter that my mind makes random connections, that I lose track of time, that I hyperfocus on silly little things?

My life has a number of qualities that are the same as the life of a neurotypical. There are also lots of things about my life that are different and are probably kind of strange. And, of course, there are things about my life and about how my brain works that cause disasters, but there are also things about both of those things that are amazing and wonderful, and I don’t see why the presence of disasters should automatically mean that my life or my brain is wrong, that I shouldn’t be how or who I am.

I am a person. I have ADHD. I am valuable as I am, regardless of how “neurotypical” I make myself seem. And that’s okay. I don’t have to be neurotypical to be worthy of respect, of attention, of achieving success on my own terms.

Society doesn’t determine those things about me. I do.

This is part three of a series. I don’t know how long the series will be or when I’ll post the next installment. I’m not sure what I’ll talk about next. I just don’t think I’m quite finished talking about this yet.