Introduction Initial meeting and recommendations Home or centre based therapy School/kindergarten support Parent training Other professionals support Introduction

C.L.I.M.B. offers services for children aged 14 months to young adults, families, educators and professionals in both Auckland. We focus on offering individualized Early and Intensive Behavioural Intervention programs, which are supervised by qualified and enthusiastic staff (Psychologists and Board Certified Behaviour Analysts). Our therapists are trained to deliver high quality services in a fun but professional manner.

We provide assistance with specific areas of concern for families by implementing evidence based and specifically tailored strategies in order to teach new skills and help the children reach their full potential while diminishing their difficulties with:

C.L.I.M.B. also offers counselling services for children, teenagers and young adults. We combine empirically based psychological strategies from CBT, ACT and ABA (acceptance, mindfulness strategies, commitment and behavior-change strategies) to increase psychological flexibility and to offer our clients the support and guidance needed to overcome challenges that they face and to make positive changes in their lives. Some of these sessions can be funded. For more details please contact us.

Initial meeting and recommendations

The first step is to organize an initial meeting. One of our Case Supervisors will meet with you and your child either at our office or at your home. During the meeting, the assessor will observe and interact with the child and go over an interview with the parents/caregivers. We will also discuss your goals that you have for your child, how ABA therapy works and how the sessions will be conducted. The meeting usually lasts 1.5-2 hours and is charged at $300 + GST. To schedule an initial meeting please contact us.

Once the initial meeting is completed, the Case Supervisor will write a report with recommendations (including an initial therapy plan and a minimum recommended number of therapy hours per week). Based on these you can decide to start services. These can include:

Home or centre based therapy

Home or centre based therapy services are one-to-one applied behaviour analysis (ABA) sessions for children. During these sessions an ABA trained therapist will teach your child fundamental skills mostly through play activities in order to make the sessions fun and enjoyable. The therapist will work with your child for 2-3 hours at a time or longer if needed.

Each child has an individualized program designed by the Case Supervisor. CLIMB uses the comprehensive SKILLS Curricula to create and implement customized therapy plans from all areas (language, social, play, adaptive, cognition, executive functions, academic and motor). We combine Discrimination Training Teaching with Natural Environment Teaching while taking ongoing data to help monitor and evaluate progress.

Our programs run on a 4 weekly clinical cycle with mandatory supervision meetings every second or fourth week, where the team members and parents come together to assess progress, implement new programs and conduct training – focused on maximising your child’s learning. We have found that consistent supervision and expert monitoring are key to children’s progress.

As an example the program for a 2-3 year old child can focus on teaching language skills, eye contact, compliance, adaptive and play skills while the program for an older child can also include programs such as: social skills, conversation training, self-regulatory strategies, and academic tasks if needed.

School/kindergarten support and shadowing

Therapy sessions at school/kindy differ from the ones at home. The therapist's role in these settings is similar to the one of a teacher aide's.

In kindy our role is to help the children participate in as many group activities as possible by encouraging them to attend activities such “mat time”, “meal times”, “play ball activities”, “group yoga” and teaching them to comply with the teacher`s instructions and play with other children.
For older children, support at school might focus on teaching them how to interact with their peers, how to deal with conflict and how to attend and stay focused on a given task.

Parent training sessions

Research shows that the ongoing involvement of parents in the therapy process has substantial benefits for the child's progress. Parent training sessions can focus on behaviour management, teaching new skills, teaching parents how to interact and play with their child, food selectivity and/or sleep difficulties. You do not have to have one-to-one therapy in order to receive Parent training sessions.

Other professionals training and supervision

CLIMB can also offer training for teachers and other professionals that your family collaborates with.

As well we can design and supervise programs for families that work with independent therapists since it is highly recommended that they receive appropriate and ongoing supervision.

Does ABA therapy cure Autism?

ABA therapy is the most researched evidence-based treatment for Autism Spectrum Disorders. Multiple studies* show that ABA therapy can help with teaching new skills and with reducing behaviours that interfere with the learning process. Some studies* also show that intensive ABA treatment can lead to a higher IQ.

How many hours of ABA therapy should my child receive?

Early Intensive Behaviour Intervention research* looks at 20-40 hours/week of ABA therapy for children aged 2-3 years old for the first 2 years. There are also studies* that have showed progress for children who received 12 hours/week of therapy. There is also an overwhelming body of evidence that ABA is effective at teaching new skills to individuals with various diagnoses, levels of ability and age. We've seen progress with most of the children with whom we've worked with. The recommended number of hours can be delivered by an ABA therapist or by a caregiver who has had ABA training. Research shows* that families who generalize the work of the therapists outside of therapy sessions see greater and faster progress.

How long does it take to start services from the moment we contact CLIMB?

The process can take anywhere between 1 and 3 months for starting therapy. This varies based on our therapists’ availability and on the length of our waiting list at the time.

Is ABA funded in New Zealand?

Unfortunately the answer is no. In most cases the families have to support the cost of therapy. ABA therapy is funded in Australia (up to $20000/year or up to 70 hours of therapy per 4 weekly cycle), majority of USA (up to 40 hours/week) and several countries in Europe.

How do I know if my child will engage in the therapy sessions?

We do our best to make the therapy sessions fun and playful. We start by tempting the children with favourite toys/activities and then use those rewards to motivate the children to engage in different tasks such as: making eye contact, copying a sound, playing appropriately with toys, matching, identifying objects and many other activities. The children we work with are excited to see their therapist arrive because they know that they will have fun during the session.

Does CLIMB use punishment techniques?

No, CLIMB does not use nor supports aversive techniques.

Does ABA work for older children and young adults?

Yes. ABA therapy works at any age. However, therapy sessions will most often be different for a 10 year old compared to the sessions for a 2 year old.

What if my child doesn`t make any progress?

If an intervention is effective, we should see some progress within 1-2 months. If there is still no progress once multiple strategies have been implemented, we will recommend to stop services. Fortunately until now none of our clients stopped services due to lack of progress.

Can I choose the therapists my child will work with?

Therapists are allocated based on their experience, availability and location. Each child will work with 2 or more therapists depending on how many hours of therapy they require. We aim to have at least one experienced therapist on each team.

What happens when a therapist leaves?

Unfortunately therapists change jobs or move to a different city/country just like many other people do. This can be unpleasant for you and your family and for us as well. However, we do our best to ensure that your child's treatment will not be affected by changes in the therapy team. Often, children respond very well to new therapists and change is beneficial for generalization of skills.

I can`t afford therapy services, what should I do?

We also offer parent/caregiver training sessions. You can learn how to interact with your child, how to teach your child new skills or how to manage their behaviour. Another option is to hire an independent therapist and have them trained by an ABA professional. If you decide to work with an independent therapist you should ensure that they have appropriate training/qualifications and that they are being supervised by a BCBA(Board Certified Behaviour Analyst).

My child doesn`t have a diagnosis, but I think we could benefit from your services. Can you help?

Yes, we don`t require a diagnosis in order to deliver services.

My child doesn't talk, can you help?

Yes, our staff has experience in using a variety of communication systems and devices such as PECS, TouchChat and Proloquo.

What is the Early Start Denver Model(ESDM)? Is CLIMB familiar with it?

ESDM integrates a relationship-focused developmental model with the well-validated teaching practices of Applied Behavior Analysis(ABA). ESDM is a comprehensive behavioural early intervention approach for children with autism, ages 12 to 48 months. Our supervisors are familiar with the program.

* please see the Autism and ABA page for details and links

What is Autism? Red flags Causes ABA ABA myths AAC Social Stories Medication Diets Alternative therapies What is Autism?

Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviours. ASD can be associated with intellectual disability, difficulties in motor coordination and attention. Some children also experience physical health issues such as sleep and gastrointestinal disturbances.
The most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age.

What makes a child on the spectrum different?
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities.

Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means.

Red flags

As a parent it is important to learn the early signs of autism and become familiar with the typical developmental milestones that your child should be reaching.
If your child exhibits any of the following signs, please don’t delay in asking your paediatrician or family doctor for an evaluation:

• No big smiles or other warm, joyful expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
• No babbling by 12 months
• No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
• No words by 16 months
• No meaningful, two-word phrases (not including imitating or repeating) by 24 months
• Any loss of speech, babbling or social skills at any age

It is estimated that 1 in every 100 people in New Zealand has autism spectrum disorder. ASD affects tens of millions worldwide. An estimated 1 out of 54 boys and 1 out of 252 girls are diagnosed with autism in the United States.

Causes

What causes autism?

Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by themselves. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development.

In the presence of a genetic predisposition to autism, a number of non-genetic, or “environmental,” stresses appear to further increase a child’s risk. The clearest evidence of these autism risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain. It is important to keep in mind that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk.

A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception. Increasingly, researchers are also looking at the role of the immune system in autism.

How to choose?

Autism therapies attempt to lessen the deficits and disruptive behaviours associated with autism and other autism spectrum disorders (ASD), and to increase the quality of life and functional independence of autistic individuals, especially children. How to choose the best treatment for your child? Before you choose an intervention, it is best if you investigate the claims of each therapy so that you understand the possible risks and benefits for your child. For more information on different treatment options please visit AutismSpeaks.org

Applied Behaviour Analysis (ABA)

Since the early 1960’s, applied behaviour analysis, or ABA, has been used by hundreds of therapists to teach communication, play, social, academic, self-care, work and community living skills, and to reduce problem behaviours in learners with autism and not only. Behaviour analysis focuses on the principle that the consequences that follow a behaviour will determine if that behaviour increases or reduces. The aim of ABA therapy is to bring a meaningful and positive change in socially important behaviours.
Applied behaviour analysis contributes to a full range of areas including: AIDS prevention, business management, education, early intervention treatments, gerontology, health and exercise, language acquisition, medical procedures, parenting, psychotherapy, severe mental disorders, sports, substance abuse, and zoo management and care of animals.

ABA-based techniques have demonstrated effectiveness in several controlled studies: children with ASD have been shown to make sustained gains in academic performance, adaptive behaviour and language, with outcomes significantly better than control groups:

• In 2011, investigators from Vanderbilt University under contract with the Agency for Healthcare Research and Quality performed a comprehensive review of the scientific literature on ABA-based and other therapies for autism spectrum disorders; the ABA-based therapies included the UCLA/Lovaas method and the Early Start Denver Model (the latter developed by Sally Rogers and Geraldine Dawson). They concluded that 'both approaches were associated with improvements in cognitive performance, language skills, and adaptive behaviour skills.'
• A 2009 comprehensive synthesis of early intensive behavioural intervention (EIBI), a form of ABA treatment, found that EIBI produces strong effects, suggesting that it can be effective for some children with autism.
• A 2009 review of educational interventions for children, whose mean age was six years or less at intake, found that the higher-quality studies all assessed ABA, that ABA is well-established and no other educational treatment is considered probably-efficacious, and that intensive ABA treatment, carried out by trained therapists, is demonstrated effective in enhancing global functioning in pre-school children.
• A 2008 evidence-based review of comprehensive treatment approaches found that ABA is well established for improving intellectual performance of young children with ASD.
• The original research conducted by Lovaas in 1987 indicated that 90% of the children who received intensive ABA treatment made substantial gains. Close to half of the children attained a normal IQ and tested within normal range on adaptive and social skills.

http://www.lovaas.com/research.php

ABA common myths

I. ABA is not a scientifically proven form of therapy for autism.
The evidence is overwhelmingly in favour of ABA. In fact, over 550 peer-reviewed studies have been published demonstrated the effectiveness of ABA with individuals with autism. ABA is the most established autism treatment by insurance providers in the US, Australia and several countries in Europe.

II. ABA therapy is a new treatment for autism.
ABA as a field has been around since the 1950s and saw major successes with autism starting in the 1970s with the pioneering work of Ivar Lovaas.

III. All ABA programs are the same.
ABA is a science of individual behaviour. This has been true since the earliest days of B.F. Skinner’s “cumulative records,” and has been a distinguishing feature of the field ever since. Behaviour analysts take a route that is different than most others in the social sciences — instead of learning a little about a lot of people in large groups, behaviour analysts learn a lot about a few individuals at a time. The latter is in line with the pragmatic goals of behaviour change. In the practice of ABA, every case is different because every individual is different — has a different history, family life, school situation, likes and dislikes, etc… Thus, every Behaviour Support Plan is customized to each individual’s unique life situation.

IV. ABA is composed of solely table work/sitting.
Discrete Trial Training (DTT) is certainly one approach used in ABA, but it is not the defining feature. For example, incidental teaching or “natural environment training” includes working with the individual as they go about their day. In these cases, behaviour analysts will provide prompts, reinforcers, activity schedules, modelling, etc… in the moment, when the skills are most needed. Each approach has its place.

V. ABA therapy is only for children with autism.
Applied Behaviour Analysis has documented applications across a wide spectrum of behaviour including Organizational Behaviour Management, environmental sustainability, and many others. Check out the Journal of Applied Behaviour Analysis, Journal of Organizational Behaviour Management, and Behaviour & Social Issues for more information.

VI. ABA therapy promotes robotic language/behaviour.
Behavioural rigidity is one of the characteristics of autism, and many mental disorders. ABA treatments seek to overcome rigidity by teaching multiple exemplars and teaching for generalization to the real-world situations relevant to the individual. In the beginning of a program, responses might seem overly simplified and therefore “robotic” but you need behaviour to work with, and those skills are eventually built up and transferred to naturalistic settings in a functional manner.

VII. Children must undergo 40-hours of ABA therapy a week to achieve a positive effect.
The length and intensity of any ABA program is dependent upon the individual and his/her baseline behavioural state. As mentioned above, the key feature of ABA is its focus on individuals, rather than groups. ABA is not a one-size-fits-all treatment.

VIII. ABA doesn’t “work” with older kids.
ABA now shows through research to yield significant skill gains with older children, as well as those who began as toddlers. While age at onset of treatment remains a powerful factor in the overall prognosis for a child with autism, this should not be sole reason to deny a child access to treatment.

IX. ABA programs institute punishment in their teaching procedures.
In the early days of ABA, punishment was used more often but today positive reinforcement is the overwhelmingly dominant mode of behaviour change.

X. ABA uses bribes consisting of food and toys to manipulate children’s behaviour.
There is a difference between bribes and reinforcers. Reinforcers occur after a behaviour and are specifically geared to increase a particular type of behaviour. Bribes, on the other hand, are made before the person engages in behaviour and are often times directed at the person rather than his/her behaviour. Moreover, bribes connote immoral or illegal behaviour. Regarding reinforcers, food is a particularly useful reinforcer at the beginning of an ABA program, especially if the individual is a child and/or has little to no language skills. However, pairing the food with other things, such as social praise, allows those things to become reinforcers themselves and gives you more to work with.

To read more about these myths, visit the National Autism Network (login required).

Augmentative & Alternative Communication (AAC)

Examples include:

• Sign Language
• Iconic Exchange (e.g., PECS)
• Electronic Devices (e.g., Dynovox, iPad)

Research suggests that AAC may improve communication skills for children with limited or no verbal communication skills when ABA teaching methods are used. However, AAC may only advance communication development to a certain extent. Individuals may use AAC for basic requesting and commenting, however the development of social language is still difficult. Case reports exist of individuals benefitting from electronic voice output devices, but no scientific studies have been conducted.

Social Stories (Carol Gray)

Stories are written according to specific guidelines to describe a situation in terms of relevant cues & common responses. Focus is on positive behaviour alternatives to challenging situations, instead of emphasizing the problem behaviour. Preliminary evidence suggests that it may be effective in reducing problem behaviour or improving adaptive behaviour, particularly when used in conjunction with ABA teaching methods.

Medication

Many medications are used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics.

A person with ASD may respond atypically to medications, the medications can have adverse effects, and no known medication relieves autism's core symptoms of social and communication impairments.

Diets

Gluten-free, casein-free diet
Atypical eating behaviour occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur; this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual; studies report conflicting results, and the relationship between GI problems and ASD is unclear.

In the early 1990s, it was hypothesized that autism can be caused or aggravated by opioid peptides like casomorphine that are metabolic products of gluten and casein. Based on this hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills. Studies supporting these claims have had significant flaws, so these data are inadequate to guide treatment recommendations.

Other elimination diets have also been proposed, targeting salicylates, food dyes, yeast, and simple sugars. No scientific evidence has established the efficacy of such diets in treating autism in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition. For example, a 2008 study found that autistic boys on casein-free diets have significantly thinner bones.

Alternative therapies

Many alternative therapies and interventions are available, ranging from elimination diets to chelation therapy. However the treatment approaches lack empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.

The Floortime/DIR (Developmental, Individual Differences based, Relationship based) approach is a developmental intervention to autism developed by Stanley Greenspan and Serena Weider. Its core precept is to understand the child's sensory differences, follow the child's lead and use these to encourage children with ASD to climb up the developmental ladder. This approach is based on the idea that the core deficits in autism are individual differences in the sensory system, motor planning problems, difficulties in communication and relation to others, and the inability to connect ones desire to intentional action and communication. When addressed through a combination of sensory support and DIR/Floortime techniques, the facilitator is playfully obstructive to redirect the child to play and relate to their therapist. Exponents of the floortime approach claim that children can thus become more social, less repetitive and also develop symbolic abilities. However, these claims should be regarded with some scepticism, owing to a lack of independent scientific research into the efficacy of the floortime approach.

Animal-assisted therapy, where an animal such as a dog, a dolphin or a horse becomes a basic part of a person's treatment, is a controversial treatment for some symptoms. A 2007 meta-analysis found that animal-assisted therapy is associated with a moderate improvement in autism spectrum symptoms. Reviews of published dolphin-assisted therapy (DAT) studies have found important methodological flaws and have concluded that there is no compelling scientific evidence that DAT is a legitimate therapy or that it affords any more than fleeting improvements in mood.