- Behavioural Health & Autism
- What is a Clinical Psychologist
- What is the difference between Psychology and Psychiatry?
- What is Applied Behavioural Analysis (ABA)?
- Who delivers Applied Behavioural Analysis(ABA)?
- What questions should I ask the Behaviour Analyst?
- What is an ABA/Home Tutor?
- What questions should I ask the ABA/Home Tutor?
Behavioural Health & Autism
Individuals living with Autism or Autism Spectrum Disorder experience many challenges that can make life very confusing at times. Unsurprisingly, many will struggle with social, emotional and behavioural difficulties.
While we know that Autism does not specifically cause behavioural difficulties; we do know that individuals with Autism are at greater risk of developing behaviours that may interfere with learning, and/or disrupt their daily routines. Sometimes, these behaviours may include actions that may cause physical harm to the individual and/or those around them.
This might include behaviours such as throwing or banging on items, arguing, running off in the community, hitting out at others, or hitting themselves. We also know that there are much higher rates of many mental health conditions among those with Autism.
When behaviours or emotional distress are impacting daily living, it is important to seek help from a behavioural health specialist who can help you understand why the behaviours or distress are occurring, and what can be done to minimize the behaviour.
Behavioural health specialists may be a Psychologist, Psychiatrist, or Behaviour Analyst. Each may use a different approach for different behavioural issues, but ultimately, they all share the same goal – which is to do everything they can to promote the mental wellness and improve daily functioning in those living with Autism.
The following information is designed to help answer some of the most common questions related to behavioural health in the context of Autism.
It’s always a good idea to reach out to your health professional for more information and relevant resources in your area.
What is a Clinical Psychologist
Clinical Psychologists provide a variety of services including assessment, therapy, and consultancy services. They work primarily, but not exclusively in child and/or adult and learning disability services where emotional, behavioural, psychiatric or developmental difficulties are addressed.
While the Clinical Psychologist has a crucial role to play in diagnosis, you may also seek a referral for your child if you have any concerns about your child’s behaviour, or emotional well-being.
The Clinical Psychologist may work directly with your child, or advise you on strategies supports. Clinical Psychologists may also deliver relevant trainings to groups of parents with slimier concerns.
Clinical Psychologists can be trained to provide a variety of therapeutic interventions:
- Direct individual therapy
- Family therapy
- Parenting programmes
- Behaviour Management
- Cognitive Behaviour Therapy
You can find a qualified Clinical Psychologist in your region by visiting the PSI Chartered Psychologist Online Directory at https://www.psychologicalsociety.ie/about/PSI-Chartered-Psychologist-Online-Directory.
What is the Difference Between Psychology and Psychiatry?
Some families are understandably confused about the difference between psychiatry and psychology. While they may often work together, the biggest distinction between the two mental health professions is the focus of treatment.
Because psychiatrists have received medical training, they can prescribe medications, and may spend much of their time with patients on medication management.
Psychologists cannot prescribe medication and focus on psychotherapeutic techniques and behavioural interventions in treating emotional, behavioural, and mental health conditions.
Psychiatrists can be hard to source outside of the public system, but you may find additional information on the College of Psychiatrists in Ireland website at https://www.irishpsychiatry.ie/
Psychologists and Psychiatrist often work together in various Multi Disciplinary Teams. The biggest distinction between the two mental health professions is the nature of treatment. Because psychiatrists are trained medical doctors, they can prescribe medications, and they spend much of their time with patients on medication management as a course of treatment.
Psychologists focus extensively on psychotherapy and treating emotional and mental suffering in patients with behavioural intervention. Psychologists are also qualified to conduct psychological testing, which is critical in assessing a person’s mental state and determining the most effective course of treatment.
What is Applied Behvioural Analysis (ABA)?
Behaviour analysis is the natural science of studying behaviour. Although it is perhaps most widely recognised for its effectiveness as an intervention for many behaviours associated with autism, the principles and methods of behaviour are universal and have been applied effectively in many areas. For example, ABA is also frequently used to design weight loss and smoking cessation programmes, and increase productivity in the workforce, and has many other applications.
Since the early 1960’s, hundreds of behaviour analysts have used positive reinforcement and other principles to build communication, play, social, academic, self-care, work, and community living skills and to reduce problem behaviours in learners with autism of all ages. Some ABA techniques involve instruction that is directed by adults in a highly structured fashion, while others make use of the learner’s natural interests and follow his or her initiations. Still others teach skills in the context of ongoing activities. All skills are broken down into small steps or components, and learners are provided many repeated opportunities to learn and practice skills in a variety of settings, with abundant positive reinforcement.
The goals of intervention as well as the specific types of instructions and reinforcers used are developed base on the strengths and needs of the individual learner. Performance is measured continuously by direct observation, and intervention is modified if the data show that the learner is not making satisfactory progress.
Regardless of the age of the learner with Autism, the goal of ABA intervention is to enable him or her to function as independently and successfully as possible in a variety of environments.
Who delivers Applied Behavioural Analysis (ABA)?
Individuals who deliver ABA have completed coursework and specialised training in the area, and are credentialed by the Behaviour Analyst Certification Board. The Board recognises various levels of training, but advises that programmes should be developed or supervised by a fully qualified Board Certified Behaviour Analyst (BCBA or BCBA-D). Others that may be involved in the delivery of these services include the Board Certified Associate Behaviour Analyst (BCaBA), and Registered Behaviour Technician (RBT). You can check the status of anyone’s certification, or search for a qualified provider in your region by visiting The Behavior Analyst Certification Board at www.bacb.com.
What Questions Should I ask Behaviour Analyst?
When looking for a Behaviour Analyst for your child you may want to consider the following information and advice:
- What autism-specific training or additional credentials do they have?
- What is their experience working with multi-disciplinary teams, and/or integrating recommendations from other fields and disciplines (OT, SLT) into intervention plans?
- What is their experience in supporting children with characteristics similar to your child? While the principles of ABA are applicable to all persons, ages, etc., it could look very different depending on the age or ability level, so it is important to know that the professional has had similar experiences and relevant skills.
- Will the BCBA be working directly with your child, or training and advising others on how to work with your child? If training and supervising others, how often will they be providing input and in what ways (e.g. direct observation, phone, emails).
- How will the BCBA develop programs for the child and what assessment tools might they use? One of the most common assessment tools is the Verbal Behaviour Milestones Assessment and Placement Program (VBMAPP). While this is a widely respected and very useful tool, others may be more appropriate depending on your child’s needs. It would be good to know that the BCBA has experience with a range of assessment tools.
- Are parents allowed to observe and participate? Or how will the BCBA support the family in using the techniques so that you have some tools with which to continue to work with the child at home
- What is the cost?
- Unfortunately, you are not able to claim any of the cost back though your Private Health Insurance or from med 1 unless the BCBA holds another qualification that would enable you to do so (e.g. SLT or Psychology). This is typically not the case.
What is an ABA/home tutor?
An ABA Tutor is one who works directly with the child, using the principles of Applied Behaviour Analysis, under the supervision of an ABA Supervisor and/or Consultant. They may work within a specific school setting where ABA is delivered, or they may work with the child in the home. The goals, curriculum, and teaching strategies will be specific to the child.
Sometimes families will have staff come into the home to work with their child several hours a week. This is probably most common in the early years, before the child enters school. However, the ABA tutor can work with individuals of any age.
If a child is diagnosed with autism, not yet of school age, and a specialised setting has been recommended but is not available, funding may be available through the home tuition grant. Funding may also be available if the child is of school age, if no educational placement is available. In very rare instances, perhaps where a child may demonstrate particularly challenging and high-risk behaviours, funding has come from the HSE. Alternatively, a parent may pay privately.
Home Tutors can be difficult to find, so here are some suggestions:
- Advertise in the Education Supplement of National Papers
- If there is an autism-related conference ask if you can advertise there, or go to the conference prepared with your details to pass around. Sympathetic organisers will sometimes put details up on the screen during the coffee/lunch breaks.
- Word of mouth – talk to other parents especially those who already have a Home Tutor
- Email lecturers or put adverts on the notice board in the Departments of Psychology in third level education centres/universities (with permission).
- Place your details and requirements on the Autism Ireland Forum
What questions should I ask the ABA/Home tutor?
When looking for a tutor for your child you may want to consider the following information and advice:
- Do they fulfil the criteria on the Application for Home Tuition?
- What experience do they have of dealing with children with autism and how varied is that experience? A tutor who has worked in a special school implementing the principles of ABA will have experienced the wide variance of behaviours and abilities on the autistic spectrum.
- Have they any further training? If your child is using PECS, you would want your tutor to have had the PECS training, similarly, if your child has very challenging behaviours you would look for a tutor who has done a Manual Handling Course.
- If you have other therapists coming to the home will the tutor work with them on programs for SLT/OT?
- Will the tutor take the child out of the home environment in order to generalise skills/learn life skills?
- Will the tutor be happy to implement intimate programs such as dressing and toileting?
- What equipment/supplies does the tutor expect you to provide? If materials such as visual schedules and choice boards are used, who will supply materials and create.
- If your child is offered a placement, will the tutor be available to support the transition.
- Will the tutor guide you to continue with programs – especially self management and self help skills – when they are not there?
You will also want to do your due diligence and check the following when vetting a potential home tutor:
- Request Garda clearance. If they are already registered with the teaching clearance, garda vetting has been checked.
- What happens when they are sick/unable to come for a prolonged time period.
- What holidays are they planning on taking and will they leave programs for you to continue with your child to bridge the gap.
- Do they have insurance?
- Be specific about the hours/days/times you agree on.
- Be specific about method and time of payment.
If you’d like more information on any of the topics above, please Contact us.