Positive Reinforcement vs. Negative Reinforcement

In general, I think there are a lot of misconceptions about what negative reinforcement is. Before I started studying behavior, I just figured negative reinforcement was giving negative consequences when a child did something inappropriate. Well, I was wrong.

I'm just going to go over some definitions to clear things up a bit, and then I'll post another day about examples of different types of reinforcement.

What is reinforcement? Something is being reinforced when the behavior increases. For example if we want a child to put away his backpack every day after school, we want to reinforce that behavior so that the probability of it happening will increase.

So the result of reinforcement is the same (an increase or maintenance in behavior) whether it's positive or negative. Let's look at what positive and negative are referring to.

Positive (+) = adding something
Negative (-) = taking something away

Positive Reinforcement = adding something to increase or maintain the rate of the behavior
Negative Reinforcement = taking something away to increase or maintain the rate of the behavior

Example: A child is asked to finish his dinner. The positive reinforcement is that he can go play as soon as he's done (being able to play is added). The negative reinforcement is that the parent nagging the child to finish eating will stop (the nagging is taken away).

Sometimes it can be difficult to discriminate between these two types of reinforcement, and in some cases it may not really matter, but overall I feel like it's important to have a brief idea of the differences when having discussions about behavior, or reading literature about it. Hope this is helpful.

In general, I think there are a lot of misconceptions about what negative reinforcement is. Before I started studying behavior, I just figured negative reinforcement was giving negative consequences when a child did something inappropriate. Well, I was wrong.

I'm just going to go over some definitions to clear things up a bit, and then I'll post another day about examples of different types of reinforcement.

What is reinforcement? Something is being reinforced when the behavior increases. For example if we want a child to put away his backpack every day after school, we want to reinforce that behavior so that the probability of it happening will increase.

So the result of reinforcement is the same (an increase or maintenance in behavior) whether it's positive or negative. Let's look at what positive and negative are referring to.

Positive (+) = adding something
Negative (-) = taking something away

Positive Reinforcement = adding something to increase or maintain the rate of the behavior
Negative Reinforcement = taking something away to increase or maintain the rate of the behavior

Example: A child is asked to finish his dinner. The positive reinforcement is that he can go play as soon as he's done (being able to play is added). The negative reinforcement is that the parent nagging the child to finish eating will stop (the nagging is taken away).

Sometimes it can be difficult to discriminate between these two types of reinforcement, and in some cases it may not really matter, but overall I feel like it's important to have a brief idea of the differences when having discussions about behavior, or reading literature about it. Hope this is helpful.

Behavior and Positive Reinforcement

In my last post I talked about the ABCs of Behavior, which is a great way to collect data on behaviors that may be a concern.  But, what do you do with that data?  First, you look for patterns.

Let's say that the pattern you found was in the 'CONSEQUENCES' column.  Every time that Sara screamed, she would receive attention.  One thing to remember is that attention is attention whether it's positive or negative attention.

Now comes the tricky part, changing the behavior.  I think that an important part of this is first recognizing what you (the adult) needs to change in your own behavior before attempting to change the child's behavior.

When it comes to 'attention', how we react to behaviors becomes very important.  We may need to change how we react to certain situations, and we may need to give more attention whenever we see positive behaviors displayed by a child.  For every correction or negative comment that is given, a child should receive at least 4 positive comments/interactions.

Here are some ideas to help you as you make a plan (I'm sure there's many more ideas that many of you can come up with too)

• Increase your positive reinforcement during times when the child is acting appropriately (not just following a "tantrum", but throughout the day)
• Plan times to spend one on one to play, especially if you know that your child is seeking attention.
• When a child is having a "tantrum" compliment the other kids who are acting appropriately, and be specific about what you like that they are doing.  Then when the child having a hard time does any of those things, immediately compliment him/her, reinforcing the behaviors you do like.  If there are no other kids around, it's fine to compliment the stuffed bear sitting in the chair for sitting quietly.
• Teach a replacement behavior.  What do you want the child to do instead of screaming?  Help walk them through the steps, then give positive reinforcement (or natural consequences of giving them what they want, if appropriate) when they use the replacement behavior.
• Ignore the inappropriate behavior (if it's safe), but follow up with positive reinforcement the second they are doing anything appropriate.  If they are screaming, compliment them the second they stop.  Be specific in your compliments though.  Instead of "good job" say "I like how you have a quiet voice and are using your words to tell me what you want."

Something to remember is that there is something called an extinction burst which means that often times the behavior will get worst before it gets better.  Sometimes the limits have to be tried before the child realizes it's not working.  So don't give up, these things take time.  Consistency is the key, and some of the most important times are not when the child is in the middle of the crisis cycle, but when they are calm and happy.  Positive reinforcement can be pretty powerful.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention for Children with Autism

photo credit: Sebastian Anthony via photopin cc

In my last post I talked about the ABCs of Behavior, which is a great way to collect data on behaviors that may be a concern.  But, what do you do with that data?  First, you look for patterns.

Let's say that the pattern you found was in the 'CONSEQUENCES' column.  Every time that Sara screamed, she would receive attention.  One thing to remember is that attention is attention whether it's positive or negative attention.

Now comes the tricky part, changing the behavior.  I think that an important part of this is first recognizing what you (the adult) needs to change in your own behavior before attempting to change the child's behavior.

When it comes to 'attention', how we react to behaviors becomes very important.  We may need to change how we react to certain situations, and we may need to give more attention whenever we see positive behaviors displayed by a child.  For every correction or negative comment that is given, a child should receive at least 4 positive comments/interactions.

Here are some ideas to help you as you make a plan (I'm sure there's many more ideas that many of you can come up with too)

• Increase your positive reinforcement during times when the child is acting appropriately (not just following a "tantrum", but throughout the day)
• Plan times to spend one on one to play, especially if you know that your child is seeking attention.
• When a child is having a "tantrum" compliment the other kids who are acting appropriately, and be specific about what you like that they are doing.  Then when the child having a hard time does any of those things, immediately compliment him/her, reinforcing the behaviors you do like.  If there are no other kids around, it's fine to compliment the stuffed bear sitting in the chair for sitting quietly.
• Teach a replacement behavior.  What do you want the child to do instead of screaming?  Help walk them through the steps, then give positive reinforcement (or natural consequences of giving them what they want, if appropriate) when they use the replacement behavior.
• Ignore the inappropriate behavior (if it's safe), but follow up with positive reinforcement the second they are doing anything appropriate.  If they are screaming, compliment them the second they stop.  Be specific in your compliments though.  Instead of "good job" say "I like how you have a quiet voice and are using your words to tell me what you want."

Something to remember is that there is something called an extinction burst which means that often times the behavior will get worst before it gets better.  Sometimes the limits have to be tried before the child realizes it's not working.  So don't give up, these things take time.  Consistency is the key, and some of the most important times are not when the child is in the middle of the crisis cycle, but when they are calm and happy.  Positive reinforcement can be pretty powerful.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention for Children with Autism

photo credit: Sebastian Anthony via photopin cc

ABC's of Behavior

I first learned about the ABC's of Behavior when I was a teenager working at a group home for people with developmental disabilities.  The women I worked with had varying ability levels, and a few of them had tendencies towards aggression.  Some days it was very obvious why they were upset, but other times it could be a puzzle.

These ABC's have come to be very important throughout my career of working in various environments, whether I was working in group homes, summer camps, schools, care centers, workshops, or homes.

So, what are the ABC's of Behavior?

A=Antecedent
B=Behavior
C=Consequence

Another important thing to consider are Setting Events, which I wrote about in another post.

If you understand these ABC's, you may be able to gain valuable information that may help reduce some behavioral outbursts.

Antecedent:  What happened right before the behavior.
Behavior:  What did the behavior look like, this should be specific rather than general.  Instead of saying "she had a tantrum", you should describe it "she screamed for 5 minutes."
Consequence: What happened right after the behavior.  This is not necessarily referring to how the child was disciplined.  It is whatever happened directly following the behavior (i.e., peers in the class laughed, the teacher stopped and asked the student to stop, the student was escorted out of the class, etc.)

Using this ABC form can help you start to recognize patterns in an individual's behaviors.  If you are looking to reduce the frequency of a behavior, you will want to be specific on which behavior you are tracking, and be as specific as possible when filling out the form so you have lots of information.

You will want to track the behavior at least 1-2 weeks, and you should take data every time that behavior occurs.  You can track multiple behaviors at a time, but to begin, I would suggest tracking the behavior that is of greatest concern.

Once you have some data, and have some ideas of why the behavior you are tracking is occurring, you can start making a plan.  Check out my next post, as I will discuss some ideas to help you with this.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services For Children With Autism

I first learned about the ABC's of Behavior when I was a teenager working at a group home for people with developmental disabilities.  The women I worked with had varying ability levels, and a few of them had tendencies towards aggression.  Some days it was very obvious why they were upset, but other times it could be a puzzle.

These ABC's have come to be very important throughout my career of working in various environments, whether I was working in group homes, summer camps, schools, care centers, workshops, or homes.

So, what are the ABC's of Behavior?

A=Antecedent
B=Behavior
C=Consequence

Another important thing to consider are Setting Events, which I wrote about in another post.

If you understand these ABC's, you may be able to gain valuable information that may help reduce some behavioral outbursts.

Antecedent:  What happened right before the behavior.
Behavior:  What did the behavior look like, this should be specific rather than general.  Instead of saying "she had a tantrum", you should describe it "she screamed for 5 minutes."
Consequence: What happened right after the behavior.  This is not necessarily referring to how the child was disciplined.  It is whatever happened directly following the behavior (i.e., peers in the class laughed, the teacher stopped and asked the student to stop, the student was escorted out of the class, etc.)

Using this ABC form can help you start to recognize patterns in an individual's behaviors.  If you are looking to reduce the frequency of a behavior, you will want to be specific on which behavior you are tracking, and be as specific as possible when filling out the form so you have lots of information.

You will want to track the behavior at least 1-2 weeks, and you should take data every time that behavior occurs.  You can track multiple behaviors at a time, but to begin, I would suggest tracking the behavior that is of greatest concern.

Once you have some data, and have some ideas of why the behavior you are tracking is occurring, you can start making a plan.  Check out my next post, as I will discuss some ideas to help you with this.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services For Children With Autism

Autism and Difficult Behaviors

Why do we behave the way we behave?  I don't know if you're like me, but there are occasions when I can't figure out why I'm doing what I'm doing.  And yet, we're supposed to somehow figure out why our kiddos are doing what they're doing.  This doesn't only apply to kids with autism, but to most kids.  However, autism throws in a whole other dimension, and sometimes makes it more difficult to figure out the reasons why.  Because what makes sense to them doesn't always make sense to us.

I will teach you what I've learned through my education, and then we'll go through a couple scenarios to test it out.

First off, when we say "misbehave" or "difficult behaviors," I just want to point out that it's all relative.  What is "misbehaving" to you may not be "misbehaving" to me and vice versa, we all have our own definitions of what a "tantrum" is.  This is one reason why it's important to define what the behavior looks like.  Instead of saying "he was having a tantrum" we would say "he hit his head against the wall and started pulling his hair out."  That definitely gives us more information, and it is objective.

Generally there are 4 reasons why people display "difficult behaviors"

• To get something
• Something tangible
• Their way
• Attention
• Adult attention
• Peer attention
• Escape
• Activity
• Task
• Sensory Stimulation
• Self-reinforcing

First Example: Refusing to eat

I shared this example in another post about Setting Events.

The antecedent (what happened right before the behavior):  He was given his breakfast

The behavior (what did it look like): He refused to eat

The consequence (what happened right after the behavior):  He was continually asked to eat by the staff (attention)

So what was the reason:

A) He wanted something else to eat

B) He wanted attention

C) He didn't want to eat, he wasn't hungry

D) He wanted his belt

If you didn't read my other post, then you might think I was just pulling something out of my hat with D, but in actuality the answer was D.  This is why Setting Events are important to consider.  He did want something, but it wasn't a different meal like my staff thought.

Why is it important for us to know the reasons why someone is acting the way they're acting?  Mainly because it is our way of helping that person.  We want to help prevent them from going through the stress of having these behaviors, we want to help teach them how to respond or request more appropriately, and we want to help them to learn how to cope and get out of those behaviors without harm.

So how did we learn from this experience?  We made sure Simon had multiple belts in his closet, and made sure he had one on before he went to breakfast.  Because Simon was nonverbal, it was hard to know what he wanted because he couldn't express it.  When eating is a health issue, you'll do everything you can do to get them to eat, you don't want a silly belt being the cause of his decline in health.  

Some moments you'll want to be careful of what you're reinforcing.  In this instance, I wasn't concerned about reinforcing his behavior of not eating by giving him a belt, it was our fault that it wasn't in his closet.  Plus, I would have given him 5 belts if it meant he would eat.  His health was getting that bad.

Second Example: The grocery store

How many times have you gone to the grocery store and either your child or someone else's child had a meltdown on aisle 5?  Each child is different, and you may see similar behaviors but for different reasons each time you go to the store.  I made a list of many reasons why a child may have a difficult time at the grocery store.  Here are just a few

• To get something
• Here you are in a room full of everything anyone could ever want.  Self control is difficult for some of us, and if you don't have a concept of money, it's even more difficult :)
• Attention
• How can you not get attention when you're screaming in a room full of strangers?  The key would be teaching how to get positive attention rather than negative attention.  Which is not as easy one may think.
• Escape
• I sympathize with the kiddos that hate shopping.  I hate it too, and I often times want to escape. 
• Sensory
• As you will see in my past post.  The grocery store is full of sensory overload.

You may be thinking that this post is not all that helpful because I didn't address what to do once you know why someone is doing what they're doing, but that would make this already long post way too long.  I will post more in the future about behaviors, but for now you can check out a few of my past posts about behavior.

Like most things, the key is that recognition is the first step.

The Holidays

Grocery Shopping Intervention

Setting Events- The belt story

The Crisis Cycle

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children With Autism

photo credit: alist via photopin cc

Why do we behave the way we behave?  I don't know if you're like me, but there are occasions when I can't figure out why I'm doing what I'm doing.  And yet, we're supposed to somehow figure out why our kiddos are doing what they're doing.  This doesn't only apply to kids with autism, but to most kids.  However, autism throws in a whole other dimension, and sometimes makes it more difficult to figure out the reasons why.  Because what makes sense to them doesn't always make sense to us.

I will teach you what I've learned through my education, and then we'll go through a couple scenarios to test it out.

First off, when we say "misbehave" or "difficult behaviors," I just want to point out that it's all relative.  What is "misbehaving" to you may not be "misbehaving" to me and vice versa, we all have our own definitions of what a "tantrum" is.  This is one reason why it's important to define what the behavior looks like.  Instead of saying "he was having a tantrum" we would say "he hit his head against the wall and started pulling his hair out."  That definitely gives us more information, and it is objective.

Generally there are 4 reasons why people display "difficult behaviors"

• To get something
• Something tangible
• Their way
• Attention
• Adult attention
• Peer attention
• Escape
• Activity
• Task
• Sensory Stimulation
• Self-reinforcing

First Example: Refusing to eat

I shared this example in another post about Setting Events.

The antecedent (what happened right before the behavior):  He was given his breakfast

The behavior (what did it look like): He refused to eat

The consequence (what happened right after the behavior):  He was continually asked to eat by the staff (attention)

So what was the reason:

A) He wanted something else to eat

B) He wanted attention

C) He didn't want to eat, he wasn't hungry

D) He wanted his belt

If you didn't read my other post, then you might think I was just pulling something out of my hat with D, but in actuality the answer was D.  This is why Setting Events are important to consider.  He did want something, but it wasn't a different meal like my staff thought.

Why is it important for us to know the reasons why someone is acting the way they're acting?  Mainly because it is our way of helping that person.  We want to help prevent them from going through the stress of having these behaviors, we want to help teach them how to respond or request more appropriately, and we want to help them to learn how to cope and get out of those behaviors without harm.

So how did we learn from this experience?  We made sure Simon had multiple belts in his closet, and made sure he had one on before he went to breakfast.  Because Simon was nonverbal, it was hard to know what he wanted because he couldn't express it.  When eating is a health issue, you'll do everything you can do to get them to eat, you don't want a silly belt being the cause of his decline in health.  

Some moments you'll want to be careful of what you're reinforcing.  In this instance, I wasn't concerned about reinforcing his behavior of not eating by giving him a belt, it was our fault that it wasn't in his closet.  Plus, I would have given him 5 belts if it meant he would eat.  His health was getting that bad.

Second Example: The grocery store

How many times have you gone to the grocery store and either your child or someone else's child had a meltdown on aisle 5?  Each child is different, and you may see similar behaviors but for different reasons each time you go to the store.  I made a list of many reasons why a child may have a difficult time at the grocery store.  Here are just a few

• To get something
• Here you are in a room full of everything anyone could ever want.  Self control is difficult for some of us, and if you don't have a concept of money, it's even more difficult :)
• Attention
• How can you not get attention when you're screaming in a room full of strangers?  The key would be teaching how to get positive attention rather than negative attention.  Which is not as easy one may think.
• Escape
• I sympathize with the kiddos that hate shopping.  I hate it too, and I often times want to escape. 
• Sensory
• As you will see in my past post.  The grocery store is full of sensory overload.

You may be thinking that this post is not all that helpful because I didn't address what to do once you know why someone is doing what they're doing, but that would make this already long post way too long.  I will post more in the future about behaviors, but for now you can check out a few of my past posts about behavior.

Like most things, the key is that recognition is the first step.

The Holidays

Grocery Shopping Intervention

Setting Events- The belt story

The Crisis Cycle

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children With Autism

photo credit: alist via photopin cc

Setting Events - Figuring out Difficult Behaviors

photo credit: blmurch via photopin cc

When I was the Program Director at a Care Center for people with disabilities, I worked a lot with managing difficult behaviors.  I was usually called in to work with someone after the staff had already been working with that person for a while, and they needed help.

Sometimes figuring out why someone is doing something is difficult, especially if that person does not talk.  Their behavior is how they communicate, and our responsibility is to figure out how to interpret their behavior.

You may be familiar with the Antecedent-Behavior-Consequence form that is used a lot when parents/professionals are faced with difficult behaviors.  If not, I will definitely blog about it another time.  With that form, you look at what happened right before the behavior, what the behavior looked like, and what happened immediately following the behavior.  This is a good way to start noticing patterns, and how to help an individual.

One thing that sometimes is missing is the Setting Events.  These are things that may have happened previous to the antecedent, and could be anything from medication changes to going to bed late or even having a bad dream.  We've all had it happen to us, where our day is thrown off because of something that may have happened the night before, or maybe we got a phone call that made us upset, but we don't erupt until hours later when everything appears to be unrelated.  Those are Setting Events.

Here is an example of why understanding Setting Events can be important.  There was one day that one of the residents (I'll call him Simon) was refusing to eat.  The staff did everything they could think of to get him to eat, but he would not eat.  The dining hall was almost empty, and Simon had not even started eating.  This was a concern because of health issues, so it was important that Simon ate his breakfast.  It wasn't uncommon for Simon to refuse to eat, but generally the staff could get him to eat without involving me. For some reason today was different.

I'm not totally sure everything that the staff tried before they asked me to come assist, but I know they had been trying for probably about an hour.  

When they came to me to ask for help, I immediately asked them if Simon had a belt on.  Now, to an outsider, that probably seems like a very odd question to ask in this situation.  What does a belt have to do with eating breakfast?  The staff said that he did not have a belt on, so I asked them to get him his belt and if he is still refusing to eat then I would come in and help.  I'm sure that they thought I was crazy, but a few minutes later the staff reported that Simon was eating.

So what does a belt have to do with eating breakfast and how did I know that that was the reason why Simon wasn't eating before I even went to check on him?  I had worked with Simon for a couple years, and I knew that he had a very rigid routine that he would follow every day.  If that routine was interrupted, he wouldn't complain, but he would start over.  Simon usually moved at a very slow pace which was opposite the pace that the staff was working at, and oftentimes Simon would be rushed.  Usually rushing Simon had the opposite effect because he would have to start over, so in essence he took even longer.  I had noticed a few days/weeks prior to this incident that Simon had become very attached to his belts, and he always had to be wearing a belt.  If he did not have a belt, then his day would be ruined.  

So one of the Setting Events was that Simon was rushed and he did not have a belt on.  The Antecedent was that he was given breakfast, the Behavior was that he was refusing to eat, and the Consequence was that the staff did everything they could do to try to convince him to eat.  You can see why Setting Events can be important, and why being aware of routines, environment, etc., can be key to your observations.  Without the setting events, our conclusion could have been he was avoiding eating, maybe it was a sensory thing with the food, or maybe he wanted something else.  It could have been that he was doing it for attention.  Those would have been good guesses, but they were wrong that particular day.  

Sometimes it's the obvious, but when what you're doing isn't working, it might be something less obvious.  This is also a reason why communication is important between parents and teachers.  I was always so grateful when parents would call me (when I was teaching) to let me know that something happened at home, or the child missed breakfast, or that they changed medications.  That information can be very useful when you are trying to decipher why there may be a change in behavior, or why what you used to do doesn't work any more.

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Intervention Treatment for Children With Autism

photo credit: blmurch via photopin cc

When I was the Program Director at a Care Center for people with disabilities, I worked a lot with managing difficult behaviors.  I was usually called in to work with someone after the staff had already been working with that person for a while, and they needed help.

Sometimes figuring out why someone is doing something is difficult, especially if that person does not talk.  Their behavior is how they communicate, and our responsibility is to figure out how to interpret their behavior.

You may be familiar with the Antecedent-Behavior-Consequence form that is used a lot when parents/professionals are faced with difficult behaviors.  If not, I will definitely blog about it another time.  With that form, you look at what happened right before the behavior, what the behavior looked like, and what happened immediately following the behavior.  This is a good way to start noticing patterns, and how to help an individual.

One thing that sometimes is missing is the Setting Events.  These are things that may have happened previous to the antecedent, and could be anything from medication changes to going to bed late or even having a bad dream.  We've all had it happen to us, where our day is thrown off because of something that may have happened the night before, or maybe we got a phone call that made us upset, but we don't erupt until hours later when everything appears to be unrelated.  Those are Setting Events.

Here is an example of why understanding Setting Events can be important.  There was one day that one of the residents (I'll call him Simon) was refusing to eat.  The staff did everything they could think of to get him to eat, but he would not eat.  The dining hall was almost empty, and Simon had not even started eating.  This was a concern because of health issues, so it was important that Simon ate his breakfast.  It wasn't uncommon for Simon to refuse to eat, but generally the staff could get him to eat without involving me. For some reason today was different.

I'm not totally sure everything that the staff tried before they asked me to come assist, but I know they had been trying for probably about an hour.  

When they came to me to ask for help, I immediately asked them if Simon had a belt on.  Now, to an outsider, that probably seems like a very odd question to ask in this situation.  What does a belt have to do with eating breakfast?  The staff said that he did not have a belt on, so I asked them to get him his belt and if he is still refusing to eat then I would come in and help.  I'm sure that they thought I was crazy, but a few minutes later the staff reported that Simon was eating.

So what does a belt have to do with eating breakfast and how did I know that that was the reason why Simon wasn't eating before I even went to check on him?  I had worked with Simon for a couple years, and I knew that he had a very rigid routine that he would follow every day.  If that routine was interrupted, he wouldn't complain, but he would start over.  Simon usually moved at a very slow pace which was opposite the pace that the staff was working at, and oftentimes Simon would be rushed.  Usually rushing Simon had the opposite effect because he would have to start over, so in essence he took even longer.  I had noticed a few days/weeks prior to this incident that Simon had become very attached to his belts, and he always had to be wearing a belt.  If he did not have a belt, then his day would be ruined.  

So one of the Setting Events was that Simon was rushed and he did not have a belt on.  The Antecedent was that he was given breakfast, the Behavior was that he was refusing to eat, and the Consequence was that the staff did everything they could do to try to convince him to eat.  You can see why Setting Events can be important, and why being aware of routines, environment, etc., can be key to your observations.  Without the setting events, our conclusion could have been he was avoiding eating, maybe it was a sensory thing with the food, or maybe he wanted something else.  It could have been that he was doing it for attention.  Those would have been good guesses, but they were wrong that particular day.  

Sometimes it's the obvious, but when what you're doing isn't working, it might be something less obvious.  This is also a reason why communication is important between parents and teachers.  I was always so grateful when parents would call me (when I was teaching) to let me know that something happened at home, or the child missed breakfast, or that they changed medications.  That information can be very useful when you are trying to decipher why there may be a change in behavior, or why what you used to do doesn't work any more.

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Intervention Treatment for Children With Autism