Sleep Training Your Child

*Note this blog contains a topic of controversy amongst parents. This is my story and why we chose the sleep method we did. I am not saying that other methods are wrong, just my reasoning for my choice.  YOU have to do what's right for YOUR family.*

Okay so this picture is a little (or a lot) misleading, this blog isn't which is better it is why I use one over the other.  In my family we sleep trained (a.k.a. cry it out method) my daughter.  We did not start out like this.  When we brought her home from the hospital we knew we didn't want to co-sleep, the risk of rolling over on her, or her suffocating on our blankets (she was born in December) was a real fear. BUT, she did sleep in a co-sleeper right next to our bed.  I tirelessly woke up every hour on the hour, brought her in bed snuggled her, fed her, changed her...and the repeat EVERY HOUR. After a month or so this routine got a little old, especially since I was home with her all day and could barely function.  So then we moved her into her own room. She woke up every hour (maybe two if we were lucky) and would not go to sleep unless she was laying on my chest.  Most of the time when she woke up she wasn't wet or hungry, just wanted to be on my chest.  We tried sleep aids like the music bear, or the bear that has a heart beat. I was exhausted, and quite frankly so was she, Isabella napped like crazy during the day, because she wasn't getting any sleep at night.  It was two months in and I was desperate for a solution.  I was going to go back to work in a month and I could not imagine being awake for the majority of the night, just to go to work and work all day with my clients (I was an in-home ABA therapist for children with Autism), so I needed to be alert at work.  I was at my wits-end and didn't know what to do, until a friend of mine suggested the book Baby Wise...and it was a GOD SEND!

When I was reading Baby Wise I started to research the "cry it out method" as well as co-sleeping to see if the hype was true about how bad cry it out is for kids, and to also see what negative impact if any co-sleep had.  What I found through my research is that neither method caused negative emotional or mental impacts on children, even in follow-up studies six years out.  The researchers ran tests analysing: mental health, sleeping patterns, psychosocial functioning, relationship with parents, mother's mental health (depression, anxiety, and stress), parents' parenting styles, and levels of stress. Stress levels in children were determined by measuring cortisol levels in children's saliva.  The results of the study were: "At the five-year follow-up, 225 children and their families were included from the 326 that were eligible (69%). The key finding of this study was that there were no differences seen between children and their mothers who received a behavioural intervention compared with those who received usual care for any of the outcomes studied. This was found for both unadjusted and adjusted data." 

This means that all of the "bad things" that people say crying it out causes, are scientifically proven to not exists.  There was one study that did say that crying it out was detrimental, however when you look at the group of children, they were Russian orphans, who spent their entire lives in the cribs.  They were fed, changed, and slept in the cribs and were never cuddled or interacted with in any way...this is NOT the cry it out method...that is neglect...BIG difference.  Additionally, when I read up on co-sleeping and spoke with parents who chose to co-sleep, I found that a big complaint from almost all of them was that their children co-slept for WAY longer then the parents wanted.  I heard parents say that it was very difficult to transition their kids to their own rooms and often times slept with parents until five or six years old, if not longer.  This often resulted in the parents taking different beds and splitting the kids to make sleeping easier.  Now I know this is not everyone's scenario, but it did come up a lot more often then I would have expected.  So, my husband and i decided to go with the cry it out method and we loved it.

As the picture states, consistency is the key.  Just like my previous posts about functions of behavior and consequences, if you are trying to change a behavior you need to be consistent with the consequences.  So this is how we effectiely (and quickly) sleep trained our daughter with cry it out.

The first thing you need to do is determine a schedule for you and your child.  It doesn't need to be super stroked, but it does need to follow pretty closely every day.  Now when I say schedule I don't mean regiment every aspect of your day, I mean plan out when you will put your child down for naps, when ideally they will eat, and when they will go to sleep.  This will help you outline your day and stay consistent. Next you have to determine how much sleep your child needs (see the chart below).  Once you know how much time your child needs to sleep at night and during the day, you can figure out how long he should be awake before each nap.

I started sleep training when my daughter was two months old, so she was up for about three hours before each nap.  Upon waking up I would take my daughter out of the crib and bring her downstairs.  I then would prepare he breakfast and feed her.  After she finished her milk I would play and interact with her as much as possible, getting in all the cuddles, social interactions, and learning that I could. When we were at the three hour mark I would take her upstairs and put her in the crib and leave.  Here is where the consistency is VERY important.  She would obviously begin to cry (because playing with mommy is WAY more fun then going to bed, duh), but I would wait and see.  If she cried for 10 minutes I would wait for a second of quiet (usually when she was inhaling) and then go in and pick her up. I wouldn't be overly exuberant and active, I would just pick her up and spend a little more time with her, either downstairs or in her room (because obviously she wasn't tired yet).  I was still happy and friendly with her but just not as much engery, because I wanted to signal to her that it was time to relax.  After about five minutes of interaction I would put her back in the crib, and leave. I did this same routine before every nap, and I will tell you she only got to the 10 minute mark of crying twice, all the other times she stopped crying within a few minutes and would lay in bed quietly until she fell asleep, usually five or so minutes later.

I also started learning her cues other than crying.  According to baby wise, crying is a child's last resort at communication, children have dozens of subtle cues that we as parents need to learn and respond to.  For instance, if I heard her make noise in the crib (not cry, but just tussle) and I saw in the video monitor that she was sucking her hands, that was a sign she was hungry, so I would go in and take her out and start the entire routine over.  I learned to pay attention to signs such as rubbing eyes (when she got older), eyes staying closed a little longer during blinks etc, to refine my schedule so that I put her in the crib when she was tired, so that she would spend very little time awake in the crib.

At night, when she would wake and cry, I would look at the time.  If it had been a few hours and she could be hungry I would go in and feed her, if she did not feed I would just put her back in her crib (once I made sure she was dry as well) and leave; if she fed, then once she was done I would change her and put her back to bed. I remained quiet and calm during this time like I did before naps to signal to her that it was in fact time to sleep.  If she was crying and it was to early for her to feed, I would wait to see if she calmed down, if she did great, if she hit the 10 minute mark I would go in to her room, take her out of the crib, try to feed her and change her and then put her back in the crib.  By doing this you are helping your child associate certain stimuli (i.e., her crib, quiet voices, relaxed mannerisms, etc) with sleep, instead of associating your bed, the car seat, or nursing with sleep.

We did formal sleep training for about two weeks, after that she was sleeping almost entirely through the night, waking up only twice to feed.  Any other time that she woke up at night she was quiet, and just observed the night time light toys attached to her crib and fell back asleep.  After the first three days she wouldn't even cry when I put her in her crib for naps or bed, and fell asleep within minutes.  I was rested and happy, and she seemed to be happier as well, and I felt like I was able to interact with her more than before, because she was not spending the majority of her day asleep, trying to recoup from the sleepless night before.

Finally, I don't see any issues with my daughter today that I have heard listed as "horror stories" that happen with cry it out.  She is a happy, loving, cuddly, kind child who is still a great sleeper and goes to bed with ease.  I feel like she has a great connection with both my husband and myself, and her emotional and social interactions are on par to her peers that were not sleep trained.  Like I said, either way that you decide to raise your children, it's up to you.  Scientific evidence shows that there are no negative psychological effects to either method. I chose sleep training because it was what was best for my family, and I will sleep train my son when he is two month old as well.  I wanted to right this post to help clear up some of the misconceptions about sleep training and show that the parents that sleep train are not "uninformed monsters" but parents who made the best choice for their family, and that should be respected, not judged.

Source

Consequences

So far we have gone over the ABC's of behavior and the functions of behavior. Now it is time for us to focus on the "C" in the ABC's of behavior, today we are going to discuss consequences!  Now like we have talked about before, a consequence is any stimulus that immediately follows a behavior.  A consequence can be administered by another person or can occur naturally without being administered by another person.  It is important to note that in order for a consequence to be the most effective it MUST occur within 0-3 seconds of the particular behavior.  Consequences that occur after that time frame may still effect behavior but it will most likely not have as strong as an effect because there has been too much of a delay, or alternate behaviors may have occurred that are not being reinforced.  Now consequences can either increase or decrease the behavior they follow, depending on the type of consequence that are delivered.  There are two main categories of consequences: Reinforcement and punishment, and of those each has two subtypes: negative and positive.

When we think of positive and negative we need to go way back to elementary math class and think of addition and subtraction.  There is both positive and negative reinforcement, as well as positive and negative punishment.  The positive and negative are not denoting something good or bad happening, but rather if a stimulus is being added (positive) or removed (negative). Remember, we can not determine if a consequence is a reinforcer or a punishment, until we see how FUTURE behavior is effected. If the behavior increases then the consequence was a reinforcer, if it decreases then the consequence was a punisher.

• Positive reinforcement:  You add a preferred stimulus after a particular behavior and that behavior increases in the future under similar conditions.
• Negative reinforcement:  You remove an aversive stimulus after a particular behavior and that behavior increases in the future under similar conditions.

• Positive punishment: You add an aversive stimulus after a behavior and that behavior decreases in the future under similar situations.
• Negative punishment: You remove a desired stimulus after a behavior and that behavior decreases in the future under similar situations.

It is important to remember that the type of consequence that is provided must be appropriate the the function of the behavior, and a FUNCTIONALLY EQUIVALENT replacement behavior must also be taught.  Also, remember that we want to use punishment as a last resort, ethically we should exhaust all possible means of reinforcement BEFORE we move to a punishment technique.  Granted this is not always the case when we are parenting our own children, and we must use punishment with discretion. However, in the professional setting punishment is a LAST RESORT.  

Functions of Behavior

As the title states, today we are going to discuss the functions of behavior! We have learned the ABCs of behavior (if you have not read this post please do so here first).  The first thing to go over is what the heck are functions of behavior! In its simplest definition the function of a person's behavior is the reason the behavior is occurring.  It is important to note that function and topography of a behavior are different. Function is WHY the behavior happens and the topography is WHAT the behavior looks like.  It is important to note that you can have many behaviors that look COMPLETELY DIFFERENT but have the same function. Likewise you can have a behavior that LOOK THE SAME but serve different functions. When this happens we say a behavior has multiple functions.  An example of this is when a child tantrums for attention but eventually learns that when he tantrums he also gets a toy, so he may begin to tantrum to get toys and at other times he may tantrum for attention.  Once we know the function of the behavior we can utilize our knowledge of the ABCs to change the antecedents and the consequences of the behavior and teach more appropriate behaviors that serve the same function.  This is a very important point: THE NEW MORE APPROPRIATE BEHAVIOR MUST SERVE THE SAME FUNCTION AS THE BEHAVIOR YOU ARE TRYING TO CHANGE. If the new behavior does not have the same function, then the inappropriate behavior will not decrease.

So now lets go over the functions of behavior, there are four functions of behavior that are recognized in applied behavior analysis:

1) ACCESS TO ATTENTION: In this function the behavior occurs to help the person gain the attention of a preferred individual.  This is usually seen in nonvocal children and adults as this is their primary means of getting the attention of people they come into contact with.

   An example of this is when a mom is on the phone talking to a friend and her toddler approaches her.  At first the child pulls on moms pants and mom tells her to wait. After several minutes the child begins to whine, mom looks at her and says "shh" the child then begins to whine and cry louder (because the last time she whined mom stopped talking for a second). This continues until the child is crying uncontrollably and mom hangs up and tends to her crying child.

2) ACCESS TO A TANGIBLE:  In this function the behavior occurs as a means of getting the persons needs and wants met.  The individual wants something (toy, food, activity, etc) and when he is unable to attain it begins to tantrum until it is given to him.

     We have all seen an example of this at the supermarket. A child wants the ridiculously overpriced and sugary cereal and mom says "no". The child begins to plead and whine, and mom says "no" again. Eventually the whines get louder and the tears start flowing. After several minutes of a full blown tantrum and the mom enduring stares from judgmental fellow shoppers, she goes back and gets the cereal.

3) ESCAPE/AVOIDANCE: Here we see someone engage in inappropriate behaviors to avoid or escape a non preferred activity or item.

       This can been seen with any parent trying to get their child to take a bath.  Dad tells Johnny "okay it's time for a bath" Johnny begins to whine and dad says "okay you get one more minute". Here Johnny's whining served the function of avoidance since the bath (or the walk to it) had not begun.  After a minute dad says "okay the minute is up time for bath" and turns off the TV and begins to guide Johnny to the bathroom. Johnny first whines and then starts screaming, crying etc. Dad then says "fine, no bath tonight, lets read a bedtime story". So here Johnny's behavior served the function of escape because he did not have to take a bath.

4) SENSORY/AUTOMATIC: Here the behavior itself just feels good. The severity of this behavior can range from flicking your pen while you read a text for homework all the way to the hand flapping that is sometimes seen in individuals with autism.  Again, it is important to note that with automatic behaviors, the behavior itself just feels good.

Now in the attention, tangible, and escape/avoidance functions it is important to note that I used the same topography of the behavior (i.e., tantrum) however ANY behavior can have ANY of the above mentioned functions.  I just used a tantrum for simplicities sake, and its most likely something we have all witness, whether we have children or we don't.  So with that our discussion on the functions of behaviors is done, and next we will be discussing the consequences of behavior: Reinforcement and Punishment.

The ABCs of Behavior

For today's post we are going to review what is arguably the foundation of behavior analysis, the ABC contingency, otherwise known as the Antecedent, Behavior, Consequence contingency.  This contingency states that all behavior does not happen in a vacuum, separate from the environment in which it occurs.  So now lets break up this contingency into its core parts and review their importance for changing and maintaining behavior.

ANTECEDENT: The easiest way to think about an antecedent is the event that occurs immediately before the behavior occurs.  It is what sets the stage for the behavior that occurs, this is a key point in determining part of the function (or what the point of the behavior is).

BEHAVIOR: A behavior is really anything a living organism can do. This includes: eating, drinking, thinking, talking, dreaming, crying, etc. In school we were given the "dead body test" which is basically if a dead body can do it, then it's not behavior (so basically, laying still without breathing, blinking, thinking, etc.) everything else is a behavior.  Behaviors can be adaptive (good behaviors we want) or maladaptive (bad behaviors we want to change). Every behavior is elicited (or brought on) by an antecedent event.

CONSEQUENCE: A consequence is any stimulus that immediately follows a behavior.  A consequence can either increase the likelihood of a behavior happening in the future (reinforcement), or decrees the likelihood of a behavior happening in the future (punishment). The farther a consequence is removed from the behavior (the longer the time between the behavior happening and the consequence happening) the less likely it is that their will be meaningful behavior change.  In order for a consequence to be effective it should happen between 0-3 seconds after the behavior.

By understanding the basic ABCs of behavior we can begin to determine the function of the behavior, and once we understand the function of the behavior we can manipulate the consequences to either increase or maintain the behavior (if its a desired behavior) or decrease the behavior (if it's a negative behavior) and replace it with a more appropriate behavior.  It is important to remember that we need to ALWAYS replace a negative behavior with a FUNCTIONALLY EQUIVALENT appropriate behavior.  Next, I will go over the various functions of behavior so hopefully all of this will come together and make more sense!

The Life of an ABA Parent

So, by the title of this blog post you might be asking yourself "what is an ABA parent?" Well, I have an answer for you! An ABA parent is a parent who utilizes the principles of Applied Behavior Analysis as developed by B.F. Skinner to guide the way they teach and instruct their children as they grow.

Now that I have that explained what being an ABA parent is, let me explain how I became to be one, and why I am qualified to give parenting advice on this blog (you don't have to take it, but I am qualified). Now I first began my trip down the ABA rabbit hole when I was a Junior at college...yes a junior at college. I was attending UCLA (go Bruins!) as a Clinical Psychology major, and I was looking for some part time work in my field. I stumbled upon an advertisement for a behavioral therapists doing in home therapy with kids with autism.  I like helping people, and I thought this would be a great way to earn experience in my field and do some good in the world (idealistic liberal college student that I was). Well, fast forward eight years and I have my masters degree in Clinical Psychology with a specialization in Applied Behavior Analysis, and I am a Board Certified Behavior Analyst (BCBA). What getting those four beautiful letters behind my name entailed was: getting my masters degree, completing 30 units of required classes such as behavior management and ethics, a minimum of 1500 supervised experience hours, and passing a GOD-awful test with a 40% pass rate (on a good testing period).

So now you ask, but what does ABA have to do with raising children, its just for autism? Well, as my wonderful e-card states, it is NOT just for the treatment of autism. At its core, ABA is the scientific study of behavior and how that behavior can be changed by manipulating the environment of an individual. Behavior, does not occur in a vacuum, it is elicited by events preceding it, and maintained by the consequences following the behavior, And it is with these basic principles, that I manage my daughters behavior (good, or bad).  ABA is SCIENTIFICALLY PROVEN for individuals across populations (typically developing, and special needs). And it is the most effective way to change a behavior QUICKLY. I used these principles to potty-train my daughter in three days at 18 months! Now, I know that these methods may not be for everyone, but I do want to put them out there for moms that are seeking help, advice, or wanting to learn about alternative ways to raise good, honest loving, successful people. (Note: This is not a quick fix and does require work, and needs to be done accurately to be 100% successful).

Now that I have gone through my hole long synopsis of ABA, I hope you all will continue to stop by to learn about this wonderful field and how it can benefit everyone! If you guys have specific questions or would like certain topics covered, please let me know!