Intervention

INTERVENTION AREAS

Based on our Professional experience, below are presented some intervention areas that were found to be more frequently seeked. Nevertheless, ABA is not limited to these areas of intervention.

1. Autism Spectrum Disorder

2. ADHD

3. Antisocial Behavior

4. Nervous Habits

5. Obsessive Compulsive Disorder (OCD)

6. Fears, Anxiety and Phobias

7. Specific phobias

8. School phobia

9. Sibling Relationships

10. Sleep Disturbances

11. School Violence

1. Autism Spectrum Disorder

Autism is a neurodevelopmental disorder of which expression varies greatly from one individual to another. It is therefore treated as a spectrum, which means that symptoms vary in occurrence and severity across individuals. Whereas one individual may present a good verbal ability, another may not vocalize at all; whereas one individual may imitate well another person’s movements, another may find this skill very difficult. Therefore, each individual should be treated differently and treatment should take this into account. However, there are some central difficulties that are observed in most individuals diagnosed on the autistic spectrum. These include:

Language and communication: these difficulties include verbal and non-verbal communication, such as eye contact, facial expression, body language, understanding spoken language, etc.

Social behavior: individuals who are diagnosed on the autism spectrum generally find it difficult to understand and/or express emotions, such as showing empathy and conversing with others. They generally present difficulties engaging in social interaction and play activities.

Behavior: individuals diagnosed on the autism spectrum generally engage in repetitive behaviors, they may insist on following routines and engage in rituals; rigid organization of objects, etc.

Autism emerges in the first three years of life. Individuals affected by autism spectrum disorder manifest developmental delays in skills which are learnt between infancy to adulthood.

Autism is a disorder that affects the individuals, their families, caregivers, educators and all those involved in their day to day life, specially when taken into consideration the complexity of behaviors, reactions and emotions these individuals present

Although treatments, particularly early intensive intervention, may improve the individual’s skills, behavior, autonomy, communication and social interaction and general functioning, there is no “cure” for autism. Nevertheless, if no intervention is applied, the probabilities of the autistic child growing into a functional adult are drastically reduced.

One of the most successful interventions, based on scientific findings, is IEBI (Intensive Early Behavioral Intervention). Based on Skinner’s operant conditioning, learning theory and research, IEBI relies on identified principles of behavior, such as reinforcement, fading, shaping, prompting, etc. Applied behavioral analysis refers to the application of those and other principles, and actually encompasses several different strategies for treatment.

One of the first studies that applied behavioral learning principles to the population of autism spectrum individuals is Dr. Ivar Lovaas, in UCLA during the 60s. In this study, 47% of the children diagnosed on the autistic spectrum who received early intensive behavioral intervention were successfully integrated into the mainstream education system. A follow-up study eleven years later confirmed that benefits were maintained. Several decades of research demonstrate the effectiveness of ABA in the intervention with a variety of populations, teachers, parents, educators, therapists, caregivers, environments and behaviors.

2. ADHD

ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder. As such, it is affected by organic, neurophysiological and environmental factors. ADHD is found to be comorbid with other conditions, such as ODD (Oppositional Defiant Disorder) and CD (Conduct Disorder). ADHD often requires the use of medication to control behavioral and cognitive symptoms.

So far, the combination of stimulant (pharmaceutical) and behavioral therapy shows the greatest benefits. An effective treatment must consider the effects of medication on behavior, physical and parental conditions, which might influence application.

Careful evaluation should precede treatment. Some of the important elements of treatment of ADHD include adherence to daily routine, educators and parental involvement, as well as autonomy and self regulation objectives. A successful intervention plan should consider cognitive needs, and address them through the application of behavioral strategies. It should increase socially appropriate behaviors and reduce antisocial and undesired or inadequate behaviors at home and at school.

Examples of important elements that are included in a behavioral intervention for ADHD are:

Setting specific goals: goals are defined and expectations are clearly transmitted to the child. The goals are broken down into small, achievable steps.
Provide clear consequences: consequences are clear and follow behavior. Consequences are aimed to encourage desirable behavior and discourage undesirable behaviors.
Consistency across environments: in expectations and consequences.
Adherence to routine.
Organization of physical environment to minimize distractions.

3. Antisocial Behavior

Examples for antisocial behavior include lying, stealing, verbal abuse, rudeness, bullying, aggression, vandalism, destructiveness, etc. Aggression (verbal or physical) is one of the main concerns currently at school and home settings. Childhood aggression is found to be correlated with other problems in adolescent life, such as delinquency, poor academic achievement and substance abuse. Aggressive behavior seems to be increasing cross-culturally and not to be limited to a certain place or mentality.

4. Nervous Habits

Some nervous habits, such as nail biting, thumb and finger sucking are common behaviors in early childhood. However, when these behaviors become chronic, they may have physical and social consequences, such as tissue damage, dental deformities, reduced peer acceptance and negative peer evaluation, which are important contributors for social development. In these situations, other nervous habits such as hair pulling might also increase.

Some theories suggest that nervous habits are evoked by stress and/or anxiety. The “environmental restriction” theory maintains that limited motor activity evokes nervous habits. On the other hand, the “arousal modulation theory” suggests that behaviors such as nail biting calm the individual in times of autonomic arousal (anxiety) and provide stimulation at times of inactivity (boredom). Currently, no one theory has gained more empirical support over another.

Behaviors such as nail biting and thumb sucking might be a normal action if indulged in occasionally; a simple tension releasing mechanism (a form of addiction); or a sign of severe internal tension if severe and persistent. Nervous habits may be maintained by different variables across individuals, making it therefore necessary to determine the function of the target behavior on an individual basis.

5. Obsessive Compulsive Disorder (OCD)

The American Academy of Child and Adolescent Psychiatry estimates about 1 in 200 children has the brain disorder known as OCD. The condition is characterized by obsessions (recurrent and persistent thoughts, impulses or images) and compulsions (repetitive behaviors and rituals, such as hand washing), that can turn the child’s life upside down. The causes of this disorder are still uncertain, although interplay between genetics and environment appears to be plausible. Children and adults who suffer from OCD often are diagnosed with comorbid conditions, such as depression, anxiety disorders, panic disorders, attention deficit disorder, learning disabilities and Tourette’s syndrome.

Children who suffer from OCD are likely to be boys of average or high intelligence, with OCD or other related psychiatric conditions within their family. The age of onset for boys is typically between 5 to 8 years, whereas girls typically show onset during adolescence.

The OCD child often suffers from fears, which seem irrational but yet torment him or her. It (erased) often becomes even more difficult, seeing as most teachers are not trained to deal with serious behavior problems. In the classroom setting, the OCD child might insist on drawing a map over and over again, continuously sharpening sharpened pencils, store papers or arrange his or her desk continuously. As the child grows older, obsessions might be paired with compulsions, taking more and more over the child’s life. The child might become isolated, later on might turn to alcohol and drugs and at times attempt suicide. Children with OCD are likely to drop out of school and to lead a life characterized by underachievement and missed opportunities.

The following obsessions are the most frequent in children and adolescents who suffer from OCD:

Fear of contamination
Fear of harm, illness or death
Obsession with numbers
Obsession with evil
Washing and cleaning rituals
Checking compulsions
Repeating compulsions
Symmetry compulsions
Avoidance compulsions
Reassurance compulsions

6. Fears, Anxiety and Phobias

Adolescents are amongst those most likely to be affected by anxiety as a result of exams pressure, extracurricular activities, dating and peer relations. Where it is normal to become somewhat anxious under those situations, some individuals feel overwhelmed. When anxiety is persistent, intense and prevents the individual from enjoying life and from functioning efficiently, it becomes a disorder. At this point, the individual may benefit from long and short term strategies that will help to control and overcome fears and anxiety caused from exposure to certain situations.

7. Specific phobias

Nearly all children experience some degree of fear during their development. Although most fears vary in the degree of frequency, intensity, and duration, they tend to be mild, age specific and to pass after a certain period of time. Typical fears that children may experience include fear of strangers; of separation; of loud noises; of darkness; of imaginary creatures; and of certain animals (e.g. spiders, snakes, dogs). These fears appear to result from daily experiences and do not involve intense or persistent reactions; they are short lived and mostly adaptive.

When fears and anxiety become persistent (last more than 6 months) and bring intense reactions, they start interfering with normal functioning. The development and maintenance of childhood phobias are thought to be influenced by genetic factors, temperamental predispositions, parental psychopathology, parenting practices and individual conditioning history.

Researchers define phobias as:

out of proportion to the demands of the situation
cannot be explained or reasoned away
beyond voluntary control
leading to avoidance of feared situations
persisting over an extended period of time
unadaptive
not age or stage specific

8. School phobia

Some children have difficulties attending school and may become extremely upset or even ill when forced to go to school. These children are neither delinquent nor antisocial. The problem might be further exacerbated by parental expectations for achievements. Berg and colleagues (1969) postulated the following criteria for school avoidance:

severe difficulty attending school, often resulting in prolonged absence
severe emotional upset, including excessive fearfulness, temper outbursts, or complaints of feeling illwhen faced with the prospect of going to school
staying home from school with their parents knowledge
absence of antisocial characteristics, such as stealing, lying, and destructiveness
a self report of heightened level of negative affect and emotional distress

9. Sibling Relationships

Sibling relationships are very unique, because they last over a lifetime and remain important through adulthood. The quality of sibling relationships changes across and within families. These individual differences in early childhood were found to relate to children’s ability of social adjustment and understanding. The shaping role of siblings on children’s aggressive behavior has been documented, and middle school children’s behavior is associated with the quality of sibling relationships in early childhood and preschool years.

One of the primary tasks of young adults is the development of personal relationships. Older siblings are often seen as a socialization agent and significant attachment figures. In light of this, then, where conflicts are a normal occurrence amongst siblings of different ages, it becomes more and more important to encourage a cooperative family system, characterized by engagement in prosocial behavior, affection and cooperative play, cooperation, help, praise, comfort, reassurance and sharing.

10. Sleep Disturbances

Insomnia, nightmares, and an inability to fall or stay asleep are normal occurrences in children and adults. When these happen frequently, they begin to interfere with normal functioning. Currently, more and more children are diagnosed with sleep disorders, a fact that might be associated with the increase of ADHD diagnoses.

Research suggests that elementary school age children who get enough sleep, which is defined at about 11 hours a night, do better in school, are more content, suffer fewer accidents, and are less likely to become obese than children who don't get the sleep they need. On the other hand, children that do not get enough sleep are more easily frustrated, intolerant, irritable, and oppositional. Research findings also indicate that lack of sleep is associated with reduced attention span and increased reaction times. Some children become more active when short of sleep.

It is well known that the biological need for sleep increases during maturation. Therefore, the ability to interact and to learn may be diminished in sleep deprived children. Reduction in cognitive efficiency and an increase of behavioral problems is often observed in children and adolescents who do not sleep enough.

11. School Violence

School violence is one of the most pressing issues, as its rate increases internationally. School violence does not only appear in its physical, most obvious form, such as bullying, insubordination and vandalism. It also appears in more subtle forms, such as classroom disruption, verbal threats and humiliation. This contributes to the creation of an unsafe and threatened learning environment (Putnam, Handler, Ramirez-Piatt & Luiselli, 2003).

Researchers have distinguished between three types of aggression: direct aggression, which is physical aggression; direct verbal aggression, such as using swear words and threats; and indirect aggression, which includes hurting or offending an individual through others, such as telling tales, gossiping, and excluding from activities.

Another dimension that contributes to the threat of the learning environment is disruptive behavior during the class. This takes several forms, the most frequent being non-compliance and refusal; aggression towards the teacher or adult; defiance of authority; and interruption to instruction.

Research findings illustrate that peer support for antisocial behaviors occurs even before adolescence, lending support to peer attention as a reinforcing factor for antisocial behavior; and also to Adler and Adler’s (1995) hypothesis that aggression is used as means to gain high social status for the individual, and that the continuation of aggressive behavior facilitates the maintenance of the achieved status. However, some aggressive children had been observed to be socially excluded, and described as unpopular. These children, though, are frequently being bullied as well as bullies.

Some scientists suggest that the age range of five to seven years is crucial for social and cognitive development, a time when children develop their perceptions and problem-solving skills. Therefore, aggression might be seen as a tool for achieving social status only at a later stage, when social cognition is more developed.

It is clear that age and sex differences exist in the phenomenon of antisocial behavior. Also, personality seems to play a role (aggressiveness as a basic characteristic underlying friendship), as well as group social norms and parental factors. An intervention for prevention or extinction should take all these variables into account and therefore target several contexts and other elements.

SCHOOL

In addition to the many contributions for education that have been achieved by the behavioral sciences, a focus on the various educational settings during at least 20 years has yielded an intervention technology for the achievement of behavior change that is effective, reliable, and easy for application by teachers or other school personnel.

The school wide intervention focuses on improvements at the whole-school or classroom level as well as at an individual level. We attempt to meet the needs of the students, families and schools, by encouraging team work and a flowing communication.

Our objectives are directed towards achieving:

A team approach for solving behavior issues.
Clear and operational definitions of acceptable and unacceptable conduct.
Practice based on data collection and continuous evaluation.
Education for appropriate social values, such as responsibility, respect and self-control.
Creating a structured, reinforcing and encouraging learning and social environment.

Sugai and Horner (2002) discussed the effectiveness of such a comprehensive intervention, which “(a) targets all students, (b) emphasizes measurable outcomes that are valued…(c) uses data to guide policy decision making, (e) is dominated by positive reinforcement and skill building approaches, (f) stress prevention, and (g) integrates all elements of the school culture…”.

Whole-School Intervention

To achieve a durable and extensive classroom behavior change, a school-based plan is developed that is sensitive to and considers the diverse needs of the population (students, parents and staff). Strategies are developed to be adaptive and practical (user friendly).

The emphasis is put on:

Values
Respect and self-control
Intolerance of violent behavior
Individual contribution to the general atmosphere of the school environments

Classroom Level

First, it is important that teachers recognize their important role as “chief contingency managers” of their classroom. The teacher is the one responsible for academic and social development of the students. We attempt to shape teachers’ view and awareness of behavioral strategies available for application, in order to transfer the classroom into a positive learning environment, characterized by attention, participation, patience, respect, motivation, and achievement.

Strategies such as peer tutoring and modeling, manipulation of peer attention, motivational systems, and organization, amongst others, can highly contribute to the classroom management skills of the teacher.

Intervention strategies must be implemented with integrity, consistently and accurately, which makes the training stage the most crucial. Teachers and parents have been successfully trained in conducting assessments and observations, as well as applying behavioral strategies that result in positive behavior change. The training can take individual, group or pyramidal form. Each one is chosen according to necessities, environmental conditions and the existing reality that influences both needs and possibilities.

Specifically, the intervention process in the school will include, amongst other things:

selecting behaviors to encourage or strengthen
selecting behaviors to reduce or eliminate
identifying individuals’ existing academic and social repertoires
matching procedures of change to the identified repertoires
selecting reinforcing contingencies to increase and maintain appropriate conduct
emphasizing use of reinforcement and other planned consequences in the natural environment
emphasizing the importance of environmental organization and structure

Individual Level

It is clear that anti-social behavior results in poor academic achievement. Also, the presence of an anti-social student or a student with behavioral difficulties such as impulsivity, hyperactivity and inattention, amongst others, could seriously hinder the fluency of the teaching and therefore the academic achievement of peers and of the classroom as a whole.

In addition, the unacceptable behavior of a specific student can at times lead to negative attitudes on the part of the teacher, harming the teacher-pupil relationship, which presents further risks for personal achievement and further decreases probability of behavior change.

By analyzing what happens before the occurrence of the behavior (antecedents) and the different ways in which the environments react to the occurrences of behavior (consequences), we can plan to systematically avoid or gradually change it. By observations and systematic manipulations of environmental variables and their effects on behavior, it becomes possible to generate hypotheses regarding triggers and function of behaviors targeted for change.

A plan of intervention based on these hypotheses will use behavioral strategies that have demonstrated effectiveness, in order to achieve behavior change. The strategies used are chosen according to the individual needs, through the consideration of application practicality (e.g. time, ease, etc.). The main objectives are achieving self-control, self-regulation, and on-task behavior, amongst others.

The individual level school-based intervention is directed at students who:

are consistently uncooperative
did not achieve a significant behavior change after implementation of whole-school intervention
present severe anti-social behaviors
have specific and/or unique difficulties
present an elevated rate of inappropriate behaviors

Finally, positive behavior change had been seen on many occasions to improve academic functioning, and increase motivation and independency. On the other hand, it also serves to reinforce the teachers’ efforts and to free their time from dealing with inappropriate behavior, so they are available to teach.

SPECIFIC

In addition to school and intensive interventions designed for children with developmental disabilities, we also provide interventions directed at challenging behaviors. An intervention of this kind will address issues such as nervous habits (e.g. thumb sucking and nail-biting), eating disorders, toilet training, sleeping disturbances, addictions, conduct disorder, oppositional defiant disorder, antisocial behavior (e.g. lying, stealing, etc.), phobias, hyperactivity, temper tantrums, and sibling relationship, amongst others.

The treatment will begin with an evaluation process, which includes interviews and observations, as necessary, based on which a delineation of behavioral strategies to increase and/or decrease target behaviors will follow. In most cases, parents training will be an integral part of the intervention. Educators and other significant individuals for the child will also receive training if and when necessary.

Some important points that the team considers when a behavioral intervention plan is created are:

Input from all significant individuals
Operational definitions of behaviors , goals and consequences
Delineation of evidence-based instructional strategies
Adaptation to various environments (e.g. home, classroom, playground, etc.)
Focus on positive support
Necessary changes in academic program, physical setting, etc.
Progress is recorded and the plan is evaluated

INTENSIVE

Over the last decade, Applied Behavior Analysis (ABA), especially with autistic children has experienced a return to popularity. Behavioral intervention can be employed positively with a high degree of flexibility. Most importantly, the intervention has proven to be highly effective.

Intensive Behavioral Intervention has been shown to successfully increase children's functioning in areas such as language, play, social, self-help, amongst others. Naturally, however, there is a range in the degree of treatment outcomes. The results of treatment depend upon several factors such as age at onset of treatment and the child's cognitive capacity. Treatment is designed to bring out the child's fullest potential.

Although the tremendous popularity of ABA is recent, ABA is not a new procedure. In fact, ABA is based upon more than 50 years of scientific investigation with individuals affected by a wide range of behavioral and developmental disorders. The research has shown ABA to be effective in reducing disruptive behaviors, such as self-injury, tantrums, non-compliance and self-stimulation. ABA has also been shown to be effective in teaching commonly deficient skills such as complex communication, social, play and self-help skills.

Some children (especially with autism) have difficulty accurately attending to, interpreting and utilizing the feedback that automatically exists in their world. ABA, and subsequent treatments, analyze these interactions and sequences of behavior, making explicit the rules, consequences, and expectations that others understand more automatically, in an effort to teach more adaptive, useful, and maintainable behaviors and skills. Behavioral intervention teaches a child not only to "know" the rules of what is expected, but to use their skills more automatically, modifying behavior and adding new behaviors using well understood and established behavioral principles such as reinforcement, shaping, prompting and prompt-fading, and generalization.

With this technology, target behaviors are broken into very small, separate components and each skill is taught systematically in a way that is likely to be effective for that child, typically individually at first, utilizing specific prompts and reinforcers (referred to as "errorless learning") until the child reaches a predetermined level of mastery that is designed to increase the likelihood of maintenance and generalization.

Successes are built upon, with constant systematic modification of the program as the child demonstrates progress, eventually adding a behaviorally sequenced generalization plan to transfer the skills into other settings and situations. The success of any behavioral program rests upon the clarity of target goals and objectives, the purposeful choice of teaching tools and lessons, the appropriate choosing of reinforcement and reinforcement schedules, the appropriate judicious use and fading of prompts and reinforcements, the purposeful inclusion of behavior generalization, and the consistent application of behavioral principles.

Age, Treatment Intensity and Other Considerations

While most research on intensive behavioral treatment has been done exclusively with very young children, experience has demonstrated that older children can benefit substantially from a similar treatment format.

Modifications are applied in the treatment plan according to the age and developmental level of the person, taking into account the need for teaching functional and age-appropriate skills, effectiveness and suitability of reinforcers, severity of disruptive and interfering behavior, and realistic expectations for achievement.

Programs may be applied with people of all ages in a variety of settings including home, schools, vocational and employment services, and residential care and training.

Intervention with older children requires addressing their unique needs, such as development of coping skills to deal with frustration, self-esteem and complex social skills. Additionally, strategies designed to deal with interpersonal issues, such as depression, social problem solving and conflicts with family and friends, are often necessary.

In determining the intensity or number of treatment hours, the child’s daily schedule should be considered in order to determine an appropriate balance between periods of intensive teaching and less intensive (but still structured) activities, as well as allowing for the child's need to have periods of free time.

Besides the number of hours of 1-to-1 teaching, the quality of teaching and the degree of structure provided outside the formal therapy hours has also to be considered. Research shows that many children will do best with 30 or more hours per week of direct instruction. The length of therapy sessions should be adjusted to provide maximum benefit. Generally it is recommended that the sessions last two to three hours. Once a child is spending part of the day in school, it may be advisable to reduce the treatment hours at home.

Teaching Setting

Initially teaching is done in an environment that will lead to early success. In most cases this may mean a controlled environment with reduced distraction. However, teaching must quickly be extended to everyday settings. Not only is this more natural but it also promotes transferring learning to all settings (generalization). Therefore, therapy should occur across the house, as well as outside and within the community (e.g., the park, the market, etc.). If distractions pose a problem, it will be critical that we help the child learn to focus even in the presence of environmental interference. Children must be able to learn in varied environments where distractions naturally occur so as to prepare them for learning in typical settings such as school.

Room adapted for therapy: In order to guarantee the initial controlled and structured conditions, it is agreed with the family, that therapy should begin in a reserved area, either in the house or at school. This room/division must have at least a table and two chairs, a structure to keep the material organized and at hand, and a few motivational items. The conditions should be entirely manipulated by the therapists to fit in with the program and the child’s necessities.

NET Training: As the child acquires new skills and abilities, the teaching surroundings must be broadened to the household, school, neighborhood, etc. Only this way does the student have the possibility to generalize her knowledge and the therapist the possibility to “test” the student in real life situations, where unfavorable conditions might persist, just as in normal day to day activities.

Material

In order to apply any program, appropriate teaching materials are fundamental. Most families choose to be an active part of the preparation of the hardware necessary, but knowing the difficulties they may encounter due to scarceness of sources; a never ending list of new material which increases weekly; or the lack of time, our team offers their services in this area too. (ERASED)

The Treatment Process

Family: The involvement of the family is critical in the treatment process. No one knows the child better nor cares more for his welfare than do his parents, and they are the ones most affected by the child’s disorder. Parents spend a great deal of time with the child and are in a position to carry over teaching goals into everyday living situations. They can also provide some structured teaching sessions to the child. However, it is important to realize that living with an autistic child takes a heavy emotional toll and coordinating the treatment team is already a large undertaking.

The majority of intensive teaching should be provided by paid staff, volunteers or school personnel. This allows parents to have some respite and the remaining time spent with their child can be more enjoyable and productive. Parents can utilize the child’s "free time" to augment intensive teaching time, in developing play, social and self-help skills. Bath time, dinner, getting dressed, and feeding the family pet are just a few examples of everyday routines that offer opportunities for teaching. Outings to the park, (erased) shopping, mailing a letter and visits to a relative's home are opportunities to generalize skills and work on improving behavior. In this way the child's entire day becomes part of the treatment process and the parents become an integral part of the team.

Team Charactarestics: ABA based intervention emphasizes a positive and systematic approach to teaching functional skills and reducing behavior problems. The creativity and flexibility of these programs enable to capitalize on the resources available for each individual child.

While certain teaching techniques have been found to be consistently effective, it should be recognized that each person working with a child has their own style and unique contribution to make to the educational treatment process. In the initial treatment phases, it is important that all members of the team adhere consistently to the smallest details of the teaching plan. As the child masters skills, it becomes important to deliberately increase variability in order to facilitate generalization to all people and settings in the child's natural environment.

It is rare to find an experienced staff member who can step in and start working with your child on the first day. While experience is a plus there are many other factors that determine whether a person will be a good behavioral interventionist. We look for people who are enthusiastic, eager to learn, reliable, and able to accept and incorporate feedback. Completion of a degree in psychology or special education is highly desirable. It is recommended that a team ranges from 2-4 therapists, who can each work between 6 and 12 hours per week.

Lead Therapist: To coordinate all parts involved, the team of therapists has a lead therapist. Directly related to the team, the lead therapist is responsible for coordination between all people involved in the intervention (parents, teachers, and other professionals), problem solving, presenting the program and evaluating the progress.

The program’s evolution depends on constant data collection by the therapists (erased) in order to accompany the child’s development. Based on the data, the lead therapist changes the program and increases the list of material. Although the program is evaluated constantly, a more comprehensive reevaluation is performed quarterly.

Finally, the lead therapist is the main bond between all significant members of the child’s life, including team of therapists, family and school, and must guarantee a constant flow of information to secure a good relationship that can only help the intervention.

The rest of the team members have the biggest responsibility of all – applying the program. Based on an individually designed program and specific strategies to deal with behavior, therapists must guarantee consistency and efficiency in order to promote ideal conditions for the child to learn or perfect skills and abilities.

Supervision: A qualified person should lead the team. It takes years of training and experience to be able to train and supervise others in the implementation of behavioral programming. While there are common elements in the treatment of most (erased) children, each child presents a unique challenge in designing and guiding the optimal learning process. The level of supervision necessary is based on a number of factors, including skill level of staff and parents, stage of treatment, complexity of programs required, number of treatment hours, etc. It is important that a qualified supervisor be involved on a regular, and as needed basis.

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13. Aggressive Behavior

Appropriate attitude towards aggressive behavior in the present may prevent future engagement in aggressive behavior. It is in our (adults) hands.