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Dr Bonnie Yee-Hebert, Clinical Psychologist

Dr. Yee-Herbert is our clinical psychologist at ABS in California and will be doing assessments at:  8350 Archibald Ave #125, Rancho Cucamonga, CA 91730

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Dr. Bonnie Yee specializes in treating all ages, utilizing behavioral therapies and conducting psychological/neuropsychological evaluations.   Dr. Yee’s current experience includes comprehensive neuropsychological evaluations for diagnosis for learning disabilities, ADHD, autism spectrum disorders, cognitive dysfunction, medical conditions impacting behavior, dementia related evaluations, and traumatic brain injuries. She also can provide comprehensive neuropsychological assessments to address a wide variety of disabilities, disorders, cognitive strengths and weaknesses, as well as rehabilitative treatments.

Dr. Yee holds a Bachelor’s of Science degree in Biology, Doctorate in Clinical Psychology, and Post-Doctoral Specialization in Neuropsychology. She obtained her Bachelor’s degree from University of California, Irvine, her Doctoral degree at American School of Professional Psychology, where she earned Magna Cum Laude honors, and a Post-Doctoral specialization at Fielding University. Dr. Yee is a member of Orange County Psychological Association.

Before coming onboard at ABS, Dr. Yee-Herbert was a Consulting Psychologist with the Department of Rehabilitation in Orange County, CA where her responsibilities included:

  • Conducting comprehensive assessment of applicants for services to determine eligibility and priority of services for Department of Rehabilitation, aid counselors in development of Individualized Plans for Employment;
  • Identifying functional capacities and limitation, and developing strategies with counselors for dealing with conflict or mental health issues that impede progress in various stages of the pre-plan process;
  • Providing consultation to counselors for the diagnosis on mental health disabilities, and consults with service delivery staff on psychological issues and concerns pertaining to the aspects of the disability;
  • Conducting psychological assessments and testing to evaluate consumers with a variety of disabling conditions;
  • Explaining results of Psychological assessments and testing to consumers;
  • Conducting staff training for mental health issues, the effects of traumatic brain injuries and identifying what compensatory strategies would improve functioning, learning and mental health disabilities, and other cognitive impairments on potential employment.

Medication for Children with Autistic Spectrum Disorders

Medication for Children with Autistic Spectrum Disorders (by Dr. Natalie Roth)

Possibly one of the more challenging decisions for parents with children that have an Autistic Spectrum Disorder is whether or not medication is an appropriate addition to a treatment plan.  In my experience, most parents feel a profound sense of responsibility in making this choice for their child.  They often express concern about their child’s comfort and safety, and I regularly hear parents talk protectively about wanting to maintain their child’s unique personality, even if his/her behaviors can sometimes be problematic.  At the same time, parents want to maximize their child’s ability to make use of and develop the skills they have so that they are able to function as independently as possible at school, at home, and in their community.  Navigating this decision often requires parents to carefully balance the potential benefits of medication use against the potential drawbacks.  This weighing of options is not always easy as neither the benefits nor the drawbacks are always immediately apparent.  As I’ve talked with parents who have been through this process these are a few points that I’ve found to be helpful:

Keep in mind that there are no medications that treat the core symptoms of Autistic Spectrum Disorders directly (the core symptoms being delays in social communication and reciprocity, and patterns of repetitive/stereotypic behavior).  However, medication can be helpful in reducing some of the auxiliary problems such as behavior outbursts, helping to regulate sleep and lessening obsessive thinking or compulsive behavior.  Additionally, many children with ASD have co-morbid diagnoses that can benefit from medication.  For example, a child with ADHD (Attention Deficit Hyperactivity Disorder) or an Anxiety Disorder can often benefit significantly from medication is these conditions are accurately identified.  Treatment of these features can lead to improvements in core ASD symptoms, but it will not alleviate them altogether.  It’s important that medication trials be undertaken with realistic expectations.  Additionally, keep in mind that medication for any developmental disorder is most effective when it is part of a more comprehensive treatment plan.  Medication can have important benefits, but shouldn’t take the place of therapies designed to teach skills.

There are some choices when it comes to choosing a professional who can prescribe medication.  If you have questions about whether medication in an appropriate option for your child, it is a good idea to initially speak with his/her primary care pediatrician.  In some cases, this person may feel comfortable working with you around prescribing medication.  He or she may also want to refer you to someone who specializes in this area.  This referral may be to a Developmental Pediatrician (a pediatrician who specializes in caring for children with unique developmental needs) or to a Psychiatrist (a medical doctor trained in treating developmental and mental health issues, with specific expertise in using medication).  If available, it can be helpful to seek out a pedatirican or a child psychiatrist who has experience treating children with Autistic Spectrum Disorders.  Experience with how certain types of medication affect particular symptoms, how medications work together, and how children with ASD’s respond differently to medications can be very helpful.  You should feel comfortable with your prescribing doctor’s level of knowledge and experience, and also with the office protocol for communicating around your child’s responses, your questions, needs, and potential emergencies.  As a parent, you should feel supported by your medical providers in your attempt to advocate for the appropriate dose/timing of any medication.  You will be the person who is most sensitive to both positive and negative effects of medication and this perspective should be valued.

When a family has reached a point where medication is being considered, they are often eager for results and it is challenging to remain patient through the process of finding the right medication and dosage.  Appropriately, most doctors or psychiatrists prescribing to children will begin with a low dose of medication to determine whether or not it is well tolerated.  However, this low dose may not be within a therapeutic range for your child initially, and I encourage parents to prepare themselves for gradual increases as they work with their doctor to determine the right dosage.  Alternately, children with ASD are sometimes more sensitive to medication and an initial trial of a particular medication may result in a negative response.  When attempting a new medication, it may be helpful to formulate a plan for how to respond if your child needs increased assistance. It can be very frustrating (and disappointing) to manage a negative reaction to a medication trial.  Try to keep in mind, though, that this does not mean that there is not a different type/amount of medication that will work for your child. 

A doctor will describe the side effect profile that accompanies medication use.  As a parent, you should be informed about what to expect and what changes may signal potential problems.  At the same time, it is just as important to have a clear understanding of what potential benefits are reasonable to expect so that you and your doctor can clearly evaluate whether the medication is providing improvement.  When I’m working with a patient whose family is weighing a medication trial, I want them to be aware of the potential negative side effect, but I also feel that it’s important to understand that there are sometimes consequences to not using a medication if it would be helpful in improving their child’s ability to function and make use of other treatments that they are receiving.  Sometimes I phrase this as the “side effects” of not using medication.  Research with children who have ADHD, for example, suggests that those children effectively treated with medication were less likely to become involved in drug/alcohol use because their symptoms were managed.  A child with ASD who also struggles with anxiety may not be able to implement and consolidate learned social skills because his/her heightened anxiety prevents real-life interaction with peers.  Often the decision around using medication involves a weighing of the potential benefits with the potential “costs”.   Talking through this question with treatment providers, your pediatrician, your child’s educational team, and invested family and community supports can often be vital in getting the information you need to make this decision. 

If the decision is made to start a medication trial, I encourage parents to identify (with the help of their doctor and interventionists) two to five specific behaviors that they are trying to address with medication.  Before starting a medication trial, I suggest that they keep some simple data on how often they observe the target behaviors on a daily basis (keeping track of the time of the day as well).  Once medication has reached a therapeutic dose, continue to keep data on the occurrence of the behaviors during the same time frame.  In addition, note any changes in a child’s environment or experience that may also affect their functioning (for example, did they return to school, go on a vacation, or become ill?).  This type of data can be very useful when attempting to monitor whether a medication is effective.  While certain changes in a child’s day to day experience can’t be helped, it is important not to make other intentional adjustments to his/her therapeutic plan during a medication trial as it is then difficult to determine which factor(s) are responsible for any observed changes. 

For those who are interested in the types of medication that are most frequently prescribed for children with Autistic Spectrum Disorders, the National Institutes of Health provides a good summary of commonly used medications and their potential benefits and side effects (http://www.nichd.nih.gov/health/topics/autism/conditioninfo/Pages/medication-treatment.aspx). 

Another very helpful resource is the medication “toolkit” provided by Autism Speaks:

http://www.autismspeaks.org/science/resources-programs/autism-treatment-network/tools-you-can-use/medication-guide.

Dr Natalie Roth, Clinical Psychologist

Alternative Behavior Strategies is glad to announce that Dr Natalie Roth has joined our team here at ABS.

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Dr. Natalie Roth is a Licensed Clinical Psychologist specializing in developmental issues, and particularly in children with neurodevelopment delays. Dr. Roth grew up in Utah and attended the University of Utah before moving to Los Angeles for graduate school. She graduated from the APA approved psychology program at Fuller Theological Seminary following practicum experience at the University of Southern California and an internship at St. John’s Child Development Center in Santa Monica, California. She and her husband returned to the gorgeous mountains and wonderful lifestyle of Salt Lake City in 2002.

Her specific interest in Autism was strengthened as part of a developmental assessment team that worked through the State of Utah Department of Health, Children with Special Health Care Needs. In this capacity, she evaluated and worked with the families of hundreds of children with Autistic Spectrum and other developmental disorders as part of a multi-disciplinary assessment team. She specializes in the assessment of developmental delays and has worked extensively with younger children (ages birth to five), but has a wide degree of experience assessing older children and adolescents, as well. Dr. Roth has expertise in testing a range of developmental domains, including intellectual testing for verbal and non-verbal children, ADOS testing, early developmental testing, and tests of academic functioning. Her approach to working with families through the process of an assessment is to provide support in determining the most accurate understanding of a particular child’s presenting issues. The results of the assessment are used to arrive at a diagnosis, if applicable, but as importantly, to understand the unique strengths and weaknesses of a child so that his or her parents can make informed, individual decisions about which steps to take next.

Natalie and her husband have two young boys who enjoy all of the outdoor fun that Utah has to offer, including hiking, boating, and camping. In rare moments of free time, she especially likes running in the foothills with her dog, playing the piano, or having dinner with friends.

As a Clinical Psychologist, Dr. Roth will be offering a variety of services through Alternative Behavior Strategies, including:

Diagnostic evaluations for suspected neurodevelopment conditions such as:

  • Autistic Spectrum Disorders
  • Attention Deficit/Hyperactivity Disorder (ADHD)
  • Anxiety Disorders
  • Obsessive-Compulsive Disorder (OCD)
  • Trauma and Stress Related Disorders
  • Depressive Disorders
  • Disorders of disruptive behavior and impulse control
  • Learning Disabilities
  • Language Delay
  • Intellectual Disability / Global Developmental Delay
  • Cognitive and behavioral issues related to:
  • Prenatal substance exposure (such as Fetal Alcohol Syndrome / Affects),
  • Genetic Disorders
  • Medical Issues with potential psychiatric/neurocognitive complications

In many cases, this type of assessment can be beneficial for children and adolescents when:

  • A child is struggling to meet developmental milestones, has encountered learning problems, or does not appear to be able to function as independently as expected.
  • A teacher, instructor, or medical professional has indicated concern about a child’s performance or development.
  • Behavioral concerns (such as heightened activity levels, poor impulse control, oppositionality, aggression, or avoidance) are interfering with a child’s ability to form positive relationships, complete daily tasks, or take advantage of learning environments.
  • A child has a medical history (including prematurity) which is known to have potential neurodevelopment or psychiatric consequences.
  • Efforts at intervention and treatment have not been as effective as hoped.
  • A child/adolescent demonstrates a change in mood status or behavior (for example, is eating or sleeping differently) or expresses persistent discomfort about his/her life experience.

As a result of a diagnostic evaluation, a family/caregiver could expect the following outcomes:

    • A new understanding or clarification of diagnostic status.
    • An assessment of a child’s strengths and how these can be applied to areas of identified vulnerability.
    • Assistance in reviewing recommended treatment options and prioritizing treatment goals.
    • Specific recommendations for different contexts in which a child operates, including home, school, social, vocational, and community environments.
    • Referrals to other specialists when indicated.
    • Documenting changes in functioning over time.
    • Attention to both the practical and emotional needs of parents and caregivers as they move through a process of better understanding their child.
    • Consultation with other providers involved in the child’s care, when requested by parents/care-givers.
    • A comprehensive, in-person review of results with parents/care-givers, followed by a detailed written report.

Dr. Roth will also be available for consultation/therapy appointments to address issues such as:

      • How to cope as a family or an individual with a new diagnosis
      • Cognitive-behavioral therapy to reduce anxiety or depressive symptoms
      • Review of family functioning around the stress that can occur when children have neurodevelopmental complications
      • Gaining optimism in parenting a child with special needs
      • Parental support during implementation of new behavioral strategies
      • Consultation with school, church, or other communities where a child is active.

As part of the team at Alternative Behavior Strategies, Dr. Roth will also be involved in the on-going care of clients who receive ABA, Speech, or Occupational Therapy, as needed. This involvement might include monthly consultation with a child’s treatment team, close work with Speech, OT, and other Mental Health providers at ABS, and on-going training for parents, staff, and the SLC community.

Is My Child’s Speech Normal?

My child’s speech & language skills… are they delayed?
by Michelle Turkoglu, Speech Therapist at ABS

A colleague of mine mentioned that when he meets his friends’ children or sees children out and about, their speech and language skills seem to differ greatly. The children are all around the same age and don’t appear to have any developmental delays such as Autism, syndromes or other disorders, so why is their language so different?

The easy answer is that there is a wide range of what is considered “normal” for speech, language, and communication development. And while that’s true, it doesn’t help parents, caregivers, teachers or anyone who works with children a good idea if the child needs therapy support or not.

Pediatricians, teachers, speech-therapists and the internet can all provide you with charts, graphs and lists of what is considered typical. While some of this information is accurate, you’ll find that the information can vary from one source to another. It also seems like people are hearing blanketed or general statements that don’t really give enough information. For example, some lists would state that the following milestones should occur between 1-2 years of age:

  • Understands “no”
  • Uses 10 to 20 words, including names
  • Combines two words
  • Waves good-bye
  • Makes the “sounds” of familiar animals
  • Gives a toy when asked
  • Brings object from another room when asked
  • Uses words to make wants known
  • Points to body parts such as eyes, nose, mouth

There is nothing wrong with this information. All these milestones should in fact occur around age 1 and before or right around 2 years. But if an 11-month-old child can do all these things proficiently and a 23-month-old child is just learning these skills, should both be considered “typical”? If we simply based our evaluation off of the “list” we could come to a few conclusions:

  • the 11-month old is advanced
  • the 23-month old is delayed
  • both children are “fine” because there is a wide range of typical

As a speech-language pathologist, I think that these lists can be helpful guidelines but really should be interpreted by a professional with advanced training in child development (SLPs, developmental pediatricians, pediatric neuropsychologist, etc.). The professional that you seek help from should spend some time with the child and engage with him or her in a variety of activities in order to get a good sense of how they communicate and interact. Videos of children at home or in various settings can provide really great insight into how a child is communicating in various environments.

Toddler-Brushing

In the case of the 10-month old vs. the 23-month-old, there could be so many other conclusions drawn once he or she is evaluated by a professional. For instance, the 11-month-old uses well over 10-20 words but all those words are related to a single topic. He or she waves goodbye but only when told to do so and does not look at the person when waving. He or she engages in sing-along but only 1-2 songs from their favorite TV show. They can identify and get items for you but maybe they need the direction repeated several times along with gestures and pointing to understand. So while they can perform the skills that are listed, the manner in which they are performed may be considered “atypical”.

The 23-month-old child may in fact be “delayed” if the listed skills are just beginning to emerge. The extent of the delay would need to be examined. The delay may need therapy to help him or her “catch up”. The delay may be pervasive (continue on) and would definitely need intervention to help him or her develop language skills. On the other hand, maybe the 23-month-old was adopted and is just starting to hear and learn English. Maybe the child’s overall communication, social interaction and other developmental skills are on-track. If we just looked at the “list”, we would consider the child to be delayed or disordered, when in fact, they could just be acquiring a new language (which is not a disorder of speech-language skills).

So if you are thinking that your child may have speech-language-communication delays, getting a professional opinion is the best option. A pediatric speech-language pathologist should be able to determine if your child would benefit from starting therapy right away or explain why he/she thinks that your child does not need therapy.

One final note…As a parent or caregiver, you know your child best. Ask lots of questions. Let the professional know that you’ve done your research and explain why you are concerned. An open dialogue will answer the most questions and help understanding for both the professional and parent.

How Occupational Therapy Can Help Your Child at Alternative Behavior Strategies

What does occupational therapy do?
by Victoria Kochanek, Occupational Therapist at ABS

Occupational therapy is client-centered, occupation-based and evidence-based. An occupational therapist creates an individual therapy plan based on the routines and environment of your family at home. Within the therapy gym and a structured home program the outcome is that your child will be able to do tasks they need and want to do, with as much independence as possible, satisfaction and success.

Occupational therapy uses a holistic approach to work with parents and their children in developing performance skills and coping mechanisms to do necessary and desired occupations and routines. When we use the word occupations we refer to a variety of things you do in your daily life. Using the word occupation for self care: an occupational therapist addresses children’s ability to get dressed, toilet/bathe themselves, perform daily hygiene such as brushing teeth/combing hair, etc. OT also addresses the skill sets and situations in which children perform entire routines; from getting ready for bed/ready in the morning to tolerating different transitions between play and work. An OT also helps a child with their occupations and skills to eventually start helping to take care of them selves such as making a simple snack/meal to doing chores/homework successfully and efficiently.

OT is also provided to help children who have delayed/poor motor coordination skills required to enjoy various play-based occupations such as kicking/throwing a ball, playing on a playground or riding a bike. Occupational therapists work with a variety of children who have special needs that impact their occupations; whether developmentally they are having some difficulty achieving these different occupations or if they have a specific diagnosis. OTs work with children who have Autism, Aspergers, William’s Syndrome, Down syndrome, Cerebral Palsy, Acquired Brain injury or other social/emotional/behavioral/neurological conditions.

An occupational therapist can address these different needs by looking at the child, their different environments and the tasks they need to do in a holistic way. Assessing the child’s fine motor/gross motor strength/coordination, visual perceptual and hand eye coordination skills, emotional self regulation, learning style and different executive function processes such as attention, memory, sequencing, organization and planning. The therapist also analyzes the different environments the child is in during these tasks as well as the tasks themselves to determine what other difficulties may occur that challenge the child’s abilities. Using all of this different information, the occupational therapist then creates a child-centered plan of treatment. The OT strives to create a functional balance and fit between a child’s abilities, the tasks they need to do and the environment they do them in.

Occupational therapy is unique in the use of evidence-based theory of sensory integration/processing for children who demonstrate unsuccessful coping strategies to the 6 senses:
• Sight, hearing, taste, touch, smell and movement.

The 6 senses of input are integrated and modulated in occupational therapy with the use of sensory integration/processing of tasks they do, their environment and even their own bodies. This is often paired with one of our other foundations of practice in neurodevelopment/motor control, cognitive processing, and occupation/skills acquisition.

ABPathfinder: Frequently Asked Questions

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ABPathfinder FREQUENTLY ASKED QUESTIONS

At Alternative Behavior Strategies, we are committed to providing better care of our clients, investigation into their problems and further education of those who serve. As a parent of a child diagnosed with autism, we understand some of the challenges you face as you and your family find the best therapy solution for your child.

Therefore, we are pleased to implement ABPathfinder across our therapy centers. Below are some frequently asked questions about the tool.

For Parents:

  • My child was recently diagnosed with autism. What does ABA therapy entail?

Applied Behavior Analysis (ABA) is a science in which procedures are systematically applied to improve socially significant behavior to a meaningful degree. An ABA program is a systematic teaching approach that involves breaking skills into small, easy-to-learn steps. Praise or other rewards are used to motivate the child, and progress is continuously measured for opportunities to optimize as needed.

ABA is widely recognized as the single most effective treatment for children with autism spectrum disorder and the only treatment shown to lead to substantial, lasting improvements in the lives of individuals with autism.

  • I’ve heard about ABPathfinder. What is it?

ABPathfinder is a leader in autism therapy management solutions that tracks skills and behaviors in one central software application, with complete data storage and security.

ABPathfinder helps the therapy team capture your child’s progress throughout his/her therapy sessions, allowing our therapists to build customized day-to-day plans for clients based on their current progress and future goals.

Alternative Behavior Strategies is proud to partner with ABPathfinder to offer a new tool to help our talented therapists as they work with your child during autism management therapy sessions.

>> FACT: A recent study resulted in a decrease of administrative time, but also an increase in therapy quality and consistency that resulted up to a 20% increase in the speed with which children mastered skills. Continue reading

Spring Retreat

ABS Spring Retreat

Our spring retreat, at the picturesque Diamond Ridge Retreat Center, was great in spite of wintery weather. Breakfast there, at 7600 ft, was delicious!

Breakfast

20 Mile March

Joe used illustrations regarding dealing with ‘bad weather’ from Jim Collins’ discussion, in his book Great by Choice, of the 20 Mile March (summary at link by Jon Karpman) to encourage us to pace ourselves as we push on in spite of difficulties.

20Mile

“Throughout the journey, Amundsen adhered to a regimen of consistent progress, never going too far in good weather, careful to stay away from the red line of exhaustion that could leave his team exposed, yet pressing ahead in nasty weather to stay on pace.  Amundsen throttled back his well-tuned team to travel between 15 and 20 miles per day, in a relentless march to 90 degrees south.  When a member of Amundsen’s team suggested they could go faster, up to 25 miles a day, Amundsen said no.  They needed to rest and sleep so as to continually replenish their energy.  In contrast, Scott would sometimes drive his team to exhaustion on good days and then sit in his tent and complain about the weather on bad days.  At one point Scott faced 6 days of gale force winds and traveled on none, whereas Amundsen faced 15 and traveled on 8.  Amundsen clocked in at the South Pole right on his pre-decided pace, having averaged 15.5 miles per day.  Scott in contrast fell behind early, with no plan of a daily pace, and as the conditions worsened, enhanced by his lack of preparation for unforeseen events, he and his team never recovered.”

The ABS Specialty & Our Big Three

We provide a Continuity of Care, a comprehensive spectrum of therapies to meet the multiple needs of every child. In particular, ABS now has on staff specialists in speech therapy, occupational therapy, and psychological services. We intend to integrate speech/social/cognitive behavioral goals into every ABA program and these specialists will be both providing their own therapies and supporting our ABA clinicians in enhancing ABA programs.

ClinicalCare(ABA Clinical Leadership: Joe Dixon, Maren Jacobson, Christa Dalton, Jeff Skibitsky)

This overall focus within ABS on providing Continuity of Care is maintained and substantiated by our Big Three operational foci:

  • To provide Quality Clinical Care – we continue to strive to provide the best, state of the art care and support for all of our clients and their caregivers.
  • Advanced Systems/Operations – this clinical care is supported, day to day, by our comprehensive use of Central Reach, AB Pathfinder, and in-house developed systems which help our staff, both administrative and clinical, to efficiently and effectively manage this complex business.
  • Highly Trained, Professional Staff – whether helping with beginning RBT certification, teaching master’s level BCBA training, or developing regular, ongoing training materials, we are committed to having all our staff continue to grow professionally.

These three characteristics of ABS are overseen by our leadership team: Jeff, Jessica, and Joe.

Big Three (ABS Leadership: Joe Dixon, Jessica Engel, Jeff Skibitsky)

Policies and Procedures

Jessica led the discussion of our updated ABS Policies and Procedures focusing on changes in ABS policy noted in the document, of which everyone received a copy.

Policies & Procedures

We’re also excited about expanding ABS, and our business model, into California. More on that in next month’s newsletter.