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Applied Behavioral Analysis: Real Strategies For Autistic Children And Their Families With Melissa Schiefelbein
We’re thrilled to haveMelissa Schiefelbein on our show. She's going to share more about her personal and professional journey as well as tell us a lot more about what is going on. Melissa, thank you.
Thank you for having me.
Tell us a little bit about your personal journey and how you’ve got intoBloom Health.
I got into Bloom Health very unexpectedly. I started as an Early Childhood Education teacher. I was very dedicated to the field of education and teaching when my son at two years old was diagnosed with severe autism. At the time, being a parent and even being in the education field, I had no idea what autism was. It was a term that was up and coming at the time.
As a parent, you don't know. I just knew one day, I was putting to bed my child who was getting words, doing lots of things, and developing normally. One morning, he woke up and was completely different seemingly overnight. I panicked and had no idea what to do. When he was diagnosed, I stopped working and dedicated myself full-time to his therapies.
While in his therapies, I was working with him alongside one of the therapists. They saw how I was interacting with him and said, “You should get into ABA. This is something that would help you with him, but then also you seem to have a knack for it.” It all went gangbusters from there. I got into the field of ABA. I became a board-certified Behavior Analyst, and dedicated much of my life to studying what autism is and what Behavioral and Cognitive Therapies do.
I started working for a major health system. Once I started realizing where the connection needed to be and looking at the whole person, and the full scope of what’s going on for a child who's been diagnosed with the behavioral disorder, that's what made me start Bloom Health. It’s to educate parents and to get parents every little bit of information that they need, so no one has to feel lost as I did.
There is a lot of misinformation out there and certainly, it's hard to find other people that have been through it as well as want to help. That's incredible. Who is ABA for? What does it stand for and what are some of the elements of it? Tell us a little bit more about that.
Applied Behavioral Analysis is a type of therapy usually recommended by a developmental pediatrician or anybody else who can diagnose a person with autism. That's usually one of the first types of therapies that's on the docket as a recommended treatment. It's a very comprehensive therapy. It was founded by BF Skinner decades ago. Over time, it developed into what we know as it is now.
It's a behavioral therapy that takes an empirical approach. It's based on research and what has been proven to be effective, and it works on a very wide range. If you get speech therapy, you're working on the mechanics of speech. If you get occupational therapy, you're working on more regulatory skills. Applied Behavioral Analysis looks at a child where they are developing mentally, what are the strengths and the deficits, and what are things that could be in the way of a child learning new skills. It works on all of them. It's a very intense comprehensive therapy.
Is it only for people that have an autism diagnosis?
No. ABA is used for a multitude of behavioral disorders. ABA practices are also great for behavior guidance in general. There are a lot of ABA programs out there for people who want to start lifestyle changes like diets. Even major companies will use them to help build up team momentum and incentives. It's good for figuring out what skills need to be developed and using reinforcement and motivational strategies for doing so.
There's going to be a lot more that comes out of this. Encouraging wellness can come in the form of healing as well as mentorship. Mentors encourage and enable other people's development, as well as help to focus their efforts by setting goals and giving feedback. For those that want to build health and wellness and take a look at nutrition, exercise, behavioral changes and mental health, what can somebody with limited knowledge or conflicting information do? Do you have any suggestions?
In terms of making big lifestyle changes and encouraging your health and wellness, the fundamental part of identifying where you want to be is identifying what possible barriers are there for you to get to where that is. A lot of times, we see these big changes we want to make in terms of our health. Many times we find ourselves not able to complete them because we take a look at what we want, but then we don't take a look at all of the steps involved to make that change and how realistic they might be. That's why it's so common for nutritional changes to drop off after a certain time because we don't take into account how it applies to our daily life.
One thing I've learned in ABA in terms of lifestyle changes is being able to identify, “This is what stands in the way of me being able to make these big changes.” For someone interested in a lifestyle change or even interested in making small steps toward a healthier lifestyle, I would first identify what are those realistic goals that I want to reach, what could possibly stand in my way, and what's going to motivate me?
It’s about self-awareness and knowing what motivates me and what I am reinforced by. It's great because ABA helps you look into all those teeny tiny details that you may not consider otherwise. It helps you work them to your advantage so that you promote success and most access to reinforcement. The biggest part is how do I access the most reinforcement.
Applied Behavioral Analysis, in terms of lifestyle changes, is identifying what stands in the way of people being able to make big changes.
How long would it typically take to do something like this when you're working with kids, adults or anybody in terms of taking the next steps? What does that look like?
When you initially start, you want to identify, “What's going to put me most in line with where I want to be?” If you're considering a child who may be developmentally behind, you would say, “What's going to put this child in line to be able to function among his peers and in the environment without support?” You would then create a treatment plan based on that.
The treatment plan would very highly reflect how much time it would realistically take to get to that goal. For some kids, you're in intensive therapy for 40 hours a week every single day, and you're working hard at trying to fill up those milestones. For a child or maybe even a person who's trying to make a smaller lifestyle change, the time would reflect that.
I've seen children be in ABA therapy for fifteen hours a week or even less than that sometimes. For some companies who are looking to incentivize teams, it's even less. It's just sessions and restructuring frameworks that are a little bit more behind the scenes. Typically, to develop a new habit or to say, “I want to make this one change and become second nature,” the statistics is usually anywhere from two weeks to several years. It depends on how much you structure that out and how many of your daily variables you're willing to work into that. I wish I had a clearer answer but it does depend on the impact and the magnitude of the change that is trying to be made.
Do you work with people remotely or in person?
I work remotely with parents mostly now. My motivation for that is because when I did work for a major health system, it was great. I'm so thankful that there are programs out there that take a child and put them into a clinic setting or a center. You work every day on these things because you're able to control the environment so much easier. If you have things like sensory defensiveness or you have other things that are constantly going on, it's harder to isolate some of these skills and work on them.
What I find in working in that setting is that we start to see a strong BCBA or therapist relationship between the child. The parent is like, “I don't know what these skills are. I don't know what they mean.” That breaks my heart personally as being a parent because the number one relationship is the parent to the child.
My program, Bloom Health, is very strong in regards to supporting the parent and making those changes at home. If you're already in treatment or if a child is already receiving therapy, what does that mean for the home life and how can we bring that into the home setting? Now, I do a hybrid. I'm in person for people who are local. I do a lot of online services coaching parents through the diagnostic process, interpreting treatment plans, and then making some of these changes at home, and trying to work with the variables that are in the everyday settings.
What are some of your favorite key takeaways, things to really think about, or the top three things where you're like, "Don't forget," that you want to impress upon families?
I know this is near and dear to your heart as well. This is something that I've had to learn along the way. No one tells you this, and it's a huge part of a child's intervention and treatment overall. It's to look at the whole picture, and it's completely overwhelming. You're given a diagnosis for a behavioral disorder, so your mind immediately thinks, "How do I treat the behavior part of it?" You don't think about what could physiologically be happening and what could be the elements in the environment that are going on.
If there's one thing that I've learned, and this is coming to you from gung-ho behavior belief. This is what I dedicated my life to. If there are things physiologically going on in the body or the environment that are working against a child acquiring new skills, then behavioral therapy will not work. You'll make minimal changes at a large risk of frustrating the child further. My number one is always asked and go from the inside out, "What could be going on here? What could be causing this?"
My son has acquired so many skills. You would never peg him as anyone to be on the spectrum. Now, he's in third grade with no support but if he has gluten, his behavior is wildly different. There are sources of wheat that are not gluten-related. There's constant inflammation. He'll get dark circles under his eyes and he would behave differently. You would never think something he's eating or something he engaged in the environment would affect his behavior but it does. Get the full scope, see the neurologist, an integrative medicine practitioner or a functional medicine practitioner, and get the blood work. See what's going on.
I've had patients who would only engage in aggressive behavior if they had some underlying infection. They would get infections all the time because of what they were eating and things in their environment that they knew nothing about. Number one is to work from the inside out. If there's a behavior occurring, see what possibly could be the basis or the medical explanation.
Another takeaway is to develop a team. I was told by a friend a long time ago, and it sticks with me, “You can't be Wonder Woman but you can be one wonderful woman.” When you're the parent, you're like, “I need to have it all figured out. I need to be the expert.” It’s understanding that you need people to be able to offer some fresh perspective. Once you have identified, "This could be a myriad of things that are going on with my child," get a team together and be the advocate that gets that team communicating. You want your pediatrician and your behavioral specialists to all be working and communicating with one another.
The third would be to try as hard as you can. It’s harder advise than you might think. Block out the negativity and try to focus on your day-to-day. I was told my son would never talk. I was told that he would rely on me for the rest of his life. He would never attend school. He would never have a relationship. When he was four years old, that seemed like a very distinct possibility.
He didn't have a relationship besides me keeping him alive, taking care of him, and getting him to therapies. It's so easy to project this idea that he's always going to need that and that's always going to be his story. Never did I imagine that at nine years old, he would have a more extensive vocabulary than me with two Master's degrees, and be in third grade without any support, have friendships where people are seeking him out.
People will tell you things because they need to prepare you for the worst possible scenario. But that doesn't mean you have to accept it.
You don't know what your child will be from here up until even a year from now. People will tell you things because they need to prepare you for what could be the worst possible scenario, but that doesn't mean you have to accept it. That doesn't mean that's your finality and you have to deal with that for the rest of your life because there's an exchange of willpower that goes with that when you think, “Is this all I could possibly be reaching for?” You stop your motivation and your reinforcement. You have to keep going. Even if it's the smallest little triumphs, you have to celebrate them and keep working because you never know. You’re constantly be asking, “We got over this hill. What's the next one?” You'd be very surprised at what your child can do.
Food is a hard thing for a lot of people too. Our food supply is not as great as it should be, and then making sure that they get a diverse diet. Do you have any suggestions on anything that none of us has time for?
I don't have time. I work from home. It's not even just time. It's finding the foods and paying the money for the whole foods that are out there. If you're trying to eliminate all possible ecological and medical insults that could be coming into your child's body, you'd have to buy 100% organic, and it's hard to do. Not to mention, your children can be picky. Even children who are not on the spectrum, most don't want to eat a diverse diet.
I would look at different ways that you could establish reinforcement for having a very good diverse diet. In perspective, my son went through some feeding therapy. It became established in our household like, “You can have a small portion of some of the things that you enjoy but let's focus on the reinforcement for things that are good for you and are going to make your body work well.” Involving him in that process was huge like saying, “These strawberries are going to help you grow stronger and feel good.” Once he started to get involved in the process of selecting things that he knew were going to make him feel better, it got easier for him to at least try new things.
Also, we offered incentives, “If you eat all of your strawberries, you can have five extra minutes of playing with Legos,” or others things that were incentivizing for him. I love when people make fresh-pressed juices that have all those good fruits and vegetables that even I can drink. I love them. They taste great. Also, look into your supplements. Kayden takes Hello Health every single day.
We strive to make sure that vitamins are good. If he is lacking in something, he's got a supplement for it. I love the emphasis on food as much as possible. That's what we're made for but it's impossible sometimes. Keep in mind, whatever he's not getting through the food, try to supplement with other good stuff.
In terms of mood and some of your experience, have you found certain things that help move the needle, whether it's Omegas or probiotics? Is there anything that resonated with you going through that?
Probiotics for sure. You don't think about it. If a child seems pretty regular in terms of digestion, you don't give a lot of thought to it, but probiotics are incredible. Your gut is your body's second brain. Seventy percent of our immune system occurs in the gut, which I learned that maybe from you. If the gut is functioning, then brain and overall immune system function are huge.
The omegas are great too because they help build up good brainpower. If my son doesn't get those things, I see a huge difference. He’s groggy, tired, irritable, and sleep issues happen. It's all these things that you think, “He's not sleeping. How do I get him on a sleep schedule? He's not going to the bathroom. Let’s give him some me MiraLAX or do this,” but if your gut and brain are functioning as they should, then you don't have those problems. The ones you mentioned are our staples, the probiotic and good Omegas.
Is there anything else that you like?
I love fiber. I stay away as much as I can from gluten and dairy. It's not that I believe that he is allergic to them. It's just that we've had to do weird stuff to these two particular products, and our bodies don't handle them well. Some people have a stronger capacity than others, so you may not see it. It does evoke a lot of inflammation in the body and the brain. As long as we're staying away from those two things, we tend to be good. If there are any few things, I try to make sure his diet does include good proteins, good fats, fruits, vegetables and fiber.
Do you have any particular favorite sources of fiber? Is there anything particular that comes to mind that you think is helpful?
The more fruits and vegetables you can get in there, the better off you are. I noticed a different vibrance. It's great too because they give that boost of energy that even for me, I would have gone to coffee or an energy drink. I find that if I eat an apple and drink a whole bunch of water has the same effect. I don't feel trashy later on. If you can take away one piece of advice, it's that fruits and vegetables are so critical.
I know for us, it was hard to get that stuff down. It got to a point where I was cutting it up really small, sautéing it and hiding it in meatloaf or ground turkey. I would hide it in chicken. The whole thing was crazy, and then it got to a point where I was blending everything up into a blender and telling them to drink it, and making stories about how there was ice cream even when there wasn't. It's not easy.
He was at a point where he only wanted to drink PediaSure shakes. Even the stuff in those has so much sugar. I was doing the same thing. I was blending everything up and putting protein powder in there that's plant-based and trying to pass it off in the PediaSure shake so that he's like, “It’s a PediaSure shake.” Maybe it tastes a little off. It's in this little container. It’s whatever I had to do, and then slowly we developed reinforcement strategies of, “I know that the spinach isn't your favorite but if you can eat this much of it, we’ll celebrate it in some other way. I don't want to give you too much junk, but you can have five minutes extra on your Legos.”
It became about making good choices and celebrating those good choices. The behavioral aspect is you're pairing that good nutritional choice with something that's reinforcing. Over time, if you look way back into some of the studies that have been done in Applied Behavioral Analysis, you're conditioning the two things together. In the back of your mind, it becomes way more reinforcing to have this other thing because it’s already been paired with this cool thing that you do like. Over time, it has a better atmosphere to it because you've paired it with reinforcement.
It became about making really good choices and celebrating those really good choices.
All this time at home has been hard on folks. Do you have suggestions in terms of whether you're forced to be online, at home or stuck under the same roof and you can't get a break?
As difficult as it may be, the structure does help. Getting yourself in a routine does help, and it's hard because you're your own motivator. I find this with myself too. Even knowing what I know about behavioral analysis, it can be very difficult when you're the person who has to come up with the motivation, to execute on it, and reinforce it. Know that the more you stick to your usual routine, your body has momentum. It’s very similar to running or any other activity where it's so much harder to start hard and then stop, and then start hard and then stop than to just keep even.
One, I would say come up with a very realistic routine and offer yourself some space for some wiggle room and stick to it as much as you can. Celebrate your victories and cut yourself some slack. Nobody expected a pandemic. Nobody knew that this was coming and we are all doing the best that we possibly can. Celebrate those great choices that you're making and treat every day as its own unique thing like, “I stuck to the routine today. Everybody's good. Everybody's healthy. That's a win.” Find the reinforcement in as many things as you possibly can.
Is there anything that you want to connect on that I haven't asked about or anywhere that folks should go to find more resources or ask more questions? It’s scary and hard when you're trying to navigate food, sleep and mental health. It’s too much.
It’s a lot. I would say, for one, check out BloomHealth.org. We're constantly posting free resources for parents. There are different sources of information and different blogs. We do offer consultations as well. These could be for questions that you may have in regards to setting up some of these routines and reinforcement contingencies. Also, we're licensed to be able to talk with you and help you see where you might be crushing it but not knowing it because you're in your own situation. We can advise small changes that you can make, so check us out for sure. If anyone is reading this but hasn't yet read the Hello, Health book, please do. It was a game-changer for our family.
There is such good information in there and it helps you understand the importance of the inside-out strategy in terms of behavior. Sometimes there's stuff physiologically going on with you, and that's a huge source of your lack of energy or motivation, so keep in touch with that. Another great resource that I depend on quite a bit is the UltraWellness Center with Dr. Mark Hyman. He's a functional medicine practitioner and has so much information about autoimmune disease and behavioral disorders in relation to nutrition and health practices. He's got a ton for you to think and reflect on, but then he's got stuff that you can do to help in your situation. Those are all my go-tos.
Thank you, Melissa. You are truly an inspiration. Amazingly, you started Bloom. I'm so happy that you're able to help so many people. There’s no doubt that all the testimonials and all the folks would be coming back to you in major force saying, thank you for getting Bloom Health.
I appreciate it. I appreciate you having me. You have helped me structure Bloom out from the very beginning when I was thinking, “I want to start something out for myself. It might look like this.” Hello Health has been such a huge part of that as well. Thank you too. Let's keep helping people find their way to a healthier lifestyle overall.
- Melissa Schiefelbein
- Applied Behavioral Analysis
- Hello Health – Vitamins
- Hello, Health
- UltraWellness Center