Bedtime Pass

Do you have a toddler that holds you hostage at bedtime? Do they still happen to sleep in your bed? The struggle to get kids to go to bed is real, we have all heard stories, and I am sure we have all counseled others on this problem. I would like to introduce you to the Bedtime Pass. Dr. Patrick Friman, and colleagues, have given us this great procedure to help with this oh-so-common issue!

The Bedtime Pass is an extinction-based procedure that allows the child to access their parents at one point after the bedtime routine has been finished, but not after that. They also can only use this pass once a night. The procedure goes a little like this; your child is given one bedtime pass. This could be something the decorate themselves, or something that you make for them. It just must be something that they have ownership of as well, make it fun! Then we teach the procedure; 1. Put the child in to bed, 2. Provide the card that can be exchanged for one “free” trip out of the room, or parent visit in the room to satisfy an acceptable request, 3. Give up that pass, 4. Ignore all additional attempts to seek your attention (Moore et al., 2006).

The last one (#4) is where it gets a little tricky because we need to be prepared for something called the extinction burst. This is where we can say that things will likely get worse, before they get better. There might be crying, screaming, and maybe some behaviors that are emotional in nature. But let me say one more time, it may get worse before it gets better! This can be the hardest part of the Bedtime Pass procedure, but we are going to stay strong. The research shows a significant decrease in bedtime resistance in three areas; calling out and crying, leaving the room, and time to quiet (Moore et al., 2006).

The Bedtime Pass is a great way to set limits and expectations to help kids be successful during bedtime routine. It also increases the independence of our kids, and allows them to have access to parents when they need it, versus when they want it!

Moore, B., Friman, P., Fruzzetti, A., & MacAleese, K. (2006). Brief Report: Evaluating the bedtime pass program for child resistance to bedtime—A randomized, controlled trial. Journal of Pediatric Society, 32(3), 283-287. https:// doi:10.1093/jpepsy/jsl025

Friman, P., Poling, A. (1995). Making life easier with effort: Basic findings and applied research on response effort. Journal of Applied Behavior Analysis, 28, 583-590. https:// 10.1901/jaba.1995.28-583

4 Tips for Desensitization of Everyday Tasks

Individuals with Autism are likely to become avoidant, non-compliant, and may protest with negative emotions when it comes to events such as: medical or dental procedures, haircuts, and eye exams (Buckley et al., 2020; Cavalari et al., 2013; Conyers & Miltenberger, 2004). Behavioral techniques called desensitization, graduated exposure, positive reinforcement, stimulus shaping, and modeling are used to help increase the levels of tolerance related to the fields and others similar listed above (Cavalari et al., 2013).  These techniques do not always yield immediate results, which can be frustrating for our clients because they are required to be repeatedly exposed to non-preferred tasks. It can also be nerve racking for their caregivers at times because they want to see the child succeed and attend appointments with ease.

  • Little successes along the way are just as important as reaching the end.
    • Remember to praise every accomplishment along the way whether big or small. Positive reinforcement plays a key role in encouraging the client to keep working at building their tolerance.
  • Try not to jump the gun!
    • Sometimes we can get a bit too excited about the increase in progress that we are seeing and are tempted to move at a faster pace or skip steps. It is critical to not fall in this trap! A negative outcome can result in an extreme regression of progress and put the child back to square one. Remember slow and steady wins the race!
  • Encourage the client to express their concerns.
    • We can observe that our clients have negative emotions pertaining to the procedure, but are they able to tell us what about it they do not like? Also, do they understand why the procedure needs to occur in the first place? Making space for dialogue is important in increasing tolerance as well. If we understand that our client is primarily afraid of the squeeze of the blood pressure cuff, then we can adjust our focus to that specific area. Explaining that the squeeze only lasts a couple seconds and not forever (with a model most likely) can provide a peace of mind.
  • Let them take the lead.
    • A possible reason for engaging in avoidance or noncompliance with these kinds of procedures is due to the feeling of having no control. Try having your child or client take the lead with roles reversed, meaning have them be the doctor and you be the patient! This can help increase confidence levels and give them that sense of control back.


Buckley, J., Luiselli, J. K., Harper, J. M., & Shlesinger, A. (2020). Teaching students with autism spectrum disorder to tolerate haircutting. Journal of Applied Behavior Analysis, 53(4), 2081–2089.

Cavalari, R. N. S., DuBard, M., Luiselli, J. K., & Birtwell, K. (2013). Teaching an Adolescent With Autism and Intellectual Disability to Tolerate Routine Medical Examination: Effects of a Behavioral Compliance Training Package. Clinical Practice in Pediatric Psychology, 1(2), 121–128.

Conyers, C., Miltenberger, R. G., Peterson, B., Gubin, A., Jurgens, M., Selders, A., Dickinson, J., & Barenz, R. (2004). AN EVALUATION OF IN VIVO DESENSITIZATION AND VIDEO MODELING TO INCREASE COMPLIANCE WITH DENTAL PROCEDURES IN PERSONS WITH MENTAL RETARDATION. Journal of Applied Behavior Analysis, 37(2), 233–238.

Differential Reinforcement of Low Rates of Responding (DRL)

Have you ever had your child, or any child really, ask you 100 questions in rapid fire succession? Have you ever had a student who raises their hand to answer every question in the lesson, and then becomes frustrated when they haven’t been called on each time? Most of us are not alone in answering these questions with a yes, because these are pretty common situations to find ourselves in. Enter, differential reinforcement of low rates of responding (DRL). Simply put; do this, but not so much, or not so often!

DRL has three different procedure components; Full-Session DRL, Interval DRL, and Spaced-Responding DRL. One of the best components of DRL is the fact that the reinforcement is not delivered based on the nonexistence of the behavior, but delivered when the behavior is below a set criterion. Let’s look at Full-Session DRL in a little more depth. In this specific procedure, reinforcement will be delivered at the end of the session, so long as the behavior occurred at or below a specified number of responses. For instance, a student leaves their seat without permission quite a lot and that starts to distract others in the room. After collecting data to see how many times the student gets of out of their seat, we determine an appropriate amount that would be allowed during a specified time frame. Using a Full-Session DRL procedure, the specified reinforcer would only be delivered if the student got out of his/her seat at the specified amount, or lower. If the out of seat behavior happened more than the specified amount, then reinforcement would be withheld!

This procedure would be great to use for behaviors that do not need to occur at zero rates, or simply need to lower the rate at which with they occurring.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2014). Applied behavior analysis (pp. 492-493). Edinburgh gate: Pearson educational international.


Reducing Burnout in the Behavioral Health Field

Burnout is a term that we hear often in today’s society. It’s a social issue that companies and organizations have been trying to solve for years now. But what exactly is burnout? Burnout is characterized as depersonalization, emotional exhaustion, and reduced personal accomplishment that stems from one’s inability to cope with long-term work stress. No one is immune from burnout, but it has been found that it hits some harder than others. Research shows that longer work days, imbalance of demand and resources, and conflicts at work are risk factors of burnout. In the behavioral health setting and special education challenging client behaviors can be considered a contributing factor to burnout among behavior technicians. This could lead to turnover in staff and disruption in services for clients. Burnout in an organization could also cause poor performance for behavior technicians that stay and additional stress for those that don’t leave. Behavioral health field organizations can assess, intervene, and monitor to reduce and combat behavior technician burnout. 

  1. Assess. Organizations and employers can look at the performance and missed therapy sessions as the first step to look for burnout in employees. Then administer additional surveys like Maslach Burnout Inventory and Areas of Worklife Survey. The Maslach Burnout Inventory is a human services survey that addresses emotional exhaustion, personal accomplishment, and depersonalization. Emotional exhaustion measures feelings of exhaustion by one’s work and being emotionally overextended. Depersonalization measures the impersonal response and unfeeling toward recipients of one’s services. Lastly, personal accomplishment measures feelings of successful achievement and competence in one’s work. The Areas of Worklife Survey scales include workload, reward, control, community, fairness, and values. 
  2. Intervene. Organizations can provide staff training for Behavior Technicians that include peer mentorship, RBT round tables, and professional development. Using evidence based practices for behavioral skills training and behavioral coaching can improve feelings of personal accomplishment in employees. One of the most important interventions that can be used is self-care. Self-care is any intentional activity to take care of our emotional, physical, and mental health. Organizations should infuse self-care and follow through with behaviors that promote self-care among employees, not just saying it’s important. This could be a team building opportunity for companies and their employees. Self-care has been shown to improve mood and decrease anxiety. 
  3. Monitor. Companies and organizations can re-administer surveys and look at performance periodically. In addition to the Maslach Burnout Inventory and Areas of Worklife Survey, have employees complete an increase/improve reinforcement survey. With on-going data analysis, organizations can use the BHCOE to be a third party assessor. Depending on the data, if it’s working then keep doing it. If the data is not then go back and reassess, come up with a different intervention plan, implement, and assess again. And the easiest thing for companies to do about combating burnout, ask the employees how they feel. 

In the behavioral health field, burnout is when workers become emotionally fatigued and withdraw emotionally from their clients. Burnout leads to turnover in employees that decide to leave and added stress for those employees that stay. For those employees that leave, they often look for less emotionally draining jobs in different career fields. Reducing burnout in the behavioral health field will help improve services for clients and improve the performance of behavior technicians. Organizations can assess the employees and how the burnout is affecting them, intervene by implementing surveys and self-care programs, and monitor the results. Addressing the emotional exhaustion and depersonalization with self-care activities and reduced personal accomplishment with professional development and continuing education trainings. No one is immune to burnout, but with a plan and companies help to reduce burnout, it can be reduced and managed.


“Burnout.” Burnout – an Overview | ScienceDirect Topics,

5 Tips for Toilet Training

“We’ve tried potty training this week and I broke down crying within the first day,” is something I’ve commonly heard from parents when they start this new routine. Potty training is a phrase that can bring both excitement and fear to a parent’s routine. While most are excited for less diapers to consume their house, it can also bring tough moments figuring out when the child is ready to potty train, what the child is motivated by and how long it will take for them to be independent on the toilet. These factors can be overwhelming to tackle all at once but breaking them down into systematic steps and becoming organized with a routine can create ease into a new routine for both the child and the family. Here are a few pointers to help create a calmer environment for both the potty trainer and the family along the way:

  1. Have the bathroom stocked– It is important to have the bathroom full of supplies from underwear to clothing in case of accidents as well as creating a fun space for the potty trainer with toys and food that are used for potty training. 
  2. Set out toys and treats exclusive to the bathroom– This will make the bathroom space more inviting and motivate the potty trainer to want to go to the bathroom more often because of the items inside. 
  3. Create visuals and read stories that talk about bathroom routine– This will show the child the process of using the toilet and washing hands which will help them to understand the process in a more direct way and will normalize the bathroom routine in their everyday life.  
  4. Stick to consistency- As the old phrase says, “practice makes perfect”, and in potty training this remains true as it will help the potty trainer to practice no matter the environment to gain the skill and decrease the time needed to potty train. Also, remaining consistent with the type of underwear used will help the child to be able to understand the routine and to be able to engage the senses to gain independence in the skill. 
  5. Allow others to be a part of the routine and go on field trips- Let’s be honest, you’re going to need a break at some point, and other family members will need to know what the routine is for your child so that they can help them in different environments or when you’re not there. It’s also important for your child to be able to use different toilets in places that they frequent including school, stores, and places you go for community outings such as the library. 

This is an entirely new routine for yourself and the child. Giving yourself and the potty trainer some forgiveness during this process is crucial. Reach out to family members and friends for help and remember that this is temporary. Pretty soon you’ll have a full fledged potty trained child!


Graphing and Applied Behavior Analysis

Graphing in Applied Behavior Analysis is how we determine if the treatment being provided to your child is showing a positive change. Graphs also allow us to adjust our interventions unique to the client to provide the best care applicable. When asked for clarification on reliability and validity we can refer to these graphs and feel confident when explaining the reason for our interventions. In this field we take pride in making sure that everything we do is based on reliable and valid empirical research.

Parents Reading Research

When a parent has come to learn their child has been diagnosed with Autism Spectrum Disorder (ASD) or even find their child engaging in a new problem behavior, it is likely they are filled with an abundance of questions. When questions aren’t answered sufficiently or are not answered in a timely manner it is likely that the parent will rely on books. This can be overwhelming for parents, who are buried in research full of numbers and graphs that are incomprehensible. It is important that these graphs are clear to understand for any reader. It can become frustrating when the parent is attempting to find what will best aid their child, but they are unable to find an answer due to faulty or confusing data. As you keep reading, I will point out some key components of graphs that are essential and explain why.

Graphing in an Applied Setting

When working in an in-home setting, the Registered Behavior Technician (RBT) is consistently taking data on the programs given unique to your child’s based on their goals and behaviors. The RBT is trained prior starting the job on how to correctly input data into their system or independently graph the data by hand. This data is then provided on a graph for the Board-Certified Behavior Analyst (BCBA) to examine. If paper data is being utilized, the RBT should spend the last minutes of session correctly drawing in data points and figuring percentages.  The BCBA will analyze and adjust interventions when they supervise the RBT or meet with the family.

There are rules for graphing that every person creating and examining graphs must know. There are general rules that everyone learns in school, such as the graph must have an X and Y axis and be labeled. However, there are a few rules that unfortunately are not practiced by many, which are vital details needed for the graph to be displayed correctly. The components I am going to focus on are: making sure the data points are legible for any reader, the use of the proportional construction rule, using an appropriate unit of time, and subjective VS objective language.

The Importance of Data Points

There are many issues with the graph above but here we are going to mainly focus on data points. In this graph we see a positive trend, this is good, that means one of our goals is increasing! Yay! But wait.  How do I know how fast the client reached this success? What did their progress look like? Here is where data points come in handy. Let me show you the difference it makes.

I have personally added my own data points to the graph. With this visual I can recognize my client started increasing at a slower rate and later moved up to a more consistent rate. Data points allow the BCBA to recognize possible errors in intervention and can compare graphs across multiple providers to ensure consistency and that our client is effectively generalizing the material appropriately.

Proportional Construction Rule

Now we have a complete graph! Right?  Not quite.  Now we need to make sure the graph is now proportional. Graphing rules state every graph must 2/3 or 3/ 4 proportional (Cooper, Heron, and Heward 2007) Why is this important? When this rule is not utilized it allows for individuals to either attempt to exaggerate or depress their data. Obviously, that is not ideal if we want to provide the best care for our clients. I have provided visuals below.

The graph above is a correct proportional graph. I have added black lines representing the two-thirds and three-fourths proportion. If you examine the graphs below, I extended the X-axis in one and the Y-axis in the other. As you can see when the x-axis is extended it depresses the data and when the y-axis is extended it exaggerates the data. The creation of these false graphs can allow the researcher to conclude that their study’s treatment data represents a higher significance or mistakenly, examine no significance than the actual results.

Units of Time

In the next graph below, we are going to focus on the term “sessions”. The National Institute of Standards and Technology (2020) explained that units of time are seconds, minutes, hours, days, weeks, years, centuries, etc. Now, let’s examine this graph. Are you able to tell me how long it took for the researchers to collect this data? The answer is no. When looking at this graph I wonder, was it nine 5-minute sessions in one day? Was it one session a week for nine weeks? Was it one session per day for nine days? We all deserve to know! If we were to use this data to incorporate into our interventions, we want to be able to hypothesize when the change in behavior from our intervention should arise.

To think about it another way, imagine your child is engaging in self-injurious behaviors. How quickly do you want the intervention to decrease the behavior? I think you and I can both agree on, as soon as possible. Based on the labels in the graph above we cannot be certain that using the techniques from this study will minimize the behaviors as quickly as we would like due to no clear unit of time represented.

Subjective VS Objective Language

While you are reading these articles, you may come across some subjective language the researchers use to help explain their graphs and results. An example of this is rapidly VS moderately VS gradually increasing or decreasing trends. There is currently no research out there expressing the criteria for what is considered rapid, moderate, or gradual. Therefore, it is subjective. Trends are only represented objectively in four ways: increasing, decreasing, or maintaining also known as zero.

Final Word

Data points, proportion construction of graphs, unit of time, and objective language are all essential components for a graph to have in order to fully understand the data being provided. Keep these in mind when reading research articles.  Some studies may state that their data represents as significant, but you can always double check by looking at how they administered their graph.


Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Hoboken, NJ: Pearson Education, Inc.

Graphing and Applied Behavior Analysis . (n.d.). Retrieved from

National Institute of Standards and Technology. (2020, March 31). Unit and Systems of Measurement. Retrieved April 6, 2020, from

The Power of Visual Supports

I remember the first time I realized how powerful visual signs were in my environment. I was fifteen and sitting with my driver’s education booklet trying to memorize all the signs that were important to pass the driving test in order to get my learner’s permit. These particular signs were vital tools to help me stay safe while interacting on the road with other vehicles. In the same way, visual tools can be powerful supports for those in the special needs community. 

Visual supports come in many different types such as videos, objects in the environment, pictures, symbols and written words that can be used across many different types of devices such as ipads, phones, or as printed tangible images. 

Visuals can be used in powerful and various ways to help those with special needs, for example:

Visuals are helpful to explain a task or a combination of skills placed together such as hand washing, getting a haircut, or playing a game with others such as go fish. 

Visuals illustrate a story such as a social story that communicates a specific message, such as the book “My Mouth is a Volcano” By Julia Cook which teaches an idea of properly asking for a turn to speak. 

Visuals are capable of forming different types of communication such as providing an image of a toilet to request going to the restroom or providing an image of an angry face to communicate the emotion of anger. 

Visuals combined together can create items such as a token system, reward chart, or a schedule to provide structure in a daily routine, or increase the wait time before receiving an item.  This last example increases the delay between when a task (or tasks) is presented and the reward being given. A real life example is a token chart where a child earns a candy every five times that they successfully use the bathroom, with the goal being to increase the number of times the child can go without receiving the reward. 


Visuals provide those in the community a compelling way to provide the learner the ability understand in-depth concepts, build their confidence, provide structure in routine, and allow the opportunity for interaction with others. Visuals are integral to the environment as an engine driving the communication to those in the community. 

Just as I learned in Driver’s Ed, visuals remain necessary for everyone in each community, not just the neurotypical or neurodiverse populations. Learning how to use visuals will continue to help bridge gaps, however small, between the two communities. 


Gerhardt, P, Cohen, M. (2014) Visual supports for people with autism: a guide for parents and professionals. Woodbine House   

Cook, J., & Hartman, C. (2019). My mouth is a volcano! Chattanooga, TN.: National Center for Youth Issues.

Visual supports. (n.d.). Retrieved December 06, 2020, from


Autism Services of Kansas Recognized as a TOP Behavioral Service Provider in the U.S.

The Behavioral Health Center of Excellence (BHCOE) has awarded Autism Services of Kansas with a three year accreditation, recognizing the organization as a top behavioral service provider in the country. ASK is currently one of 18 companies to earn this accreditation in the U.S.  The accreditation celebrates exceptional behavioral health providers that excel in the areas of clinical quality, staff satisfaction and qualifications, and consumer satisfaction. These areas are measured via a wide-ranging audit, including interviews with agency clinical leadership, a detailed staff qualification review, anonymous staff satisfaction survey, and anonymous consumer satisfaction survey.


A BHCOE Accredited ® Organization is an applied behavior analysis provider that has demonstrated it has met and continues to meet an assortment of clinical and administrative standards as determined by an independent third-party evaluator.


No, providers are not given the accreditation, it is earned. Providers are evaluated on a number of measures related to clinical quality.


The BHCOE Accreditation serves as a consumer protection mechanism that indicates the organization to quality improvement, transparency, and accountability. Collectively, BHCOE’s lead a growing movement of behavioral health
providers that aim to increase the collective quality of services across the United States.

The BHCOE Accreditation requires that the company continue to meet the Code of Effective Behavioral Organizations. As an employer, you know that your organization’s success starts and ends with its employees.

The BHCOE distinction demonstrates to employees that their company cares about their feedback, is able to look internally, and can set goals for
continuous improvement.

The BHCOE distinction demonstrates a company’s commitment to complaint resolution. Accredited providers are required to respond to compliance concerns brought forth to BHCOE regarding best practices. Many organizations utilize the compliance process to ensure that consumers and staff have a voice to file compliance concerns and resolve any areas of improvement internally. Think of the compliance review process as a mechanism to create a complaint resolution process that relies on independent third-party evaluation.

Learn More About the BHCOE

Tips for Whole Body Listening

What is whole body listening? It is often described as a set of behaviors that are needed to show others that you are paying attention to the conversation or activity that is taking place. The brain thinks about what the speaker is saying, the eyes are towards the speaker, body facing the speaker, mouth is quiet, and a calm body. However, whole body listening also involves perspective taking, feeling, and thinking. Teaching whole body listening helps children take the perspective of others and to show others like teachers or peers that you are listening and part of the group. While using whole body listening, children can become aware of their brains and bodies and ways to help them attend to others. It’s important as providers, parents, and teachers to understand that whole body listening come with challenges. Listening can be a difficult skill for children and most of the time they must demonstrate that they are listening to the speaker. In our culture, if you do not appear to be listening it can cause offense and lead to others having a negative reaction. But it is important to remember that everyone listens in their own way. How we show we are listening depends on cognitive and sensory regulation. Here are some tips for the eyes, mouth, and body for children to demonstrate whole body listening.

  1. Eyes- Look towards the speaker but remember this does not have to be directly. Have the child look at and observe facial expressions of others. To help children focus with their eyes, limit visual clutter and distractions. Remember that eye contact can be difficult, stressful, and overwhelming for some people.
  2. Mouth- Children can chew on gum, chew jewelry like a necklace, or drink water. This allows the child to receive the sensory input needed and they can also practice impulse control. While they are chewing or drinking, children are practicing thinking before speaking. However, some children need to produce verbal sounds to stay calm and process what is being said.
  3. Body- While listening and processing to speakers, have children squeeze hands or have a fidget available. Explore sensory exercises and strategies like deep breathing or adaptive seating. Some children need movement to feel comfortable and attend to others. This could be flapping or moving hands or moving around the room.

Whole body listening is not an easy skill for children and the process is complex. Children are expected to look towards the speaker with their eyes and body, keep their mouth quiet, their body calm, and process what is being said. Teaching children whole body listening develops into active listening as teens and adults later in life. Paying attention and listening are essential for learning and communication. Using these tips can help children stay alert and attend while others are speaking. Teaching children to use whole body listening can be beneficial for children to learn, grow, and succeed.

Resources: Sautter, E. (2019). Social Thinking Articles. Retrieved July 23, 2020,

How to Teach Expected and Unexpected Behaviors

An expected behavior is a behavior that keeps others calm in situations. This could be being quiet during circle time, sitting at the table during snack, or standing in line with the class. An unexpected behavior is a behavior that other people might find stressful or could make someone feel uncomfortable in the situation. Unexpected behaviors could be a child talking loudly during circle time, running around during snack, or having a tantrum in line with the class. These unexpected behaviors can affect how others perceive the child and could lead to being in trouble with the teacher or other adults. To increase expected behaviors, reinforce these behaviors when you see children engaging in them. Here are three things to remember when teaching clients or students about expected and unexpected behaviors. 

  1. Do not skip over the thoughts and feelings. Perspective taking and interacting with others starts with children understanding their own thoughts and feelings. They need to recognize that with their thoughts and feelings, that other people have thoughts and feelings as well. If children do not understand this, then “expected” and “unexpected” has no meaning to them. 
  2. Make your expectations clear. Let your children know the plan, so they understand what is expected of them. If you do not give them your expectations, it will set them up for failure and lead to unexpected behaviors. 
  3. Listening to your body is important. The body is the part of communication that is often forgotten about. You use your whole body to move closer to people to indicate you want to communicate or join the group. If a child is not aware of what his or her body, then it makes it difficult to show his or her intentions to the group. This could increase unexpected behaviors, but the child is unaware of this. 

Expected behaviors are the socially aware behaviors that occur in everyday life like walking quietly in line or sitting for circle time. Unexpected behaviors can be considered tantrum behaviors or lead to tantrums for children. Instead of focusing all your attention on a child’s unexpected behaviors, pay attention to the expected behaviors. When teaching your clients or students it is important to include learning about the thoughts and feelings of others, listening to your body, and make your expectations for the child clear. What we do and how we act affects how others think about us, increase your child’s expected behaviors and watch them grow socially. 



Reinking, R. (2017, September 27). Social Thinking Articles. Retrieved July 2, 2020,