ABA therapy is a relatively new area of practice, but it’s widely recognized by pediatric specialists as a highly effective form of early intervention for children on the autism spectrum.
ABA – short for applied behavior analysis – is a type of one-on-one behavior therapy that’s based on learning theories. It helps boost a child’s independence and overall quality of life – short-term and long-term – by providing evidence-based guidance and support for the development of social and emotional skills. Unexpected or dangerous behaviors are reduced, while helpful/expected behaviors are positively reinforced.
Experts have concluded the earlier it starts, the more effective it is. Ideally, kids will begin ABA somewhere between ages 2 and 5, though it’s not unheard of for a child to start younger or a bit older.
While many children may struggle with “behavior issues,” ABA therapy is uniquely reserved for children with specific diagnoses for which this intensive, interpersonal therapy has proven beneficial. It’s considered the “gold standard” for autism treatment, but can also be great for helping children with conditions like Down syndrome or global developmental delay.
Insurance companies in Florida are required by law to cover medically necessary therapies – including ABA therapy – for children with autism, Down Syndrome, and other “eligible” conditions, though the exact diagnostic codes that would qualify a child aren’t expressly defined in the statute. What we can say is that kids who do not have a diagnosis of autism, Down syndrome, or developmental delay will have a tougher time securing insurance coverage.
We know this can be a bit confusing for families. At FOCUS, we’re committed to providing the best answers and insight we can, and to helping parents navigate this process.
FOCUS Therapy offers ABA therapy and ADOS testing to children in Lee County, Florida. Call (239) 313.5049 or Contact Us online.
Many ABA therapy providers in Southwest Florida share similar approaches and philosophies with respect to evidence-based methodologies and evaluation standards. That said, there are different schools of thought when it comes to the optimal treatment setting – whether that’s in-clinic, at school, at home, or some hybrid combination. At FOCUS Therapy in Fort Myers, we prefer in-clinic ABA therapy for our patients – and there are tons of good reasons why.
ABA stands for Applied Behavior Analysis. It’s widely recognized as one of the most highly-effective, child-oriented, results-driven therapy for kids diagnosed with autism spectrum disorder. It’s also proven very helpful for kids with traumatic brain injuries, oppositional defiant disorder, obsessive compulsive disorder, attention deficit/hyperactivity disorder, and Down syndrome. These conditions don’t have a “cure,” per se. What ABA therapy does is teach appropriate/safe/expected behaviors while minimizing and extinguishing inappropriate/unsafe/unexpected behaviors. Individual target goals may differ, but most long-term goals involve improving kids’ independence, safety, social skills, academic participation, and community engagement.
Although the skill of the therapist is certainly important, so too is the setting where therapy is provided.
Among the many upsides to Southwest Florida in-clinic ABA therapy:
- Easier transitions to (pre)school. For most families, the goal is for their child to ultimately transition to a mainstream learning environment. In-clinic ABA therapy can better prepare kids for that transition, structuring environments that more closely mirror their experience in school so that their skills are more easily generalized.
- More opportunities to teach and learn social skills. When our registered behavior technicians (RBTs) and board-certified behavior analysts (BCBAs) are working with children in the clinic, there are going to be inherently more opportunities for social interactions – both with peers and adults. We can practice key skills like turn-taking, recognizing social cues, and self-regulation/coping skills.
- Better quality of care and supervision. This is not to say at-home ABA therapy providers don’t provide adequate care. But when we have multiple RBTs, BCBAs, speech therapists, occupational therapists, physical therapists, and support staff on-site, there are simply more eyes, ears, and hands if challenges arise. Plus, it gives supervisors the opportunity to regularly observe, make recommendations, and ensure treatment is on-track. They can see what’s happening in real time (rather than relying on RBT notes after the fact) and are able to make immediate modifications as necessary.
- Multi-disciplinary setting. Lots of the kids we treat at FOCUS require numerous therapy interventions. If your child needs ABA therapy, speech therapy, occupational therapy, and/or physical therapy, you can get all of that in one location. But parent convenience is just part of this benefit. When you have highly-skilled pediatric therapists in a broad range of disciplines all working in close proximity to each other, it creates opportunities to learn from each other. A speech therapist might notice an issue in passing that an RBT wouldn’t have immediately identified – and offer possible solutions. Those kinds of interactions and collaborations happen all the time – and we encourage them because kids get optimal benefits when we approach treatment from the “whole child” perspective.
- Tons of positive reinforcers. Every parent can recall at least one time their child was super into something – and then just suddenly decided they were ALL SET with it. Like, all they want to eat every single morning is a strawberry Pop-Tart, so you eventually go all-in and buy the Costco size – only for them to decide two packages in, they never want to see another strawberry Pop-Tart for as long as they live. Reinforcers in ABA therapy can be like that too. These are the unique-to-each-child incentives used to encourage interactions and activities that allow us to target behavior goals. But what a child was willing to work for one day might no longer interest them the next. With in-clinic ABA, the therapist has immediate access to TONS of alternative reinforcers – games, puzzles, books, sensory gym, etc. We can quickly find the “next best thing” and go from there.
- Easier transitions when there are staff changes. As much as we love and value our amazing ABA therapists, they don’t always stay forever. For these kids, transitioning from one therapist to another can be a major challenge. But when kids receive behavior therapy in a clinic setting, there’s a good chance that their new therapist is a friendly face they’ve already seen and directly interacted with.
- In-clinic ABA therapy works. Like, really well. While there’s no one-size-fits-all approach that works for every kid in every therapy, it’s been our experience that in-clinic ABA provides the most “bang for your buck” in terms of results – and a conclusion solidly backed by research. Just one example: A National Institute of Health study analyzed the effectiveness of at-home ABA therapy vs. in-clinic ABA therapy. They controlled for variations in individual child skill sets by treating the same group of kids in both settings at different times, and then tracking their progress during each. Kids treated in-clinic mastered 100 percent more skills-per-hour compared to those treated in their homes.
With in-clinic ABA therapy at FOCUS, we’re able to provide the best quality therapy in a setting that is welcoming and fun as well as structured and safe. If you have questions about our therapy services or Fort Myers ADOS testing, reach out!
FOCUS offers ABA therapy and ADOS testing to children in Lee County, Florida. Call (239) 313.5049 or Contact Us online.
What Is Applied Behavior Analysis? June 23, 2021, Medically Reviewed by Jabeen Begum, WebMD
More Blog Entries:
Top 4 Benefits of In-Clinic ABA Therapy, April 2, 2022, Fort Myers ABA Therapy Blog
FOCUS Fort Myers ABA and Occupational Therapists on Expressing Feelings vs. Energy on the Autism Spectrum
As our FOCUS Fort Myers ABA and occupational therapists can explain, lots of kids with autism and ADHD have difficulty recognizing or describing their emotions. There’s actually a name for this: Alexithymia.
It’s not a medical condition in its own right, but lots of neurodivergent people describe it as very real, characterized by substantial and continued difficulty with emotional awareness. It was detailed in a recent study published in the journal Frontiers in Psychology.
Some neurodivergent people who experience alexithymia say that it’s easier to discuss feelings as levels of energy, which can seem a bit more tangible than emotions.
Our FOCUS Fort Myers ABA therapists and occupational therapists recently came across a resource created by the therapy consultants at AutismLevelUp.com that describes the various energy levels, and it inspired us to create our own visuals/explainer.
This idea of identifying energies versus feelings closely relates to the Zones of Regulation that our therapy team uses frequently. (i.e., Blue Zone 🔵 = Sad, Tired, Bored, Sluggish; Red Zone 🔴 = Mad/Angry, Scared, Out-of-Control; Yellow Zone 🟡= Frustrated, Worried, Wiggly, Silly, Excited; Green Zone 🟢= Happy, Calm, Focused, Relaxed).
Every person may have their own unique manifestations of these various zones or energy levels (i.e., one may become hyperactive when they are overly-tired – perhaps because they’re overstimulated).
The bottom line is that any time we can help kids better identify their feelings and/or energy level, the better able we are to help them learn the most effective self-regulation strategies.
Self regulation plays a key role in relationships, well-being and overall success in life. People who are able to manage their emotions and control their behavior are more prepared to manage stress, deal with conflict and achieve their goals.
If you have questions about the Zones of Regulation, identifying energy levels, or setting self-regulation goals for your child with autism and/or ADHD, our FOCUS Fort Myers ABA therapists and occupational therapists are here to help.
FOCUS Fort Myers offers ABA therapy, occupational therapy, speech therapy, feeding/swallowing therapy, and physical therapy to kids throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
More Blog Entries:
FOCUS Therapy Only Schedules Evaluations if We Have Space to Treat Your Child, Aug. 1, 2022, FOCUS Fort Myers Therapy Blog
The symptoms of sensory processing disorder may depend substantially on the type of sense that is impacted, how it’s impacted, and the severity experienced by each individual.
Sensory processing disorder occurs in each of our sensory systems:
A person might have just one sensory system that is affected, or they could have all eight, with various different subtypes. That’s why our FOCUS Fort Myers occupational therapists drive home the message that each child with SPD needs to be individually assessed – and treatment for every child is going to look different.
Those with sensory processing disorders have difficulty interpreting the sensory input they get. They might feel overwhelmed by sensory information – or they might crave it. They might seem to be untuned to the sensory input or feelings of others. They might be described as “clumsy,” “awkward” or “delayed.”
Here, we explain the main SPD subtypes.
Sensory Modulation Disorder
Sensory modulation disorder is when a person has trouble regulating their responses to sensory stimuli. There are three types of sensory modulation disorder:
- Sensory over-responsiveness. This is when a person may respond too soon, for too long, or too much to a type of sensory stimuli that most people find pretty tolerable or normal.
- Sensory under-responsiveness. This is when a person might be unaware of certain sensory stimulation. They might have a delayed response to it, or their responses could be muted or with less intensity than most people might show.
- Sensory seeking. This is when someone may be compelled to seek out sensory stimulation, but once they do, they may be ultimately unsatisfied or it only results in disorganization. At the very least, it may be seen as socially problematic.
Sensory Discrimination Disorder
The second type of SPD is sensory discrimination disorder. This is when a child may have difficulty interpreting the subtle qualities of people, places, objects, or environments. This can include:
- Auditory discrimination disorder. This would be trouble interpreting auditory/heard stimuli.
- Visual discrimination disorder. Trouble determining or interpreting visual stimuli.
- Tactile discrimination disorder. Trouble interpreting stimuli that is felt or touched.
- Vestibular discrimination disorder. This is trouble determining or interpreting stimuli that is experienced through movement of the body against gravity or through space.
- Proprioceptive discrimination disorder. This is difficulty determining or interpreting sensory stimuli experienced through joints and muscles.
- Gustatory discrimination disorder. This is when someone has trouble interpreting or determining sensory stimuli that is tasted.
- Olfactory discrimination disorder. Trouble interpreting/determining smelled stimuli.
- Interoception. Trouble interpreting internal organ stimulation. (They may not feel the need to use the toilet or they might have frequent stomachaches.)
Sensory-Based Motor Disorder
Sensory-based motor disorder is when one has trouble with motor coordination, balance, and performing skilled motor tasks.
- Postural disorder. Someone with postural disorder would have a skewed perception of their body position. Therefore, they’d struggle with poorly-developed patterns of movements that depend on stability of the core. They would appear to be weak or have poor endurance.
- Dyspraxia. This is when the person would have trouble thinking of, planning, or carrying out skilled movements – especially new movements they aren’t familiar with.
FOCUS Therapy Treats Kids With Sensory Processing Disorder
If your child struggles with any type of SPD, our skilled team of occupational therapists can help!
FOCUS offers pediatric occupational therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
What is Sensory Processing Disorder? March 31, 2022, By Janice Rodden, ADDitude Magazine
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Fort Myers Feeding Therapy Tips for Picky Eaters, July 24, 2022, FOCUS Therapy Blog
Evaluations are an important step in the process of securing speech, occupational, physical, and/or ABA therapy for your child. But parents and caregivers should be wary of facilities that offer these evaluations while lacking capacity to immediately treat the child.
FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco explains that unless her team is being called on for a second opinion of an initial evaluation, they refrain from conducting formal assessments if unable to promptly provide treatment once the evaluation is complete.
“A standardized assessment is only a snapshot in time during the child’s development,” Voltz-Ronco said. “It’s like taking a picture of a child now, and then expecting it not to change in a few months. … If your child cannot access therapy within 1 or 2 months of that evaluation, the results are no longer going to be accurate. Kids develop new skills every few months. But the longer the child goes without therapy, the more significant that standard score comparison/discrepancy to same-age peers is going to be.”
Beyond this, families who rely on insurance to cover the cost of these evaluations (and they aren’t cheap) should be aware that insurers typically only cover one evaluation every six months or so. Even though clinics can utilize standardized assessments administered by another, it’s not ideal.
“Your child gets the most benefit when the team that directly observed your child’s abilities and deficits are the ones who ultimately formulate a plan of care and follow through with treatment,” Voltz-Ronco said. “In my opinion, it’s unethical for a clinic to profit from an evaluation that reveals a child is delayed or needs intervention – without providing that help.”
Types of Pediatric Evaluations FOCUS Therapy Offers
Children are usually referred to FOCUS Therapy and other therapy specialists by their primary care physician. Evaluations are typically ordered when a child is showing some developmental deficit, such as not sitting up or crawling, not talking or making regular eye contact, or red flags for a possible cognitive deficit. They could also be diagnosed with a condition that we can pretty well say for certain is going to require some combination of therapy services (such as cerebral palsy, down syndrome, vision impairments or hearing deficits).
Depending on the child’s condition and identified areas of concern, qualified therapists will be scheduled to conduct age-appropriate assessments to determine the need for therapy intervention services.
The specifics of the evaluation may vary, but they are generally going to include:
- A look at case history, including medical status, education, socioeconomic, cultural, and linguistic backgrounds, and information from other providers.
- Child and/or parent interview.
- Review of the child’s auditory, visual, motor, and cognitive status.
- Standardized and non-standardized assessments of specific aspects of speech, non-spoken language, swallowing function, cognitive communication, etc.
- Assessment of self-care and/or self-awareness.
- Skilled observation. This is where we keenly observe an accurately record a child’s abilities and behaviors.
There are several different types of standardized tests (including the ADOS test for autism screening, which FOCUS Therapy also provides).
“If a parent wants a second or third opinion after their child has been evaluated by a school or another provider, that’s one thing,” Voltz-Ronco. “But they’re most likely going to pay for that out-of-pocket – and they’re going to understand the purpose upfront. But if parents are looking for action, to get the ball rolling on the therapy interventions that a child needs, then the clinic conducting the assessment should be able to provide that.”
Not all of them do. Therefore, it’s incumbent on parents to ask the question before scheduling the assessment.
“We’ve gotten calls from parents of children who were evaluated other clinics, only to be told after the fact that the clinic did not have the ability to treat their child,” Voltz-Ronco said. “They were told to just call around and see what other clinics may be able to use the report generated from their assessment. That, to me, is not ethical.
“It’s a situation where parents need to be aware of this issue, and make sure they are asking the question upfront: ‘If I schedule this assessment and my child needs treatment, do you have the capacity to provide that treatment?’ If not, I would advise parents to move on and find a place with the capacity and willingness to do both.”
FOCUS offers ADOS testing and other standardized assessments in Fort Myers and throughout Southwest Florida for children who may need speech therapy, occupational therapy, physical therapy, or ABA therapy. Call (239) 313.5049 or Contact Us online.
Assessment and Evaluation of Speech-Language Disorders in Schools, American Speech-Language Hearing Association
More Blog Entries:
ADOS Testing, FOCUSFlorida.com
When working with kids who have varying sensory struggles, it can be difficult to tell the difference between a tantrum or a sensory meltdown. Our Fort Myers ABA therapists recognize that it often takes some detective work to differentiate. But determining which is which is important when formulating the most effective response.
A sensory meltdown can be especially tough to identify because a child’s sensory thresholds can vary from day-to-day or even hour-to-hour.
Some behaviors that may be present in BOTH:
- Hiding or avoidance
Tantrums, however are typically a response to a child not receiving something they want or an anticipated outcome. Sensory meltdowns, meanwhile, stem from sensory overload, with reactions being to the big feelings that the overload can cause.
In the case of a meltdown due to sensory issues, parents may need to formulate a strategy that plans ahead, rather than simply react to the meltdown when it happens. That means meeting their sensory needs through a sensory diet (unique to each child) that can help them avoid feeling completely overloaded and overwhelmed.
We need to look carefully at the sorts of things that can trigger a sensory meltdown. Some possible meltdown triggers can include:
- Being overly tired or hungry.
- Generally not feeling well. (This can stem from illness, food sensitivity, overheating, etc.)
- Being expected to “hold it together” for long periods of time, such as going to summer camp, school, or on play dates.
- An abrupt change in routine – anything outside of the ordinary – can set off sensory overload.
Because the overload may not be immediate, it can sometimes appear like a meltdown “came out of nowhere.” But there is almost always a source when we look very carefully at the “antecedents,” or events that occurred prior to the meltdown. You may even have to go back a few days to pinpoint the cause.
Toddlers and preschoolers may be especially prone to tantrums because they do not have the motor, language, or problem-solving skills to work through some of their frustrations on their own. They may have an emerging desire to be independent, without having the skills to actually BE independent. They might have emerging language skills, and thus are unable to communicate what they actually want or need. They may have big feelings, but lack the prefrontal cortex development to emotionally regulate. They may have a growing understanding of the world around them, but also a lot of anxiety about how to move through it.
Tantrums usually only end when a child gets what they want or when they’re rewarded for better behavior.
Meltdowns, on the other hand, only end when the child tires out or the sensory input is altered. They stem from what we sometimes refer to as a “physiological traffic jam” in the central nervous system. There is too much overstimulation and feeling limited in your ability to “exit.” This can trigger a “fight or flight” response.
As parents, therapists, teachers, and caregivers, it’s important to recognize that the behaviors we’re seeing are not controllable behavioral reactions. Rather, they are physiological responses. This is why our Fort Myers ABA therapists and occupational therapists put such emphasis on identifying which is which so that you can appropriately respond.
With tantrums, you need to recognize the motivation or purpose, reinforce positive behavior, and build skills for success.
Meltdowns, however, can sometimes be avoided when we use visual schedules, social stories, and checklists to help kids know what is expected. There are no surprises or question marks. Reducing the unexpected changes in routine is going to reduce the overall stress that can trigger a meltdown.
We also recommend routine sensory diet activities, like scheduling quiet time or offering them breaks for sensory input.
Parents and teachers should also be able to recognize signs of a child’s distress. This could be covering their ears or rocking back-and-forth or humming or bolting from the room. Once you are able to quickly recognize the signs of overstimulation, you can respond to help them regulate before reaching the meltdown stage.
FOCUS offers pediatric ABA therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Expert Ways to Help Tame Tantrums and Manage Meltdowns, June 18, 2021, By Alescia Ford-Lanza, MS, OTR/L, ATP, Autism Parenting Magazine
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Study: Less than 1/2 Kids With Autism Undergo Early Intervention Therapy, July 30, 2022, FOCUS ABA Therapy Blog
Early intervention therapy for autism is crucial to optimal long-term outcomes for children on the spectrum. “Early intervention,” defined as a combination of speech therapy, occupational therapy, physical therapy, nutrition/feeding therapy, and ABA therapy, should ideally begin before age 3 to be the most effective. Yet a new study found that more than 50 percent of children with autism do NOT get the critical early intervention that has been proven to lay the foundation for yielding the best sustained results.
Researchers at Rutgers University analyzed the early intervention participation of kids with autism in one state, and found less than half were receiving early intervention therapies before turning 3.
The study, published in JAMA Pediatrics, revealed income and racial disparities unfortunately played a role in how likely children were to have access to early intervention. Study authors opined that the issue was likely worse in other states.
As our FOCUS Therapy Fort Myers team understands it, the researchers analyzed data from the New Jersey Autism Study, a monitoring system that was set up by the Rutgers New Jersey Medical School, focusing on the records of some 23,000 kids. They identified approximately 4,000 8-year-olds diagnosed with autism. Of those, only 1,890 of them had participated in early intervention therapy services. This was true even though these services are required by federal law under the Individuals with Disabilities Education Act.
To identify where the disparities were most prominent, the team analyzed information on wealth indicators (median household income, primarily) and discovered that kids who lived in areas with higher incomes were 80 percent more likely to have access to early intervention autism services than kids who lived in lower-income neighborhoods. They also learned that Black and Hispanic children were less likely to enroll in these services compared to their white counterparts.
Study authors stressed that understanding socioeconomic and cultural barriers to both early diagnosis and these essential therapy services are important components of helping improve education and access.
Early Intervention Therapy Key to Addressing Child Development Concerns
Autism Spectrum Disorder (ASD for short) is now diagnosed in 1 in 44 children in the U.S. As a broad range of conditions characterized by deficits in social skills, speech, communication, repetitive behaviors, and other challenges, the ripple effect of the condition impacts more than just the individual diagnosed. In fact, home carryover of early intervention therapies (speech, occupational, and ABA) is most effective when everyone in the home is committed to following our recommended strategies.
Our Fort Myers ABA therapists recognize that families – and neurotypical siblings in particular – may struggle with anxiety, depression, and social difficulties, as outlined in a recent study. On the flip side, researchers also found that children with autism who have a neurotypical older sibling tend to have better social skills than those who did not.
The key is striking a balance, and ensuring that both children are supported – and given the tools to understand each other.
A child with autism may, inevitably, demand more of a parent’s time, energy, focus, and resources. This may leave siblings of kids on the spectrum feeling as if they are being overlooked. It’s important to validate and address these feelings so that it doesn’t grow into a much larger issue as time goes on.
ABA therapy is considered the gold standard treatment for kids with autism spectrum disorder (ASD). But the process of starting this therapy is not as simple as calling and setting an appointment. There are several steps that must be taken to initiate the process.
It begins by recognizing the early signs of autism, and sharing these concerns with your child’s pediatrician. Doctors should screen all children at 18 months for risk of autism as a matter of routine – but parents absolutely can bring concerns to their doctors at any point. Signs of autism can be clearly identified as early as 12-months-old.
The doctor will then initiate a referral for a full assessment, known as ADOS testing. This test must be administered by a qualified provider. FOCUS Therapy does provide ADOS testing for children in Southwest Florida. The results of the ADOS test are then shared with a pediatric specialist, who ultimately makes the diagnosis and then issues a referral for early intervention services – such as ABA therapy, speech therapy, and occupational therapy.
If your child is under the age of 3 in Florida, they may qualify for early intervention services through a state program called Early Steps. This can serve as an important stop-gap, given that many private therapy clinics that offer Applied Behavioral Analysis in Southwest Florida have waitlists.
Our ABA therapy services at FOCUS Therapy are conducted one-on-one, in-clinic with experienced professionals called RBTs (registered behavior technicians), with oversight from a BCBA (Board Certified Behavior Analyst) and physician specialist.
If you have questions about autism screening, ADOS testing, or ABA therapy in Southwest Florida, our trusted team of therapists, coordinators, and insurance billing professionals can help.
FOCUS offers ABA Therapy and ADOS testing in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
What Are the Early Signs of Autism? HealthyChildren.org, American Academy of Pediatrics
More Blog Entries:
5 Fort Myers ABA Therapy Techniques, May 24, 2022, Fort Myers ABA Therapy Blog
Behavior therapy – specifically, applied behavioral analysis, begins with understanding the science of behavior. At our Fort Myers ABA therapy clinics, we use this understanding to employ specific strategies proven to help children with autism and other conditions achieve their goals – ultimately allowing them to gain greater independence and engage more fully with the world around them and people in it.
As explained by the American Psychological Association, ABA therapy is an evidence-based practice, meaning it’s supported by peer-reviewed literature. It identifies the motivation behind the behavior before addressing it with one or more proven strategies.
Each Fort Myers ABA therapy plan of care must reflect what reinforcements are most effective with that specific child, with clear goals we want to see them meet within a set time frame. Our ABA therapy team then works with kids one-on-one with them – day after day, week after week, and month after month, and sometimes year after year. We want to see them thriving in all environments – from home to school to play dates to community events – to the fullest extent of their capabilities.
Most all strategies involve some use of the ABC’s of behavior. That is, we study the Antecedent, then the Behavior itself, then the Consequence. By studying each element, we can determine what is the motive or what’s being communicated by that behavior – and then change either the antecedent or the consequence with the goal of altering the behavior.