SOS: SPECIALIZED OUTPATIENT SERVICES
ELIMINATE YOUR CHILD'S CHALLENGING BEHAVIOR - FAST.
CARD SOS provides services to individuals with and without developmental disabilities.
What is S.O.S.?
CARD's Specialized Outpatient Services (S.O.S.) is a unique service that targets a child's more extreme behavior which can make daily life difficult for a family. These services are a short-term intervention meant to fill any potential gaps not covered by other therapies. Our goal is to make the home lives of our clients as enjoyable and productive as possible.
The behaviors addressed by CARD S.O.S. tend to be more severe in nature. Often other providers have attempted unsuccessfully to address these behaviors. Utilizing the principles of Applied Behavior Analysis, the CARD S.O.S. team provides consultation and direct one-to-one intervention to reduce inappropriate behaviors and increase socially appropriate behaviors.
Duration of Services and Fees
CARD S.O.S. works with each family to determine particular needs. Our goal is to provide services in an effective and efficient manner. The duration and intensity of services are individualized. All assessment, treatment, and report-writing services are provided on a flat hourly rate. Please contact CARD S.O.S. to receive more information.
How to Get Started
CARD S.O.S. services families and individuals all over the world. However, because of staffing and logistical limitations, some services are only available in certain locations. For more information or to start the intake process, contact CARD S.O.S at 855-345-2273.Typically, after a brief phone consultation, we will schedule an initial evaluation and provide recommendations. Once accepted, services can begin.
THERAPY PROGRAMS: CARD CLASSES
The Center for Autism and Related Disorders, LLC. (CARD) offers a variety of customized, hands-on classes and seminars that provide ongoing development for families, caregivers, professional educators, clinicians, and students with the opportunity to benefit from over 150 years of combined experience in Applied Behavior Analysis (ABA).
CARD Classes are held at a variety of CARD office locations, as well as community centers around the country. Please click on the links below to learn more about each opportunity and register today! If you have any questions, please contact: (855) 345-2273
UPCOMING CLASSES
Social Skills Groups for Kids (Ages 6-12)
Ongoing classes
Fresno, California
Social Skills Groups for Teens (13-19)
Ongoing classes
Fresno, California
MORE DETAILS
SOS: CHALLENGING BEHAVIOR CLINIC
Autism presents families with numerous hurdles to overcome on a daily basis. Behavior problems are often one of the most cited concerns by parents. These issues not only inhibit the development of the child, but can curtail the activities of the family as a whole.
Common behavior problems seen within the autism spectrum that can cause significant harm to the child and others can include:
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Self-injury (self-biting, scratching, pinching, hitting, etc.)
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Aggression toward others
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Property destruction
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Pica (eating inedible objects)
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Non-compliance
Although perhaps not as serious, there are other sets of challenging behaviors that our clients display that make the home environment more challenging. These include:
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Sleep dysregulation
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Inappropriate toileting
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Inappropriate sexual behavior
Behavioral Intervention
Behavioral interventions have been utilized to address challenging behavior for decades. Between the years of 1960-1995, over 550 peer-reviewed studies were published documenting the effectiveness of Applied Behavior Analysis techniques in teaching skills to children with autism (Matson, et al, 1996). Currently, ABA-based interventions are considered to be the gold standard in intervention The CARD Challenging Behavior Clinic provides services for individuals with and without developmental disabilities, who display problem behavior in the home, school, and/or community setting. Utilizing the principles of Applied Behavior Analysis, the CARD S.O.S. team provides consultation and direct one-to-one intervention to reduce inappropriate behaviors and increase socially appropriate behaviors. Using state-of-the-art functional assessment procedures, presenting symptoms are identified and assessed. A function-based intervention is then developed to replace the challenging behaviors with newly-acquired, appropriate skills. Skills that are targeted for acquisition range from basic language and play skills to more complex social skills. Once new behaviors are mastered, CARD focuses on generalization of the newly-acquired skills to the home, school and community settings. Significant time and effort are invested in caregiver training to ensure that the child uses the new, appropriate behaviors with individuals besides the therapists.
SOS: FEEDING CLINIC
For many children and adults, great joy can be found in the act of eating. However, for some children, this seemingly simple act can cause great strain on the individual and the family.
Pediatric feeding disorders occur when a child does not consume enough food or liquid to gain weight and grow as expected. On a whole, feeding issues are relatively common in children and even more common in children with developmental disabilities. However, the severity of feeding issues can differ greatly from child to child.
CARD SOS CASE STUDY:
At the beginning of his services with the CARD’s SOS Feeding Clinic, Mitchell was small for his age, being within the 10th and 25th percentiles for height and weight for his age. Upon discharge, Mitchell is 37.5 lbs (on the 50th percentile) and 38 inches tall (between the 25th and 50th percentiles).
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MITCHELL
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BEFORE
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AFTER
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Age |
3 y 5m |
3y 10m |
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Weight |
30 lb |
37.5 lb |
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Height |
36" |
39" |
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Texture of Food |
Mushy (i.e. porridge, mashed potato) |
Regular texture, bite size |
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Seating |
High chair, bath, tub |
In age appropriate booster seat |
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Feeding Style |
Mom fed him |
Self-feeder |
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Amount of Time Per Day Feeding Him |
5 meals, each at least 1 hour |
4 meals, each averaging 30 minutes |
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Variety |
Less than 10 foods eaten consistently, only water |
Anything we put in front of him. At least 40 different foods |
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Inappropriate Mealtime Behaviors |
Gagging, crying, throwing up, cough, giving back food |
Almost non-existent |
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Chewing |
Swallowed food whole |
Self-regulates chewing |
A child with a feeding disorder may only eat a few foods, completely avoiding entire food groups, textures, or liquids necessary for proper development. As a result, children diagnosed with feeding disorders are at greater risk for compromised physical and cognitive development. Children with feeding disorders may also develop slower, experience behavioral problems, and even fail to thrive. Severe feeding disorders can cause children to feel socially isolated and often put financial strains on families.
There are many different types of feeding disorders, and they can take on one or more of the following forms:
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Difficulty accepting and swallowing different food textures
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Throwing tantrums at mealtimes
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Refusing to eat certain food groups
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Refusing to eat any solids or liquids
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Choking, gagging, or vomiting when eating
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Oral motor and sensory problems
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Dependence upon high-calorie substances
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Gastrostomy (g-tube) or naso-gastric (ng-tube) dependence
In most cases, no single factor accounts for a child’s feeding problem. Rather, several factors can interact to produce them. Feeding disorders typically develop for several reasons, including medical conditions (food allergies), anatomical or structural abnormalities (e.g., cleft palate), and reinforcement of inappropriate behavior. Unfortunately, at this time, the concise etiology of pediatric feeding disorders is still unknown.
While a wide variety of factors can contribute to feeding disorders, certain medical and psychological conditions may accompany feeding disorders more often, such as:
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Gastroesophageal reflux disease
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Gastrointestinal motility disorders
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Failure to thrive
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Prematurity
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Oral Motor Dysfunction (dysfunctional swallow, dysphasia, oral motor dysphasia)
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Food allergies
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Delayed exposure to a variety of foods
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Behavior management issues
Awareness of risk factors and clinical presentations of feeding disorders, combined with appropriate referrals at an early age, will produce the best outcomes for children and their families.
Feeding Disorders Within the Autism Spectrum
Although it has long been reported by parents, recent research has shown that there are significant differences in the eating patterns of children with autism and those who are neuro-typical. Children with autism are shown to be more selective in the types of food eaten, textures of food, and variety. Additionally, these children tend to need more specific environments and utensils (Shreck 2006). Nutritional intake is also seen to be lower for children on the autism spectrum (Bandini, 2010; Cermak, 2009).
Behavioral Intervention for Feeding Disorders
Behavior disorders (including feeding disorders) often involve an interaction of operant and biological variables. Behavioral psychology allows for systematic analysis of environmental variables. This allows the underlying function of the target behavior to be covered. Treatment intervention can then be developed fully when the function is known (Piazza 2003a).
Behavioral interventions have been shown to be useful in reducing and even eliminating not only tantrums and non-compliance during meals but, also, even the use of tube feedings (Piazza 2003b; Matson, 2005; Linschield, 2006). Interventions of these types have been published in peer-reviewed literature dating back to the mid-1970s.
The CARD Feeding Clinic provides services for individuals (a) with and without developmental disabilities, (b) who display difficulties in self-feeding or have problems such as partial or total food refusal or food selectivity by type or texture, and (c) who do not have a feeding disorder of a biological basis (as determined by a pre-screened medical examination).
Trained clinicians design interventions based on the results of a systematic assessment of an individual’s feeding problem. Intervention cane be provided either in the clinic or home setting.
As individuals show consistent improvement in feeding skills, caregivers are trained to implement interventions with clinician support. Treatment goals have been met once individuals demonstrate generalization to novel foods, and are eating well with caregivers in the home setting, and caregivers feel confident implementing procedures independently.
SOS: MEDICAL FACILITATION CLINIC
There are many ways to compromise medical interventions. One oft-cited reason is simply failure to comply with recommendations. This includes non-compliance with medication as well as regular testing, follow-up visits, and examinations. For children on the autism spectrum, this failure to comply can be taken to an even greater level involving tears and tantrums due to possible difficulties with sudden changes in environments and routines.
The Medical Facilitation Clinic provides behavioral services to individuals to assist in assuring the individual’s adherence to medical procedures. Medical procedures include, but are not limited to, the administration of oral medication (capsules and tablets), capsule endoscopy, physical examinations, dental visits, obtaining vital signs, and IV procedures. Families are required to show documentation of a thorough physical examination by a licensed physician prior to intervention.
After a review of the client’s medical history, our staff is able to design a personalized behavioral intervention to teach the client necessary new skills and to desensitize him/her to medical procedures. Once the individual has shown mastery of the specific procedure, all caregivers are trained to implement the successful intervention.
CASE STUDY
9-year old Eli was required to take 9 pills each day to adhere to his medical regimen. At the beginning of treatment, Eli willingly put the pill in his mouth, but was not able to swallow it. Using size fading, Eli began his intervention using very small placebo pills (tapioca). Once he was successful in swallowing that size, the size was increased systematically. When he was able to swallow the biggest pill size (capsule size 0), his mother began to run the sessions with great success.
SCHOOL CONSULTATIONS
The staff at CARD S.O.S. is thrilled to provide our services and experience to school districts.
The Individuals with Disabilities Education Act (IDEA) requires that IEP teams address behavior problems that interfere with a child's ongoing learning. This includes conducting a functional behavior assessment to determine the underlying reasons that the problem behavior occurs. Once the function of the behavior is known, an intervention based upon that function can be constructed. Function-based interventions are shown to be more effective and long lasting in addressing problem behavior
Staff members are able to meet with school personnel, families, and the children in order to conduct a thorough functional assessment. This can include:
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Indirect functional assessment
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Direct functional assessment
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Experimental functional analysis
All assessments are tailored to the individual child. Behavioral recommendations can be provided upon request to guide the formation of a child's Behavior Intervention Plan (BIP).