Bridges FAQ

1. I think my child may have an autistic spectrum disorder. What do I do?

Contact your pediatrician and ask for a referral for a possible diagnosis. Most children are diagnosed by developmental pediatricians, psychologists, or psychiatrists. Early intervention is crucial for your child's prognosis. While you are waiting for your appointment you may want to investigate some of the diagnostic tools used to screen for autism, such as the CHAT. A link to a full description of this can be found here. Remember, this is a screen, not a definitive diagnostic tool. Many other resources can be found to learn about autism diagnosis and treatment options. A good starting point would be FEAT, (Families for Effective Treatment for Autism), the Association for Science in Autism Treatment, or Cambridge Center for Behavioral Studies websites. Links to these are in the web link section of this website.

2. My child was just diagnosed with an autistic spectrum disorder. What do I do now?

First, remember that there is something you can do. If you are in California, contact your local regional center and start the process to become eligible for services. If your child is over three years old you may also want to contact your local school district for the options they may provide. We strongly recommend you contact your local FEAT representative for help with emotional support, sorting through the tangle of regulations and rights, advocacy if needed, and to obtain information about services. Your local school district and/or regional center will also have information regarding options for treatment and other services. You will need to research the various options available for your child before deciding which one is the most appropriate.

If you decide on an intensive ABA program we strongly recommend that parents view programs from various agencies before deciding which is best for their child. Some guidelines for researching the quality of different programs can be found in our presentation "Some Considerations When Choosing an ABA Program for Your Child," which is linked from this page.

The web site of the Sacramento area FEAT organization can be found on the web link section of this website.

3. What is ABA?

ABA is an acronym for Applied Behavior Analysis. Bridges uses an ABA approach for all of our clients. An excellent description of ABA can be found here.

4. What is discrete trial?

Discrete trial breaks down complex skills into single steps and teaches those steps in isolation to avoid the confusion many children on the spectrum have with complex tasks such as language.

Discrete trial training is one of the instruction procedures frequently used in ABA  programs. Discrete trial training is often abbreviated as DTT. Most of the time when a therapist is “in the chair” with a child at a table discrete trial will be the method used to teach.

Discrete trial is the teaching methodology that teaches one small piece of information at a time. Each discrete trial has three basic components – a stimulus (or antecedent) , the behavior (or response), and the consequence of either a reinforcer or the lack of a reinforcer depending on whether the child responded correctly.

An example would be in a lesson (also called a drill) such as receptive object labels.

The label being taught (we will use apple as our example) requires two parts for the stimulus.

The apple itself must be present and in the child’s view. This is called “in the field.” Generally there will be several objects in the field to insure that the child is discriminating the word “apple” and not just indicating whatever object happens to be in front of him or her.

The word “apple” must be part of the direction. This is specified at the top of the data sheet as “vocal direction” and is usually “touch apple”, though simply “apple” may be also be used.  The requirements for each particular child will be written under the vocal direction section at the top of the data sheet.

So in this case the stimulus (or antecedent) is the presence of the apple and the words “touch apple.”

The desired response (or behavior) is the child independently touching the apple.

The appropriate consequence is the reinforcement of the desired response. If the child does not give the desired response the appropriate consequence is the ending of the trial without reinforcement.

Discrete trial training is used to teach individual pieces of information. Once enough of these individual or discrete units are learned, entire concepts can be acquired. In the apple example above not only is the word apple being taught, but the underlying concept that a sound can symbolize an item is also being taught. Once several discrete skills are taught in many given concepts (for example – the child may be taught to imitate 5-10 distinct gross motor movements) then the targeted skill will be imitating novel, or previously untaught, gross motor movements. This tells us that not only can the child imitate several skills, but that he can imitate any gross motor skill within his physical capabilities, and the concept of imitation of gross motor skills can be considered to be acquired at that point, (at least in one on one situations). Discrete trial can be used for more advanced skills as well as simple skills. Even complex social skills such as determining what behavior changes should happen in response to another person’s facial expression can be started in a discrete trial format, and then generalized to more unstructured “real world” environments.

5. Who hires the tutors/therapists?

Bridges is responsible for screening and hiring all the ABA therapists that work directly with your child. We recommend that parents also interview any prospective therapists. Bridges will allow therapists to stay at a given clients' program as long as that therapist is benefiting the child. We believe that a therapist can learn an individualized program more completely over time and do not unilaterally move any people on a child's team except at the request of the parents. If a staff member requests a transfer we will keep them in place until a replacement is found and trained for the individual child. All pay issues, insurance, etc., are Bridges' responsibility. Detailed descriptions of this position are in the employment section of this website.

6. How do you know what to teach? Who decides that?

What to teach in ABA is referred to as "programming". Bridges uses a Skinnerian language approach to programming. We do not automatically attempt to replicate the exact developmental sequence that a typical child will use when learning language and other skills, though the goal is to arrive at the same skill level as those typical peers. Bridges looks at the specific function of each type of language and uses those functions to teach children that language is useful to them immediately. Most typical children develop labeling skills before they learn to ask for items. During the assessment we will look at your child's requesting skills and may decide that these should be addressed first, because requesting language is automatically reinforced. Labeling items that results in social praise that is motivating for a typical child may not be reinforcing for a child with an autistic spectrum disorder. Children may be able to ask for items but not label them. Both functions of the language must be taught. These decisions are made by the clinical program directors, who hold at least a Master's degree and are very experienced at language programming. There are also guidelines to insure that all the crucial elements of language are addressed when and if needed by your child. Many complex decisions will be made as your child progresses in language, from when to teach plurals to when to go to pronouns and noun-verb agreement. We will be happy to explain the rationale behind all programming decisions to you, and welcome and value parental input on this as well.

7. What happens at regional center and school district meetings?

Most of our clients are also clients of the California Regional Center system. The regional center requires that the parents of all clients in program have meetings with the regional center representatives on a regular basis to review progress and discuss any changes that may be needed. These meetings are attended by the parents, the child’s Bridges’ clinical program director, and the regional center staff. Bridges will prepare a report that shows your child's progress based on the data since the last meeting, and that will be presented by your child's program director. If the school district is involved with a child they frequently attend these meetings as well, though the official school IEP (Individualized Education Plan meeting) is usually only held one time per year. Some parents opt to combine the regional center meeting and the IEP.

8. What are clinics?

Clinics are weekly meetings run by your child's consultant with the parents and therapists. During these meetings the consultant will go over the progress your child has made over the last week, changes in program that may be recommended by the program directors, address any problems that may have appeared in the last week, and insure that all lessons are being implemented consistently. Any problems that show up in the data, new behaviors that may occur, or other concerns are also addressed during clinics.

9. What training is provided?

At the beginning of each child's program a workshop (typically three 8 hour days) is given by the behavioral consultant and clinical program director to all the members of the team as well as the family. This covers specific programs prescribed for your child, as well as basic concepts such as discrete trial training, reinforcement, data, prompting, discrimination, how to analyze language behaviorally, how to teach the child functional skills, generalization, and functional analysis of behavior. If the child is on PECS we will teach everyone how to communicate with this method at the specific level for the child, and how to increase vocal language with PECS. If a child is already in program and needs a new staff person we will provide a workshop for the new staff person (the parents do not need to attend again) as well as doubling with the experienced staff before they will work with your child on their own. Additional trainings are also offered on more advanced topics several times a year. Bridges also sends staff to conferences and other trainings as appropriate. Parent training is also provided both at the end of program and earlier if requested.

10. How do you teach the children?

Bridges uses applied behavior analysis (ABA) methods to teach your child. ABA is well documented to be the most effective tool for teaching children on the spectrum in many studies. Discrete trial is a large part of many of our ABA programs. There are other behavioral teaching methods such as backwards chains, etc., that are also effective with certain kinds of skills. The techniques used are taught in great detail at the initial workshop as well as in the ongoing supervision visits. We are always happy to explain why we are using a certain technique when teaching your child.

11. What happens if I don't want you to use candy with my child?

We honor any requests parents make regarding what you wish your child to be exposed to, including diet restrictions, any toys you may wish us to avoid, etc. We will work with parents very diligently to find effective reinforcers for your child that do not conflict with your wishes or, of course, any allergies or other medical conditions.

12. What happens if my child is already in speech or occupational therapy?

We frequently work with local speech and occupational therapists to follow through on their recommendations for your child as part of our programs.

13. Has Bridges ever "recovered" a child?

Many of Bridges's former clients are now functioning at grade level with no additional support in regular education classrooms. Some of these had PDD diagnoses, and others had autism diagnoses. Several no longer fit the criteria for an autistic spectrum disorder diagnosis.

14. Do I have to pay for Bridges?

Most Bridges programs are funded entirely by Alta California Regional Center and/or local school districts. Occasionally programs are partially or wholly funded privately. Alta California Regional Center and most of the local school districts have signed a memorandum of understanding that identifies the percentage of the ABA program that each agency will fund at different ages for each child.

Some parents may also be able to be reimbursed for services by their private health insurance.

Any prospective parent is welcome to contact the office to discuss details of who to contact for funding or what the costs are for private pay options.

15. Will PECS make my child not want to talk?

No. PECS was developed by Frost and Bondi, and the initial research showed that 61% of the children who started on it achieved spoken language. Our experience is that the vast majority of children who start with PECS learn to speak, and we may modify the PECS approach to demand a vocal component early if a child seems close to speaking. We do not recommend PECS for every child, but do use it with children who seem to be most likely to benefit from that procedure as part of their program.

16. Who are all these people who are working with my child?

Every child has three different staff positions working directly with him or her. The clinical program director oversees the entire program. The clinical program director has a Master's degree and years of experience working with children on the spectrum. Between the clinical program director and the therapists is the behavioral consultant. This person sees your child during therapy and makes sure that the programs are implemented as prescribed by the clinical program director. Consultants hold a Bachelor's degree, and at least two years direct ABA experience. The therapists who work directly with your child are there for the prescribed number of hours per week. They are also there when the program director and consultants are there. Most children have more than one therapist on their staff. Details about qualifications needed for clinical program directors, behavioral consultants, and therapists are in the employment section of this website.

Additionally, your child may have other people working with him or her that such as speech therapists, occupational therapists, infant program specialists, or special education staff. Team coordination is important to insure consistent expectations, and worth the time to make sure everyone is working together.

17. What is the big three-ring binder for?

The big three ring binder is the main data book. Data is the record of your child’s behaviors and learning, and that information is updated and used constantly to determine when and how to prompt, reinforce, and start teaching new skills. Data is not there for the purpose of generating reports, it drives everything we do with the child. The main data book is first used at the child's initial assessment. This is where the bulk of the detailed information about your child is recorded. Most books are arranged so the therapists can easily and quickly find the data for each lesson in them. The data tells them what to target, what response form qualifies for higher levels of reinforcement, what prompt level a child needs for any given target, and, if the child masters a target that day, where to go next. The data book is also reviewed on every visit by the supervisory staff. Data books tell the therapists exactly what to do and how to do it, and tell the clinical program directors (and anyone else who looks) exactly where your child is on any given lesson. It provides the information to the program directors and behavioral consultants needed to determine if the child is ready for new lessons, if a lesson needs to be modified, and much more information. Children will also have data books specifically used for school and peer. Details about how and why data is recorded as well as how to read the data are presented at length at the workshop.

You can view several of our data forms here.

18. How old can a child be before he or she is too old for Bridges?

Bridges provides intensive early intervention program designed for toddlers from the age of 15 months through the start of full time school (typically first grade) for those children who still need support at that point.

19. Why must the child do so many hours?

Bridges provides intensive early intervention ABA (Applied Behavior Analysis ) services to young children with autism. This program is designed for young children and the peer-reviewed research that supports it was done on very young (preschool age) children. Peer-reviewed research shows that the intensity of the program is a critical factor in the success of the children. Intensity refers to the number of hours of 1:1 ABA intervention per week that the child receives. Research shows that programs with subclinical hours (less than 25 hours) of intervention have been shown to be much less effective than full time programs (25-40 hours). Some agencies offer specialized part time behavioral skills training to children with autistic spectrum disorders. These are a different kind of program than intensive early intervention programs. They serve a different purpose than intensive early intervention programs.

20. What if I want my child to stay in their special education class?

Peer-reviewed research studies have shown that early intervention programs that combined an eclectic special education class and part-time ABA home placements were not effective. Bridges does not recommended these combined programs as early intervention for this reason. Preschool will be part of the child’s program only when the data indicates that this is best for the child, and that the specifics of each child’s entry into school and the type of placement (regular or special education, etc.) and supports for school are based on each child’s individual data.

Page Updated 6 August 2007