New Marcus Autism Center program trains parents to address challenges

Up until about six months ago, trips to Wal-Mart were close to impossible for 4-year-old Liam Holbrook.

“He would cry from the moment you’d enter a Wal-Mart and have a complete meltdown,” said Liam’s mother, Shannon Holbrook, of Nashville, Ga. “Sometimes, we would try to run in and grab a few things. But a lot of times, we just gave up.”

Holbrook and her husband, Stacy, struggled bitterly trying to manage the challenging behaviors of Liam, who has autism and has a limited ability to speak. Transitions, such as getting Liam off the computer and into his seat at the dinner table, were extremely difficult, often dissolving into kicking-and-screaming tantrums.

But things started to change over this past spring and summer when Shannon Holbrook enrolled in a new “Parent Training Program” at the Marcus Autism Center in Atlanta. The program armed Holbrook and her husband with new skills and strategies to prevent and better manage challenging behaviors, such as uncontrolled outbursts and noncompliance, which is a term that refers to behaviors that involve ignoring or refusing to respond to the request of others.

The program, Holbrook said, “has changed our life. We have hope now.”

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Holbrook learned many new parenting strategies, including the following: using a small clock as a visual cue to help Liam anticipate changes. Holbrook said she also now tells Liam “five more minutes” before dinner and then reminds him each minute closer to when it’s time to head to the dinner table, rather than suddenly telling him it’s time to eat. She also uses a clock to help Liam transition from getting out of the bath and into his pajamas for bed. And before going to a doctor’s appointment and therapies, she uses photographs as visual cues to help him prepare for the visit.

“Amazing,” said Holbrook, letting out a deep sigh of relief. “It’s like he just needed time to be prepared.”

The program is covered by most insurance companies, according to the Marcus Autism Center. So far, 27 families have participated in the program.

It typically lasts between 12 and 14 weeks and involves one-on-one, hourly weekly sessions with a clinician who helps parents identify triggers to outbursts and gives parents a series of strategies. While the center offers a wide variety of services for children with autism, including programs to help children with feeding problems and to better communicate as well as more intensive services for behavioral problems, this parenting program is the first of its kind at the Marcus Autism Center, which operates under the umbrella of Children’s Healthcare of Atlanta.

The new Parent Training Program, designed for children from the ages of 3 to 10, stems from what is believed to be the largest study of a behavior intervention with children with autism spectrum disorder (ASD). In the multi-site study, 180 children (ages 3 to 7) with ASD and serious behavioral problems were randomly assigned to either 24 weeks of parent training or 24 weeks of parent education.

The study, which was published in the Journal of the American Medical Association in April, found parent training was more effective in reducing disruptive and aggressive behavior than parent education.

While most parents participate in the program face to face at the Marcus Autism Center in Atlanta, Holbrook, who lives four hours away (each way), participated in the program remotely.

While much of the session is spent with the clinician talking to the parent, the child is also present, and the two will sometimes practice a skill with the child during the session.

“The first thing we do is to get parents to understand why a behavior occurs,” said Dr. Karen Bearss, assistant professor of pediatrics at Marcus Autism Center and Emory University School of Medicine, and lead author of the study, “and what triggers the behavior and what we can do to prevent the triggers and have more appropriate consequences in place. The feedback we hear is ‘my family came over and they commented how well my child behaved or I was used to avoiding family gatherings because my child was so difficult to manage. But now I can do that. I feel empowered, capable and confident.’”

Holbrook said she’s even learned strategies to make trips to Wal-Mart not only bearable, but almost a breeze.

“The parent training gives you so many strategies that are actually very simple, and when you put them in place, they make the world a lot easier for (children with autism),” she said.

Holbrook said the key is being prepared. She now packs a snack, often raisins, and something to drink. She also packs a toy truck, and she’s learned that with Liam being sensitive to light, it’s a good idea to bring shades and a cap to help block the glare from the fluorescent lights of a big-box store.

“Before this program, all I could picture for Liam was special ed for Liam forever. Not that it is bad, but I never would have thought he would have a chance to go into a kindergarten class and sit and listen to a teacher. But after this training, we can now go into a classroom and as long as he has raisin reinforcements, he listens, sits. … It’s now endless what he may be able to do.”

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