APPLIED BEHAVIOR ANALYSIS: COMMON
QUESTIONS
by Richard Saffran
Applied
Behavior Analysis has been rigorously
tested and proven useful in reducing developmental delays in
children with Autism
or Asperger's
syndrome. A parent who has found this intervention useful for
his son answers some of the common question parents have. A list
of the questions follows. Please scroll down the page to read the
answer to a particular question.
What is an Applied Behavior Analysis program?
What kind of progress can I expect?
I want my child to learn naturally, not behaviorally. Applied
behavior analysis looks so unnatural.
What about diet, vitamins, and other therapies to treat the underlying
cause?
I've heard applied behavior analysis leads to rote, "robot-like"
behavior.
I can't see my child spending all his time doing drills. Doesn't
he need to go to school and play too?
Won't a mix of Applied Behavior Analysis and other good approaches
work best for my child?
Is applied behavior analysis appropriate for older children?
Could placing so many demands on my child harm our relationship?
What is the role of a school aide in an Applied Behavior Analysis
program?
Are there risks with applied behavior analysis?
I read that the "Lovaas method" is less than 50% effective.
What happens after Applied Behavior Analysis?
Can I teach my child myself?
What is an Applied behavior analysis program?
There are three components that all have to work
together: people, programming, and practice. And they have to work
together for quite a while - at least two years, usually longer.
The people are a behavior analyst, 'therapists,' you and other significant
family members, and usually (although perhaps not at first) your
school staff. The behavior analyst (usually just called the 'consultant')
is responsible for the other components, programming and practice.
He will help train the therapists and you in the practice of Applied
Behavior Analysis, and give you (your team) the curriculum ('programming')
that tells you exactly what and how to teach. He will also periodically
evaluate results and adjust the program as your child learns.
The therapists provide the actual instruction
(usually one-on-one, but not always). Why the quotes above? The
term therapist has a medical or professional implication: it implies
training and certification in a specialty. Training and good practice
are important in an Applied Behavior Analysis program, too, but
there is no specific degree, coursework, or internship required.
In theory, anyone can learn to become an effective Applied Behavior
Analysis instructor - college students, retired persons, freelance
musicians, even exceptional high school students. A degree or specialized
education may be helpful, but what counts most are reliability,
enthusiasm, creativity, ability to follow directions, and just plain
"being good with kids."
Parents can be therapists, too, if they have the
time and the inclination, but this is very much a personal decision.
It can be a way to save money, keep the hours up, and it certainly
gives you better knowledge of your child's program and progress.
School staff do not provide one-on-one service
(except for specialists, who may or may not be working with the
Applied Behavior Analysis program), but they are still very important - they
are part of the environment in which your child will either learn
or fail. This is a complex topic, but it's certainly true that cooperation
is critical; if they "don't believe" in what you're doing,
or think they're doing something better (but the evidence shows
otherwise), then your child may not benefit from that environment.
The programming is, in my mind at least, the most
distinguishing feature of an Applied Behavior Analysis program.
Bits and pieces of the practice show up in other "methods"
or therapeutic approaches, but to my knowledge there is no other
program which puts so much care and thought into planning exactly
what your child should be learning, how the material is paced, how
it is reviewed, and how it is practiced across multiple settings.
It is this tremendous discipline and attention to detail that makes
it possible for some children to become truly indistinguishable
from their peers in 'just' a few years.
Programming centers on discrete
trial drills, the exercises that your child does one-on-one
with a therapist to learn language, play, and social skills. These
drills are completely individualized to your child; while there
is a substantial core curriculum that all children must complete,
which programs are introduced when, and what items are used for
teaching, are carefully tailored to your child's abilities and interests.
The pace of the drills is important too. It is
quite possible to go too quickly, leading to superficial progress
but not a solid, useful repertoire of skills. A good consultant
will plan how often new items are acquired (taught), how often know
(mastered) items are reviewed (maintained), and when it might be
time even to hold off on new items and just spend a couple of weeks
practicing mastered items. Skills must be mastered across multiple
settings (home, school) and with multiple people (therapists, parents,
peers). This 'generalization' is done systematically with the goal
of giving your child skills that he can use independently in any
setting.
Finally, it is practice, how skills are taught,
that at first seems the most unusual feature of Applied Behavior
Analysis. This is because the discrete trial format looks so very
different from 'natural' teaching methods. But discrete trials teaching
is really only one result of applying Applied Behavior Analysis
- the functional analysis of behavior - to the problem of helping
your learning disabled child to progress to his maximum potential.
A lot happens in those one-on-one sessions, but there are things
that you and others can do at other times and in other settings
to help your child learn. Again, a consultant will help you learn
how to reinforce appropriate behaviors, to help your child, as he
learns new skills, to discriminate desirable behaviors from undesirable
"autistic" traits. In simpler terms, this is called "catch
'em being good."
Applied Behavior Analysis practice applies equally
well to the school environment, even though your child will not
be doing "drills" there in the strict discrete trials
sense. This is where a trained aide, who is part of the home program,
is an essential part of the program. This is also the part that
often confuses parents and distresses schools - unfortunate, because
if done right, the benefits to all are tremendous (a good aide makes
the teacher's job much easier). One of the most common mistakes
parents and schools make is to place a child in school without coordinated
support from an Applied Behavior Analysis trained aide, on the theory
that "he needs to be around kids to learn social skills."
Again, if your child could learn like that he wouldn't have Autism.
If we put it all together - people, programming,
and practice - this is what you have:
A home program of 10 to 40 (or more) hours/week,
with one-one-one discrete trials drills delivered by 2 to 5 therapists or parents;
Workshops with a consultant, every 2 to 12 weeks, for 2 hours to
2 days, for an average of about 1 to 2 hours/week;
Weekly team meetings are desirable for all therapists to compare
notes and discuss problems, get parental and teacher input;
For many children, a school placement of just a few hours up to
full time, with an aide who is also a therapist;
Perhaps also play dates supervised by a therapist, usually structured
sessions with one other peer;
You, personnel manager, accounting department, receptionist, special
education teacher, supplies manager, ... and parent.
This is a home-based program, probably the most
common model today; there are also center-based programs, which
do most or all of the above at a single facility.
What kind of progress can I expect?
The amount of progress your child will make depends
on two things: his innate ability to learn, and the quality of his
instructional program. How much a child can learn given the best
possible program is something no one can really predict, although
there are indications from research that a higher developmental
age (Lovaas 1987) and a younger chronological age (Fenske 1985)
at intake are predictors of greater eventual progress. More recent
experience suggests that the child's progress in the first few months
- a measure of his ability to learn - is related to long-term success,
rather than his initial degree of disability. Above all, understand
that this is a very poorly understood subject: there really are
no reliable markers in a young child that predict what he will be
like as an adult. (Note too that some children benefit from other
interventions, such as diets
or drugs, that increase
their ability to learn.)
Program quality is something you can influence.
The number of hours per week is one obvious measure: since your
child has a lengthy curriculum to get through, it is to his benefit
to do it as quickly as possible. (This is one thing that many school
administrators really do not understand; they believe that they
can save money by doing fewer hours of programming each week, or
fewer weeks each year. Yet the research suggests exactly the opposite:
an intensive program is likely to be over sooner, while a lower
intensity program may go on for years and years, costing much more
in the long run.) Not only do more hours mean more learning, but
if your child is not yet able to initiate appropriate activity,
every hour spent learning is one fewer hour spent practicing undesirable
activities. In the battle for your child's future, every hour falls
on one side of the ledger or the other; you want to tip the balance
towards productive, quality time.
Instructional quality is just as important. As
one administrator assured us, "Any idiot can do Applied Behavior
Analysis." This is true, but to do it well and actually help
children takes a lot of training, attention to detail, and plain
hard work. Children with Autism are not often the best customers
for good intentions; simply sitting down and trying to teach on
instinct may lead to a wide array of unwanted behaviors, but little
useful learning. The principle of providing positive
reinforcement seems simple, but it's rarely enough just to give
a child a piece of candy every time he gives a right answer; there
are many, many details and strategies which a good Applied Behavior
Analysis teacher must master to really move your child through the
curriculum as quickly as possible.
You can and should expect your child to learn
to his maximum potential, even though there is no way to be sure
exactly what that potential is. You should, however, expect that
if your child is learning some skills but then fails to progress
in other areas, that the program, not your child, may be at fault.
Educators and parents alike are often too quick to blame the child
for failing to learn. This is the great shame of the IDEA law, that
any progress (or lack of it) may arbitrarily be considered "appropriate"
for your child. The research proves that some children do recover
completely, and most others can make very substantial progress.
While no one can tell you if that is possible for your child, he
does deserve the same quality of instruction and the same chance
at a normal life as the many children who have recovered completely.
Expect also that progress is like the stock market
- you really have to play it for the long term. Three steps forward
and two back is more the rule than the exception. Daily or weekly
plateaus, spurts, and regression can be emotionally exhausting,
but a high quality program should lead to measurable progress from
month to month.
Does behaviorally-based teaching provide all the
answers for all children? Certainly not; many children have cognitive
deficits that cannot be completely remedied by any amount of teaching
and practice. While those children (and adults) may gain a great
deal, they will still need help learning strategies to work around
their limitations, as well as a good deal of understanding and accommodation
from the rest of us!
I want my child to learn naturally, not behaviorally.
Applied behavior analysis looks so unnatural.
Applied Behavior Analysis is a well-developed
technology for maximizing learning. It guides the teacher in maximizing
those elements of one-on-one instruction that lead to the most efficient
and longest-lasting learning. While at first glance it may look
very "unnatural" that's only because the student typically
is so learning-disabled that certain elements which are present
in all learning must be greatly exaggerated. As an Applied Behavior
Analysis program progresses, if it is successful (as it is about
90% of the time), the student's brain changes - he "learns
how to learn" like his typically developing peers. The teaching
process then starts to look more and more "natural."
The very saddest thing a parent or teacher can
do to a child with Autism is to hold on to the illusion that he
can learn as his peers do, and place him in a typical environment
(even with extra support), expecting him to "get it."
Child development involves an astounding amount of learning in a
remarkably short time. Children with Autism are typically far behind
their peers in a broad range of prerequisite skills, even as young
as age 2. There is simply no way they will learn "naturally"
if they are not prepared with the base skills they need to understand
what is happening in the world around them.
For example, suppose your child is in school and
the teacher is talking about caterpillars and butterflies. Typical
children will learn this in one lesson and have a lasting interest
in the subject that will help them enjoy the world and give them
something they can share with you and their friends. But consider
what they first have to know in order to learn this lesson:
1. The categories of insects and food
2. The idea of one thing changing into another
3. The concepts of eating and sleeping
4. The preposition "around" (as in "spins a cocoon
around him")
5. Sequencing (first he spins...then he opens...)
6. Past vs. present.
That's just a partial list. They also need attending
skills just to pay attention to the teacher in the first place.
Expecting a child who lacks even some of these prerequisites to
learn "naturally" is as misguided as placing an infant
in the same classroom.
So what about all the odd-looking repetition,
the use of edible treats, the insistence on sitting at a table,
and the other "unnatural" trappings of Applied Behavior
Analysis? All these are the result of very careful research on learning,
an amplification of the processes that all children use to learn
and develop. The teaching process may seem a little more "natural"
if you compare it to the way a parent instinctively teaches his
or her infant to smile. At first an infant has no idea how to respond
to his parent - he may make contact or look at something more interesting.
But when the parent gets even a little response - BAM! - a big smile,
hugs, lots and lots of attention to the little guy. This is done
over and over again until in short order he learns to give Mom and
Dad a big smile and lots of eye contact.
This is pure positive reinforcement - a way all
of us learn. A child with Autism needs this type of intensive attention
- or even more intensive attention coupled with individualized reinforcers
- to learn very simple concepts like "on" and "in."
But the good news is that if this is done properly then the child
often will learn how to learn faster and with fewer and fewer "unnatural"
interventions. There is simply no shortcut, no "natural"
alternative. Just as infants cannot go to Kindergarten, so cannot
children with Autism "just learn" at their chronological
age level. They must be led through the proper language, play, and
social developmental sequence, not moving ahead until they have
mastered each step.
I can't see my child spending all his time doing drills.
Doesn't he need to go to school and play too?
An Applied Behavior Analysis program is not just
discrete
trial drills ("table-top work"). While drills may
make up the bulk of a program at the beginning, the same principles
used to instill very basic skills apply just as well in all settings,
including classrooms, at home, and in the community. Remember that
for typical children learning is a full-time job - it just happens
without you even noticing. (If it weren't, no child would be able
to attend Kindergarten without going to pre-school.) For a child
with an Autism Spectrum Disorder
it takes careful planning by responsible adults to take advantage
of as many opportunities for learning as possible. This means coordination
across all settings, school included. Parent training and involvement
is an essential part of almost all successful programs - remember,
even if your child is in a full-time program, you probably still
spend 60 hours/week with him.
Yes, children with Autism can and do go to school
with typical children, but no, it is not a good idea to do that
unless the child is ready to learn in that setting and the school
is committed to working closely with the rest of the Applied Behavior
Analysis program. For several reasons, it can be quite harmful to
the child to pretend that it is OK to have "two programs"
that don't share goals or techniques.
Children with developmental disorders are at risk
of developing maladaptive behaviors: aggression,
self-injury,
self-stimulatory
and perseverative
habits. These unwanted behaviors often increase or decrease
in direct response to the actions of parents, teachers, and other
care-givers. It is essential that everyone be on the same page and
respond to the child in a consistent manner designed to reduce maladaptive
behaviors, and that progress (or lack of it) be periodically reviewed
and adjustments made as needed. We suffered years of serious behavior
problems because the adults in charge of our child were not skilled,
did not teach us what to do, and when asked for an appropriate behavior
management plan, they were not able to execute it.
Your child deserves to benefit from every possible
opportunity to "catch up" to his peers. This means learning
and practice, practice, practice. If he has the skills required
to understand what is going on in school and to be involved in what's
going on, great. If not, even though he may be quite happy, it's
just not fair to put him in an environment where he's not capable
of learning and not capable of participating. The school must be
involved daily in your child's progress and structure the environment
so he can generalize his skills. One way to do this well is to have
one of the Applied Behavior Analysis therapists be a one-to-one
aide in the classroom.
This was one of the hardest lessons for us to
learn: our son was (and is) very happy to go to school, but he literally
was learning nothing (positive), despite support from an OT and
SLP in the classroom and supposedly trained teaching staff. The
school administration fought tooth and nail to keep our "methods"
out of his classroom, supposedly for his benefit(!). Only after
we gave him the basic language, play, and attention skills to understand
what was happening did he start to benefit at all from school.
The same applies to peer social interactions.
There is perhaps nothing more painful for the parent of a child
with Autism than to watch your child "play" in a group
of typical children. Teaching play skills is very much part of an
Applied Behavior Analysis program, and like all other skills, it
is done one baby step at a time so the child cannot fail. The development
of play skills is just as important and deserves just as much attention
as language development.
Applied Behavior Analysis is not "just"
drills. If it were, no child would recover to normal functioning.
Your child needs you, his teachers, service providers, and all the
other significant people in his life to work together to maximize
his chances for progress. If any one of those people is not willing
to participate, they shouldn't be allowed to waste his time.
What about diet, vitamins, and other therapies?
Isn't it more important to treat the underlying cause?
For many children there may be a way to correct
whatever biological mechanism is causing the symptoms of Autism.
Even if that's true, however, your child may have already spent
years unable to learn language, play, and social skills as fast
as his typically developing peers. He will need a lot of help to
learn those skills, and ideally should do so at an accelerated pace.
Regardless of the efficacy of other interventions there's still
a lot of teaching to do, and that's where an Applied Behavior Analysis
program is most helpful.
I don't mean to say don't try biomedical
interventions because Applied Behavior Analysis is "the"
right choice. Just consider that if you could wave a magic wand
and eliminate the underlying cause of your child's disorder, chances
are he would still need a lot of help to "catch up" to
his peers. (This is a mild statement of the importance of Applied
Behavior Analysis in recovery from Autism. In fact, the research
shows that for many children Applied Behavior Analysis alone leads
to a total loss of symptoms - that is, full recovery. It seems to
defy 'common sense' that any amount of education could overcome
a biological disorder, but the evidence is clear that an intensive
program does lead to profound, permanent changes in the way the
brain operates.)
I've heard applied behavior analysis leads to rote, "robot-like"
behavior.
Have you ever learned a foreign language (let's
pick French), or watched someone else learn English? When you're
first learning, you do sound rote, forced, unnatural, and you also
feel the strain of trying to come up with the right words and keep
up with a conversation. With time and practice your speech both
comes more easily and sounds more natural. When introduced to someone
you struggle at first even to say "Je m'appelle - - - -"
. Months later, it is hard to imagine that is was so difficult -
but now you're having exactly the same trouble with conditionals:
"Si vous... voudriez me telephoner, je...je...serais chez moi...ce
soir." [Any grammatical error is my responsibility!]
Or, you may learn some 'rote' phrases on what
to say in a typical situation, like eating in a restaurant. You
like chicken sandwiches so you learn "Je veux le sandwich poulet
avec viande blanche." To an observer, you look silly ordering
the same thing every time - because that's all you know and are
comfortable doing. But the desire to gain access to the full menu
will spur you on to master the language until you sound natural
ordering a full meal, and can chat with the staff too.
Let's look at a more relevant example. My three-year-old
learned to identify emotions using the "developmental approach"
- that is, learning from observation and practice. She made very
frequent errors - "You don't want to watch TV, you're embarrassed,"
or "I'm fishing - be very quiet, so I don't get concerned."
Because she could speak spontaneously and without any time delay,
these statements sound delightful, not "robot-y." Yet
the truth is, she was doing exactly what my son is doing - practicing
language, making mistakes, getting corrected, and learning.
It takes time and practice for anybody, at any
age, with any degree or ability or disability, to attain fluency.
It is absolutely amazing that a child with such a severe disability
actually can achieve fluency at language, play, and social skills.
The fact that these skills may look less than completely natural
at first should tell you that the child needs more practice and
more opportunities for learning, not that he should be denied a
proven teaching method. "Children do not fail to learn, teachers
fail to teach."
Won't a mix of Applied Behavior Analysis and other good approaches
work best for my child?
A good Applied Behavior Analysis program - and
by good I mean the level of quality implemented by Lovaas and reviewed
in his 1987 study - has the potential to help many children gain
the skills needed to overcome their disorder. This runs the full
spectrum of skills from verbal imitation to prepositions all the
way up to persistence, creativity, playfulness, empathy, self esteem,
and curiosity.
This does not mean that just because someone says
"I do Applied Behavior Analysis" or an administrator tells
you "We're doing Applied Behavior Analysis" that your
child will learn as much as he needs to. It has to be done right.
Parents of children with high-quality Applied Behavior Analysis
programs seldom look for alternative educational approaches. But
it would be willful blindness to pretend there aren't Applied Behavior
Analysis programs that don't work well. In those cases parents naturally
look to other methods to help their children learn.
In one sense, an Applied Behavior Analysis program
always does incorporate "other" teaching methods. Since
the whole point of the program is to teach your child to learn normally
- that is, largely from observation and imitation - the intervention
by definition must include carefully supported practice in normal
educational and social settings. This happens towards the end of
a program (although this "end period" may last years!),
and is every bit as important as the highly technical discrete-trial
teaching. Some parts of a successful Applied Behavior Analysis program
may be identical to practices promoted in other methodologies. It
is the use of teaching methods targeted specifically to your child's
learning style - methods that may change as his learning style changes
- that makes your child successful. Research shows that leaving
"behavioral teaching" out of the mix may mean he doesn't
have a chance to get off the starting line.
There is an important caution here, however. Behavioral
intervention addresses many of the deficits of many kids. Research
shows it addresses all of the deficits of some kids. But the glass
that is half full is also half empty: the same data proves Applied
Behavior Analysis does not address all of the needs of some children.
And, there is no reliable way to predict how much behavioral intervention
will do for your child. It is important to work with a consultant
or educational team that is not only well qualified in Applied Behavior
Analysis, but also understands and is familiar with interventions
for learning disabilities.
Many are quick to offer opinions or to trust in
someone's reputation, but it takes courage and discipline to look
first for data. There simply are no studies that show any intervention
with a success rate better than those published by Lovaas,
Fenske, and others (in progress). Applied Behavior Analysis is not
a 'philosophy' that maintains credibility by excluding other methods.
It is a science that continually advances its practice to best serve
your child. Don't be afraid to ask tough questions of anyone offering
any intervention for your child, whether it's Applied Behavior Analysis
or another 'brand.' You will be living with the results for many,
many years.
Is applied behavior analysis appropriate for older children?
There is a popular misconception that Applied
Behavior Analysis is useful or appropriate only for young children
(under age five). This notion probably comes from the remarkable
successes of the UCLA Young Autism Project, in which many young
children achieved normal functioning. While it may be true that
the greatest benefit results from starting very young, this is of
no importance when you are considering your child's future: however
old he may be, you need to be sure you are giving him the best possible
future.
The teaching principles of Applied Behavior Analysis
apply to all people at all ages. It is a science of human behavior.
It guides us in how best to achieve goals of skill development or
independence regardless of age or disability or ability. Within
the limits of your child's potential, intervention based on Applied
Behavior Analysis principles will help him learn as much as he is
able. Even if full recovery (normal functioning) may not be an option
due to the severity of his disability or, perhaps, his age, there
is no teaching method shown to have the same ability to develop
his full potential.(A real tragedy is being played out again and
again: young children are denied Applied Behavior Analysis services
for years; then the parents advocate for a program, and are told,
"Sorry, we won't pay for that because your child is too old
to benefit." The resulting legal battles are now working through
the courts.)
Could placing so many demands on my child harm our relationship?
It is very true that an Applied Behavior Analysis
program places many, many demands on your child. And it is also
true that for the program to be effective, you (the parent) have
to place many of the same demands. If all his teachers make him
ask for his own juice, but you don't like to see him struggle to
find the right words and just jump in and offer juice before he
asks for it, then he may not generalize that communication skill
as quickly as he otherwise would.
This is a simple example; there are other things
you may need to ask of your child that he will find much harder
and to which he may react more strongly - by crying, yelling, hitting,
running away. These are extremes of reaction, and they shouldn't
happen often, but some level of problem behaviors is more the rule
than the exception. It is hard as a parent not to give in and just
do whatever seems necessary at the moment to make things easier
for your child.
In the long run, however, it is probably easier
for both of you to maintain the demands and make learning happen,
than to adapt yourself to his (unconscious) desire not to change.
This is not peculiar to children with Autism; all parents learn
that life goes better if they insist that their children clean up
their toys, observe table manners, stay close in stores, even if
it takes some amount of stress to enforce those rules.
Does this affect your loving, trusting relationship?
The trust and love that you and your child feel for each other is
built on thousands and thousands of positive, successful, joyful
interactions. It would take a far greater effort to undo something
so deep and powerful. Being firm when it is appropriate is the quickest
path away from unwanted behaviors and situations, the best route
to positive, happy experiences. You don't have a choice: you will
have to place more demands on your child as he grows older. It is
best for both of you if you can help him learn to be successful,
independent, in control of himself and his environment, and able
to find his own happiness from you and others.
What is the role of a school aide in an Applied Behavior Analysis
program?
First, you have to be sure that school is an
appropriate environment for your child. Just as you would not send
an eight-year old to a college calculus course, so you would also
not want a child with the communication and social skills of a toddler
in a Kindergarten class. It is not only not an appropriate placement,
it is cruel to the child; he is being set up to fail.
Once your child is ready to learn with other children
in school, however, chances are he requires a level of attention
that no teacher can be expected to provide. He may frequently lose
attention, engage in disruptive behaviors, not respond to questions,
not follow along with other children, or simply not understand instructions
reliably. These are problems all children have to some degree, but
which are effectively addressed by the classroom teacher. Children
with Autism may require such a high level of prompting or redirection
that it is simply not possible for the teacher to do his job properly.
An aide, therefore, is there first to help the
teacher teach, and to help your child second. He is an extension
of the classroom teacher, giving additional attention to those who
need it most (which, most of the time, will be your child). He will
prompt your child as needed to keep his focus on the teacher or
the other children, reward him as needed for doing a good job, cue
the teacher if your child needs a reminder or additional instruction,
and intervene to prevent maladaptive behaviors. He is an extra pair
of hands and eyes and ears to help maintain order and progress in
a classroom that has more than its share of children who need very
clear instructions. He is there to give the extra attention needed
to make sure that a certain special child is included in social
activities, and has a friend who won't let him fail. His ultimate
goal is to work himself out of a job; by intervening only as much
as needed, he will help the classroom teacher integrate your child
into the classroom and learn effectively alongside his peers.
Here is a nice first-hand account from news:bit.listserv.Autism:
I have been a classroom aide many times over the
past 5 years, both in preschool and grade school. From my experience,
there are both benefits and disadvantages to having an aide in class
with your child... The benefit is that a good aide can enhance the
whole class experience, social and academic. The good aide will
not draw "special" attention to your child, but be a friendly
helper for all the kids. The good aide will make it a "fun"
experience for other kids to socialize with your child, naturally
and without inciting jealousy. The good aide will reinforce the
teacher's direction, rather than becoming a "separate"
teacher. The good aide will keep in touch with you (the parent)
constantly, letting you know all the ups and downs, and will keep
written daily notes of the child's progress. The good aide will
work to work him or herself OUT of a job - fostering independent
work and social skills constantly.
The bad side is that unless you do have an extremely
good aide, the presence and "help" of the aide will seem
strange and unfair to your child's classmates, fostering envy and
resentment. As the grades get higher, the more other children are
wary of what is "different". In addition a poor aide will
cause your child to become dependent, to ignore the real teacher
and to indulge in behavior to get extra help. The poor aide will
feel "sorry" for your child and not push him or her to
do the best work that is possible. The poor aide will exclude you
(the parent) from the educational process, will feel insulted and
defensive when asked for specific information. The poor aide will
not work with the classroom environment or with the teacher as a
team member, and will set up "special rules" and exceptions
that will cause your child to be a pariah.
So interview CAREFULLY; check references; watch
the aide interact with your child and in the classroom before hiring;
if possible, visit the classroom often in person to observe; never
be afraid to train a person yourself; do not hesitate to give feedback
to and even to remove a person who is not doing the kind of job
you want. There ARE good aides (and potential aides) out there...
keep looking. And good luck!
Are there risks with applied behavior analysis?
Keep in mind that the terms "Applied Behavior
Analysis" and "behavior modification" are largely
unregulated. With few exceptions, any professional can hang out
his shingle and say "I'm doing Applied Behavior Analysis."
The same is true in schools: an educational administrator who has
attended a seminar or two can legally call herself an "Early
Childhood Specialist," provide "Applied Behavior Analysis
programming" for your child, but face no consequences if your
child makes no progress.
When accountability is absent, the risk of malpractice
is high. Untrained or inadequately trained people will, at best,
waste your child's precious time - often at public expense. This
would be intolerable in a medical setting, but the powers that be
have decided that Autism is not a medical problem. I have heard
from many families who put enormous energy into getting a program
for their child, only to face an even greater struggle to get quality
programming and staff. At least you should check any service provider's
qualifications and get references from other families.
The risk can be greater. Some professionals -
even, in some cases, those with specialized training in behavior
analysis - mistreat children (or adult clients). The organization
Children Injured By Restraints and Aversives documents allegations
of abusive practices, primarily in institutional settings (both
public and private). Physical restraint may be needed to reduce
the chances of injury, but as a "behavioral consequence"
it is not a teaching method. (Note that abuse is possible under
any conditions; there is no evidence that a person or institution
claiming to practice Applied Behavior Analysis is any more or less
likely to use inappropriate restraints or aversives.)
With appropriate caution, this shouldn't happen
to your child. To the best of my knowledge, none of the resources
listed in Applied Behavior Analysis Resources suggests the use of
aversives or restraints. (The 20-year old "ME Book" has
a chapter on punishment describing practices no longer taught or
recommended.) Certainly all the people I have selected to work with
my child have done so with a degree of patience and gentleness that
any parent can only aspire to. (They're not better than you or I,
they just get to go home at the end of the day!) In particular,
if the bulk of the therapy is done in your home (the so-called "Applied
Behavior Analysis home program") then you should know everything
that goes on. If your child is in a school or institution, you should
be permitted to visit at any time.
I read that the "Lovaas method" is less than 50% effective.
This is a perfect example of damning with faint
praise, almost always by those who would like to ignore the data
and promote a different approach, or simply want don't want to spend
their money on your child. Much has been made of the Lovaas 1987
published result showing 9 of 19 children (47%) achieved lasting
normal functioning. This is an amazing, stupendous, wonderful result,
but also an almost useless statistic - by itself. What really matters
is that 90% of the children in the study made very significant progress
- far more progress than the children in the control groups. It
matters little whether 5 or 10 or 15 of them "went all the
way" to total recovery. No other study has shown near the level
of average progress, and no study shows any other intervention to
be more effective at helping a child realize his maximum potential
development - which is all anyone can ask for.
Here is a typical description by a well-known
PhD:
The Lovaas method...uses behavioral techniques
- molding and rewarding desired behavior, and ignoring or discouraging
undesirable actions - to achieve its goals... Some research has
shown remarkable progress in about 50% of the children receiving
this therapy. The Lovaas Method is getting wide attention, but,
as with other therapies, it needs more study.
This was in between summaries of "occupational
therapy" and "vitamin therapy" in a long list of
interventions for Autism. Notice how "50% achieved normal functioning"
turns into "50% showed remarkable progress," with no mention
of the benefits to the rest of the children studied. In fact, more
study is warranted, and there are "Lovaas replication"
studies in progress, repeating the original experiment - including
studies of potential improvements to the decades-old protocol.
what happens after applied behavior analysis?
Most children with Autism require some support
services throughout childhood, and often into adulthood as well.
The best behavioral intervention program has at most an even chance
of getting a child far enough along to participate fully in regular
education. And, for too many reasons to list, few children get "the
best," leaving most needing some extra services for many years.
While the most severely disabled may benefit from a continued one-on-one
behavioral intervention program, more will participate to some degree
in a regular classroom with a mix of special
education services. What should those services look like? How
do you transition from a 'pure' Applied Behavior Analysis program
to a special education setting?
The complete answers could fill several books.
There is a short answer, however. Behavior analysis can continue
to play an important role even if none of the teaching follows the
discrete trial format. (A not-so-secret secret: successful teachers
of typical kids use behavioral principles all the time to run their
classrooms, even if they don't consciously think they are doing
it.) The principles that help your child learn when he is three,
four, or six years old are still valid when he is eight, eleven,
fifteen. The format may be very different, but the underlying thinking
is not. If he needed clear step-by-step visual instructions, chances
are that is still true. If he was more able to follow a classroom
routine with a reinforcement program, that will continue to be a
useful tool, though the reward program may take a very different
form. Just because something works well is no reason to stop doing
it!
One principle you will want to keep for life is
that each person is an individual, with specific strengths and weaknesses.
People are most successful, and generally happiest, when they can
apply their strengths and find ways to "patch" their weaknesses.
A "one size fits all" education can't be perfect for anyone,
and will probably be especially mismatched to your child. There
are many good resources for overcoming learning disabilities and
making the most of individual strengths. I haven't catalogued many
yet, but one good book to start with is A Mind at a Time
by Mel Levine.
Can I teach my child myself?
For better and worse we are all one of our children's
most important teachers (perhaps "guidance counselor"
is a better term). The question here really is "What role can
I play in a challenging and technical special education program
for a developmentally disabled child?" Notice a child, not
your child. Ask yourself first: as a busy parent whose first responsibility
is protecting and advocating for my disabled child, do I also have
the time and energy to become trained in a new field and commit
to being an effective teacher? If you can picture yourself doing
that for someone else's child, then there's a good chance you could
do it for your own. You may turn out to be an outstanding teacher!
(In fact that's how some parents have started new careers - some
I know have even founded new schools.)
If on the other hand you already have your hands
full, your time or patience is stretched thin, it may be better
to rely on outside staff to do the teaching. You may still want
to attend the training sessions and have some supervised practice
so you can better assess how well other people are teaching - maybe
do some yourself as time permits - but chances are both you and
your child will be more successful if you don't overextend yourself.
I hear from a number of parents, including many
in developing or underdeveloped countries, who have no consultants
or teaching staff - all they have is their child and some Web sites
or books that seems to hold the promise of a better future. There
is no school, no government assistance, no "free appropriate"
education for their child. Those messages are tough to answer. I
can't tell anyone not to try teaching, and I can't tell anyone they
are guaranteed to do more good than harm in the long run. This is
a very technical field. While the basic principles are amazingly
simple, putting them into practice effectively and adapting to the
very specific needs of an individual child is a complex and demanding
job - not an obvious "do
it yourself".
Click here
to read an introduction to ABA.
Click here
to read about choosing an ABA provider.
Click here
to read an example of ABA used to develop listening skills.
Reproduced with permission from http://rsaffran.tripod.com
Copyright 1998-2006 Richard Saffran. This content may be redistributed
provided (1) my text is not substantially altered and (2) my authorship
is clearly attributed. Copyright otherwise remains with original
authors.
|
