Saturday, February 03, 2007

Entirely different due to ABA

While it's going to look like I'm singling out two specific parents, that isn't the purpose. They are just two of the many available examples of what I want to illustrate. There are many more similar examples--not only reported in the media, but also in the science, where the observers are not parents but behaviour analysts and cognitive scientists.

The first parent is the Conservative MP Mike Lake, who has talked about his brilliant autistic son in the media and in the House of Commons. The first I read about Mr Lake's son Jaden (who, at age 11, communicates via keyboard) was in a National Post story. Here is Mr Lake describing Jaden at about age 2yrs:

We could tell he was a smart kid, in terms of numbers and the way he played with letter toys. But he would sit in a corner and play and you could not get his attention at all. We wondered if he was deaf, but if you went into a different room and put Winnie the Pooh on television, he'd hear it.

It looks like Jaden has taught himself both some degree of numeracy and some degree of literacy--all by age 2. As is characteristic of autistics, he does not orient to stimuli in typical ways, and is attracted to the kinds of information from which he learns well.

In the House of Commons, Mr Lake elaborates on Jaden's extraordinary abilities, evident from a very early age:

Between 18 months and 2 years old Jaden started doing some pretty amazing things. Like just about every kid his age, he had one of those foam alphabets that fit inside a foam frame. One day on a whim Debi took the frame away and left him with just a jumbled pile of letters. Jaden proceeded to put the letters in order just as fast as we would do it the very first time.

Then to our amazement, a friend of ours mixed up the letters in a pile and put out the letter Z. Jaden, without missing a beat, put the letters in reverse order Z, Y, X, W, V and so on just as fast as he had done forward.

This shows that Jaden has learned a great deal from his environment, that he is responsive to this environment, and that he responds to the actions of others (his way of communicating and playing). But Mr Lake again sees problems:

As amazing as things like this were, during his second year we started to notice some other things that caused us some concern regarding Jaden's development. He was extremely content playing on his own with little or no interest in playing with other kids or interacting with adults. His speech was not really developing beyond the first initial few sounds and he was very focused on patterns, often spending an inordinate amount of time lining up his videos or stacking cups in perfect order. He paid little attention when we tried to talk to him or play with him. We would have thought he had a hearing impairment except for the fact that if he heard a video he liked start up in another room at very low volume, he would instantly stop what he was doing and go to watch it.

So what is the solution? This is Mr Lake describing Jaden's ABA program in the National Post:

The first thing they did was sit Jaden at a table and put a spoon in front of him and ask him to hand them the spoon. They would do that six hours a day, for days and weeks. The next stage, they would put a spoon and a fork down and go through the whole process again. It is very tedious and intensive. But his pediatrician said that he is entirely different due to ABA. He's now one of the most amazing kids -- he will look you in the eye and he will understand you when you ask him to do something.

The second example, where ABA is also said to have changed everything, is from Autism Vox. Here is the first part of the first comment on a post about ABA and recovery:

My daughter has made great strides with ABA therapy as well. I mean I don’t think there’s any question of the effectiveness of it for enabling autistic children to learn. Every single thing she knows, she learned from ABA. This is fact. Except for the things that seem to be her gifts. She spelled words with refrigerator magnets long before ABA therapy. She plays the piano almost in spite of ABA therapy. She taught herself to read without the use of ABA therapy. Adding and subtracting. She was obsessed with numbers and sequences of numbers before ABA.

Having said that, she had no language before ABA, no eye contact, no social skills, absolutely ignored everyone and everything. This is really amazing though. My mother has a small dog. She babysat for Jodi for the first two years of her life. She started a not so good ABA home program in my mother’s house where she spent the day. This dog never meant a thing to her. After ABA therapy, when we go to my mother’s house she’s afraid of the dog. It’s weird. It’s almost like before ABA that dog didn’t even exist. I know this is subjective, but prior to ABA she seemed much less engaged in the world. Much less is an understatement. She seemed like she wasn’t even there and when something was thrust upon her like someone saying hello up close that she couldn’t avoid, she’d cover her ears.

ABA changed all those things in 1 year.

This is how I responded on Autism Vox:

An autistic who teaches herself (it looks like, very early) to read and spell–has “no language” and totally ignores everything?

And she doesn’t just teach herself to read and spell, but plays the piano (in spite of ABA–because ABA won’t allow her to learn how she learns well), teaches herself to add and subtract, etc?

And this girl is oblivious? And since when does written language mean “no language”? And how does a girl who is totally oblivious (according to the above, “She seemed like she wasn’t even there”–the usual description of us as not really existing because we orient atypically to stimuli) teach herself how to read and spell, etc.?

Even when autistics demonstrate clearly that there are ways in which we learn extraordinarily well (including learning language), because the way we learn is atypical, this is written off as “she wasn’t even there” and “she had no language before ABA”. Therefore, she has to be completely altered by ABA programs, in order to persuade her entourage that she is “there” and that she can learn.

My view is that ABA “works” when autistic children are totally written off (“not there”, oblivious, “no language”, etc). In this case, at least ABA will demonstrate to parents that their child exists and can learn–by giving the child “right” non-autistic behaviours, and eliminating “wrong” autistic behaviours. This is even though the “wrong” autistic behaviours previously resulted in extraordinarly learning by this child. This is even though the child learns with much greater difficulty in ABA, and in a much more limited way, than she would if provided with the materials and opportunities to learn how she has amply demonstrated she learns best. But even though this use of ABA “works” (see above–after ABA, the parents notice that the child is present and sentient, and then they credit all progress to ABA), this is fundamentally unethical. A child should not be put in a program to compromise her learning (how she learned to read, spell, do arithmetic, play the piano, etc.) in order to deal with parents who, against all evidence, decide she is oblivious because she is not like them.

It is some kind of tribute to autism advocacy (Mr Lake read "Let Me Hear Your Voice"--a book which describes autistics as being non-sentient, inhuman, and dead--just before Jaden was officially diagnosed) that so many parents view their autistic children the way the parents above did.

I was asked once if there were circumstances in which I might consider that ABA programs really should be used with autistic kids. I gave examples where autistic children are described as, and assumed to be, non-sentient. When autistics are described and treated as non-sentient, this is now routinely praised by autism advocates as "autism reality", as being a true representation of how devastating it is to have an autistic child.

Being considered non-sentient can be dangerous for any child. Autistic adults also routinely get described and treated as non-sentient (this has happened to me), and this is definitely dangerous for us.

If ABA programs result in parents altering their views to see their child as sentient, aware and able to learn, then the child's situation may not be as bad as it had been. But as I wrote above, this is not an ethically acceptable solution. The ethical course of action is to train parents to recognize that their child is sentient, responsive (to the environment, to other people), capable of learning (though not necessarily in typical ways), and communicative (ditto). Parents can then be trained to respond to their child's communication and learning. Interventions which train parents to be responsive (rather than "directive" and "intrusive") to their autistic children have demonstrated their success in several published peer-reviewed papers, including a randomized controlled trial (Aldred et al., 2004).

But we live in a world where autism advocates deny that this kind of science even exists. Also, we live in a world where autism advocates use their power and influence to disseminate the "facts" that autistics can't communicate, learn or even be sentient outside of ABA programs. So is it better for an autistic child to be in an ABA program than to be treated as though non-sentient (unaware, unresponsive, incapable of learning, unable to communicate, etc.)? Why should this "choice" be imposed on anyone?

(Edit: And some parents whose autistic children receive optimal ABA services still continue to view these children as non-sentient and doomed, and are applauded by autism advocates for expressing these "autism reality" views in the mass media.)


Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45, 1420-1430.


Another Voice said...

I am glad I found this site. While I may not agree with certain statements, I have found much more to agree with here than not. I appreciate seeing a fresh perspective.

Camille said...

Thanks, Michelle. It's so hard for me to understand why parents wouldn't just be amazed on the abilities described in those children and find a way to build on them, rather than insisting on stupid things like "eye contact" that a Japanese child, for instance, would be expected to avoid.

I wonder if "non-sentient" autistic children in Japan ever make eye contact in a socially unacceptable way and are taught with ABA not to make eye contact? Probably not...

kristina said...

I've never understood why, but our first ABA program(run by a Lovaas agency) did not work on eye contact with Charlie and this has never been part of is program.

The only reason I'm in support of ABA is because of how it has helped Charlie, in regard to the results that we see (and we have tried numerous other therapies of more naturalistic nature). I really have been learning a lot from your analyses here. I have had my own disputes with many an ABA provider in the past. Our current ABA provider (Lovaas again), seems agreeable (for us, at least, but we've been through a lot of providers) to being more flexible and starting always with Charlie.

I look forward to more of your posts on this topic.

Michelle Dawson said...

Thanks, Another Voice.

You're welcome, Camille! And if you read enough science, you get blown away by all kinds of evidence (left, right, centre...) of autistic learning and autistic abilities in kids and adults--which are either interpreted as deviant or dysfunctional, or ignored altogether ("uninterpreted data"). This happens in both the cognitive and ABA literatures in autism.

For Kristina, Dr Lovaas has recently (in his 2002 book) expressed slight doubts about training eye contact right at the start of ABA/IBI (as opposed to later). But eye contact remains a priority (and usually an immediate priority) in all major ABA programs which have existing formal descriptions (as reflected, e.g., in Handleman & Harris, 2001; and in the major manuals, e.g., Maurice et al., 1996).

Then there is the more general issue of orienting to stimuli. I'll try to blog about this soon because our paper in this area has just been published.

But there are more fundamental problems with ABA programs as they are designed for autistics ("naturalistic" approaches--i.e., incidental teaching, PRT, VB, etc--are also ABA and have the same problems). How autistics learn well as reported in the science (going back to Kanner, 1943, 1951; Asperger, 1944; and Scheerer et al., 1945) and as demonstrated anecdotally by the accounts of the parents in this post (and many others similar) is more or less the opposite of how ABA programs teach (see the autistic girl who learns piano in spite of ABA). This contrast engages a lot more issues than eye contact. E.g., there is the rationing of materials fundamental to ABA programs (preferred items are rationed, as are the materials used for teaching, in both didactic and more "naturalistic" ABA programs), which contrasts with the exuberant use of materials by autistics who learn well.

This is a book(s)-length subject (ABA vs autistic learning), but I'll try to blog more about the problems with ABA programs, and also about autistic learning, in the weeks and months ahead.

jypsy said...

Perhaps that's why we chose not to go the ABA route. Although I was well aware (and had been told) of his difficulties -
"I was unable to make eye contact with Alex......frequent TEMPER TANTRUMS which I witnessed at the office.....his room is basically stripped down to bare. At night mum locks his bedroom door.....Overall, Alex is displaying significant difficulties and has a severe communication delay. ..... my "gut feeling" about this child is worrisome. Prognosis is indeed guarded."

what I saw was -
"Mum stated "Alex is not stupid, maybe he'll be a mad scientist". Mum commented "He's a Sweetie""

(Those comments are from an assessment by an SLP the day before he was officially diagnosed, just after his 3rd birthday.)

r.b. said...

Oy, it was all about the eye contact with ABA, but I never forced my son to look at me. The other part of ABA is teaching your child language in a way that he learns, by "showing". I was his ABA therapist, at a savings of $60,000. I think many of our children would pick it up without any intervention, but there is that part of us as parents that worries for the future. Until acceptance comes, that is. Bless those who start with acceptance.

T.E.A.C.H. out of North Carolina seems to be a much gentler way. I know very little about it, but have known practitioners who respect the child's needs.

mcewen said...

We gave up the 'eye contact' battle about 18 months ago when a kindly and experienced speech therapist pointed out that it wasn't the 'be all and end all,' that it appears to be when you first get a diagnoses.
Perspective and hindsight are great tools. I doubt if there's as much emphasis on 'eye contact' today as there was 5 years ago.
As for the ABA our amateur attempts are just enough to help us make progress as a family with some of the bumpier bits [like dressing] but it is only one method of making progress.
More often than not, it's minescule things that are easy to miss [if you're busy] that make the most significant difference.
Best wishes

Bron said...

For Kristina

I wonder about ABA's successes that I strongly suspect have nothing to do with what the therapists think is going on. I have no data on this - just a lot of speculation.

For instance, Lovaas's experimental set up and from what I have read, other behavioural experimental set ups, looks extraordinarily like the human equivalent of a Skinner box. This cognitive deprivation environment is not there to benefit the client, but to limit the number of behaviour's that are able to be expressed so that the therapist has more control. That's why it's called Applied Behavioural Analysis.

I think the advantages of this set up are both marginal and counterproductive if the goal is a conceptual one (see Lake and the girl from Mother's Vox). However, if the goal is a procedural one - how to do something, then there may be some benefit where there are issues of motor planning to slowing the process right down, breaking it into tiny steps (Amanda says she needs that). But the big payoff of this set up is making the teacher 100% predictable. Note that the behaviour being best controlled here is the therapists, not the client. Now here's the issue. A lot of the benefits of ABA being touted are procedural and I think the benefits have nothing at all to do with any principles of ABA. Indeed I think that ABA is on the whole harmful, mostly because a constant diet of reinforcement has to undermine anyone's capacity to learn in the long term. Actually, where is the data that shows that that this diet is safe and not just for autistic children but for anyone? The reason why I think this is a reasonable question is the admittedly anecdotal stories of children supposedly falling apart without their ABA programs. That looks an awful lot like training for dependency, not for learning.

This is just thinking out loud you understand. If anyone has other and reasonable ideas I'd like to hear it.

Michelle Dawson said...

For R.B., I don't support TEACCH (which has also used aversives in its history), though "practitioners" working within any kind of popular autism intervention can sometimes get past the problems and weaknesses in these interventions. But counting on this is not a good idea.

I haven't yet encountered an ABA program that allows for the ways in which the science shows that autistics learn well. Information and materials are rationed in ABA programs (including in more "naturalistic" programs). There is no credible consideration of why some materials and information might be preferred. The behaviours associated with successful autistic learning are considered inappropriate, inadequate, maladaptive, etc. I have found no exception to this.

The breaking down of everything into tiny pieces, and then presenting the pieces one at a time, also represents the opposite of how autistics learn well (if you are going to quote an autistic, you should provide a source). This contrast is striking in the published science (see how hyperlexics learn, vs how reading and writing are taught in ABA programs).

Estee Klar-Wolfond said...

We need this work. I canned ABA programs in he first two months of trying... Anyway, one thing is for sure, I'm thankful that I was able to experience the joy of Adam, and learned to avoid the naysayers -- they are everywhere.

jypsy said...

The day after the assessment in my above comment, Alex was finally (a year after the process began) seen and diagnosed by Dr. Joe Dooley, Pediatric Neurologist from Halifax, NS. Here's part of his letter to our Family Dr. with the assessment, Dx, etc. He was 3 years, 1 month & 1 day old. --

"In his language, he is responding to "no" for the past 6 weeks but still does not respond to his name. He is babbling but has no meaningful words. Mrs. Bain reports that he makes eye contact less than 10% of the time and although he does not engage in repetitious activities he does like to line things, such as cars and soldiers, up in rows. he won't sit for a story and has no interest in books, although at one stage he liked to rip up books.

He does like to scribble and has coloured the families walls with crayon marks.

As you know, Mrs. Bain is a very relaxed lady who seems to be coping remarkably well."

jypsy said...

Assessment by Alex's SLP:

"With the consistent and enthusiastic support of Alex's teacher assistant and parents, Alex entered Grade 1 at Gulf Shore in September 1993, with the ability to use all of the following means of communication -- sign language, gestures, Canon Communicator, picture communication symbols, infrequent vocalizations and an immerging ability to print words"

"On February 17, 1994 Alex attempted production of "p", "b", "m" and four single syllable words. By March 31, 1994 his imitative production had expanded to 68 words. At the time of this report (May 26/94) Alex would attempt any consonant and any word in imitation of his teacher, aide, or clinician, and is spontaneously producing words of his own in the classrooom. He consistently marks all syllables of a multi-syllabic word and is presently being encouraged to close words using the final consonant. Alex can now read any grade level material aloud and because of his reading ability his teacher assistant has been able to show him the final consonant on a printed word so he can include it in his pronunciation."

lolamom said...

Thanks for such a great blog, Michelle. I am new to all of this, as my daughter "Lola" was just recently diagnosed PDD-NOS (she is nearly three). At their first meeting with her, the lead psychologist thought Lola's case to be mild, and suggested therapy at a special preschool. Upon seeing her for her cognitive evaluation, however, he changed his mind and recommended a year of IBI. Lola doesn't respond to typical "reinforcers," and he thinks it is important that she learn how to respond when asked, and to respond to typical reinforcements.
I was appalled, and told him I didn't like the idea of ABA/IBI, that it just seemed cruel. He laughed off my concerns, saying, "Well, it's no different than what I was doing today. You don't think that was cruel, do you?" I was silent, mostly because my opinion about ABA was still at the gut level, but reading some of your papers is helping me verbalize my feelings.
The evaluation team thinks Lola does quite well when SHE chooses the interaction, the toy, the activity. But when she is asked to comply with a request (even one she knows how to do), she shuts down and refuses to comply. THAT is why they want her in IBI - to teach her COMPLIANCE!
My problem with that is fourfold: 1) of all the things to teach a child, obedience/compliance is pretty low on my list. 2)compliance is not required for her to learn. She has repeatedly demonstrated her ability to learn new things - it has to be something that interests HER, though. 3) Forced compliance with stimulus/response method of teaching is cruel, because LOLA interprets it that way. I can see it in her eyes that she does not understand the "if, then" model (IF you perform as I ask, THEN you will get a treat). I think Lola sees the interaction as this: you ask her to do something unpleasant, she cries. Then you show her something interesting, which perks her up, only to rip the interesting thing away and present the bad thing again. She gets more and more upset each time this is repeated. Despite her aloof appearance, Lola is people-oriented. She is not associating her misery with her failure to perform - she is associating her misery with YOU, the therapist. All that the IBI session taught her is that you are you are a bast@#&!. 4) Even if Lola can EVENTUALLY learn how to respond to typical reinforcements in an IBI setting, that cannot be the BEST way to teach her. I want her educators to figure out a way to teach her that follows her lead, that harnesses her energy and intelligence. I want Lola to be MOTIVATED to learn, not browbeaten into learning.
Whew, I feel a little better. My question for you, Michelle (and any others out there), is not how do I teach Lola, but how do I motivate her to learn more? Any reading material or teaching methods you could suggest for me would be greatly appreciated. And in the meantime, keep up the good work

Michelle Dawson said...

jypsy wrote, from a letter to her doctor: "As you know, Mrs. Bain is a very relaxed lady who seems to be coping remarkably well."

That's just about perfect. Wonderful.

ControlGroup said...

Lolamom--The way your happy "own-agenda" autistic child will be framed into pathology is utterly depressing--I think the most depressing part of having an autistic child. I think the notion of the "social construction" of autism is a useful one--not referring to a description of autistic individuals, but rather to describe how the therapeutic/professional community will come to see everything about your child as a deficit that has to be corrected, unless it falls into a narrowly delineated path of "progress". Since LionBoy got his diagnosis we have already seen the change in attitude from his SLP: what previously she praised as progress is now considered inconsistent displays of ability.... "and wouldn't it be nice if he did that all the time...."

If you read Michelle's Archive and her homepage there are a bunch of great references to get you started on alternative ways of looking at autistic learning and building on Lola's strenghts. I'd highly suggest Gernsbacher's paper on reciprocity in communication, which I think cuts to the heart of the issue you are concerned about.

Be prepared to stand your ground with therapy professionals, as they are going to push ABA and you'll get the "parent in denial" treatment when you start to ask questions

Michelle Dawson said...

Hi Lola,

While I wouldn't use the word "cruel", I have a lot of problems with some aspects of ABA programs that you describe, particularly the rationing of materials and information, and also the working for reinforcers bit.

I also highly recommend Dr Gernsbacher's reciprocity paper, which is here.

For much less formal (though still science-based) stuff about how to encourage learning, see if this post, starting with "Mr Parker, sorry for the great delay..." (which is in response to a similar question) is useful. The discussion in which this post is situated might generally be useful. I've learned a lot since I wrote what I did over there, but most of it is not too bad, and might give you some ideas. There are links to other resources.

All I have time for right now (back to work).

Michelle Dawson said...

Right, and should have addressed my comment to "Lolamom"... not "Lola"... but hi to Lola too (back to work again).

lolamom said...

Controlgroup and Michelle-

Thanks so much for your advice. I read the posts and Gernsbacher's reciprocity paper, and it was wonderful - just what I was instictively feeling. Hopefully we can create the best education plan for Lola, one that respects her and her beautiful uniqueness.

Anonymous said...

Hi all,

I am curious about the reference Michelle has made regarding the paper by Aldred & Adams (2004) and the suggestion that it represents an effective model of intervention. It look promising to say the least and appears ot be a very well designed experiement (RCT).

Is there a published manual re. the approach? I am interested enough to add one to my library if it is available. The positive change on the ADOS schedule is very interesting.

A couple of questions about the results (and a few others that are not related to the results):

1. Is it correct that children in both the treatment groups and control groups ALL showed improvement in comprehension of language with no statistically significant differences found between the two groups? Interesting if this is correct as I would have expected to see scores improve for the treatment group more then the control group.

2. I also understand that results for both the treatment group and control groups did not improve on the other measures of communication skills, socialization, motor skills and daily living skills. Is this correct? When I first began to read the paper I had thought that commuinication and siocialization scores would improve for the treatment group... (I had not thought to see improvement in motor skills or daily living ability as this seems to be outside of what the approach was meant to address). DId scores for socialization and communication not improve for a reason?

3. What happened to the two children in the treatment group that showed no improvement on the ADOS?

4. Was there follow up reporting done? How are the kids doing now 2 years after?

5. Were any steps taken to help the children move from the home environment with "sensitive" and "less intrusive" parents to other environements? Basically I wonder about how the transition is made from home ot other places and people. Did the children require the approach over the long term or did they learn "to conform" as per the follow up study Kanner, & Eisenberg (1956/1973) published? Did they develop skills to communicate outside of the support circle of trained parents, family and professionals?


Michelle Dawson said...

(edited for clarity, with apologies)

Hi Dave,

(Not using your numbering system.)

1. The paper is Aldred, Green, and Adams (2004).

2. If you've read the paper, you know there's a manual.

3. The use of the ADOS in a scalar way is not a good idea (and is a complaint I have about this and many other papers). Fortunately, the authors express some awareness of this problem.

4. The between group difference in language comprehension has exactly the same significance as the between group difference reported in Cohen et al. (2006) for the same ability.

5. Neither the Vineland social nor daily living domains were used as measures in Aldred et al. (2004), so your reporting of results in these areas (and motor skills, etc.) is mystifying. The authors clearly list the measures they used.

6. While the follow-up is after one year of this intervention approach (the same period as some prominent ABA studies), this comes after six months of diminishing intervention instensity. In the first six months, parent training sessions are every month. In the last six months, sessions are less frequent.

7. The intervention requires parents to work with their child only half an hour per day.

8. The above 2 points seem to indicate that effects are durable, and there is no report that the children were unable to function anywhere but in the 30 minutes per day of intervention. The very large increase in expressive language would, e.g., have the effect of the child being able to function better in any environment.

9. Indeed, typical children probably receive more than 30 minutes per day of this kind of "intervention", that is, their communication is responded to, rather than ignored.

10. I think this approach to autism needs a lot of work--a lot of improvement. But the approach itself merits a lot of consideration based on evidence from well-designed studies, and a lot of attention as a subject of research. And in fact, there is a lot of current research in this area.

11. The child (in fact, all the children) described by Kanner & Eisenberg (1956) did not seem like much of a conformist to me--just imagine what his Vineland scores would be. I guess conforming isn't what is used to be (or something like that).

Anonymous said...

Hi Michelle,

You note that "(t)he very large increase in expressive language would, e.g., have the effect of the child being able to function better in any environment."... I hope this is true. I was wondering if the "sensitivity training" the parents had recieved was maintaining the enhanced efforts and if the kids entered a diiferent environ the new skills would "tank". I want to think that you are correct but... show me the data.

I meant is the manual available to "joe public" (me)... I know there is a manual (as per p1422 of the paper) but how does one go about getting a copy (and would it be worth anything to parents)?

I was reading the CAIRN (Canadian Autism Intervention Research Network) summary of the Aldred, Green and Adams (2004) paper at about the same time that I was reading the research paper and in my notes I blended the two. The CAIRN summary notes "Neither the treatment or control children improved on tests of communication skills, daily living skills, socialization and motor skills." You are of course correct... the authors do not report on any of these dimensions (to bad). See link to the CAIRN site (and I am going to try HREF again so.. as I am not very good at it I give you both).

( )


You note "But the approach itself merits a lot of consideration based on evidence from well-designed studies...". I agree. I will be passing it (and some of the other papers you have referenced) along....


Michelle Dawson said...

Hi Dave,

1. The manual would be for those who train the parents. But you are free to ask the authors if you can get a copy. This is why there is always contact information for at least one author of every peer-reviewed paper.

2. Aldred et al. (2004) do not mention "sensitivity training", though the word "sensitivity" is used to describe one part of this many-part intervention.

3. As I mentioned before, the intervention takes place for 30 minutes per day, only. Also, this intervention largely provides what non-autistic children receive as a matter of course.

4. CAIRN, like ASAT, is not in any way a reliable source of information. Both of these autistic-free organizations share those low/no standards of science and ethics that autism advocates have (successfully) demanded for autistics.

Anonymous said...

Hi Michelle,

"CAIRN, like ASAT, is not in any way a reliable source of information"... so it appears. That is a pretty big "goof" on the part of whom ever was reading and summarizing the paper.


Andrew said...

Having heard parents say, "ABA saved my child" has worried me, a behavior analyst, moreso probably than anyone on here. Granted, I am writing from the states, where there seems to be less of this type of discussion, for whatever reason.

ABA, as it is supposed to be, is inherently pragmatic:
1) What needs to be taught? Where do we need to get?
2) What are the ways we need to teach and reinforce the skills? How do we get there?

It also should be incredibly humanistic.

However, to say there is a universal way individuals with autism learn that is counter to ABA grossly neglects 30 plus years of research and thousands of experiments validating that a systematic, science based approach to challenges for ASD's is effective and should be considered.

Do behavior analysts make mistakes?
Sure, the point about eye contact is well made. Does that undermine all the other aspects of ABA? Absolutely not.

Do children learn without formal intervention? All the time. We come into the world equipped to learn, to respond to reinforcing stimuli and events. ABA is not necessary to learning. What it is an attempt to step back and systematically look at what's going on so learning can be better understood.

Those who helped gain popularity for this approach (Lovass, Hawkins, Baer, Wolf, Risley, Lindsley) were inherently concerned with those who others referred to as "unteachable" . These pioneers knew individuals with autism and mental retardation did learn and can and should be taught but that their learning necessitated an individualized, data based approach.

Allowing oneself to be dissuaded from ABA because of the shortcomings of a therapist/particular program is akin to foregoing all medicine due to a doctor's poor bedside manner.

Michelle Dawson said...

Let's see.

For some renowned, frequently-cited (including in Canadian litigation) ABA-related rhetoric from the US, see this.

The behaviour analytic literature in autism goes back 46 years. I've seen wildly inconsistent claims as to number of studies which "prove" ABA is "effective" in training autistics to resemble non-autistics (or to work towards this ubiquitous goal in some way).

A large number of studies in itself does not prove anything about how autistics should be treated. After all, there is a large, impressive ABA literature in autism, which extends to the present, claiming the effectiveness and necessity of aversive procedures (including overcorrection).

And there is always Tang et al. (2002) to remind everyone of what is meant by a study showing the "effectiveness" of ABA in autism.

The massive ABA literature in autism has in 46 years produced a total of one randomized controlled trial (Smith, Groen & Wynn, 2000, 2001--don't forget to read the errata). This study's results were poor.

For a bit about the published science re ABA-based autism interventions, see this (it is now slightly out of date) and this, for starters (references at the end, in case you want to verify things).

Particia Howlin (with Tony Charman as the senior author) is presenting a study at IMFAR 2007, where there was no difference in the outcomes of autistic children in ABA programs compared to those receiving non-ABA services in the UK. It's a large sample for an ABA study (44 children). I have no idea yet how well this study is designed, and of course, it may never be published.

For an introduction to the ethics of ABA-based autism interventions, see this (notes, sources and references at the end).

For Ivar Lovaas' statements about autistics, and a bit about how he described and dealt with the exuberant but atypical autistic learning he constantly encountered (very disruptive for ABA programs), see this.

I disagree that there is or has ever been any evidence that autistics are unable to learn except in ABA programs, though I agree this is a common, unfounded prejudice.

The best adult outcomes reported in the literature belong to autistics who grew up before ABA-based interventions were available, and who met the strictest, narrowest autism criteria ever devised. That is, they were extremely atypical children.

There is evidence that autistic learning is atypical. This evidence can be found in the behaviour analytic literature, as well as directly (learning is atypical) and indirectly (information processing, intelligence, etc., are atypical) in the cognitive and cognitive neuroscience literature, as well as in the savant literature.

Renowned behaviour analysts do not agree with each other about what kinds of ABA are or are not "effective" or evidence-based, or should or should not be funded; and also disagree about what is or isn't behaviour analytic.

Deb said...

I'm a frustrated mom who has 2 children "on the spectrum." My oldest (now 7 1/2) is one of the children who have shown adverse effects from aba/discrete trial teaching.

We sought out different programs and attended the option institute (son-rise program) through which we created a whole new approach.

We ultimately used and use a child-led/child-centered approach which "worked" amazingly. Our whole outlook on autism has completely changed and our whole family especially our children have benefitted.

I was led to believe by our sons' school that they were also doing a child-led/child-centered approach and found out a year later they weren't.

I guess I just wanted to say that whatever methodology we favor or view(s) we have, I find it disgusting that any educator or system would lie to a parent. For those who state that it is a myth that the use of aba/discrete trial teaching causes robotic behavior I can tell you that in MY sons case this is exactly what happened--it's not a myth and is scary at best!