Who knows ABA best?

The first autism blog I read – entering a portal to a whole ‘nother world, was the excellent blog The Voyage.  The blog author, online-name Sharon, is very cordial to commenters, including me even though this blog is not on her blogroll.

[ I am NOT keeping score. Ahem.]

Sharon introduced me to the term ABA. My first thought was that ABA implied a 3-step process where the first step was repeated after the second step. Not. Applied Behavioral Analysis as a term required some translation, however. The specific combination of 3 generic words means….what?

A great deal of opinion on ABA floats in the blogosphere. Much less exists in scientific journals.

My summary of Sharon’s posts on ABA is that she does not choose this method for her son with autism, and she does not want the government to mandate the technique within public school regulation.

The chronicler of The Voyage also shares my disdain for emotional and erroneous media depictions. A post by Sharon on February 7, 2008 ends with a quote from parents in litigation to get ABA for their son:

We have spent almost all of Sean's life begging and pleading for services that should be his automatic right, but we have no regrets. How could you regret fighting for your child? Anyone would do it. We are no different from anyone else.

Sharon: They are right. He does have an automatic right to an education. But not to ABA.

Sharon concludes another post with:

I don't understand however why all these new-style ABA programmes that people talk about are still called ABA though. Is it just shorthand for 'eclectic mix of speech therapy, occupational therapy, play, child-led learning, with a hint of discrete trial training'?

[Well, ABA is shorter, Sharon.]  I have a lot of respect for Sharon’s opinions albeit it is important to note she lives in Ireland. In her decision to homeschool is evidence of her ‘fight’ for her son. [Studly Hubby and I have spent very little time musing homeschooling for our children. Little time many times. Not.for.us.]

I greatly admire parents who choose to homeschool. May they all do well and prosper.

I still contend that ABA is behavior modification according to specific protocols. 

Julie left this comment in response to that last statement. 

I will be interested to read your input on behavioral modification. I have evaluated it and found that I could not put it neatly into my world view. When I catch myself using positive or negative reinforcements to get my children to behave in a certain way it always makes me stop and evaluate my parenting goals. Because, on the whole, changing behavior isn't my underlying goal. I am trying to change attitudes. Besides, in life there are many things we have to do that don't necessarily come with an immediate, obvious carrot. [My emphasis.]

Julie’s comment helps me remember to say there are different types of learning – not an outlandish statement – you know - math, words, motor, sensory, reading, writing, creative, concrete – all words used to distinguish types of learning.

Not to start parsing the brain into discrete areas, but the kind of learning Julie refers to (attitudes) is in the cortical area, the brain tissue necessary for executive functioning. I’ll reach a little bit here and say that some children*(people) need some work at the sub-cortical levels before executive level functioning becomes obvious in their behavior. Meaning, behavior modification techniques work for some. *for those whom it does not happen naturally on a common timline.

In a follow-up email message from Julie:

Behavior modification was the primary “tool” used by Marissa’s EBD resource class instructor. [If you are a carpenter, then every problem is a nail and your primary tool is a hammer.]

I learned while Marissa was in school that it didn’t work. It kind of assumes that Marissa can do something and punished her (more precisely withheld rewards) when she did not choose well. One of the things that she could earn points for was choosing to keep her locker organized. There is a photo of her locker on my blog.  Marissa scores in the bottom 5th percentile for object assembly. She could not do this task without accommodation and assistance. She also had goals for choosing to be to class on time prepared to learn. Again, this is not a skill she had demonstrated that she could do and was now choosing to slack-off. She had never been able to do this.

The schools goal was that Marissa should be independent at the level of her “same-aged peers.” This despite the fact that her IQ is borderline and she has FASD. Research has shown that people with FASD have poor executive functioning and typically function lower then what would be expected based upon their IQ test scores alone.

Besides that Behavior Modification doesn’t work for my child, I have a philosophical problem with the concept.

Julie is generous in sharing her experiences on her blog. For more of Julie’s posts on behavior modification:  Treating People as People,  The Twin Incentives Used in Behavioral Modification, and Human Dignity.  Julie is in the US, and she also homeschools her children.

Alternating to different opinions of ABA, here is a comment from MeghatronsMom: 

I don't often post much about ABA on my blog. I just know that we spent hours having it done, hours getting trained & hours doing it. We live the ABA way too. Always reward the good (not necessarily with tangible items, usually lots & lots of praise), never punish, ignore the negative, etc.

More reference for ABA comes from well-known (in some circles) Kristina Chew, PhD. 

Applied Behavior Analysis—ABA—has been the core of my son Charlie’s education ever since we started a home program for him in September 1999… Living with Charlie has come to mean not an endless recovery effort, but simply endless efforts to teach him, however long it takes to learn any particular skill.

Notice Kristina refers to ABA as a teaching method.

I think Danette makes a lot of sense with her recent comment here: 

Good post, and good info. We haven't done any "official ABA" but I know we and our sons' teachers have used some of the same kind of techniques to some extent. Same goes for floortime techniques. We have done structured ST and OT, which have been very helpful, and we've integrated a lot of our therapists suggestions at home also. Aside from that we've tried to learn as much as we can about different techniques, adapt them to our kids and create sort of our own tailored approach of whatever seems to work. If that makes any sense.

JoyMama is writing an excellent series about the services provided to one of her daughters - services that include an element of ABA. Her comment here recently prompted this comment from me:

Thank you, JoyMama for adding yet another useful insight to the discussion. You have made me aware of, for the first time, that those who purport ABA exclude sensory theory.

My emphasis is that ABA is a technique - a potentially useful technique. There are also many useful techniques that are based-on theory of how the sensory system works and repairs. The decisions for implementing which techniques to use for any child are important decisions - difficult for many parents.

My recommendations are for parents to trust the professionals to whom they give those decisions. Most of the parents I've read in the blogosphere are active in trying to understand the basis for the techniques. I offer them information to increase their understanding. (Not all parents are as active in this process.)

Services are not evenly distributed and professionals are not all equal. But generally, a person who has earned the title of occupational therapist or physical therapist is worthy of initial trust. In my experience, teachers are more widely variable for their skill.

Generally, technique-based intervention is prone to exclusion of all other perspectives and likely to miss an avenue of benefit for the child. Indeed, ABA and sensory integration methods need not be mutually exclusive.

Technique-based mandates are as bad as arbitrary exclusions of methods in special education and behavioral medicine. [Which of these two do you consider an oxymoron?]

Those who purport ABA are fighting the myth that the technique ‘turns people into robots’. I think ABA turns the ABA-purport-er into a robot. (I have said this before here -) if the services or service provider are technique-based, that should be a red-flag to you.

Technique-based service providers are not professionals, they are technicians. Professionals know and can apply a range of theory and technique, individually to their clients/patients.

Backtracking a bit….In late September 2008 I attended a local 2-hour presentation titled Introduction to ABA and Applications. [Seemingly serendipitous timing, but I do not believe in coincidence.]

The presenter was the owner of a business in the town where I live. He was hawking his business and he was not very experienced in talking to a group. I can empathize with being in front of a group who are lion-like in their beliefs [PT students. Oy vey.]. It was another of those situations where I could not keep my hands under my ischial tuberosities (the boney prominences we sit on). 

I did ask nicely. I asked him how he distinguishes between the behaviors he is trying to extinguish/modify and perseveration. His cover-up was close to good, but not good enough. He did not know what perseveration meant. He called repetitive behaviors “stereotypy”. Nice. A new word. Not.in.the.scientific.vernacular.

Which reminds me – I did examine the ‘references’ listed in the handout. Keeping my opinion of the short reference list short: unimpressive. But then I am perhaps pickier than most [which is unrelated to sitting on my hands. Ahem.]

The ABA-presenter had the initials MS after his name, and BCBA – Board Certified Behavior Analyst. In other words, no legal oversight. His services are ‘over-the-counter’. (Did I hear him say that some private insurance companies will pay for ABA?)

His business brochure carries this motto: “Shaping Independence through Science”. Buyer beware. 

*****

Our Christmas tree was undecorated and put in the attic yesterday. If I get this posted today AND all the rest of the Christmas decorations put-away I’m going to reward myself by working in the yard tomorrow.

Comments

[This Little Piggy]

Food for thought.

Chewing on it... ;o)

[tara @ kidz]

Excellent information, as always!

[JoyMama]

Thanks for the linkback! A couple of things from other bloggers you quote that jump out at me:

Meghatron's Mom's statement "We live the ABA way too. Always reward the good (not necessarily with tangible items, usually lots & lots of praise), never punish, ignore the negative, etc." A nice way of stating some of the basic principles!

Second, Sharon's question about some ABA programs: "Is it just shorthand for 'eclectic mix of speech therapy, occupational therapy, play, child-led learning, with a hint of discrete trial training'?" Sounds like there are other House Blend mixes out there...

[Fran]

Self-ABA thrown in at the end. I like it! I am not a professional in this field, and I lack personal experience with said professionals, but...I have experience with the principles of ABA in the working environment. I'm currently coaching my engineering team to apply some of these techniques as we "retrain" coworkers to respond to us in our new roles. Very interesting stuff.

[Barbara who lives here]

I do worry about posts being too long and not being able to hold reader's attention through the whole post. Too big of a meal, TLP?

Thank you, Tara. Your few words only encourage me!

Yes, JoyMama, and joyously so. I try so hard to encourage parents to make decisions that are individual to their children and families. Information is part of that encouragement.

[Maddy]

Looks like a lot of us are aiming between the same goal posts, although some are a little wider than others.
Cheers

[JoyMama]

Returning to this post with one thing I forgot to mention before -- the term "stereotypy." I'd never heard it before, then came across it twice in a week. Once was here, the other was in Time magazine quoting Temple Grandin's new book Animals Make Us Human (the exact context of the quote escapes me at the moment.)

Is there a nice compact word that already exists in the scientific vernacular for "stereotypy"? If not, I'm just as glad to see a precise word appear in the language. Although before I'd start campaigning to get "stereotypy" into the dictionaries, first they need to approve "stim," which I keep wanting to use in Boggle games but can't since it's apparently not yet dictionary-worthy!

[the Barbara who blogs here]

Fran, generalizing information is the height of intelligence. You are among many smart readers here. Thank you.

Maddy, you get kuddos for so succinctly summarizing the breadth of this topic.

And JoyMama, I think I saw that same reference to 'stereotypy' that you did...causing me to reconsider my reference to the word in this post. Not necessarily a negative to produce new compact words. But until the term is accepted and operationally defined in a research context - work to reduce 'stereotypy' remains unaccountable or subjective.