Thursday, July 3. 2008
ABA Treatment for Children with Autism: Scientific Language vs. Parenting Behavior
Posted under: Research
Two recent experiences got me thinking once again about the relationship between scientific terminology and parenting.
Experience 1: At the beginning of an initial consultation, I recommended that at least one of the parents conduct some of the 1:1 therapy for at least the first six months. The parents were hesitant and stated they didn’t want their child to see them as teachers who put lots of demands on him. They just wanted to “be the parent.”
Experience 2: I attended a follow up consultation with a child who has a brother and sister. When the child and team went to the therapy room to practice a few programs, the brother and sister came rushing in afterwards. The mom laughed and said that the brother and sister don’t think it’s fair that her other son receives so much attention and gets to have so much fun with the instructors. They want to participate too.
The scientific language of behavioral treatment can sometimes make the therapy seem cold or unfeeling. We talk about reinforcing behaviors (rather than rewarding a child). We talk about prompting a child (rather than helping a child). Such terminology is important in therapy because it allows us to be more precise and accurate in our statements. At the same time, I’ve found that once parents have seen behavioral treatment in action, they are pleasantly surprised at how caring and empowering the techniques can be for their son or daughter. They often state that the techniques give them better insight into the interactions they already have with their son or daughter on a daly basis.
I’m interested if anyone has specific examples of using principles of applied behavior analysis to help a child while still “being the parent” (either experiences from parents or recommendations from consultants).
By Vince LaMarca, M.A., BCBA, Editor
Lovaas Institute - Indianapolis
Comments
A former colleague once told me that she had an autistic son. I felt for her (because I know what severe autism looks like) until I met her boy. He was certainly lagging behind in school and still had trouble tying his shoes at age eight nor could he differentiate between the days of the week or accurately tell time on a clock that wasn’t digital. I soon began to understand what was at the root of problem. The boy had no peers with which to socialize and his parents spent zero, and I do mean zero, time with him. Their response to his very presence was "go away." I made a few attempts at discussing this with his mother and suggested that she work with him on the lacking skills. I went so far as to create a calendar for him featuring his favorite cartoon character. I used text and images to establish routine days and special events. I gave it to his parents and asked them to “rehearse” the calendar with him each evening, discussing the routine events of the day, reiterating which day it was, and then asking him to repeat the process for the upcoming day, again reiterating which day “tomorrow would be.” I soon learned that she had given the calendar to the child but proclaimed herself too busy to work with him (meaning curling up in front of the TV after work). Her response was complete apathy. She was able to dismiss him as "autistic" and therefore beyond help (other than medicating him). Beyond lacking a few skills the boy behaved in an otherwise normal manner. Needless to say, I just allowed the friendship to lapse. However, I do wonder what become of the boy. It seems to me that the “epidemic” is not autism.
Consider that the expansion of the definition of autism has much to do with the so-called "epidemic." Note also that the instances of boys diagnosed with autism (at about age three) are higher (at a rate of 1 to 5 according to the NIH) than girls of the same age. This does not strike me as coincidental as boys are generally more rambunctious, if not social, than girls at age three and would tend more often to exhibit some of the "behaviors" listed on the assessment. Moreover, shy children may also "exhibit" some of the behaviors used as indicators. As a child, I would certainly have qualified as "autistic" due to a reserved nature. Let's also not forget that children spend much more idle time in front of the television than they once did and though I will not go so far as to blame the programs, it does appear to me that the hands-on teaching of proper behaviors and skills has been replaced by TV time. It has also been suggested that television reduces the attention span (more so in youngsters than in adults). You can be sure as well that the drug industry has much to do with the escalation of the autism (and ADHD) "epidemic." I note that the prescription of Ritilin and Prozac are listed as treatment options for both.
I would suggest that “applied behavior analysis” has a high rate of success because the process can otherwise be defined as “teaching.” You take the time to actively engage a child and the child learns. Once upon a time, parents took on the role of teacher in a child’s pre-school years, but as you have noted, when you requested that the parents of one of your “patients” engage in 1:1 learning activities with their child, they declined. There lies much of the problem. The rest of the problem lies with the expanded definition of autism and the new criteria used for diagnostic purposes.
See: http://www.medscape.com/viewarticle/508429
See: http://www.slate.com/id/2151538/
Parents ARE a child's first teacher. Who is better qualified to be able to address the winding road of learning than the person who knows him/her best.
Posted by: JANE CAPPIELLO 2008-07-11 21:59