One last comment about effective, varied reinforcement. Since the beginning, the Lovaas Institute's newsletter Meeting Point has featured 5 surprisingly different reinforcer ideas in each issue. I'd like to add my 5 favorite reinforcers to the list:

1. Put a child's hands on top of your hands. Count down slowly and with anticipation 5-4-3-2-1. Then yell "blast off!" and fling the child's hands into the air.
2. Pick up a child's foot and pound on the bottom of it with the side of your fist (with or without shoes on the child).
3. Blow air into the sleeves or back of a child's shirt.
4. Slowly lower a Kleenex in front of your face, then blow forcefully on it and let go so it zooms across toward the child.
5. Hasbro Playskool Busy Ball Popper Hands down one of the most entertaining ball toys.

Anyone else have a favorite reinforcer?

One of the benefits of research into incidental teaching techniques has been the attention that is now paid to motivation when designing programs for children with autism. Labeling colors may be learned by teaching a child to touch different color cards, but this skill can also be approached by teaching a child to pick up different colored trains (if he demonstrates interest in trains). Another extension of this can be teaching a child first to request different colored trains, and later to expressively label them. The format used can be tailored to the specific interests and learning style of a particular child.

Some skills can take a very long time to teach. The length of time necessary to teach a skill can lead to the format of a program becoming less and less motivating. And, it's not always feasible to continually change the format of the program. However, one of the benefits of research into discrete trial teaching has been the attention that is paid to continually assessing and delivering a variety of reinforcers in treatment. This additional reinforcement can be included within the format of the program to keep a child from getting bored.

Whenever I hear an instructor say, "This child is bored of the program," my first inclination is to look at the reinforcement that is being used. Often, it seems more appropriate to say that the child isn't bored of the program; he's bored of the reinforcement that's being given in the program. Mindi Fisher, the first consultant from the Lovaas Institute who ever trained me, made a comment that remains my mantra when it comes to delivering effective, varied reinforcement.

"If you don't break a sweat, you're not doing Lovaas."

As early as 1978, Sepler and Myers noted in the Journal of Applied Behavior Analysis that learning to effectively implement behavioral treatment was not easy. Attending a series of lectures or reading books on behavioral treatment does not generalize into an ability to provide quality treatment (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1311286). Again in 2000, Dr. Lovaas emphasized the importance of quality control in behavioral treatment replication research. In fact, both replication research studies – Sallows, 2005 and Howard, 2006 – not only required years of experience from those supervising treatment, they also included checks for accuracy through direct observation of the staff implementing treatment.

Currently at the Lovaas Institute, we train instructors in such a way that emphasis is placed on the evaluation of performance-based objectives, relevant to the implementation of behavioral treatment for children with autism. Our internal certification process requires a demonstration of the skills you have learned. Certification indicates to parents and other professionals that you not only know what to do, but can actually do it.

Question 8:
What is incidental teaching?

My Answer:
Incidental teaching is a precise procedure that builds off of discrete trial teaching and mand training. If you recall, discrete trial training is a potentially five-part unit of instruction consisting of:

1. the discriminative stimulus (i.e., what the instructor says or does)
2. a prompt (i.e., any help the instructor gives to the child)
3. a response (i.e., what the child does)
4. a consequence (i.e., whether or not the response is reinforced)
5. an inter-trial pause (i.e., the few seconds before the next discriminative stimulus is presented).

Mand training is a potentially four-part unit of instruction consisting of:

1. establishing operations (i.e., environment is created in which objects become valuable)
2. a prompt (i.e., any help the instructor gives to the child)
3. a behavior (i.e., what the child does)
4. a consequence (i.e., whether or not the behavior is reinforced)

Incidental teaching is not the same as mand training. Incidental teaching can include mand training, discrete trial teaching, or both. In incidental teaching, mand training or discrete trial teaching are implemented in a specific way. That specific way is as follows:

One of my favorite ABA comments is the following, "It doesn't take a rocket scientist to implement ABA therapy...It's much more difficult than that!" Rocket scientists get to work with numbers and formulas that stay constant. 2+2 always equals 4. Behavior therapists get to work with children whose attitudes and desires vary from day to day. The rewards and prompts a child needs today may not be the same rewards and prompts he needs tomorrow, let alone a month from now. Still, like any science, I've found some basic guidelines that I return to frequently when behavioral treatment isn't going as well as planned.

Let’s stop mentioning errorless learning when comparing different behavioral treatments for children with autism. The discussion, as currently framed, isn’t really helpful.

In the late 90’s, the term “errorless learning” started to appear in discussions of behavioral treatment for children with autism. Unfortunately, rather than contributing to the dialogue on effective treatment, the use of the term simply caused confusion. Upon closer scrutiny, it turns out errorless learning has been a part of behavioral treatment for children with autism for a long time. The only thing new in the 90’s was calling it “errorless learning.”

Ever since the 1987 Lovaas study, a lot of attention has been paid to the way in which behavioral treatment occurs in a 1:1 setting. Ongoing research is helping us recognize which procedures or guidelines are helpful when teaching a particular skill or teaching a child with particular characteristics. However, all of this attention on behavioral treatment in a 1:1 setting has made it easy to forget that Dr. Lovaas’ behavioral treatment program was not simply 1:1 treatment. That’s one of the reasons I reject labeling Dr. Lovaas’ work as synonymous with Discrete Trial Teaching. In both the 1987 study and replication studies of 2005 and 2006, the treatment progressed to include play dates with peers and time in school. These interactions were carefully planned, were initially facilitated by a trained aide, and included systematic progression that required just as much time and effort as the 1:1 treatment. It is unfortunate when a behavioral treatment program places all of its emphasis on the 1:1 treatment component while ignoring the importance of these other critical elements of treatment.

Question 4:
Why is it important to discuss behavioral terminology?

My Answer:
Ambiguity and misunderstanding of ABA terminology has resulted in some surprising statements. The current mixture of procedural names and branding names used in ABA make for some interesting facts. For example, consider the following statements, all of which are true!

• It's possible to follow a no-no-prompt procedure while implementing errorless learning.
• The only difference between Natural Environment Teaching and the Natural Language Paradigm is the name.
• Natural Environment Teaching includes discrete trial teaching.
• Natural Environment Teaching does not include Discrete Trial Teaching.
• It's possible for a child to demonstrate fluency in a skill without being fluent in a skill.

Question 5:
We have already identified two procedures that encapsulate the vast majority of teaching that occurs in behavioral treatment for young children with autism (discrete trial teaching and mand training). Are there variations to these procedures?

There are two kinds of variations to the above procedures: 1) variations that relate to every trial and 2) variations that relate to a series of trials.

Which is more important:

1. teaching a child with autism to ask others to do things for him or
2. teaching a child to do things for himself?

For example, would it be better to teach a 7-year-old child to ask for a bowl, spoon, milk, and cereal for breakfast or would it be better to teach him to get breakfast for himself?

I think requesting trumps learning to complete an activity independently. Recent research in applied behavior analysis also seems to follow this track. For example, in the 2005 replication research of Dr. Lovaas' 1987 study, Dr. Glen Sallows includes the following statement in his description of treatment procedures, "Requesting was taught as early as possible, initially using nonverbal strategies if necessary (e.g., gesturing, signing, or the Picture Exchange Communication System PECS (Bondy & Frost, 1994), in order to reduce frustration (Carr & Durand, 1985) and increase the child's frequency of communicative initiations (Hart & Risley, 1975)."

Sallows, Glen O. & Graupner, Tamlynn D. (2005). American Journal on Mental Retardation, 110 (6), 417-438.

While learning to complete a task (like making breakfast) can improve independence in one area, it may not generalize to other situations. On the other hand, the ability to request has the potential to generalize to a wide variety of situations. Thus, for some children, it can be helpful to practice requesting, even in contrived situations that will later turn into independent skills, in order to focus on this fundamental skill.

We, as behavior analysts, are on the verge of either dramatically improving behavioral treatment for children with autism or hopelessly tainting our research with ambiguous terms and petty distinctions.

In my experience, discussion of behavioral treatment for children with autism can be broken into three different time periods. From the 1960's through the 1980's, research was steadily compiled demonstrating the effectiveness of behavioral treatment for many children with autism, as well as the limitations of this treatment. During the 1990's, different approaches were branded either as "tried and true" methods of behavioral treatment (e.g., Lovaas, traditional ABA) or "cutting-edge" methods (e.g., Verbal Behavior, PRT). With the start of the new millennium, research has started to move beyond specific terms and more systematically focus on different aspects of behavioral treatment and the likelihood they will best help a particular child.

Unfortunately, the terminology used to describe procedures, methods, approaches, etc. in behavioral treatment has not always been defined precisely enough. If we are to truly research what works best for a particular child, it is important that we don't confuse the issue by using ambiguous terminology.

This is the first in a series of discussions on refining the behavioral terminology we use in research. My discussion on behavioral terminology may not be flawless, but I have enough background to get the conversation going and am more than willing to learn from other people's insights. So, here we go...

By Vince LaMarca, M.A., BCBA, Editor
Lovaas Institute - Indianapolis

Discrete trial teaching is sometimes regarded as helpful only with one-to-one instruction. However, the principles and procedures associated with discrete trials can be applied in a group setting as well. Incorporating these principles and procedures can increase a child’s success in small group work.

1) Make directions and questions consistent and clear.

a. Example 1: After a teacher talks for a minute about fractions, she always states the students name before asking a question. The name can serve as a “get ready” cue in case the child is not been paying attention.
b. Example 2: After a teacher talks for a minute about fractions, she always says, “now solve the problem” to indicate to the students they should start to work on the next problem on their paper. Using the same words helps a child discriminate when a specific behavior (i.e., writing on their paper) is required.

By Vince LaMarca, M.A., BCBA, Editor
Lovaas Institute - Indianapolis

I read with interest the article from the Associated Press concerning autism and insurance laws http://ap.google.com/article/ALeqM5iT3S7GDQdN8H8DfSkpTf58lqVCKAD93U0F7O0

As a behavior analyst for the Lovaas Institute in Indianapolis for the past 9 years, I have seen behavior therapy move from a treatment (prior to the insurance mandate of 2001) that I typically provided to families of doctors, lawyers, and businessmen, to a treatment that I now provide to a variety of families including teachers, retail store employees, and police officers. 
 
Let’s be clear. The autism mandate has allowed the most effective treatment for children with autism to become accessible to families at all income levels.

Note: Recently, Dr. Tristram Smith was misquoted in a MSNBC article by the Associated Press (http://www.msnbc.msn.com/id/27276558/). We have reposted his response to this article below:


The article, “Parents Press States for Autism Insurance Laws,” quotes me as saying that the evidence for applied behavior analysis (ABA) after the age of 6 or 7 years is “sparse.” Actually, I said there are many studies showing that ABA is effective for children for autism at all ages. Toddlers and preschoolers benefit the most, and the intensity of ABA intervention should diminish as children progress and enter school. However, studies show that ABA is still valuable for older children and adolescents. For example, it can be used to design specialized classrooms, support inclusion in other educational settings, and address particular areas of need such as social skills. These services are vital to children with autism and their families, and they deserve our support.

Tristram Smith PhD
Associate Professor of Pediatrics
University of Rochester Medical Center

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.

I just finished attending the 34th annual ABA convention, this year held in Chicago. 3394 participants from 23 countries presented research and discussed issues, all of which were open for critique by other behavior analysts. Just a few of the various topics for discussion included: marriage and divorce, economics, workplace environments, bullying at school, and interventions for children with autism. Perhaps the most enlightening talk I heard was from Dr. Per Holth of Norway who demonstrated how behavioral descriptions of joint attention are helping develop and refine effective strategies for teaching these critical skills to children with autism.