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Meeting Point: Latest From Lovaas

March 07

Meeting Point: Latest From Lovaas

Searching for Answers
Part 2 of a 4-part series

Read Part 1 in the February 2007 issue of Meeting Point to learn about Bronwyn's family's struggle to initially obtain a diagnosis.

Given the right conditions, ordinary sights and sounds often assume extraordinary significance - a knock on the door, for example. It had been months since Bronwyn was diagnosed with autism, and her mother and father had spent that time finding out on their own what treatments might prove helpful. On this particular day in June, a knock on the door meant that their behavioral consultant from the Lovaas Institute had arrived, and they were about to learn all they could about behavioral treatment for their daughter.

Learning wasn't a passive process. After three short hours of listening to their behavioral consultant talk about basic terminology and principles in applied behavior analysis, they started applying that information directly with Bronwyn. Training was a combination of watching the consultant interact with Bronwyn, practicing the same interactions, and then receiving feedback about what was done well and what could be done differently from both the behavior consultant and the others being trained. Teaching heavily emphasized finding things that Bronwyn liked that could be used as reinforcers (in her case, singing songs and stuffed animals ranked high on the list) and prompting Bronwyn so that she would both be successful and learn to answer quickly.

To Bronwyn's parents, it was apparent from the outset that therapy was going to be different from anything she had received in the past. Her mother emphasizes that besides trying to teach Bronwyn, behavioral treatment "addressed 'learning to learn' skills that other therapies weren't." For example, the ability to imitate and paying attention were learning-readiness skills other therapies assumed Bronwyn would already have. When she wasn't paying attention or wasn't learning through modeling and imitation, nothing in those other therapies changed. In contrast, by improving critical learning-readiness skills, behavioral treatment not only was more successful, it also made learning in other therapies easier.

Looking back, Bronwyn's mother was surprised that there wasn't more crying during the first few days of treatment. "It wasn't the same as you often read about in books," she said. "I know initial consultations have changed over the years so maybe it's because of that or maybe it was just my child's disposition." The most difficult part for Bronwyn's mother those first few days was that she "could see how little Bronwyn was paying attention." Her mother and father knew from research that ninety percent of children made progress and ten percent didn't show significant improvement. Her mother worried, "What if she's in that ten percent?"

Her parents didn't have to wait long for an answer to that question, and the answer didn't even rely on possible bias from her parents. Earlier in the year, in January, Bronwyn had started going to a developmental preschool and also began receiving services from an occupational therapist and speech-language pathologist. A review of her progress in May, at the end of the school year, showed she had made no major progress toward completing her IEP goals. In June, she began receiving behavioral treatment through the Lovaas Institute. Upon returning to school in August for another year of developmental preschool, her teacher asked, "What did you do? She's a different child. Her attention has improved so much." Teachers were impressed that she would sit still, remain on task for longer periods of time, and even use better eye contact.

Each of these skills had been important in her behavioral treatment program, but none of them was taught in isolation. For example, rather than instruct Bronwyn to "look at me" or "sit still" she was prompted and rewarded for activities that were difficult to complete without looking or sitting still (for example, finding a matching picture with 24 pictures on the table or imitating fine motor and oral motor actions). In the process, Bronwyn had not only learned foundational learning-readiness skills, she had also made measurable progress in the first six months of treatment, including: following 9 basic instructions that her parents now used at home, receptively identifying 14 new objects, including those associated with Christmas at her house, receptively and expressively identifying 11 different colors that could be used when she colored pictures, following 12 gross motor actions, 8 fine motor actions, 6 oral motor actions, and 8 actions with objects that all served as the foundation to further learning through imitation, completing 8 task completion activities that served as a starting point for solitary play, and matching pictures in a field of up to 24 pictures.

Bronwyn's father attributes the success of the program to the fact that, "every skill is broken down to its very smallest pieces." Her mother relates how task analysis helped Bronwyn learn in a matter of minutes what she hadn't learned for months. After the initial consultation with the Lovaas Institute, Bronwyn's mother decided on her own to teach Bronwyn how to string beads, a task that had been attempted in other treatments in the preceding months without success. After a few minutes with Bronwyn, her mother realized the one missing piece was that she had not been taught to switch hands. Her mother started prompting and rewarding her to switch hands while stringing the beads. After five minutes, Bronwyn was able to string beads independently!

The first six months of treatment did have its share of difficulties. The hardest part of treatment for her parents was recruiting people and hiring instructors, some of whom ended up being unreliable. There was less personal space with "so many people parading in and out of the house," says her mom. Still, they felt relieved with the support they were receiving from the Lovaas Institute. "The therapy, documentation, the training – the Lovaas Institute did truly take over and give guidance in those areas," says Bronwyn's father. "Some consultants have more of an academic background. The Lovaas Institute seems to have more people with an experiential background. They're able to talk with parents and instructors about real world implementation, not just Ph.D., from the ivory tower talk," says her mom.

Next month, follow Bronwyn's family as they discuss the ongoing challenges they and Bronwyn experienced.

The names of all children in this newsletter have been changed in respect for family confidentiality.

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