Posted by Dad
on August 02, 2000 at 12:00:07:
In Reply to: ABA posted by Sophie in Arkansas on August 01, 2000 at 22:09:18:
ABA stands for Applied Behavioral Analysis, Lovaas is the Dr. who studied it, and developed it into a system specifically to work with autistic children, although is has been used with some success with Down's and other "MR" children as well.
The Lovaas method uses Discrete Trial Training (DTG), which utilizes repetition of very basic skills development exercises, coupled with positive reinforcements for the correct answers/behaviors and unemphasized, short "no" for wrong behavior extinction. Basically, it is very much the same as good parenting, but due to the limitations in both attending and cognitive skills in many autistic children, the lessons a normal toddler would learn in just a few corrections, the (usually) older autistic child often takes weeks to master. Once the basic skill has been demonstrated to have been learned, you add the next, with frequent review to ensure retention.
Typically, the first lessons are "come here", "sit down", "quiet hands", "look at me", etc., focusing on attending skills. Also typically early lessons are verbal prompt imitation "do this" followed by a simple action, such as clapping hands or rapping on the table. To cope with the child's short attention span,
frequent breaks are allowed, and each round of "lessons" is ended on a successful note, so that the child doesn't take the lesson of "if I hold out, they'll let me go from the table." Often positive reinforcements are used as carrots to improve the desire in the child to succeed at tasks on OUR request (as opposed to when he feels like it), typically small food rewards like skittles or m&m's. As the child progresses, these are replaced by larger rewards, sometimes called token economies, where the child earns credits which can be traded for a bigger "prize". Some people feel this is bad, that the reward should simply be the desire to achieve. To this the response is yes that is the goal, but remember that the autistic 6 year old is operating at the psychological level of a toddler, and this abstract thinking must be developed. Actually, this is little different from the parent using "no desert till you eat your dinner", or "no TV till you finish your homework".
It is important to note that not all ABA programs are the same, and a good program utilizes positive reinforcement, and no aversives stronger that a short, non-emphasized "no". Restraints are also avoided, as they can quickly escalate into a situation where the child is either traumatized against the trainer or actually hurt. Autistic kids are very often very strong, and very fast, and they seldom pull their punches, so to get them in a physical tussle can be injurious to both them and the trainer. Time out is also to be avoided. Autistic kids do not suffer in the least by time out isolation, indeed it is often more of a reward, as then they can stim in peace and not have to deal with a lesson they are not interested in.
Which brings me to the next point. Why bother at all? Don't they have the right to be autistic? Why should we force a change on them? This is a concept that is growing more popular among many people who see the "disabled" as having unique qualities and should be allowed to live their own lives without being forced into different modes of thought and behavior. The fault in this perception is clear if you dissect the argument. If the autistic does indeed have the right to be left unchanged, then the normal child also should not be forced to learn lessons they don't want to. Therefore, a teenager who would rather stay home and play Nintendo should also have that right, and there should be no standards for promotion or graduation, and truancy should be equally acceptable. We can see this is not correct. Also, it is a big, mean, and uncaring world, and the autistic child must be helped into cognitive self-sufficiency, as the only other option is internment into residential facilities (expensive to parents and taxpayers alike). And finally, autistic children do not have the knowledge background to make this decision for themselves.
ABA is an intensive program. Lovaas found that it requires 30-40 hours per week for 2-5 years to help the children escape their isolation and reach our world. His success rate was 47%. In the control groups (first no ABA, then 10 hours per week ABA) he had 0% success, and all those kids ended up in residential facilities, unable to do more than the most menial tasks, with caretakers guiding them, and most lost all verbal skills entirely. Lovaas was strictly a behaviorist, and spent no effort looking into the medical pathologies that often accompany autism (lead poisoning, gluten intolerance, auto-immune issues that attack the neurons of the brain, etc.) and these underlying medical problems were not treated in any of
his kids. I (among others) am a firm believer that the psychological help must be coupled with rectifying the medical issue, and I am convinced he could have achieved 90% or better had he had medical programs involved as well. It is critically important to note that Lovaas did NOT use Ritalin OR Prozac family drugs to cure hyperactivity, and again, I (among others) am convinced that THESE ARE NOT NEEDED. PERIOD. Both of these drugs are widely prescribed by doctors who have no clue about autism, and all they do is dope these kids into a semi-stupor, while the triggers of the autism (gluten, lead in the blood, etc.) continue to intensify the very behaviors the medicine is attempting to stop. It's like driving with one foot on the gas and one foot on the brake. The car runs poorly, and all you do is burn up the engine and transmission.
ABA has been proven effective. There are pockets of ABA in use scattered throughout the country, usually around a large university or other program that focuses on autism and ADD. There are programs that will export the method anywhere it is needed, but it ain't cheap. This is the big hold up for many (coupled with the misinformation about Lovaas that many educators learned when they took their psyche classes). But it has been proven that it is far cheaper for the states to pay for proper treatment NOW, rather than spend on 12 years of spec ed and then a lifetime of residential care. Again, the problem is nobody who writes budget worries about the long-term picture, just this year's expenditures. Sooner or later, the administrators and legislators are going to have to wake up and realize they have little time to waste.