Sunday, March 1, 2015

Developmental Interventions versus ABA:A Recent Experience

I am in a Google Group for DIR Research, and in that group there are a lot of interesting posts. One I recently came across is by Mona  Delahooke, a psychologist who wrote a recent post describing the possible sensory and other backgrounds elements of 'behaviors'. Here is the link:

As a trained BCBA, we were trained to believe that there are four functions of behavior: Attention, escape, tangible, and automatic (it feels good to the child). While I understand that these four functions are a result of 'observing' behaviors and testing out their functions, have been studies over and over again in the field by ABA researchers.  never have I REALLY believed that those four functions were the only reasons people behave the way they do.

For one thing, with children with autism, motor planning and praxis are a challenge. So are repetitious behaviors. Articles and books have been written by adults and adolescents with autism talk of not being able to control their bodies in consistent ways on consecutive days.

And with my DIR/Floortime training and certification, I have come to see the many, many possible reasons for a child's behavior, and the authentic ways of responding to them.

But here is my dilemma. I work with a team of great and really good people who are basically only trained in ABA. That is the language that they speak.  They are all well-educated and are fine people. We are on good terms and I try to be a team player.

However, in one case, during a recent 20 minute consult period (once a week), I tried to come up with a way to handle one child's behaviors from a relationship-based perspective, and I couldn't explain myself well enough to dissuade them from using a time out and ignoring. How can I explain how one would handle the behavior in a DIR-based way? I found myself coming up short.

How do I go about imparting some elements of DIR with my team? Where to start? I want to help them see that there are benefits to DIR as a strategy in a school district. I'd love some suggestions! the two ways of thinking about children with autism are almost contradictory, and given less than 20 minutes a week, how can I share with them the limits I see in ABA-only and the benefits that the addition of DIR thinking can really benefit our students? I know ABA, and I also know Floortime. Shouldn't I be able to do this?

Tuesday, February 17, 2015

Declarative Language for Children with ASD (Similar to my statement: "We don't ask questions in Floortime)

When I am working with paraprofessionals in DIR/Floortime, the first behavior I change in them is their habit of constantly asking the students questions, even when what they mean is a statement or a directive. For example, in my room children enter the room, sit down and take off their shoes. Too often a paraprofessional (or, often a teacher or Related Service Provider) will say, "Do you want to take off your shoes?".

Wrong. This is not a choice, But I understand, these are adults who want to  be nice.

This does not help children on the spectrum learn language. And what would happen if a child answers, "No thank you"? A therapist should only ask choice questions when there are real choices.

And I just read an article that was given to me by a parent on the importance of using declarative language with kids on the spectrum. It was only two pages long, and it is a  beautifully written statement about the need to use declarative language with these students.

Declarative language is stating out loud what one knows or thinks, in the form of a statement.  It can be used to share an opinion, predict something, announce/celebrate, observe, share past experiences, or to problem-solve.

When our language with children on the spectrum is largely imperative, that is, questions or demands, this teaches the child that there is a right or wrong answer to everything.  Authentic communication is about experience-sharing. If children on the spectrum are expected to how to socially communicate, they need a linguistic environment rooted in declarative language input.

What can we do? Stop asking questions that are not really questions ("can you get your bowl for snack?"). Say, "It's time for snack", and then stand near the bowls so the child sees them. A therapist might say, "WE need something to put the snack in". We want the child to think and help solve the problem.

Model self-narratives to help a child develop his/her own inner voice. Model by making predictions, ponder opportunities, reflect on past experiences.

Provide a window into another person's experience. Use declarative language to describe what is going on, what the child might be experiencing, and comment. We also want to use declarative language to help the child 'zoom out" to see the bigger picture. I have a child who loves to put certain people figurines in one room for the dollhouse, and then  repeat a script about seat belts and blasting off.

I say, "You really love to play that. Look, I can put people HERE and they can blast off", and put different people in a different room. Often, she will simply put my people away, but I keep at doing such things so she sees the bigger picture of the doll house. Or I hide her people, and model blasting off with different people. Then I tell her we have to find her people and we look for them.

I do not remember in which journal I found this article, and I only have a paper copy. I think it might have been ASHA weekly or monthly; it's a newsletter. But the author is Linda Murphy, a S/LP, CCCC. You might want to google her. And we call might want to/need to reflect on our own language around the students. We could make a checklist and take data on ourselves!

Tuesday, February 10, 2015

Thoughts On A Snowy Day

Today as the snow settles and the driveways and cars are all shoveled out, I am taking a few hours to catch up on some reading.

"Coloring Outside Autism's Lines" is an easy read. Written by Susan Walton, a parent herself, it's for parents, and outlines 50 + activities, adventures and celebrations for families with children with autism.  There are chapters on preparing, comfortable clothes, weekend and vacation routines, grandparents and special friends. Here is the link:

I also breezed through "Developing Play and Drama in Children with Autism Spectrum  Disorders" by Dave Sherrat and Melanie Peter. The first couple of chapters rally helped me think and understand about the physical and neurological changes that occur when children play. And play, in children with ASD, tends to be repetitive, scripted, obsessive, and restrictive. Here are a few things that I learned that refueled my passion for play.

Children with autism seem, for the most part, not interested in the world around them or other people. They do not learn without support, and learning to understand and appreciate their own emotions and those of the people in the world around them are generally diminished. They have trouble making meaning. Their inability to perceive meaning mitigates against purposeful involvement, both in the real world or in make-believe.

With the emphasis in schools today on teaching primarily through telling (telling a child what to do, where to do it, and how to do it) often at work desks or cubicles lacks learning through context. As much as these teaching events are structured, children risk "learning equipment' rather than learning contexts for developing  relationships and discovering pleasure in human contact.

Play is essential for helping children with autism developing sense of self and evaluating affective states (their own and that of other). Rote learning is difficult to put in its proper contexts.

This is truly a thoughtful book. It begs the question: Do how do we use this to increase a child's school-based learning?

Here is the link:

With the advent of structured interventions in schools nowadays and the impact of testing on curriculum,  using a relationship and affective-based approach, would cause a hugely difficult problem to solve: How do we do instruction in academics?

I am working on that question right now!

Wednesday, January 28, 2015

Why The Emotions of Children with ASD Matter in Schools

This is not something we talk about much in schools or preparing for an upcoming IEP meeting.  In fact, in ABA parlance, emotions are not observable or measurable, and for the most part, not mentioned. And when an ABA team is talking about the functions of behavior, the talk centers on attention, automatic reinforcement, escape or tangibles. I believe that emotions would be considered in the category of "mentalisms", those vague and nonmeasureable aspects of a child's behavior.

But to think only in terms of the four functions limits how we think about a particular child. One boy I know  is struggling about his mother's recent hospital admissions and having to live with grandparents. Surely he is sad, sometimes angry, and almost certainly confused on most days. He is a very bright boy and often 'loses it' in class when something is hard or it's something he derives no pleasure from; he'll cry, yells, refuse to comply or listen to the teacher,

And in turn, he will often get pulled out of the room and his teacher will have a stern conversation with him. If he wants to stay in her class, he will need to 'get it together' and keep a calm body, follow the directions, and in general, comply.

I'd prefer an intervention in which he gets warm support from his teacher who recognizes that he sometimes gets angry or scared, that he appears to be angry, confused, and/or sad. We could comfort him in his state of emotions, and recognize that while it's OK to be upset, yelling is not the way to get his needs met. I'd then do deep breathing with him, and offer some suggested alternatives to him for emotional support.

And since emotions and cognition are so entwined, not acknowledging a child's emotions and not giving emotional support probably does effect what s/he learns that day.

I love this blog post writer: and I love this recent blog post:

When a child with ASD is upset or angry, we adults need to recognize these emotions as legitimate. I know if I got to work angry, it is very, very difficult to be really present and available to the children I serve. If I can't regulate myself, it will be really hard to help a child regulate and pay attention.

So I propose this: Let's widen the conversation in our schools to consider how a child's emotions might impact his or her behavior. Let's use emotion words with students to help them understand why they get 'stuck' in a particular pattern of behavior. "I've seen that when you think the work is too hard, you get frustrated and break your pencils or walk out of the room without permission. Let's talk about better strategies for when you are frustrated. But first let's calm down and you can tell me all about it".

We ask children with ASD all the time how do they feel, and most are limited in the words they use to describe their feelings. Maybe we as adults should be using the feeling words with out students so they becomes more familiar with anger, frustration, irritation, impatience, and not keep them limited to "sad" and "happy". It's seriously worth a conversation among the adults and he teams that support children with ASD in schools.

Sunday, December 28, 2014

Random Thoughts During School Vacation

First, I apologize for not having blogged for so long. I often wonder if anyone reads this. Then, let me say that I know that while I am home relaxing, the parents of the children I serve are not able to do the same thing. I apologize! But being on vacation has given me much time to think about services, interventions, and more.

I read an article today on the effects of structured teaching on children with ASD. The author is a British professor, and she was reviewing TEACCH methodology. (Note: she did not include ABA as structured teaching, which I thought was odd; comment if you want me to post a link to the article). And her review and summaries were interesting. She quotes Dr. Mesibov, one of the founders of the intervention, and I will paraphrase here: he described TEACCH as more of a 'Gestalt' type of intervention with an effort at making learning more meaningful. However, all of the studies on TEACCH have been only on measurable behaviors, not the 'GESTALT ', and not on the what the children are learning or the why of what they are learning.

She also comments that there is no research on the experience of the people implementing or receiving the intervention.

Regarding the latter, I think that we NEVER discuss the experience of the teachers or our students. What's it like to implement structured teaching all day? More so, what is the experience of the student who is on the receiving end?  Certainly it builds skills (or behaviors) but what skills or behaviors? And at what cost?

And that leads me to this: never before in education as I know it NOT concerned with children making meaning of what they are learning, and that's not only the case for children with autism. We have the Common Core and also state standards which pretty much dictate what a child must learn. I often wonder if our students are making any meaning about what they are learning.

And I do not like that at all.

Friday, November 14, 2014

More Thinking Outside The Box

Last weekend I went to the International ICLD Conference; ICDL is the organization that developed and trains people in DIR/Floortime (The Profectum Foundation also does this). Then last night I went to a lecture on some facets of genetics and autism.

I just love how these two experiences open my mind to many possibilities. The genetics researcher mentioned that there is an intervention that improves IQ in 20-50 % of children and that intervention is ABA.

Yes, he said that. I responded with a comment that there are other interventions and mentioned DIR/Floortime. Well, I had several people come up to me after the talk to see if I've had experiences getting school districts to accept DIR/Floortime. I said no, but we are working on it.

We also had an advocacy group at the ICDL conference. I mentioned that I know young people are getting their BCBAs so they can have a job in autism where they can get paid. So far, that is generally not true of Floortimers. The group was mentioning media packets, going to legislators and other politicians. Apparently ICDL has also hired a lobbyist, who has been influential in California. We'll have to bring him or her to Massachusetts!

Me, I sent a proposal to my top level boss to create a developmental ASD kindergarten next year. And I created a professional goal to introduce developmental concepts into our ASD classes. And that is really what I want to do in my current position.

But how do I do that when our entire team thinks in terms of antecedents, behaviors and reinforcers? DIR is not a single-use strategy, but is rather a long-term commitment to a method of being with kids. So I could use any ideas from anyone about how to go about this. I'd love to get a group of DIR providers to work with me on advancing this idea.

Is there any way we can talk about this?

Thursday, November 6, 2014

Some (Potentially Controversial) Comments About Ethics

Lately I've been thinking a LOT about ethics in the field of autism. I am doing this because I am a BCBA AND a certified Floortime Provider. There are those who say possessing both certificates and actually implementing Floortime is "unethical".

Now, I know that the Guidelines for Professional Conduct written by the Behavior Analyst Certification Board state such things as the Behavior Analyst should be aware of the scientific nature of ABA, hold true to those beliefs, and implement ABA in the most ethical ways.

The ABA guidelines also state that the Behavior Analyst derives knowledge from science.

BCBAs sign a form that states (and I am paraphrasing here) that we will only use and implement evidence-based measures. And I've come to learn that this means ONLY studies that are based on the ABA principles.

So, how can people conduct research on other interventions when they are bound by the restrictions of ABA-based research?

I happen to know that there are 26 studies in the literature that capture the effectiveness of relationship-based interventions.  However, most likely the ABA-only proponents would probably not include most of these articles because they are not designed with ABA in mind.  I also happen to know there are a multitude of scientific articles about child growth and development through relationships and experience. But because this research is not based on antecedent-behavior-consequence, it is not given any credence by the ABA-only advocates. I wonder what an ABA-only advocate would say about Piaget's research on language and cognition?

That said, I believe in the use of both ABA and relationship interventions. With the circular reasoning of BACB guidelines,  a Behavior Analyst cannot, by definition, learn, think or add skills to his/her repertoire that do not fit within these Guidelines.  So most, if not all, behavior analysts only read the ABA literature, only know about ABA interventions, and do not think outside this "box".

This "box" ignores child development. Children learn through experience, through relationships, through play, through interaction. If their experience of interaction is only DTT from when they are 2 or 3 years old, that is quite a one-sided set of experiences. The adult tells them what to do, what to point at, what to say, and how to do all these things. So ABA-only, by definition, ignores the life of the child outside ABA as not being important.

There are important skills that can be taught using ABA. What I have experienced in my career is that there is more than one way to teach and reach a child.  Some kids thrive on ABA; some kids don't. And for the ones who don't, we as professionals must be alert to this and find other ways to reach them.  This is, indeed, in my opinion one of the limits of ABA. It's as if the Guidelines were intended to keep Behavior Analysts from having a different experience, from learning something new, and growing in their careers.

So what is wrong with thinking outside the ABA box?  I chose to do that and it informs my practice. I choose to expand my knowledge and thinking about children with autism and how they grow. I also choose to provide parents with an option of how they want to treat their child. Not all ABA is bad, or foolish as some on the child development side would and do think. When are we going to stop arguing over who is right and find ways to reach each individual child?