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:

http://www.thevisibleparent.com/tuning-in-to-the-emotional-lives-of-children-with-special-needs/

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?

Thursday, October 9, 2014

A Little About 'Scripting'

I know, I know, I abandoned this blog much too long ago. There are times when I used this blog to think things through, and there are times when I actually am too tired to do that.

But tonight, I've been thinking about the use of 'scripts'. I've just finished reading, "Life, Animated" by Ron Suskind. It's the story of how he and his wife 'found' their child, who regressed into autism at about age 2.

When he was first diagnosed, Mr. Suskind states that they tried ABA and Floortime, but did not see any progress. They may have tried a few more things also. Eventually they got him into a private school for children with learning differences, and together the family watched an awful lot of Disney animated movies because their son Owen loved them. He scripted a lot of phrases that sounded like they were from these movies, but they could not decipher exactly what he was saying.

At one point, Owen was saying something that sounded like " Juice yer voys" over and over. Eventually, his mom, Cornelia, recognized he was repeating a famous line from The Little Mermaid:
"Just your voice". And eventually they recognized that the lines he repeated over and over had meaning for him. He used phrases such as "Just your voice" as a way of trying to communication with them, as if saying over and over "Just your voice" was telling them he wanted to talk. As time went on, they began to recognize phrases that signaled anxiety, fear, fright, happy, sad. and they would respond to his 'scripting' by following his script with the next phrase from that dialogue. And eventually, they began to comment to him how they thought he felt when he was saying these phrases. They learned to 'interpret' his speech as if it were real communication and not just a script. Over time, and after doing this hundreds of times, he began to reflect on his own use of each phrase. He was using "just his voice" to communicate that he was trying to talk to them. He didn't have the words to explain that he wanted to talk, and eventually he began to expand on his simple phrases, combine phrases from different movies, and engage in meaningful communication. As an adult now, he is aware that in certain situations he will script and manage to tell what he is really trying to say.

So the family never 'banned' his Disney movies, never made him earn them for 'doing his work', but they incorporated these well-learned lines into his academics, social skills, and communication. He told them that he was a 'sidekick' and not a hero, and that the job of 'sidekicks' was to support the hero.

Well, this does sound a little like DIR/Floortime, in which you support the apparently nonfunctional scripting and try to make meaning from it. Sometimes I simply repeat what the child is saying with rich affect, and even the littlest ones suddenly look at me as if I am speaking their language. And maybe I am!

So it was with great interest to me to read this post on the many functions of scripting and the uses people with autism have for them:

http://musingsofanaspie.com/2014/10/09/echolalia-and-scripting-straddling-the-border-of-functional-language/

And then I followed up with this post:

http://emmashopebook.com/2014/10/09/scripts-a-communication-bridge/

So perhaps for some kids we might try imitating their scripting and/or giving it meaning as a means to begin to tease out true, intentional communication? And perhaps if they see that their scripts have a meaning for the listener as well as the speaker, intentional communication will grow.



Sunday, September 7, 2014

A Great Resource

Someone in my Google Group sent a link to a set of videos called, "Ask An Autistic". What a wonderful idea! This young woman, Amethyst, describes stimming, echolalia,  and many other autism-related issues based on her point of view as a young woman with autism.

And in this particular video, she comments on ABA and then describes DIR/Floortime. Amethyst states that she thinks ABA should not be used with anyone (Well, I can't really agree with that, although I've made it clear several times that I do not believe ABA should be the only intervention) and then does on to talk about Floortime.

https://www.youtube.com/watch?v=qkd0I3lTvO8

I am going to make it a point to watch all of her videos. I find that the insight gained by listening to people with autism is expansive and really starts me thinking about how  we approach teaching and being with people on the spectrum.

In my own experience, working for about an hour a week at the most using DIR with children in sub-separated classes results in limited but useful progress. For many of these kids, I dream about seeing them in a full-day, school-based DIR program. I know that is very hard to imagine, (and it is also difficult for me to imagine), but I'd love to see a school where children are not seen as 'having behaviors' and where we limit our adult thinking about the functions of their behaviors in strictly behavioral terms. Can't we successfully think both about specific functions of behaviors that include pain, medical issues, hunger, anger, boredom, and many other issues that are functions of our neurotypical behaviors?

Outside the box? A more comprehensive approach? Yes, let's try!


Tuesday, September 2, 2014

Back To the Blog

Well, I know I took an unintentional vacation from this blog.....since July 5, 2014.

And it was good. The vacation, I mean. I am hoping to start some interesting discussions about treatment and intervention.  And points of view!

So, I really would love folks who read this to comment. And argue.  And present some different opinions....

I stumbled  upon this little video which I like a lot.

Check it out:

http://op-talk.blogs.nytimes.com/2014/08/29/look-at-life-through-autistic-eyes/?_php=true&_type=blogs&nlid=67532143&src=recpb&_r=0