Applied behaviour analysis (ABA) versus Speech and Language Therapy

[TLSP]

My DS is a 5 year old an autistic child. I would like to get some private help for him but I am confused by what ABA, and private S&L Therapist can provide. From my internet research there are private S&L therapists who claim they have experience working with autistic children, but will such therapists just concentrate on speech and language or include social interaction?

ABA seems to focus on social interactions, but I am confuse with the structure as it talks about having a supervisor, finding a therapist/ tutor and getting training for parents and therapist then creating a programme. Does ABA include speech and language?

Money is limited so I wish to use it wisely to get the most benefits for my DS.

I have spoken to the school's S&L therapist and was told that she will only provide a consultative service to the teacher assistant, teacher and the SENCO; she does not do any actual S&L session with my DS.

Any advices and recommendations will be greatly appreciated on the benefits between and ABA and private S&L therapy especially if you have used either or both. We live in North East London.

[moondog]

ABA is a set of scientific principles that can underpin any discipline. Thus you can have behaviourally (ie ABA) oriented maths lessons, gold lessons, reading lessons, occupational therapy and so on.
Very few people understand this, least of all it would seen, s/lts.
Many people think that the very intensive form of ABA practiced with very young, usually autistic and non verbal children in an expensive home based programme is ABA. It's not, it's |EIBI (Early Intensive Behavioural Intervention).

I am an s/lt whose work is all influenced and driven by ABA.
That means that tasks are broken down into component parts and worked on over and over again (discrete trial training), data is taken on everything (otherwise how do we know what works and what doesn't?) and there is never any coercion or 'You'll do it because we say so' or 'She won't do it because she doesn't want to, so what can we do?'

Rather, contingencies of reinforcement are established so a child gets something good (and that will e whatever the child likes, not what the adults around her assume she will like) that appeals to her when she has done something we want her to.

Sadly, there are only a handful of behaviourally oriented s/lts in the UK which is a huge shame as ABA makes s/lt vastly more effective.

[sickofsocalledexperts]

My ASD son was seen by oodles of SALTs, both NHS and private. None of them made any headway at all, as I feel they simply applied their "normal kid" techniques to my (fairly severely) autistic boy, with additional Learning Difficulties. ABA tutors got the first functional bit of speech out if him within 3 weeks.

I feel that, crucially, the ABA tutors understood the autism better. They realised the need to work on his skills of imitation first, as imitation is pretty crucial to human speech, and they also realised that the lack of a "social desire to please" meant they were going to have to MOTIVATE him to use language in a different way to other kids.

The holy grail comes when ABA and SALTs combine resources and skills, to help with the unique challenges underlying autistic speech problems, but there are sadly very few like Moondog around.

[lottieandmia]

I decided to run an ABA programme when my dd with (severe) autism was nearly 3, because nobody could get her to do anything at all (Speech and Language Therapy did nothing because she had no skills to work with).

It's quite hard to understand what an ABA programme does until you've seen one in action (although once you do see it it all makes sense) so I would suggest trying to find one in your area and ask to have a look. This is a very useful way of understanding how they work.

Also there are some examples of good ABA programmes with young children on Vince Carbone's website if you have a look there. See here for examples of both table top discrete trial training and natural environment teaching.

[amberlight]

ABA can also be controversial, in the opinion of a good number of people on the autism spectrum. It attempts to turn autistic people into non-autistic people, in effect. Very nicely, true. But that is the aim. To make us do what other people want - not necessarily what is natural, pain free or best for us...by bribing us repeatedly to ignore the pain and our own individual natures and do what people say. Which for a fair number of us is a problem since some of us don't want to be non-autistic. I worked for a well known ABA place for some years and gave up after having doubts about the principles. Another specialist did the same after the same doubts. So - it does what it says, yes. But there are ethical issues that some see as relevant.
So, parents can choose ABA and some will find an excellent place and get good results out of it. But there are questions about some of it for some families and some people on the spectrum.

[bialystockandbloom]

What sickof says is absolutely spot-on.

the lack of a "social desire to please" meant they were going to have to MOTIVATE him to use language in a different way to other kids.

^ That is one of the most important and fundamental truths ever spoken imo, and is crucial to understanding the different approach needs for children with autism.

Also need to remember that the whole structure of how an ABA programme works is different. An ABA programme would be likely to cover many hours throughout the week (in and/or outside school), where your tutors come to your house to work for hours each day with your child. They would work on a huge range of targets, covering social interaction, play, communication, self-helf, academic skills, as well as discrete S&L targets. A typical ABA programme for a pre-school child might be at least 20 hours a week - obv once they're at school, unless they have an ABA tutor as their 1:1, most sessions would be after school/weekends so less hours.

The supervisor is the one who basically sets the targets for the tutors. So you might have team meetings every few weeks with the supervisor and tutor(s) to review progress, set targets etc.

It will also, most probably, incorporate the same targets that might be set by a S&L therapist (eg working on pragmatic language, social communication etc) but these would be worked into the ABA programme itself, and most likely in a Natural Environment Teaching setting. ie the ABA tutor might be playing what looks like a game with ds, but if you look closely you'll see that they might be working on specific skills.

As you found out, SLTs would tend to assess and then give you the targets to work on - they don't (afaik) provide direct therapy themselves.

[bialystockandbloom]

Amber, with the greatest respect, honestly, I don't think ABA (at least the VB approach we've used) does have that aim. The most important thing I think we have done by doing ABA with ds is give him the communication skills he just was not learning by himself. When he was 3yo he just didn't know how to join in, but it was clear he wanted to, desperately. We just taught him the skills that were needed to do so.

I suppose many people, when starting ABA, read so much about how successful it is, and kind of hope it'll partly 'cure' autism, but you do realise that it isn't what it does - it hasn't stopped ds having autism at all, but god, it has improved his abilities to interact, to communicate, and to play 10000%, and he is a thousand times happier as a result.

It also gave us a way of understanidng how to 'be' with him - how to communicate with him in the best way, how to understand what motivated him, and how to help him. Not one single professional in any area (paed, LA intervention, school, SLT, anyone) gave us a shred of advice about that.

[dev9aug]

some of us don't want to be non-autistic but you are able to articulate these thoughts and tell us what you want. What happens in the instance such as myself, when my 4 year old is unable to express a single need by any means of communication available to him, despite our best efforts.

[dev9aug]

OP what Bialy and Sickof said. We saw a SALT as well as an ABA program and If I am being honest the ABA program more or less covered the targets set by SALT before they even saw the reports so I would go with ABA.

[amberlight]

At age 4 I couldn't have expressed a single need either, dev9aug. I am an autism expert as well as autistic. I work with hundreds of autistic people - from all ends of the spectrum, and I'm an adviser to the Government on autism. My family are autistic and I brought up a son who is autistic and started off very typically non-verbal and very very challenging indeed. All the usual stims, 'Mr Escapo', etc. He's now at Uni after being prefect at school and playing national level rugby. Not a jot of ABA was used. Not on him, not on me, not on DH, not on any of our friends who managed the same. We certainly needed really clear rules and tons of practice at stuff. But the ABA wasn't needed. So there are lots of paths to success. As I've worked for an ABA famous establishment, I think I can express a viewpoint and tell you the viewpoints of other autistic people who have told me themselves of their concerns about ABA. Like I say, it works for some families. But some of us have concerns.

[dev9aug]

We certainly needed really clear rules and tons of practice at stuff.
But thats pretty much what we are doing Amberlight. We initially were scared of the same stuff what you have mentioned. This was the reason we refused to go with one provider earlier on as they were deemed too traditional. We switched to them this year and it has been a breath of fresh air. My child is not pushed any more than he can handle, plenty of accommodations are made to suit his particular learning style and when it gets too much, he is allowed his usual stims/escape etc..

If you had said that I am concerned about rogue ABA providers (and there are plenty), then I share your concerns, but I have no concerns or ethical dilemmas with regards to ABA. I don't know what he is thinking but I can see him happy when he has achieved something. He might moan a little during the sessions but he adores his therapists and has fun with them.
I have no way of knowing how he would have turned out without ABA, but I can see us miserable as a family with no hope and that can't be good either now, can it?

Thanks for sharing your story with us as well. It is always nice to hear that it is not all doom and gloom.

[dev9aug]

oh, we are very far away from the model family for whom ABA has been a miracle, where their child starts talking a week after starting ABA. Progress has been slow and non existent at times, but I would much rather this than no progress at all.

[lottieandmia]

'ABA can also be controversial, in the opinion of a good number of people on the autism spectrum. It attempts to turn autistic people into non-autistic people, in effect. Very nicely, true. '

Amber. Please do not post rubbish and misinformation like this - what you say is patently untrue and perhaps you have a bad view of ABA because of your specific experience of working for a certain provider? There definitely are some bad practitioners out there.

ABA has nothing to do with ignoring pain!! And has nothing to do with making an autistic child not autistic - that was certainly never my aim with my own dd and I'm quite offended that you would suggest that all parents are aiming for this. I know that there are a few parents who think they can make their child not autistic but they are in the minority quite honestly. And it's misinformation like yours that gives ABA a bad and undeserved image.

Certainly, the early days of a programme are intense but the end result I have is a child who does have good receptive language where previously she had none at all and a child who has been taught how to learn, where previously she could not sit down for more than 2 seconds.

Some young children with autism (like mine was) can't function at all and do not ever learn by example unless specifically taught over hours and hours and hours in a certain way. The alternative for my dd would have been to let her stim all day long which would have been cruel - she stimmed and stimmed until she was in far more 'pain' than any intervention the ABA programme caused. So perhaps consider that.

[sickofsocalledexperts]

I have been 8 years doing ABA now (VB actually) and have never come across a single tutor anything but wholly dedicated to giving my son a better, fuller life. Absolutely never any discussion of "normalising" him. I think that may be an old-school view of ABA?

I agree that some higher functioning children with autusm will get there without ABA, like my own hf autistic stepdaughter, but at anything below hf I have found in my own experience (plus that of hundreds of other families I know) that ABA works best. In particular, it has helped my boy to talk and to stop harmful behaviours such as self-injuring or aggression to others. Plus it helped with toilet-training, reading, going to the cinema, swimming ...the list gies on.

[lottieandmia]

I think it's important to remember that autism is not one thing.

Some people with autism are very high functioning but some, like my dd are very disabled and rarely talk. My dd will need 24 hour care for the rest of her life - she's 11 now and will not be going to university, I can confidently say! BUT she's much better than she would have been with no ABA programme - at least we have something to work with and she will accept teaching and can engage with it.

[lottieandmia]

sickof, I completely agree - it's also about learning to cope in the wider world too so that the child can enjoy more experiences.

[sickofsocalledexperts]

There is a TV programme about ABA coming in October on BBC4 and certainly on that film there are those who express the same views as Amberlight. But I think the film does end up showing what good ABA can do. I had goose bumps at the end about how well one little boy had fared at the wonderful ABA state school, Treetops.

[lottieandmia]

Does Treetops still have Vince Carbone consulting?

[lottieandmia]

I will look out for that programme, thanks sickof.

[sickofsocalledexperts]

Yes, Vince is on the film too as Treetops consultant and makes clear that ABA works only on things that make life better for the child and his/her family. Must admit that I find the anti ABA prejudice odd, when to my mind the real national scandal lies in the hundreds of indolent, near-useless state "special" schools which are pretty much just babysitting autistic kids till they hit 16.

[sickofsocalledexperts]

It is only my opinion, and i know that there is the odd rare exception where a special school has a truly inspirational head, but I reckon that unless the child can hang in there at mainstream, ABA is the only or best chance for a child with autism. ABA is the norm in the US, even recommended by the US Surgeon-General as far back as 1999.

[TLSP]

Many thanks for all your useful comments. It is just so informative. It seems ABA would provide my DS with more benefits than private SALT. My DS is 5 and can speak about 50 words, but don't interact with other pupils at his reception class or in the park when him see them. He also "day dream" most parts of his day and has his habbits in school.

How do I go about finding a supervisor and tutors as well as training for oursleves as I have also read that we (parents) needs to be trained to carry on with the programme in between the tutor's sessions. Does any one have recommendation for these in North East london please?

[lottieandmia]

I totally agree, sickof - we're very fortunate to have found a special (high) school for dd which seems really good - I cannot believe this school exists in the town in which we live (the junior school is nothing like it). Sadly I've seen many examples of bad special schools, where whilst looking round, the children looked stressed and some where not being redirected from stimming or SIB. I must say though that I don't believe a school placement would ever have been accessible for dd at all had she not done ABA for years from a young age.

At a time when parents are being threatened with having their rights taken away, the last thing we need is misinformed ABA bashing and more excuses for LEAs to say ABA is evil.

[lottieandmia]

TLSP - have you joined the Yahoo group ABA-UK? Lots of information there. You first of all need to decide whether VB or Lovaas ABA programme style would suit your ds. We started with a Lovaas programme (UKYAP) then switched to VB under Sean Rhodes who works with Katie Parker as supervisor. If you're in London you may find it easier to get tutors than I did where I live.

[moondog]

TLSP, if you go down this route is is a HUGE commitment for many reasons. You need to be prepared for that.
I can't recommend this book highly enough.
I would suggest you read it and then make a decision.
Best of luck.
The number one weapon in the arsenal is the parent and family that expects more than what is usually available, as Sickof describes so well.

'the real national scandal lies in the hundreds of indolent, near-useless state "special" schools which are pretty much just babysitting autistic kids till they hit 16'