Can someone explain VB (Verbal Behaviour) in a nutshell ?

[chickeninabox]

I have tried looking on t'internet and in library for books on the subject but can't find anything which really explains what it actually is. I understand it's a form of ABA and sort of understand what ABA is all about but beyond that I am foxed.

Thanks for your help folks.

[ancientmiddleagedmum]

VB is a form of ABA and in a nutshell, it uses the child's own motivation to get them to use words. Example - my DS loves to be pushed on a swing, but the tutors would not push him till he said "p" or then "pu" or now "push me", three years later. Similarly, no juice unless he tries to say juice, prompted at first, later unprompted. They also use lots of reinforcement (eg praise or rewards) for good behaviours and some aversive techniques for bad behaviours (eg naughty step or other techniques, I used hairwash but that was my idea, not my tutors.)

It is all about teaching them that certain words get them certain results, and elimiating bad behaviours. It's much more play-based than classic ABA, and there's not nearly as much table-work as I've seen in some programs.

You have to be a bit flexible about it though, some tutors insist on trying to get 500 mands (- words or demands) per session, but that is bonkers.

It has worked for us - my ASD DS was non-verbal 2 years ago and now has more than 100 words, plus understands a lot more.

[yurt1]

Jessica Kinglsey publishes a book on it haven't read it but usually her books are pretty good and her website will give a good summary of the book.

VB hasn't given my son speech - and if your child doesn't get speech you can get a bit stuck with progressing with VB (imo), but I really like Vince Carbone's idea of fast trials. That has helped DS1 a lot.

[chickeninabox]

Thanks both very much - will look at the Kingsley web site later yurt1 and thanks for the 'nutshell' amam. My son (3.5 ASD) has really started using lots of words (and some 2/3 word sentences) since Christmas, but his speech isn't very clear, and can sometimes be quite garbled and rushed. He is also now making simple requests, and has even spontaneously commented on a couple of things he has seen on the tv which is great for him. It's difficult to know if something like VB would be useful, as he seems to be progessing by himself. We are supposed to be getting some sessions from the specialist speech therapist but all has gone quiet since his diagnosis in December - will chase her up as a first port of call and see how we progess from there.

[Davros]

However.... imo there is a lot of hype around VB and what Ancientmiddleagedmum has described is class Lovaas ABA BUT VB practitioners don't want anyone to think that, (i.e. not handing over a desired object unless there is an attempt to request, they even do that in Sonrise!). One of the big things about VB is the ABLLS which is an assessment tool which works well to track progress BUT you can use the ABLLS in Lovaas or other ABA programs, it is not VB exclusive. Like Yurt I found it hard to understand or see how VB could progress unless your child develops spoken language as it seems to be so dependent on it and I asked that very question at the first VB conference in 2000 and did not get a clear answer from Carbone or McGreevy. I don't like their anit-PECs position either. I also think the thing about fast trials is a red herring, there is no reason you can't do that if it suits a child and I baulked at all the "play orientated" stuff as I knew a lot of former Lovaas tutors who adamantly switched to VB as it was so much more fun.... more fun for whom? The idea that Lovaas or other ABA is not fun-based, functional and possible to generalise is just not true, it was put about by the first VBers, in my opinion to set up a not very helpful competitive environment. They placed great emphasis on "natural environment" as well which was just insulting as it implied that non-VB programs only functioned in a controlled table-top setting. It is true that "classic" ABA (usually Lovaas) teaches at the table and personally I have always felt this makes complete sense and works, certainly for my own DS and most like him.

[yurt1]

Well our fast trials were certainly done at the table And were Lovaas type trials. I agree about the anti PECS stuff. Until ds1 learned to imitate (which he did via Lovaas) signing was not an option for him (unless taught hand over hand, and not much point as PECS is easier to teach hand over hand- and more accurate for ds1 who tends to morph signs).

I think its really important to fit the therapy to the child- know your child well. A lot of therapies are difficult for ds1 to access because of his attention etc problems and zero speech.

[sphil]

Hmmm - interesting discussion. We do a mixture of table work and Natural Environment Training in our programme - a lot of it is VB as we aim to teach a word in all its different functions: receptive, expressive, echoic, as a mand and according to its feature, function and class. It works extremely well at the table but not so well in the natural environment where his attention is less focused and responses less accurate. He labels items fairly readily at the table but this hasn't yet translated into spontaneous labeling in normal life. However, what has worked brilliantly for him is mand training (which we do away from the table nearly always) - setting up situations where he has to ask for what he wants (usually food, videos, music or physical games). He now requests spontaneously all the time (though nothing like the fabled 500 times a day!)

I think he just doesn't see the point of using language to do anything other than get what he wants .

We do fast trials too but not enough I don't think. I would agree they've had an effect though (as has the whole programme) - DS2 is now willing to sit, listen, look and learn. 10 months ago he would just turn away if anyone tried to teach him, test him or ask him anything.

[walesh]

One reason VB proponents dont like the PECS is because there is a connection between fluidity of physical movement and fluidity of speech. The more activities you can do with your child that increase better physical movement will connect to speech. Although I think PECs are great option for many children, especially in the beginning because it gives them an immediate communication system. They don't have to wait and learn all the different signs, as soon as they have the exchange figured out they can use any of the pictures.

I'm a ABA/VB consultant. I just moved to London from America (have a British husband). I'm not working here as I'm currently raising a two year old and pregnant now.

A good way to describe VB is to say that we use language for many different reasons. We give those more technical names like imitation (echoic and mimetic), mand, tacts, intraverbals, and receptive.
I'll give you some examples

With a mand a child would be asking for an item.
So a child sees pizza and wants it and says "Pizza".

If the child is tacting they would see the pizza box in the fridge and not be hungry and say "pizza"

With imitation I would say "pizza" and the then the child says "pizza"

Intraverbals are conversation skills, so I would say what is your favorite food? and the child would respond "pizza"

Receptive Language would be showing a visual of a pizza and asking the child "which one has cheese?" the child would then point to the pizza.

So the idea is to see that we can use one word to mean many different things and that all of these different ways of language use needs to be taught to autistic children.

I used the pizza example in all for clarity, a child wouldn't be taught one word's complete VB usage before learning another word.

[Davros]

walesh, it is good to hear from someone with a better technical understanding. I dislike the so-called anti-PECs stance because my own DS is a prime example of someone who can successfully use PECs and sign. We started signing long before anyone over here had heard of VB and he already had PECs established. At that conference in 2000 the idea of children with ASD using signing was like a bolt from the blue for many parents but it was old news to me, I am an old know-it-all!! I already knew the limitations of both forms of communication for a child who does not develop verbal communication and, let's face it, many of our children won't. That doesn't mean we shouldn't try or that it can't be successful, just that we really do need to have something more rounded to fall back on when we realise that we need to teach and concentrate on communication in all its forms, including visual strategies (not just PECs). The problem comes when you have parents and practitioners who have an ingrained prejudice against one type of communication and will not allow their children access to it, regardless of whether it could help them or not, and I know more than one parent who takes that stance! What sphil describes where you set up a situation to target requesting is something we did in our Lovaas program and is not specifically VB but more pure ABA imo.
To me the truth is that ABA is good if it is good ABA although I do think part of its success is down to it being Early Intervention, delivered intensively and often 1:1.

[chickeninabox]

Walesh that is really useful, thanks. And to others for your comments. Will certainly look up 'the Verbal Behaviour Approach' and try to garner some RL views as well.

[Davros]

My advice Chick is, if you find someone you like who is available and not too £££ and they do VB or Lovaas then go with them, as long as you can form a relationship and they are good at what they do. Most programs, because of individual tailoring, become hybrids although you have to keep a close eye on diverting TOO much from the theory and principles. If a VB practitioner fits the bill then that is the one to go with, if a Lovaas practitioner fits the bill then that is the one to go with!!
BTW, when I refer to ABA I mean VB and Lovaas (some people think that ABA means Lovaas only) plus the other forms of ABA such as CABAS, Direct Instruction, Precision Teaching etc etc (not forgetting Growing Minds of course). No doubt I have forgotten some and, of course, some of these such as CABAS are school based or have some other limitation...... Walesh probably has a much better understanding of all the methods.

[walesh]

It is true that a lot of people will only stick to strict communication practices. I do think that is sad, because not all children will be able to achieve the same communication level.

The difficulty sometime comes in not pushing hard enough and pushing too hard. Finding the right balance can be tricky. For example, if you beging a program by teaching signs and after a couple weeks see ZERO indications that a child is progressing with it (they aren't holding their hands out to be helped to sign correctly, prompt fading isn't working, and they seem oblivious to what is happening) then a new approach is needed. At the same time a child shouldn't just be given PECS and not taught how to speak. Some people think it's all one way or another.

Quite frankly I think it's a bit cruel to make a child struggle to communicate for a couple months learning some initial signs when it could have taken a couple weeks (usually a lot less) to get them a picture exchange system that works really well.

Vocal Communication can always be worked on, but I think the most important thing is to give a child a system that gives them the quickest way to no longer be frustrated. And then it should be developed to the next level.

It's true ABA has to be good and delivered by a team that the child likes and responds well too.

Davros, how old is your son, is he verbal?
Since I'm new to England I don't know anything about how autism service work here. Is it hard to get a child into an appropriate school? Are there several early interventions available?

[ancientmiddleagedmum]

Walesh - your description using pizza was brilliant and concise. In answer to your question, I think it is a nightmare over here to get your child into an appropriate school compared to the US. The state system very rarely funds ABA, and parents have to fight every step of the way to get a decent education for their child - whether they are fighting for the mainstream system or the special needs system. Many parents end up in court or paying for the whole ABA program themselves (we remortgaged our house).

I have always wanted to know how it works in the US, as my understanding is that you are WAY AHEAD of us in terms of how you educate autistic kids. I heard that there are some schools where half the class is autistic and half not, or is that not right?

[walesh]

Well let's see. It depends on where you are as to what services you get. Some schools have more money than others, and of course in those schools better services are available. Some schools in my area have complete autism programs: Occupational therapists, speech therapists, teachers, behavior analysts,physical therapist, and lots of assistants all specifically dealing with autism. They try to mainstream these children as much as possible. So the children would go back and forth to different classrooms depending on their skill level.

In other schools there is no autism program, there is just a special needs program and all children the same age are in the same class. These aren't the best programs, but are what's available in that area. And you have to go to the school in the area in which you live. There is no choice, unless you move somewhere else.

However, all children with autism get government insurance which provides an early interventionist once or twice a week, speech, occupational, and physical therapy every day. Until a child is three years old the government will pay for ABA 20 hours/week. On the child's 3rd birthday, this service stops and the child is eligible to go into the public school system. But again that depends on where you live as to how good that school is. The child is also entitled to 15 hours a week to have a personal care assistant come to the house. This isn't a trained person, but someone who will do your laundry and prepare meals.

There are not a lot of services for ABA or other in-home early intervention. The ones that are available are really expensive. An average program is $50,000/year. So most people come up with their own programs. It basically works like this, if you have an extra $50,000 a year you can get great services for your child. If you don't have that much extra then you will struggle to find an appropriate intervention plan. We definetely have amazing resources, it's just that not everyone has access to them.

I'm currently working on a project back in the states for parents who have no resources to set up their own intervention programs. Parents really are the best resource and will spend a whole lot more time with their children than I will, so it's important to empower them to become involved.

Private schools are available, but expensive. There are some charity pre-schools where typical and ASD kids are put together, but they aren't common.

I think the best thing is diagnosis. Usually, a child should be able to get a dianosis before they are 3. Sometimes there is a long waiting list to be evaluated for autism.

What is the diagnosis process like? Do you have to see a specialist? Do they give you information on what to do with your child if they receive a diagnosis? How do people find services? Do most children do programs at home or is access to that restricted?

[ancientmiddleagedmum]

This is fascinating Walesh - can't believe you get 20 hours a week free ABA til child is 3! Over here, diagnosis is a nightmare. We would have had to wait a year to see a paediatrician, so in the end we went private and paid $2000 for a diagnosis. In some areas, kids can wait three years for even an assessment - meaning they miss out on early interventions as they are on a waiting list. But it's the statementing system which is the real scandal. Without a statement, your child will get the bare minimum of help and will pretty much just be chucked into a mainstream school alone, to sink or swim. Yet they are using more and more excuses to avoid giving out statements, and unless you have the money to retain a lawyer, you are often told your child is "too able" to be statemented. This is particularly the case now that autism (or autism diagnosis) is exploding in this country. Once you have a statement, you have a legal entitlement to everything on that statement. Like the US, some areas are better than others. The state system thinks ABA is wierd and you pretty much have to go to court to get a home program paid for - they use a system over here called TEACCH, which is basically and IMHO highly INeffective, but a lot easier to deliver in the state system than ABA would be. Is ABA the norm over there in the US, or is it still seen as a little left of field?

[moira199]

Hi

Just to let you know about some state provision for ABA here in U.K

My DS gets 15 hours ABA a week provided by local council here in Glasgow. He started at 3.6 and will get it til he goes to school. It has helped enormously though it is 'ABA lite' compare to what I have read about. It is working for him though as his speech has really come on. He is even starting to use a bit of 'grammar' now not just single words and learned phrases. The program has been running for 2 years now and the results have been very good for all the children attending - at least the ones I know about.

[ancientmiddleagedmum]

Wow, did you not even have to fight the council to get it???

[yurt1]

"I'm currently working on a project back in the states for parents who have no resources to set up their own intervention programs. Parents really are the best resource and will spend a whole lot more time with their children than I will, so it's important to empower them to become involved.'

Sphil and I have been talking about the possibility of doing that here (as a social enterprise). Would love to know more about how you're doing it.

[yurt1]

They're starting the same here moira.

"Vocal Communication can always be worked on,"

How? DS1 is almost 9. He has always vocalised and intonated words but he cannot remotely speak. he finally learned to imitate age 7 (has been using PECS since he was 3, started signing since imitation kicked in- and after I'd seen how effective Davros' son was using both) - but he cannot seem to get anywhere with speech sounds. For a while he could imitate 'ba' but that slipped back to 'ya' so now - nothing.

Like Davros' son he is very communicative. And uses mix of gesture, sign, PECS , pointing and shouting - oh and the first letters of lots of words on a letterboard (we're teaching some typing- or trying to). TBH I don't see how we can work on speech though.

[walesh]

I do know what TEACCH is. It was developed here. The University that developed it still does most of the research. That is about two hours north of where I am from, so it's used in the schools that don't have much money.

ABA isn't a weird technique here anymore, it's what most people do and what most school systems try to incorporate. Here you need an official diagnosis to get services, but it's easier to get the piece of paper. A pediatrician, developmental psychologist or a board certified behavior analyst could give you a diagnosis that would be sufficient for government help.

If most people have to pay out of pocket for ABA services, how much does this cost them? Are there enough providers? Were you given advice by doctors about what to do?

It's interesting that the would put the children in a mainstream classroom. Here that doesn't happen unless a child can actually participate at some level. It's nice that there is always a special education classroom open with a trained teacher, but sometimes it's hard to get your child into a mainstream classroom once they are able to cope with some of the work.

But like I've said I just moved to London and have no clue what happens here. Are services similar all over the country? Does everyone find it hard to actually get a diagnosis?

[yurt1]

sorry that how? sounds a bit stroppy- I don't mean to- I would genuinely love to know how - I thought it was something that we would be able to work on with imitation- but it just hasn't been possible. DS1 has loads of language - if he could say as much as he can understand it would be life changing for him.

[walesh]

yurt1 has your son been seen by a speech language pathologist to determine if he has some oral motor issues that are affecting his ability to speak.

Lots of autistic children have apraxia. Apraxia affects the child's ability to control their mouth movements voluntarily. This means that while your child is imitating a favorite movie they might say "car" perfectly, but when you try to get them to repeat they can only say "ah" or say absolutely nothing, even though you know they understand what you are asking of them.
Is your son able to imitate oral motor movements? Does your son make any sounds at all? Also some children with apraxia will only be able to say vowel sounds and "h" (because you just have to open your mouth and blow air). The inability to control motor movements also means if you ask them to stick out their tongue they can't do it, but if you give them a lolly pop out goes the tongue.

With several children I've had to work closely with a speech therapist to develop the best program to get children talking.

When your son made the "ba" sound how was it reinforced? Also, it's okay when children begin talking that the sound doesn't come close to the word. At first some children are only able to say "uh" for cookie. That's okay because we want them to understand that when you open your mouth and make a sound it means something.

How does he vocalize and intonate words?

[walesh]

Oh and working on the parent lead intervention. There is a parent support organization here that all parents are usually referred to as soon as they get a diagnosis. They get you in touch with a support parent who helps you through the initial paperwork and gives you someone to talk to.

One of the parents there wanted to put something together for newly diagnosed parents who didn't have any money. So she asked me to help prepare the information and she is organizing the parents.

[yurt1]

Growing Minds diagnosed him with apraxia last year. I'd been saying he had it for years (since he was 3) but the NHS SALT's view was that he was so unable to say anything there was no point treating him We did work with a good private SALT for a while who thought he had lots of auditory processing problems as well- although I suspect those have improved.

I have attempted a days workshop by Nancy Kaufman a few years ago. I have some Kaufman cards too - the first pack, but ds1 doesn't have the speech sounds for even the simplest card. He has some vowel sounds (which he can't produce on demand) and very few consonants. Initially we couldn't use the Kaufman approach as he couldn't imitate.

He can imiatate oral-motor stuff quite well - licks lips fine, is a bit dodgy on chewing, but the real problem seems to be speech sounds- perhaps he does have auditory sensory stuff going on too.

[yurt1]

ba - was done at the table initially so it was reinforced with whatever the strongest reinforcer was. We tried the word approximation thing then reinforcement as well, but ds1 actually has loads of word approximations (all a variation no 'uh' or ayee or something like that) but he produces so little variation it was impossible to shape. He speaks whole sentences 'aye un mmda' (i want toilet for example) which mean something to him (and if you know him well might mean something to you, or one of several possibilites to you) but without the variation I don't know how to shape. It's been fixed 'uh' 'an' etc for years.