ABA without dx?

[bluebikewithflattyre]

hello,
have been lurking here forever but this is my first post :)

we have DS (3.5). he has very delayed and disordered speech. he also has behavioural and sensory issues and a lot of asd traits. but a lot of this behaviours are very un-asd-ish (great eye contact, joint attention...)

we are under Salt and the dev paed. however, they are in no hurry to diagnose and are sitting on the fence for the time being.
other than one block of salt we didn't have any therapy but we are on waiting list for a further block of salt, DS's speech and understanding are about 18-24 month behind). DS is getting a lot of support from nursery (1-1, IEP, EYA+).

we saw a private salt recently and she said DS might have a general delay with his learning and recommended further developmental assessments (but paed wants to wait and see). paed won't rule out asd at this stage either but thinks it might be more of a speech/language problem. so bottom line is - something is not right with DS but we don't know what. could be asd, could be s&l issues, could be LD

I know a lot of you had good results with aba and as DS really likes very structured learning environments, I wonder if this is the way to go.

anybody here using aba without dx? do aba providers support without dx? would aba be of any benefit if DS actually has a s&l disorder or LD rather than asd?

ABA isn't just for DC with ASD, to my knowledge. It's structured to the individual child's needs. It just happens to be very effective for those with ASD, but should be just as effective for other LD. The 'experts' will come and tell you, I'm sure. But I do believe that treating a child as if they have ASD generally does no harm, and in fact could easily benefit those with ASD 'traits' (even without ABA.)

We started ABA (Verbal Behaviour) before ds was diagnosed. He is high-functioning, and in some ways doesn't present as 'typical' ASD though he is most certainly on the autistic spectrum. He has great joint attention and eye contact too. However, we were pretty sure we were going to get that diagnosis.

But tbh even if we didn't, we knew he needed some help, and after we'd researched it felt that ABA was the best thing for him. The thing about it is that you can target whatever you want, and whatever are the biggest impairments. Speech & language could definitely be a part of this, though in our case this isn't a major part of the programme (more behaviour & social interaction).

Yes you can start a programme without a dx. Though a good ABA provider would not take your money if they did not think your ds would benefit from a programme - make sure you research thoroughly, meet as many families as you can who are doing programmes, and do a lot of research into providers and consultants.

Oh and welcome

I don't want to comment too much about whether ABA would be the most appropriate therapy for your ds, op, but I haven't really heard it said explicitly that ABA wouldn't be any use for s&l delay or disorder. There seems to be debate about whether it's more beneficial for higher/lower functioning ends of the spectrum, but I've seen even on this board some people saying it's only good for HF, and some for only lower-functioning

So, the only thing I would reiterate is that a programme is tailored to your child's specific impairments. Ds's progrmame doesn't do much work on speech sounds (echoics), but it does include lots of work on functional language, conversation (intraverbal), and social communication. Perhaps this is more a feature of Verbal Behaviour strand of ABA, I'm not sure.

The other thing worth bearing in mind is that (particularly if you don't have a dx) you will wait an awful long time for any help from the NHS (and the help you do get won't necessarily be as intensive as you'd like), so if you want to start doing something to help now, worth setting started with something.

thanks for your replies so far.

zzzzz, thanks for pointing out that aba might not be that beneficial for children with s&l issues... atm, s&l is by far the biggest issue with DS.

The other thing worth bearing in mind is that (particularly if you don't have a dx) you will wait an awful long time for any help from the NHS (and the help you do get won't necessarily be as intensive as you'd like), so if you want to start doing something to help now, worth setting started with something.

yes BialystockandBloom, that is exactly who I feel. we have been in the system for a while and are getting nowhere. I feel therefore that we must do something ourselves now to help DS. loads of precious time has been already wasted.

we have used ABA with great success.

we started our official programme after dx, but we did a lot of research on it prior to dx.

one of dd1's biggest issues is s&l. she (since she started talking) has always been very verbal, but with not much functional language - she didn't know our names, couldn't engage in conversation, had no clue about any of the complex and abstract sides to langugae. she did know: colours, shapes, numbers etc - the concrete stuff, and learnt lots of language in chunks - whole converstaions (eg what/when to say stuff at mealtimes), songs, rhyming books such as the Gruffalo etc. but no functional language at all -she oculd not ask for a drink, couldn't tell me she was hungry, couldn't tell me she was unwell etc.

now, 4 years on (dd1 was very severe), she is having cnversations with us - proper exchange of info conversations - she jokes, and can both listen to and follow instructions. she is learning to read, and this has helped her grammar come on even more. she is now at the questioning stage- she constantly asks who/what/where/when questions; not quite yet got to 'why' (thankfully !)

ime, ABA can (and does) tackle language issues, if that is an area that needs working on.

bluebikewithflattyre

Your DS could have an ASD diagnosis at his current age, which would be based purely on behavior criteria.
Sensory and Speech and Language delays can be part of natural development, and are not considered to be classified as a disability until after the age of maturation 7 - 8 years old when children stop growing out of these types of issues.
ABA is a behavior base program, but the issues you have mentioned are not behaviour issues they are cognitive development and sometimes physical development issues. Most of the developmental related issues tend to be of a genetic origin, with some existing family history.

So you really do need to identify the type of problems your DS is facing, and looking into the the various types of therapies available for each of the issues.
Unless you have diagnosis you can only guess the true nature of any medical or clinical problems, and so you can only guess, which could be wrong, about any form or remedial support.
You have to be able to identify the exact disabilities and then identify how your DS is best able to develop his own coping strategies, using his own alternative strengths, and some programs may be trying to enforce a different set of coping strategies which may not best cognitively suite your DS. And all of this takes time.

Yes, ABAers will work without a diagnosis. In fact a pal of mine has had absolutely stunning results with ABA for her son who has LD and delay but no ASD. It is a way of teaching which can really be applied to anything. I would go for it, not least because you will be offered fuck all else.

ABA is totally the right thing for speech problems. Particularly the Verbal Behaviour branch of ABA, which is entirely geared towards speech and language development. I used to tell the SALTs v sweetly that I didn't need their input as ABA was in fact speech therapy. My pal's LD boy is now talking in sentences; he was non-verbal till age 5, when he started ABA. This is not an exagerration!

Dolfrog - speech and language delays may not be classified as a disability till 7, I didn't know that. However, the best neurological research suggests that the best years for developing language are pre-5. It would therefore not be sensible for the poster to go with her LA's wait and see approach. These are the key years.

As sickof said, Verbal Behaviour is specifically targeted towards the production of functional speech.

That has certainly been the main focus (and the main gain) of his programme.We (and his consultant) consider useful speech to be the most important thing of all, and the 'behaviour' part comes in as regards motivating him to speak.

I have never, ever heard anyone say that ABA is not useful for s&l, and am very [shocked] to read such a claim here. If I understand correctly, speech is a problem in some form or other with pretty much all asd children, so if ABA wasn't working on speech what would be the point?

Sorry, I meant the main gain of DS's programme

I don't mean to sound as if I'm only advocating ABA - I'm not (honest!). Just that it can be used to teach language. When used as a therapy for ASD children, it is used to teach a child to want to communicate using language (motivation, essentially), and then how to use language functionally and for the purposes of social communication.

I can't see why that aim, and the method used (positive reinforcement, basically) would not work "just" for s&l delay/disorder.

However, it is expensive, and tbh if you are sure that ASD is not in the equation, there will be lots you can do productively yourselves without actually doing a full programme.

Search old posts by lingle and totalchaos, they among others, have posted lots and lots of advice in the past couple of years about s&l. I have seen lots of recommendations for Hanen (More than Words) too.

x-posts with a lot of people there.

Would also definitely recommend Mary Lynch Barbera 'The Verbal Behaviour Approach'. It should answer a lot of your questions about the suitability of VB/ABA for your ds. Also Robert Schramm Educate Towards Recovery, which is a bit more technical/jargony but still readable for the layman.

I totally agree (of course) with pp that ABA/VB would do nothing but good for s&l problems. And I am a hugely enthusiastic advocate of ABA.

But as someone said, ASD is often characterised by a lack of desire/motivation to learn for the same reasons as nt children. So, the difficulty with language isn't just a disorder or delay, but also an impairment in the realisation that language has a purpose. This is at the heart of VB.

I really do not know much about purely s&l delay/disorder, but imo if you suspect that the nt motivation is there, and he understands that language has a purpose and function, there will much you can do without ABA.

But if money is no object, I would not hesitate in employing experienced VB tutors to run a s&l based programme.

we started an ABA (VB) programme specifically to address ds' speech & language issues. We started 3 months before his third birthday & at that time he was pretty much mute (but signing well) his language deficit was vast. We chose an independent provider that had experience with children with primarily S&L issues and our programme has focused pretty much exclusively on S&L (more recently social communication & also some OT issues).

Ds was later given a dual diagnosis of language delay/disorder and ASD - although the ASD issues are extremely mild, I still don't think (& many professionals who work with him agree with me) that it is an appropriate diagnosis, he wouldn't be diagnosed now I'm sure.

We'd done months of Hanen type stuff before hand & while it was useful I don't believe that ds would have speech (he is now in the typical range for both expressive & receptive (yay!)) with ABA.

doh I meant without ABA :)

(can also recommend the Mary Lynch Barbera book)

sickofsocalledexperts

At birth all children are capable of learning any language, but in the first few months or so they develop the skills required to learn the language system they have been born into, and the abilities they do not use they loose. Which is why for many learning a different language can be difficult, each language has it is different sounds that need to be reproduced.
Langauge is about processing meaning from the gestures, and sounds produced by others, to be able to decode the code, and derive meaning.
Some unfortunately have problems processing different types stimuli and others have problems processing meaning from the stimuli, or may not be able react or respond to a form or type of communication.

Sometimes we need to to find alternative compensating abilities to work around specific types of communication deficits.
Have a look at these themed research journals
The perception of speech: from sound to meaning
Cultural transmission and the evolution of human behaviour
Evolution, development and intentional control of imitation
Word learning and lexical development across the lifespan

The researchers are better and explaining these issues than I am.

What support are the nursery putting in. Think about not whether it is lots, but whether it is working. Then ask yourself how you know this?

I am an advocate of ABA, but not especially many ABA providers in this country. Be wary of any up front costs, contracts that tie you in and claims that you can only do it if you commit for 5/20/40 hours. The truth is the more opportunities you get to practise something the better you get but it doesn't mean you won't improve with a bit.

Make sure you skill up yourself. Not to deliver the programme necessarily but to support the programme out of hours.

Wrt it being for S&L issues, the problem again is that this country has some dubious characters offering provision. ABA programmed are more simple to set up for development of early skills, but advanced language and communication is complicated and you have to have someone who knows what they are doing. Provided you do then ABA is probably the best method for teaching it.