Article discussing the myriad of approaches to treating autism - worth a read

[boxinggrubs]

Found via a tweet from Ben Goldacre. Interesting stuff, and food for thought. It made me think about Tinsley House support thread and how parents of children with autism really have a minefield to deal with in terms of what to do, as well as worry for their children -
autism treatments

[moondog]

It would be foolish to assume that all behaviour analysts are competent with all issues or indeed are good (although the BCBA qualification goes a long way to sifting out the charlatans.
That is the same in any profession. i know s/lts who are fantastic and others who i wouldn't trust with a hamster. Ditto teachers and myriad others.

ASD captures a lot of attention because it is a growing issue and it costs so much in so many ways-financially and emotionally. So naturally people look at ABA in that context too. Also makes for a more punchy story. The journalist picks the bits that make most impact. One of my academic collegaues was approached to be the ABA expert for the story that ran in the DM recently. He couldn't get back to the family in time but I know if he had, he would have emphasised its relevance to other populations (but no guarantee the journalist would have used this.)

I am clear about where I can and can't help. I turn down a lot of approaches to work privately with very small children with severe ASD (from MNers as well as people I know in RL) because this is not the area in which I feel most competent.

Give me a slightly older child with other issues and I am rolling my sleeves up straight away. This is my territory.

[inappropriatelyemployed]

I agree Moondog. I got the second one by recommendation and he had worked for a leading autism school but I don't think he even had very effective communication skills with children.

[StarlightMcKenzie]

I think some in the area think they are gods and teachers are stupid. Parents don't like to challenge because it is their last hope. They and their tutors can wade into a school and remove the last shred of a relationship that exists. Word gets around that ABA is BAD.

It's a frigging mess.

I hope the compentency thing does a LOT about building relationships.

though to be fair some teachers ARE stupid

[moondog]

To me the real challenge is getting these interventions into regular schools, not just in the flashy specialist ones (which cost £££) or in home based programmes. ABA is about changing the environment, not the individual, because once you change the environment, the individual will change as a result. Any areas of difficulty exist because of environmental issues (in the vast majority of cases).

Thanks to a huge amount of hard work by a great many people, where I am, behavioural approaches are the backbone of what we do. The joy and excitement and pride that so many school staff in then seeing children blossom and develop is indescribable. It makes me leap out of bed every morning, full of excitement about the day ahead and what new changes we will see.

That may make me sound like a nutter or someone who has drained the best part of a bottle of wine but it is true. I wish I could give you more specific examples but that would not be professional of me. All I know is that I want for other people's children the huge changes I have seen in my own child and that is what we are getting-without spending anything over and above the money alreay allotted.

[StarlightMcKenzie]

A consultant I have recently come across, aims firstly to reinforce the behaviour of the teaching staff, by showing them quick wins for minimum effort and to build their trust of her.

She also makes it clear to the school that they are not soley responsible for the child's development, and that the parents should be charged with some responsibility for this too.

I quite like her.

[inappropriatelyemployed]

I agree Moondog.

The sad thing is our school was really welcoming to the idea of ABA but after two days with a guy who pumped out a generic report and wanted masses of data monitoring on DS's compliance with teachers' requests, and a lack of any defiinite plan, they switched right off because they did not see DS as a child who was refusing requests, and did not see the approach as relevant or helpful.

Now they see ABA as not helpful to a chld with AS although they are paying for it out of their own pocket for another younger boy with classic autism.

[moondog]

It's also a hell of a thing for people to have someone come in from outside and tell them what to do. You need to have excellent social, communication and diplomatic skills. You need to keep nodding and msiling and cajoling and persuading and always, always always stay on side with the people whose behaviour you are trying to change (they are the environmen that you need to be changing) otherwise you lose their goodwill and then you are stuffed.

[inappropriatelyemployed]

That sounds good star. Our therapist seemed to want to concentrate on training and not skilling DS or staff. His needs are subtle but significant e.g. He doesn't get body language/ non verbal communication, he doesn't always see why people need to know what is in his head (eg he doesn't give his explanation when things go wrong), he forgets things and can't organise himself and very high anxiety.

I had made it very clear what DS's needs were too,

[inappropriatelyemployed]

Moondog he really tried but in a very creepy way. The report was all full of how fab and warm and gorgeous school was but then full of lists of things that could be changed if school wanted him to work on them.

He came in, made DS have an absolute meltdown by forcing him to stay by the classroom when he was having an anxiety attack, telling him he had to obey the teacher and couldn't pick and choose what he liked to do (anyone who knows DS knows that he is so far away from feeling like he is control at school) and ally turned school staff off.

Yet I get feeling this was done for the benefit of the staff!

[moondog]

Oh dear.
It's such a bloody gamble, parting with ££££ to get people to help with your children isn't it? I often think about it and how hard I would have found it. The person I found to help me was someone I met while studying for my MSc and she has become one of my biggest allies as well as a dear friend.

[inappropriatelyemployed]

It's a lottery and I got this guy as a recommendation from someone with a lot of experience. It was just out of his comfort zone.

[moondog]

Well if it isn't being made explicit to you that changes in the individual will only come about if changes are made in the environment (and remember that changes in the behaviour of others greatly form that environment) that's rather concerning. In that case what is being practiced is not ABA but random attempts at behaviour modification with no reference to the huge body of research that demonstrates how best to achieve what we want.

Those who possess good language skills are at an enormous advantage of course because you can use language to explain behaviour that is rule governed. Thus a simple example of rule governed behaviour woulod apply to getting up in the morning. I find it hard to rise early but do so because my boss has explained to me that if I get to work late, I wll get the sack.

However, a non verbal child with a severe learnnig disability is not going to stop self harming because we ask him nicely to by pointing out that he is hurting himself physically and distressing his family! We then have to look at what contingencies are at play. He might be doing it for attentino because when he does, people rush to his side. Or to avoid tasks as demands then stop. Or to express distress at excess noise. In all cases, we have to change our behaviour and the environment and then he will change. It wil take time and patience and discipline but that is what we are paid to do.

So for more able children ,there is going to be a balance of rule governed behaviour (explainig what is and isn't socially acceptable) in addition to environmental changes. It's not about blaming the child-nothing could be further from what ABA is about. We aren't surgically excising undsirable behaviour. We are changing what it is we all do to set in train a series of steps that will help him.

My dh knows that nothing stresses me more, when I come in from a long day, driving from school to school and talknig to scores of people than him tackling me straight away on domestic issues. I need to have at least 30 mins. decompression. This used to irritate him beyond belief and we woudl then have huge rows over my perceived 'lack of interest; in domestic issues but I led him to understand that a tweak in his behaviour (ie leaving me for 30 mins.) would bring about a dramatic one in mine (ie taking an interest in what the electrician said or the credit card bill).

[moondog]

That's disappointing to here.
The challenge is of course that often one inadvertently reinforces behaviour that one thinks one is actively discouraging (example being how a child continues 'playing up' because by doing so, she has her parent's attention.)

I remember gonig for a walk with my sister and one of her kids refusing to walk. There was a big scene, with her cajoling and persuading, him refusing, all the rest of the party stopped in their tracks, everything getting worse. I told her to just stop cajoling and walk away and not look back. We all did. For about 5 mins. he didn't move and she nearly caved in but eventaully he got up, ran to us and we carried on. A trivial example but one that demonstrates unintentional reinforcement.

I'm no guru or paragon of parenting. I do my fair share of shouting and losing it, at which my dh loves nothing better than to whisper in my ear 'What would your ABA pals says if they could see you now eh?'.

However, reflecting on about 5 years worth of collaborative work in schools with education staff, every single successful interevention (and there are scores) has come about because we have adjusted the nevoronment first and not the child.

[StarlightMcKenzie]

I think that is why it is so difficult being the parent therapist. I often know the theory but it is my life, not my job and it can be very hard to stay objective when confronted with new behaviour and analyse both the cause and best way of handling it when you're trying to make dinner fast, in order to get the kids to bed on time so you can get out on a rare date, - particularly as you know correct handling will be best in the long term but require extra time right at the time you don't have it.

[moondog]

'particularly as you know correct handling will be best in the long term but require extra time right at the time you don't have it.'

So true!
So contingency for you is deilivery of reinforcement ( ie getting things to go your way)
Immediate reinforcement-leaving the house because you have done up your child's coat
Delayed reinforcement-taking time to teach him to do so which is difficult as you are already late and your dh bellowing in the car )

[StarlightMcKenzie]

Yeah, so like most people, I just shout at them, relieve my frustrations, cause tears, get a date on time and spend it mostly guilty and desperate to get back to cuddle my children!

[moondog]

Yes, that is perception of old style home based programmes particularly but it is patently not true to the spirit of ABA. It's not ABA in fact. The first thing we point out to all involved is that if you want the child to change, you have got to change first, whatever it is you are doing with him as it is patently not working.

There's an Einstein quote to this effect-something about madness being essentially doing the same pointless thing over and over again and expecting iot to have an effect.

[moondog]

Sounds really great.
The first thing you do is pair yourself with reinforcing activities.
Doesn't matter what they are-you want the child to associate the person doing the teaching with enormous fun and laughter and pleasure.
Doesn't sound like your BA did that which is extremely worrying.

[moondog]

The gratifying thing where I am is that everyone has embraced this approach with open arms and open minds. We can't keep up with the demand which is so wonderful.
I'm talking regular schools here too. Nothing fancy or fee paying.
Just ordinary people in ordinary places realising that they can make a massive difference to kids' lives and that everyone can have a wonderful time doing so.