ABA - could/would it work for us?

[LemonGoby]

I know many on this board feel ABA is really worthwhile for children with ASD. I don't know much about how it works (am going to start reading up), but I am curious to know if anyone with more knowledge and insight than me thinks it might help my DD.

DD is 3.8 and currently has no diagnosis, but is on the spectrum. This is how she presents, with the areas I am most worried about (and hope we can work on improving)....

She can't hold a back and forth conversation. She has masses of echolalia, both immediate and also her own commentary. She asks an excessive amount of questions of a non-functional nature, that seem to have become a habitual response to statements by others - so if I say, 'Look DD, it's raining really hard', she will follow with, 'And Mummy, is it raining really hard?'. She also asks a lot of questions that she obviously knows the answer to, eg. 'Does it hurt?' if she bangs herself, or 'Am I having toast for breakfast?' when she is already eating it.

I am holding onto the fact that all this, and her endless repetition of scripted conversational topics, do show a desire to communicate, but conversationally it can feel like Groundhog Day. However, on many other occasions it is impossible to get an answer out of her at all. I don't think a lack of understanding is the principle problem (SALT assessment plus the SALT who did her recent ADOS said receptive language was bang on for age, and I feel this is more or less true), but more the issue is that she feels no desire to reciprocate socially and to converse for the pleasure of interacting with another person - she doesn't do small talk! I sometimes feel that she really will only engage if she wants her needs met, or to talk 'at' people about her areas of obsession. Otherwise comments and conversational overtures made by others can be just totally ignored, even when repeated numerous times. She retreats into her own world and this seems more valuable/rewarding for her than sharing ours. Sometimes she appears not to be actually doing anything for ages at a time, just staring off into space, or repeating stories from books to herself.

Similarly, she is very non-compliant unless it is something she already wants to do. She ignores repeated requests (to put boots on/hang up coat/come for meals for example) not just from me but also nursery staff. It is as if she simply doesn't see any value in responding to others and doing things to please/earn approval. I am aware that she is of course still young, but the behaviours seem excessive and particularly entrenched, even for her age. If going on a walk she lags behind, getting further and further away, and shows no desire to walk/share the experience with us. I constantly have this feeling that I wish there was a switch I could flip that would magically 'switch her on', or unlock something.

Reward charts haven't been very successful - she doesn't seem to care enough about or imagine far enough ahead to envisage the proposed reward, or else wants the reward immediately but doesn't see why she should work for it(!). The only things she responds to is the immediate removal of favourite things after bad behaviour.

She has areas of obsessive interest, and seems to be becoming ever more restricted to these as time goes on. Within these areas she occasionally has a little imaginative play/activity/desire to explore, but it is actually very repetitive and restricted, and certain imaginary scenarios with toys that she plays out always follow a precise script. She is obsessed with books/reading, and wants the same ones read to her over and over until she has memorised them verbatim, and thereafter she 'reads' them to herself for ages at a time.

She doesn't like trying new things and often refuses. I think there is some fear of failure there, but also inflexibility and a lack of motivation. I see that she is becoming defiant more often, yet nursery is more concerned by how passive and disengaged she appears there. She is not engaging with other children, but also is very easily distracted and can't focus/zones out. Nursery staff say that without the 1:1 support that they have been trying to give her there to keep her focused on activities and the routines of the day, she would just disappear to the book corner and spend all her time there (this I can well believe).

I know she is still very young, but my gut feeling is that none of this is going to magically get better by itself and that we need to do something to help her. I really fear for her future at the moment.

So, I guess my questions are - could ABA help my DD in these problem areas? If so, how do we go about finding a tutor? Do we interview? For how many hours a week should she have ABA, and for how long? Do you follow a course for weeks/months/years? How do you square ABA tuition with school (she is due to begin Reception in state mainstream in September)? She has no statement. We have applied for statutory assessment though I am assuming we will get turned down and need to appeal.

Any insight into how ABA might/might not be able to improve things for my DD in these areas would be really gratefully received. Thanks for reading!

Re compliance. I agree with bialy. It is really just about motivating a child to learn something and then hopefully to want to learn more of it, my nt dd is 'compliant' at school because she understands what is in it for her. She's no more or less a robot than ds.

Star and also the thing is with ABA you wouldn't say "if you do x, then you get y". The reinforcement is given if and when the desired skill/behaviour is mastered, but is not made explicit beforehand. And as you say, there's no punishment (ie removal of promised reward) involved.

I think it's sometimes misunderstood as a system of bribery, and the reinforcement concept is a bit misunderstood. Reinforcement just means that behaviour (in its broadest sense) is shaped by how others respond to that behaviour. I might start launching into an anecdote and if I get nods and smiles and laughter I'll carry on telling the anecdote, and do it again in the future as the response is reinforcing to me, but if I get blank looks and people look away I'll realise what I'm doing isn't appropriate and I won't try it again. But no-one would say beforehand "if you say something funny I'm going to laugh" - I'll learn from the natural consequences.

That's true but my kids DO expect reinforcement. They expect a good time for their efforts. They change their behaviours to ensure it. They have learnt delayed reinforcement is still worth it.

Dd knows if she puts up her hand often (though not a bargain) her teacher will pick her. She knows if she tries hard she increases the chances of teacher praise, though to form is again not known or guaranteed.
. Ds does not have the social skills or emotional maturity to learn using these types of reinforcers so we have to start with ones that are meaningful to him, which due to the social deficit aspect of his disability do not always appear 'natural'to those who are NT.

I'm pro ABA, but not always pro a specific service supplier. I do think parents have to research their consultants VERY carefully, (pref through word of mouth from other parents) before taking out a second mortgage.

I do think there are cowboy operators out there in the world of ABA. (I often compare it to non-nhs plastic surgery - another field where the shysters seem to gain a foothold, lured by the promise of "easy money").Things are getting better as there is now a professional organisation so you can check qualifications and quality etc. It's so important to remember too that the public sector funds some utterly useless non-ABA interventions for autistic children too.

I actually get quite cross nowadays when people talk about implementing the TEACHH approach in mainstream as a cursory level of research into this method very quickly demonstrates that whatever it is they are implementing in the average mainstream classroom is nothing like genuine TEACHH. (As it's almost impossible to achieve given the mainstream environment and staff training required to implement the real methodology). A misapplied buzzword does not automatically equal a good outcome.

Also it's hard to find experienced consultants for HFA/adolescents, as historically in the UK most of the effort has gone into marketing to parents of younger children.

If you research ABA properly, you'll quickly see how based it is in common sense. Straight away you'll be able to see that a decent ABA programme for child Y, may look totally different than for child X as both children will have different intrinsic motivators and barriers to learning. ASD is complex.

One last thing - those that compare it to dog training etc, obviously aren't the poor souls who get called to the police station because their 17 year old son has been caught fiddling with himself at the bus stop again. Some behaviors have to be tackled in order for a child to have any chance of being treated like a human being in wider society. (My Mum was a secondary SN teacher who used to rail bitterly at how few of the SN kids she taught didn't have these behaviors addressed in primary school.)

It's true the industry was unregulated a few years ago as happens when something grows very fast and demand outstrips supply.
However it is now an extremely regulated industry with many many hoops to jump through and rightly so. A BCBA ( board certified behaviour analyst) of which there are fewer than 140 in the UK has to undergo an extremely stringent process and to pass not only an msc but an absolute stinker of an exam. The ethical component is very demanding and about to get even more so- dad more demanding than the ethics demanded of the commoner helping professions.

Always work with a BCBA as opposed to a random person. All bcbas are listed on the online bacb registry.

If we are talking ethics, I question the ethics of the hundreds if not thousands of people operating in our society who happily offer intervention with little ir no evidence base. These include teachers, slts and ots as well as the reiki healers and reflexologist a and Hopi candle users. Kinda makes you stop and think huh?

The reply of Julie Vargas, skinners daughter who is a highly respected academic and teacher in her own right to accusations of 'animal training' is a beatific smile and a gentle ' and isn't it wonderful that we know that these powerful interventions are safe before we use then in our precious children?'

Again I see the parallels with childbirth and breastfeeding and the relatively recent move to distance ourselves from animals, disgust ourselves with their behaviours and rate ourselves as far superior.

You see, I am not saying everything about parenting an ASD child has to be science and that's all we do...I use plenty of un-scientifically proven methods with my DS too, I am not just a twenty four hour ABA dispenser...we do cuddling, eating chocolate, love, running around, physical play, massage, going on outings to the zoo....the list is as long, and pretty much the same, as the activities and methods (and emotions) of any other parent with a small child. And they all have value, in many many ways. They are not however enough, without the ABA programme, to address the core deficits that he has.

It's like me saying you have an physical illness which needs to be treated with this particular medication, or this surgical procedure, which is scientifically proven to have an effect. I would not say that you cannot also have nice food, family support and love, nice books, a television, a holiday, a warm bath, chocolate (a bit of a theme there!) etc etc, and all of those won't have a positive effect on your life. It's just that they are not going to on their own treat your illness.

PS along the same lines, the comments above about the importance of using properly qualified people are very important.

In the analogy above, would not get just anyone to prescribe the medication or carry out the surgery would you? (and in that case it would of course be illegal). So also you should not get an unqualified, uncertified person to do the ABA (unfortunately this is not properly regulated yet, as is the case for psychological therapies in general, anyone can call themselves a therapist).

Genuine question as I have never really looked into Aba as we are on benefits , in what specific areas has it helped your children?

It helps whatever you want it to. One of the biggest benefits IMO is that you can only do it once you have done a very detailed assessment of skills currently mastered and that these are tested at a deep level not just superficially.

Then for each skill tested you work out the next steps required and teach that. Like every intervention for ASD social skills are harder to teach especially when you are using unpredictable 'others' ie peers, but because you analyse very carefully the interactions and record them you can teach those skills in more predictable environments first. The difference is all in collecting information on the progress towards or otherwise of the desired skill in a way that proves it has been acquired.

Thank you star sorry one more question how would it work with social interaction which is an identified area that dd 2 has huge deficits in

autumnsmum - In the last 12 months some 'tangible'/ change in prognosis in quality of life type achievements have been - toilet training & self feeding - 70% done. She is gaining more and more independence in terms of holding hands when walking down the road, drinking from a cup, washing hands, dressing up

What has however been the biggest change for us is that between 1-3.5yr it was impossible for us to try any therapy with her - OT/reflex integration/Speech/oral motor/PT etc etc. She just wouldnt comply. Now we know how to motivate her, how to desensitise her and that now allows us to work with her.

She isnt verbal yet which is what we had hoped to get out of the program. However, one year on, I now know, that communication is more important than speech and we focus on that now.

Some changes which dont mean a lot in terms of her quality of life yet, however, we hope these are the building blocks of getting her ready to learn:

1 - She understands some simple requests like - give me 'x'/stand up/wave bye-bye etc
2 - She can request for a few items which she finds motivating - songs, ipad, bubbles, ball
3 - She can touch a handful of items in a field of 3 - eg ball, hat etc
4 - Can play with new toys once demostrated and we are now working on turn taking with peers.
5 - Copies some actions on action songs
6 - Copies phonic sounds

Now, you might find the last set of changes quite useless.. The other day grandma commented that 'will these tutors teach her every word like that'? We hope that in years to come she will learn from her peers and will learn by watching others. Mind you, we only run a program for 22 hours/week with tutors. For someone as challenged as her, we should ideally run 30+. Hopefully the funding will allow for that.

Does this help?

Also true that most ABA has to date been intensive and directed at snall non verbal autistic children. More cooee toy known as eibi ( early intensive behavioural intervention) one of many applications if ABA.
It isn't my chief area of clinical interest. There are already many excellent behaviour analysts who specialise I. This field. I am more focussed on higher level social interaction and literacy and maths interventions. Also active support which is a systematic data driven wag of addressing the needs of much older kids and adults with pmld

Thank you for replying salondon I think we have probably made very different choices for our daughters but I respect you tremendously and always find your posts interesting . As I say I'm not considering Aba I was just interested as to how it differs from what dd2 is doing now

What is your daughter's intervention like autumnsmum? I think there is a lot to learn from every one's programs

ABA has it's own terminology which I think scares people and makes it look like something 'special' and outside the convention.

However, most resources we use are not made by ABA people, they are just used in an ABA way.

I know there are people who disagree with me but imo all you need for a successful ABA intervention is a pen and paper, a detailed assessment and knowledge/advice.

It won't be optimal but it will be better by miles that at least what was offered to ds as an alternative.

Hi salondon I agree we can all learn from each other . At dds school they are trying to extend her play skills I.e talking to her about sand not just letting her dig it. She does a weekly keep fit session to help with her hyper mobility. She has paired speech therapy with an emphasis on turn taking and microphone work sad she is very quiet outside the home . She has had music therapy as well . They are also helping her make choices at snack time .i have also asked that she is not allowed to drift which she did at mainstream nursery

Mainstream behaviour strategies

These work well for most NT dc, and also for many dc with SEN. And the way the teacher learned the each technique was by observing or devising them (selection of task), finding a bit they can do (breaking down into subtasks) trying it out (discrete trial), observing the result (taking data), feeling happy if it worked (reinforcement), trying it again (more trials, building fluency), and doing it more effectively over time (progress), based on how reinforcing it was (shaping), building on his first few minutes of success till a whole lesson was sorted (chaining).

You could even argue that the kids used ABA to teach this teacher how to use these behaviour management techniques (listened to him- positive reinforcement; or stopped messing about- negative reinforcement)

Of course it's really chicken and egg. Experienced, effective teachers of all types use task breakdown, selective reinforcement, shaping, chaining, trials, data analysis. As do experienced, effective learners. Mostly without having heard of ABA, nor the theory, nor ever using any of the ABA jargon.

autumnsmum, to give you an idea, here's are the heading from our ABA programme's latest monthly summary (DS is 4 years and 4 months / HFA):

COGNITIVE/LANGUAGE SKILLS
• Verbal Imitation
• Phonetic Reading
• Receptive/Expressive Opposites
• Drawing Imitation
• Sequencing
• Sight reading
• Expressive my/your
• Receptive Object Function
• Multiple Discrimination
• Expressive Object Function
• Writing
• Counter Questions
• Why/Because
• Environmental Sounds

SOCIAL/PLAY SKILLS
• Block Imitation
• Parallel Play
• Pretend to be…

In practice, this means that in just over six months he has progressed from a child with disordered and repetitive speech (no independent questions, no ability to have a back and forth conversation, echolalia), extreme rigidity and no imaginary play to a little boy, who can answer social questions, is able and willing to interact with strangers (not interested in his peers still, apparently they are "boring") and does a lot of pretend play (but, of course, he often picks up one type and wants to play it ad nauseum we are always on the watch!). Some of the more academic programmes above a done as traditional table top discrete trials he very much enjoys it though.

Our primary objective when we started was to prepare him for Reception (i.e. he could access the mainstream easilly, engage with teaching staff and peers and not suffer from being "odd one out"). If the nursery we recently started is anything to go by, we are well under way. The only thing left is for LA to get their finger out and start picking up the cost of the intervention...

As Star says, there is no clash of ideology between ABA and what she calls 'attachment parenting'. Most of the ABA crowd I work with are a pretty bohemian bunch. Very arty, creative and interested in other childhood issues like breast feeding and co sleeping.
I also work very successfully with several music therapists who quickly learn to realise they are actually masters if basic principles of ABA. Shaping, fading, reinforcing, chaining. What they lack is data and they are quickly realising that in a world of limited resources and increased demand for evidence based practice, collecting this will do their profession an enormous favour.
Taking data is surprisingly easy. As long as you gave some baseline data, some data during intervention and Sara taken after intervention to ensure generalisation, you are doing great. A pity therefore that sk few professionals so this.

Whoever you are working with, of whatever discipline, always ask for data. If they can't or won't collect it, then I would run a mile.

Thanks Star - this is really interesting. I knew very little about ABA - and clearly my early efforts failed because I wasn't doing it in the right way, I'm not a natural teacher! With the poo on the loo problem, DD progressed happily to sitting on the loo in a pull up, but cannot seem to go that last stage. She says it just feels wrong and she is 'too little' to try. Same with food - has progressed to having new food on her plate, touching it, smelling it - but no further. I would welcome anything that could help DD with some of her issues - but don't know any ABA resource where I live.

Has anyone started using ABA pre-diagnosis? I'm worried that at 3.4 my DS has already missed out.

Somewhat, ABA can be used effectively with anyone at any time. It is quite simply sound teaching. There is powerful evidence that an intensive behaviourally based programme ( more correctly known as eibi -early intensive behavioural intervention) is particularly effective for very young children with autism but that dies not preclude its efficacy with other populations.