Only for Young’uns?

Since my husband and I are driving back from my hometown in the deep South as I type, I thought this title was perfect for my next blog. I know it’s been a while, but we were in the middle of answering a series of questions about misconceptions related to Applied Behavior Analysis (ABA). The first question was about whether these techniques are only helpful for individuals with autism diagnoses. The next question is this…

True or False: ABA is relevant for young children; however, its applications with older children & adults are limited.

And the answer is…………………………………another FALSE!!!

In my opinion, this might be the biggest misconception about ABA. It is, by far, the one that I have heard the most among parents searching for treatment options. The conversation typically goes like this…”Well, we’ve heard great things about ABA, but our child is beyond the ‘window’ so we’re looking for other options.” You’re probably wondering what this so called “window” is all about, but I’m going to go ahead and bust your bubble by telling you that it isn’t as special as it sounds. You see, a lot of people believe that once a child is outside of a specific age range, ABA is significantly less helpful for them. This is simply not true and can be easily refuted by looking at past and ongoing ABA research.

Before going any further, let me remind you that the first most influential publication on ABA was done with children (Lovaas, 1987). As with the first misconception, the participants of this well-known study also likely led to the “birth” of the age misconception. Another similarity relates to funding, as ABA services are more accessible for children, which further misleads people into believing that ABA isn’t as important for older individuals. Finally, remember that the number of professionals working in a particular area is heavily dependent on funding; just because most BCBAs work with children doesn’t mean they couldn’t help others! Instead of making assumptions about whether age matters based on publicity and/or funding, let’s dig deeper and see what the research says – this research may not be as well-known, but there’s a lot of it!

Here are numerous ways that ABA has been used to help older individuals with various disabilities:

  • Teaching cover-letter writing as a part of the job interview process (Pennington et al., 2014)
  • Teaching menstrual care to women (Richman et al., 1984)
  • Teaching safety skills, such as how to seek assistance when lost (Taylor et al., 2004)
  • Teaching conversation skills (Bourgeois, 1993)
  • Teaching internet leisure skills (Jerome et al., 2007)

Just from this small sample of studies, you can see how ABA has already been used to help older individuals live more independently, build friendships, stay safe, and grow in careers that they love! Despite this truth, please don’t think that I am discounting the importance of early intervention! Just because ABA can help beyond childhood doesn’t mean that waiting is a good idea. On the contrary, starting early will help people reach more goals, more quickly. What I’d really like to leave you with is this…DON’T GIVE UP! Whether you’ve gotten early intervention services or not, ABA can help people of all ages in amazing ways!

As always, I’m happy to send more research your way if there is a topic that you’re particularly interested in for your child or someone else. The more we educate others on the truth, the more we can get people the help that they so desperately need!

Also, you definitely won’t want to miss my next blog about the common complaint that ABA is too boring, so stay tuned!

~Liz

References:

Bourgeois, M. S. (1993), Effects of memory aids on the dyadic conversations of individuals with dementia. Journal of Applied Behavior Analysis, 26: 77–87.

Jerome, J., Frantino, E. P. and Sturmey, P. (2007), The effects of errorless learning and backward chaining on the acquisition of internet skills in adults with developmental disabilities. Journal of Applied Behavior Analysis, 40: 185–189.

Lovaas, O. I. (1987), Behavioral treatment and normal educational and intellectual functioning in young children with autism. Journal of Consulting and Clinical Psychology, 55: 3-9.

Pennington, R., Delano, M. and Scott, R. (2014), Improving cover-letter writing skills of individuals with intellectual disabilities. Journal of Applied Behavior Analysis, 47: 204–208.

Richman, G. S., Reiss, M. L., Bauman, K. E. and Bailey, J. S. (1984), Teaching menstrual care to mentally retarded women: acquisition, generalization, and maintenance. Journal of Applied Behavior Analysis, 17: 441–451.

Taylor, B. A., Hughes, C. E., Richard, E., Hoch, H. and Coello, A. R. (2004), Teaching teenagers with autism to seek assistance when lost. Journal of Applied Behavior Analysis, 37: 79–82.

Only for Autism?

It’s time for some answers! Ready for the first True/False question of this series on the most common misconceptions of ABA? Here we go!

True or False: ABA has only been proven effective with children diagnosed with autism.

And the answer is………………….a resounding FALSE!!!

I am assuming that this will be a surprise to many people reading this blog. Why? Well, this is what the majority of parents & teachers hear through word of mouth. Let me start explaining my answer by telling you how this misconception came about in the first place.

If you don’t already know, ABA is a relatively young field of study with research only dating back to the 1950s. After about 30 years, a study on an intensive, 40 hours/week ABA program was published (Lovaas, 1987). This study continues to be the most influential publication supporting ABA. Who were the participants? You probably guessed it…children diagnosed with autism!

What happened next truly set the stage for this misconception to stick. Based on what I’ve told you about the history of our field, who do you think insurance companies were first mandated to cover ABA services for? Children diagnosed with autism, of course! Thus, where do you think the most & highest paying jobs are for BCBAs who provide & supervise ABA services? Yep…with children diagnosed with autism! You see, the Lovaas study was really when ABA got people’s attention. It was finally our chance to show that we could bring something different to the table. Something that was unlike any treatment at the time. I guess you could say that ABA “got its foot in the door” through its work in the autism community.

The unfortunate part of this history is that we have yet to get the same recognition for the plethora of research supporting the benefits of ABA with others. So now, let’s now shift our focus to what IS true. ABA HAS been proven effective across a wide variety of disabilities and challenges! And no, that’s not just my opinion. As I’ve already mentioned, there is a great deal of research showing how successful ABA can be beyond autism treatment. Below are just a few examples…

  • Helping individuals diagnosed with traumatic brain injury (TBI) learn to recognize names & faces (Cowley et al., 1992)
  • Helping children diagnosed with attention deficit hyperactivity disorder (ADHD) learn to stay on-task during work tasks (Rapport et al., 1982)
  • Helping older adults diagnosed with dementia stay active & engaged in their living environments (Engstrom et al., 2015)
  • Helping typically developing preschool children respond safely to lures from strangers (Johnson et al., 2005)
  • Helping individuals with addictions to abstain from engaging in those behaviors, such as cigarette smoking (Reynolds et al., 2008)

This list could go on forever, but even these 5 examples show the variety of people that could benefit from ABA techniques. I hope that this post helps people reconsider ABA as a treatment option if this misconception was holding them back from doing so. For others, help us educate people! We could really use any help we can get!

My next blog will be similar to this one, but I’ll be specifically looking at whether age plays a factor in the effectiveness of ABA. As always, I’d love comments & questions. I’m even happy to research other applications of ABA if you’d like more specific resources! And just so you know, I may not be talking about Auburn football quite as much this fall; if you haven’t noticed, they’re not looking so hot this year…and that’s NO misconception. ::sigh::

~Liz

References

Cowley, B. J., Green, G. and Braunling-McMorrow, D. (1992), Using stimulus equivalence procedures to teach name-face matching to adults with brain injuries. Journal of Applied Behavior Analysis, 25: 461–475.

Engstrom, E., Mudford, O. C. and Brand, D. (2015), Replication and extension of a check-in procedure to increase activity engagement among people with severe dementia. Journal of Applied Behavior Analysis, 48: 460–465.

Johnson, B. M., Miltenberger, R. G., Egemo-Helm, K., Jostad, C. M., Flessner, C. and Gatheridge, B. (2005), Evaluation of behavioral skills training for teaching abduction-prevention skills to young children. Journal of Applied Behavior Analysis, 38: 67–78.

Lovaas, O. I. (1987), Behavioral treatment and normal educational and intellectual functioning in young children with autism. Journal of Consulting and Clinical Psychology, 55: 3-9.

Rapport, M. D., Murphy, H. A. and Bailey, J. S. (1982), Ritalin vs. response cost in the control of hyperactive children: a within-subject comparison. Journal of Applied Behavior Analysis, 15: 205–216.

Reynolds, B., Dallery, J., Shroff, P., Patak, M. and Leraas, K. (2008), A web-based contingency management program with adolescent smokers. Journal of Applied Behavior Analysis, 41: 597–601.

True or False?

[ File # csp8317961, License # 1990404 ] Licensed through http://www.canstockphoto.com in accordance with the End User License Agreement (http://www.canstockphoto.com/legal.php) (c) Can Stock Photo Inc. / bbbarMy grades throughout high school & college were extremely misleading. See, they made it seem as though school came easy for me. Truth be told, I was one of those nerds that worked myself to death in order to get good grades. Tests and quizzes were never easy for me – I ALWAYS had to study. A lot. True/false questions were one of my least favorite types of questions because I would immediately jump into over-analytic mode when I saw one. As most people know, this is a sure fire way of getting the answer wrong. Despite my distaste for these questions, I will be answering a few of them for you over the next few posts. These questions are easy for me because I am asked to answer them ALL the time, so I’ve become very familiar & knowledgeable about the right answers. All of these questions relate to Applied Behavior Analysis (ABA). Let me pose them to you now so that you can be thinking about your own answers:

True or False…

  1. ABA has only been proven effective with children diagnosed with autism.
  2. ABA is relevant for young children; however, its applications with older children & adults are limited.
  3. ABA is enjoyable & fun for learners.
  4. ABA can result in “robotic” behavior/language.
  5. ABA is a different type of therapy than PECS, Discrete-Trial-Training (DTT), and Verbal Behavior.
  6. The primary benefit of using ABA is to address challenging behaviors.
  7. Anyone with knowledge about autism and/or general experience as a behavior therapist can use ABA techniques effectively.
  8. For children who understand how therapy “works,” ABA is not successful.
  9. ABA can involve strategies that are extremely difficult & time-consuming to implement.
  10. For the most part, all Board Certified Behavior Analysts (BCBAs) are equally qualified.

As we’ve talked about in many of our posts, questions about different therapeutic approaches can be extremely difficult to answer. The crazy amount of personal opinions and misinformation flying around about ABA makes it almost impossible for a parent to find accurate answers to any of the questions I listed above. Although my answers will obviously draw from my professional experience, my goal is to rely as much as possible on the research literature.

By writing a blog series in this fashion, I hope to discuss, in detail, the concerns that too often keep families and professionals from considering ABA for their child, student, or client. As you will see, many misconceptions keep people from seeking these services despite desperately needing them (and despite more & more easily being able to access them). It is my mission to constantly inform others about the proven benefits and limitations of ABA, as well as the determinants of its effectiveness,  so that families & professionals can make well-educated decisions about when it would be beneficial. I hope you will join me in this journey by commenting on and asking questions about each of the topics posed.

Stay tuned for question #1: True or False – ABA has only been proven effective with children diagnosed with autism. This answer, along with the start of football season, will be coming very soon! 🙂

~Liz

“Play nice in the sandbox”

AS0000114FD07 Children, in park and adventure playgroundThese kids seem to be playing nicely together, right? And that’s what we expect of them, isn’t it? If they weren’t playing nicely together, the parents would be hovering to make sure everyone stayed happy and unharmed by flying sand or toys. We, as adults, are often told to figuratively “play nice in the sandbox,” typically when discussing heated topics or collaborating across disciplines. But I always feel the need to ask the question, “Do I really have to?” And, better yet, “Is it really helpful?”

Personally, I think the short answer to both of those questions is, “No.” In general, the notion of “playing nice in the sandbox” is flawed fundamentally. It is based on the premise that this “getting along” ideal is both necessary and helpful in all situations. But what we fail to recognize is the dangers in this type of thinking…this all or nothing thinking.

We live in a world where, if you disagree with someone, you are immediately labeled as (and shunned for being) “hateful” or “anti-_____” or “closed minded,” and the whole world learns of such “truths” about you as a person. There in lies the problem: disagreement is NOT, in any sense of the word, judgement. Our society’s need to be politically correct and accepting of every idea anyone ever had is, in my view, leading to the degradation of critical thinking and healthy debate leading to progress. Don’t get me wrong, people have value (as fellow human beings) independent of their agreement or disagreement with others and deserve to be treated as such. That, in no way, suggests that we must tread so carefully as to not ruffle any feathers. Being kind and loving towards other people does not preclude me from having strong opinions and sharing them (in respectful ways) and advocating for what I believe is best. It also means that others can (and should do the same) with people yielding their misplaced focus or trust when needed.

Let me give you an example from the life of a behavior analyst…I’ll even borrow from our previous posting on sensory diets:

Let’s pretend I’m a behavior analyst (well I suppose that isn’t a hypothetical) who is doing an assessment for a student who runs away from the classroom, and I learn it is happening to both escape work and access preferred sensory activities. I also notice that the frequency of running away increased dramatically after the first time an adult played with him in the sensory room. If someone were to suggest that this behavior was a result of a sensory need during difficult academic tasks and that he should be allowed to continue accessing the sensory room under these situations, I would be remiss if I failed to point out that that was directly observed to make the situation worse.

But, truth be told, the notion of “playing nice in the sandbox,” and the proponents of its universal value, would suggest that the best response would be to say, “Sure, we can definitely incorporate such a sensory diet in the midst of those tasks. I can definitely see how that is something he really needs.” Wait…hold on a second…didn’t I just say that this response already resulted in an increase in running away?! It seems to me, then, that that particular response is neither helpful nor necessary. It might help to make everyone feel included, but it certainly would be expected to help the student.

On the other hand, consider the following response: “I see how it might seem like he ‘needs’ these breaks because he is running off so frequently, but the data show that this pattern is actually leading to increases in running away. I would be more inclined to teach him a more appropriate way to request these breaks and to better tolerate longer periods of difficult work while removing access to the ‘fun stuff’ accessed by running away.” People would suggest (and I’ve experienced it personally) that I would not be “playing nice in the sandbox” because I simply “dismissed” another’s suggestion. But what I know about this 2nd response is that it was polite but clear regarding my position and offered an intervention that is more likely to result in a positive change for the student.

And, again, here is the problem: disagreement does not equal judgement, even though society tells us it does. I’m not judging that suggestion; I’m simply offering an explanation why, scientifically, we wouldn’t expect it to be effective and offering another option.

I work daily to build positive relationships with people that may or may not have the same beliefs and training and passions that I do, but I don’t believe that the only way to do that is to avoid ruffling feathers at all costs. It is only through being challenged on our beliefs and actions that we can learn to understand them, defend them, and change them (when necessary). Without being challenged, we go through life as lemmings, willing to follow each other off a cliff when there is a route to safety.

Personally, I would rather be shown why I am wrong and have the chance to be better than always be told I’m right while sacrificing my very being in the process. So the next time you feel pressured to “play nice in the sandbox,” resist the urge and exercise the practice of respectful honesty instead.

Stephanie

Sensory Diets: What Are We Even Talking About?

Use of the term “sensory diet” or “sensory needs” has grown tremendously among professionals providing services to individuals diagnosed with autism. These days, it would be more surprising for a parent not to contact this idea than to contact it, both within and outside of the school setting. Families and schools spend crazy amounts of time and resources to ensure their children contact this type of therapy. In my experience, “sensory diet” and related phrases are one of the top 5 phrases used in IEP meetings, hands down. So, what do these terms even mean? Let’s first take a look behind the curtain of this infamous phrase to see how it got here. Although many people may not be aware of this, what we are really talking about when we say “sensory diets” or “sensory needs” is what’s called “sensory integration therapy” (SIT). Here is one source’s definition of SIT:

“Sensory integration involves providing a ‘diet’ of sensory stimulation to a child, in an attempt to improve the way in which the child’s brain processes and organizes sensory information. This can include vestibular and tactile stimulation, purposeful movements, use of weighted vests, and brushing, among other techniques.”

Sounds familiar (and experimental), right? Although most professionals using these strategies do not typically refer to them as sensory integration, the techniques and underlying theories would likely be described similarly as in the definition above. Put more simply, all of these terms imply that children with autism need some amount of various sensory experiences in order to function more normally from day-to-day. Now, at first glance, this seems to make a lot of sense. After all, many people with autism certainly love sensory activities – so it would be easy to assume that these are things they need from a biological standpoint. But are the acts of loving and needing synonymous? What if they aren’t? What if these sensory experiences are truly just preferences that are out of control because of a lack of social skills that help all of us keep our weird sensory habits (mine would be forcefully moving my feet under the table) in check? If we play devil’s advocate, this would mean that we are spending a TON of time, money, and energy on something that has nothing to do with progress or a better quality of life!

Now, take a deep breath. This next paragraph will likely blow you away and possibly even offend you. I simply ask that you finish reading with an open mind. I can also promise that you will still walk away with a positive outlook on the “S”-word if you’re able to make it to the end!

The bottom line is that nothing (to date) has proven that love=need when it comes to sensory experiences. I know it is easy to think that the underlying evidence supporting these ideas has been growing as exponentially as has use of the techniques themselves; however, this is completely false. Let me now present you with some factual information. According to the 2009 National Standards Project (NSP), a comprehensive literature review of research on many commonly used treatments for autism, sensory integration neither falls in the “established treatments” or the “emerging treatments” categories; instead, it was categorized as an “unestablished treatment” meaning that, “little or no evidence was found to assume its effectiveness.” More specifically, unestablished treatments may not have any research supporting them or the studies that were conducted have very low scientific merit scores; in the case of sensory integration, only seven total studies were found. These findings are comparable to other older sources such as, “Controversial Therapies for Developmental Disabilities” (2005). Based on an extensive review of the existing research at that time, the book echoes the NSP by noting that, “available studies [on sensory integration] are sparse and tend to be methodologically flawed.”

Despite multiple reviews with the same findings, the use of sensory integration techniques is widespread and typically incorporated into IEPs, treatment plans, and daily/weekly routines at home & school without question. As was my reaction upon learning this information, the common question is, “Why? If this is true, why are so many clinicians doing it?” Well, let’s remember the lesson we are always trying to teach our kids…that just because everyone is doing something, doesn’t mean it is good or right. I think this is one major example of us adults failing to practice what we preach.

Now for the positive note! We can easily see that people with autism seek and avoid certain sensory experiences in many different ways. Just because providing them as part of a “sensory diet” isn’t supported in a therapeutic sense, doesn’t mean that (a) these experiences can’t be used in meaningful ways and (b) people who love them can’t be taught to scale back on them based on social situations, just as we do. If we know these experiences are things that they love, can’t we simply use them for motivational purposes and/or to pair ourselves with fun stuff in the process!? In other words, there are a number of beneficial roles for preferred sensory experiences outside the theory of sensory integration that, therefore, don’t result in the sacrifice of precious time and resources on unproven therapeutic techniques.

I think we would all agree, as passionate clinicians and loving family members, on the importance of using time and resources as wisely as possible to help people live life to the fullest. To continue using any type of therapy with a lack of evidence simply does a major disservice for helping them reach this goal and at no fault of their own. My hope is for this entry to challenge all service providers and families, including myself, to continue seeking information on scientifically validated treatments so that our language, resources, and therapeutic strategies are as passionately driven by evidence-based practices as we say they are.

Precious lives are at stake…let’s know what we’re talking about!

Resources:

National Standards Project (2009) http://www.nationalautismcenter.org/about/national.php

Jacobson, J.W., Foxx, R. M., & Mulick, J.A. (2005). Controversial Therapies for Developmental Disabilities (pp. 68-70; 218; 252-253).

Liz Van Dorn (and yes, you did notice a trend of Auburn football colorsWAR EAGLE!)