ABA therapy for children with autism is a science of both what to teach and how to teach. The more prominent discussions concerning ABA often revolve around how to teach. The use of discrete trials, incidental teaching, and generalization training are all examples of strategies of how to teach that have been assessed in the research. Yet just as important as how to teach is deciding what to teach. ABA therapy for children with autism has been engaged with this question through the years as well. One example of this engagement I find interesting is when and how to teach a child eye contact.
In 1981, Dr. Lovaas published, The Me Book, the first manual for the general public that describes in detail how to implement behavioral treatment for children with autism. Eye contact was one of the first skills taught to a child. In Chapter 6 entitled "Directing and Maintaining the Child's Attention" the first program discussed is called "Look at Me." The instructor delivers the instruction "Look at me," and the child is expected to look at the instructor for at least 1 second. Eye contact was seen as a pivotal skill to get the child to pay attention and be ready to learn. However, at least by 1995 (when I started as an instructor), eye contact was no longer taught at the beginning of ABA therapy. Dr. Lovaas even gave an interview in the Autism Society of America's newsletter around then explaining why some changes, such as eye contact, had been made in the program. (Unfortunately, I can't find that article anymore.) I have heard a variety of different reasons for the change including: a) even though Dr. Lovaas discusses generalization of the skill, it proved difficult to facilitate generalization to other environments early on for some children, b) eye contact was not a necessary prerequisite to gain a child's attention because other aspects of therapy (prompting, reinforcers, consistency) already resulted in gaining a child's attention, and c) the eye contact program might actually decrease eye contact in some children because they learn that the instruction "look at me" will be followed by other demands.
Rather than teaching eye contact as a means of establishing attention at the beginning of treatment, eye contact was taught later as an important element of conversation. Thus, when a child was learning how to engage in a conversation, eye contact was often incidentally taught as an important way to show interest in and maintain the conversation.
Fast-forward to the present, and eye contact has started to be taught to early learners again. However, rather than focusing on eye contact as a way to gain a child's attention, eye contact is used to teach a child to reference others for information, to respond to non-visual cues, or to participate in joint attention. In a future blog, I'll talk about some of the recent programs I've seen used that focus on eye contact. Until then, I'm interested in anyone's opinion about when or how eye contact should be taught.
Vincent LaMarca
Lovaas Institute – Indianapolis
Comments
I have used eye contact to teach an early, non-verbal learner to request "more" of something. For example, if the instructor and the child are participating in an activity like bouncing on a ball, the instructor would stop the activity, wait for eye contact, reinforce that eye contact by resuming the activity and delivering social reinforcement. This is obviously a very early step in the requesting process, but it gave the child a way to appropriately request more. The child was then taught to request more by signing for more. He independently paired the sign with eye contact because of the reinforcement it received in the past.
Hi Vince,
Well, our family's first experience when our child was very young was "old school", as in interventionists who may not have had the most up-to-date information and training, and our experience is that the "look at me" drill did result in orientation during skill work, but did not generalize, and developed a prompt dependency. We rebooted later, taking motivation into consideration and within the context of mand training and incidental teaching during enjoyable activities. Much more successful, and this is when my child was 7. Naturally, if we had it to do all over again, we might do this very early in programming.
Here's a recent blog post discussing the matter of "eye contact". I gave a complimentary shout out on your current posts. Perhaps you and the blogger can have a dialogue.
Sometimes it Doesn't Matter What the Data Says
The Interactive World Blog, Psychology Today
Published on January 8, 2010
http://www.psychologytoday.com/blog/the-interactive-world/201001/sometimes-it-doesnt-matter-what-the-data-says
Regina,
Thanks so much for your insight. It's so helpful to have posts from the practical experiences of other families. I'm glad to hear you found greater success with eye contact when motivation was taken into consideration!
Eye contact is something that my grandson has had difficulty with since he was an infant. When he was 2 and 3, if I wanted to be sure he was paying attention to what I was saying, I stated, "Alex, look at my lips". He could not make eye contact but was more than willing to look at my lips while I was talking. It seems this practice made him more comfortable and was eventually able to start making eye contact although not always.
He is now 8 and has done remarkedly well with making eye contact with the help of therapy and school.
For the first time, the other day, he looked me staright in the eye and ask me to 'go to the birthday party with him'. That is the longest he's ever looked me in the eyes and I almost broke down in tears (with joy of course!).
With our verbal child, getting involved in his world/interests, which were limited, and expanding from there created improved eye contact naturally and actual interaction within the family. Motivation is the key to improving behavior with built in rewards and positive re-inforcement.
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