Monday, February 15. 2010
Weakening the Evidence for ABA Therapy, Part 2 - A Dialogue
Posted under: Research
To continue the discussion, I thought I'd share my specific opinions related to each of the guidelines in the last post. I must emphasize that these are my opinions that I purposefully offer up for debate. I'm very interested in starting a dialogue with those whose opinions differ from mine.
1) One general term should be agreed upon as a general umbrella term under which all brands fall. When discussing their brand, individuals should always start by disclosing that their brand falls under this general term.
Ultimately, I think "ABA" is the best general umbrella term that all brands should utilize. Further, I think brands should be known as "Models of ABA." Of course, I'm biased, since I already say I work for the "Lovaas Model of Applied Behavior Analysis." I think we should start saying the "Verbal Behavior Model of Applied Behavior Analysis," the "Pivotal Response Model of Applied Behavior Analysis" and even the "Early Denver Model of Applied Behavior Analysis."
2) Branding can continue for general interventions in ABA therapy (i.e., those interventions with a general curriculum and teaching procedures), but branding should be avoided when talking about specific procedures unless that new brand procedure is observably and measurably distinct from other procedures, precisely defined, and demonstrated to be of enough significance that the technique deserves a separate name.
I don't like the use of the procedural terms Discrete Trial Teaching (used in capital letters) or Natural Environment Teaching because I don't think they are precisely defined. I do like the procedural terms discrete trial teaching (lowercase letters), incidental teaching, and mand training. I also don't like when the brand names are used as procedural terms. You can't "do" Lovaas, Verbal Behavior, or Pivotal Response Training. You utilize procedures from applied behavior analysis under the direction of a particular model of ABA.
3) Individuals who brand general interventions in ABA therapy need to be careful to clarify what observably and measurably distinguishes one brand from another and what procedures, guidelines, etc. are common to other ABA therapy brands.
I posted a previous blog about how I think the term "errorless learning" is misused (see Effective, Individualized Behavioral Treatment - 3. Errorless Learning Procedures). I think more dialogue amongst different models of ABA would be helpful in determining exactly what real differences there are among the models. For example, while I don't agree with all of the distinctions, I think Megan DeLeon, BCBA has pointed out some good areas for comparison on her blog: So what is Verbal Behavior anyway?. I responded to some of those comparisons, and she in turn responded to me. Of course, this dialogue amongst models of ABA would be further helped with objective research into differences between the models.
4) Individuals who brand general interventions should be careful not to contribute to the misinformation of other ABA therapy brands by supporting any claims they make about that other ABA therapy brand with observable evidence.
Here are a couple of the sites I plan to contact in the next month because I think some of the information they provide is inaccurate:
ABA Chicago, Inc: About ABA & Verbal Behavior
MISINFORMATION: "In a traditional Lovaas approach the concept of "cookie" may be considered mastered when a child can point to a cookie and say cookie when shown a cookie, but with a Verbal Behavior approach the concept of "cookie" is not considered mastered until the child can: ask for a cookie when it is wanted (mand), find the cookie when it is asked for (receptive), select a cookie if asked [questions about the function, feature, or class], and answer questions about the cookie when it is not present: (intraverbals)."
CLARIFICATION: I've worked with the Lovaas Institute for over fourteen years now and never discussed mastery of a "concept." A child may master the ability to receptively identify a picture of a cookie in a field of three cards. He may go on to master generalized responding by identifying novel pictures of cookies. He may go on to master the ability to expressively identify the function of the cookie. In laymen's terms, we may say that the child has mastered "cookie," but we always mean this in the context of a particular program. In behavioral terms, we talk about mastering skills or behaviors, not a cognitive concept. I have a feeling even someone who utilizes the Verbal Behavior Model of Applied Behavior Analysis would agree the above description of when the "concept of cookie" is mastered is really talking in laymen's terms.
Verbal Behavior Therapy: Mand training (for non or less verbal children)
MISINFORMATION: "One major difference between the Lovaas Approach and Verbal Behavior Therapy are the first skills taught to a child. The Lovaas Approach typically begins with training the child to sit and make eye contact...In Verbal Behavior the therapist motivates the child by allowing them access to preferred items/activities by using mand (request) training."
CLARIFICATION: Eye contact as an initial program was described by Dr. Lovaas in the 1981 Teaching Developmentally Disabled Children: The Me Book. So, as a historical distinction, the statement is true. However, since the 1990's, eye contact has been addressed in more subtle ways through differential reinforcement and shaping procedures, rather than through discrete trial teaching. This generally results in more natural, generalized eye contact. I talk about this in a recent blog (see Eye Contact - What to Teach and How to Teach).
5) Brand names should not be used in research literature unless the brand itself is actually the focus of the research.
No examples at this time.
Comments
I do agree with most of your "Clarification."
HOWEVER, what you coin as "misinformation," you yourself clarify.....You stated "In LAYMAN's terms [my own emphasis], we may say that the child has mastered "cookie," but we always mean this in the context of a particular program.
I myself have been in the field for over 15 years and had first-hand experience for 4 years as a full-time therapist "Lovaas model" from an exceptional ABA "consultant" from the Lovaas Institute, so in fact, yes... my discription of the "traditional Lovaas model" is accurate based on my personal experience. I am fully aware that the model, as is our science, continues to evolve.
The information is IN FACT written for the LAYMAN, or what I like to identify as parents and other professionals who are completely lost over terminology such as "i do ABA, not VB" (which yes, is nails on a chalkboard).
I do agree that branding should be avoided. So may I ask why your website has BRANDED "Lovaas Model" and compared it to the "Traditional ABA" Programs. Please define the "Traditional ABA" program so I may respond to this.
...and in response to your erroneous comment about "misinformation," YES, the reader of the website you are referring to is obviously a parent or other professional with little understanding of what ABA is, let alone all the terminology involved in a parent's life... ABA, IEP, IFSP, DTT, NET, XYZ.
Essentially, I am not quite sure there is any argument to be had. I agree with the information you are providing, but please keep in mind that the information is provided in order to open the doors of ABA to parents and let them know that we are not stuck in the same method of programming as we were 20 years ago.
By the way Vince, Mindi Fisher was my first behavior consultant too!
Selma,
Thanks so much for responding! Looks like we have some things in common with the Mindi Fisher and Midwest connections. It’s been a busy week, and I haven’t had time to respond to all of your points, but let me start with a few comments and feel free to keep the conversation going.
1) I’m actually ok with branding. Megan and I started discussing this briefly in the initial blog on “Weakening the Evidence for ABA Therapy.” It is an interesting discussion that I’d be interested in your opinion on. I think general models that are associated with a general curriculum and teaching procedures can be branded, but that we should be careful in branding specific teaching procedures. (see #2 at the beginning of this blog).
2) I would define the Lovaas Model of Applied Behavior Analysis as: A behavioral treatment program
a. that follows the treatment procedures and curriculum initially described by Lovaas (1987) and refined in replication research by Sallows (2005) and Cohen (2006), and
b. includes ongoing training and supervision of staff utilizing performance-based assessments from
c. individuals at the Lovaas Institute or one of the other sites listed on the Contact Us page of the Lovaas Institute (http://www.lovaas.com/contact.php).
3) I don’t try to define “traditional ABA” because I don’t think traditional ABA is really a brand. I’ve seen the term used to describe some historical aspects of treatment (e.g., aversive procedures were first used in traditional ABA http://www.socialthinking.com/what-is-social-thinking/published-articles/106-is-aba-the-only-way-), and I’ve seen the term used in comparison to “better practices” (e.g., the CNN coverage of the “pleasing kind of therapy” of the Early Start Denver Model compared to “traditional ABA which is delivered at a desk” http://www.cnn.com/2009/HEALTH/conditions/11/30/autism.study/). However, I’ve never seen anyone refer to traditional ABA as a model brand with a general curriculum and teaching procedures – at least in part accessible through specific research and books - in the same way the Lovaas Model of Applied Behavior Analysis, Verbal Behavior, Pivotal Response Training, or the Early Start Denver Model serve as brand names.
Any comments?
I’ll try to respond to your point about the use of laymen’s terms and my thoughts on potential misinformation hopefully this evening.
Selma,
OK, here’s my response about “the concept of cookie” misinformation. First, I certainly appreciate the fact that what you are trying to do on your website is make information accessible to parents in part by using laymen’s terminology. However, I still think the comparison is inaccurate. Here’s why:
a) Both the Lovaas Model of ABA and the Verbal Behavior Model of ABA discuss mastery criteria for specific behaviors. In the Lovaas Model of ABA, we may discuss mastery of a specific behavior (e.g., “when a child can point to a cookie…”) using mastery criteria such as “the child responds correctly 80-100% of the time, including other acquired objects, across two sessions.” In the Verbal Behavior Model of ABA, there are synonymous mastery criteria such as, “Typically the target has to be correct 3 sessions in a row on the first response and then on hold for 2 days and tested for correct responding.” (http://blog.navigationbehavioralconsulting.com/2009/11/19/so-what-is-verbal-behavior-anyway-with-videos-2.aspx?ref=rss)
b) Neither model has a narrow understanding of what the concept of cookie entails (i.e., that mastering one or two specific behaviors = mastering a concept). Both have a robust understanding of the wide variety of skills associated with a concept. For example, you mention a wide variety of skills associated with a concept. Every one of the skills you mention is a program I have completed in the Lovaas Model of Applied Behavior Analysis since I began fourteen years ago.
“Ask for the cookie” – there’s a program we have called Requesting
“Find the cookie when asked” – there’s a program we have called Find
“Select the cookie when asked…” – there are programs we have called Function, Reversed Function, Feature, Category, Reversed Category
“Answer questions about the cookie when it is not present” – there are Who, What, and Where programs, just to name a few.
There are some real differences between the Lovaas Model of ABA and the Verbal Behavior Model of ABA, and perhaps you really meant one of them. Here are some differences:
1) The Verbal Behavior Model of ABA uses verbal behavior terminology in its programming curriculum. Words like “tacts, mands, and intraverbals” are used in assessments such as the ABLLS as well as in the grouping of programs utilized in therapy. The Lovaas Model of ABA does not use this terminology in its programming curriculum. Whether or not this is important is an interesting and relevant question. I could see a couple possible answers.
a) Yes. It’s important. By using verbal behavior terminology all the time, we focus on the precise, functional relations of the words we use in language. Teaching parents to use this terminology and continuing to focus on it ourselves will lead to better treatment for children with autism.
b) No. While it’s important that behavior consultants are knowledgeable of and can converse in verbal behavior terminology, it is better in our programming curriculum to use the same basic linguistic terms (e.g., “expressive, receptive”) as other professionals with whom we often collaborate (e.g., SLP’s, special education teachers, etc.).
c) Neither of the above. Our programming curriculum should refrain from using any professional terminology. Programming curriculum should be written in a form that is easily understandable to parents, the primary caregivers and educators of their children (e.g., it’s not Tacting Objects or Expressive Object Labels; it’s just Identifying Objects).
2) The Verbal Behavior Model of ABA and the Lovaas Model of ABA may address/teach skills at different times. In other words, the scope and sequence of teaching language may be different. I say, “may be different,” because I think the starting point for any comparisons between the two models will be to define in objective, measurable terms how the scope and sequence of teaching language occurs based on direct observation of treatment in each model with a particular child with autism (or different children with similar characteristics).
All of the above comments and questions are not asked with the intent of “bragging rights” being given to the Lovaas Model of ABA or the Verbal Behavior Model of ABA as the “better” model. The point of all this is to help clarify where the true distinctions lie so that research can then concentrate on how different procedures result in different outcomes, specifically for a particular child with particular characteristics learning a particular skill. As one mother once put it, “I don’t care what it’s called. I just want to know what will work best for my son…not everyone’s son…my son.”
Thoughts?
Hi,
I guess my comment would be WAY more general in a sense. The aplied behavior analysis I might practice with a child with ASD and say an identified Emotional Disturbance is significantly different from that of a preschooler with PDD. Again this is significantly different than the ABA principles that have been applied to the identification of a Learning Disability through multitiered educational support system in a given school district or the ABA practiced with individuals with brain injury.
As our dear friends Baer Wolf and Risley wrote in their establishment of ABA, ABA is a scientific practice that applies to many different systems and populations (sidenote: if you arent familiar with these dimensions, they can be found online).
All that being said, just calling it ABA is fine with me. However, for the general public, I think it would be appropriate to add on the therapy part so: "ABA Therapy" is my vote. All of those previously discussed items would fall under that umbrella.
I understand that folks have worked hard to create different levels of training for different types of modalities but in my opinion a good behavior analyst would derive those technologies (DTT, PRT, NET, Denver, etc) without any additional training from a commercial agency. Some support from someone who has done it before would be appropriate but no expensive multiday/week trainings would be needed.
Just to add to my previous comment, reading journal articles and attending conferences would also be appropriate for learning a "new" treatment mode.
As "just" a parent I find the topic of branding interesting but not high on my priority list. I have seen the damage improperly trained staff can do especially when it's usually under trained TA's implementing the programs. I watched my child go from a few behavior (minor) issues to major meltdowns on a daily basis sometimes 2-3 times a day. When removed from that environment and placed in another that still uses ABA there was a drastic change. What I would love to see is a discussion on how to properly train the TA's working with the students because many of the TA's at best have a high school education themselves. There should be some kind of criteria on who can actually implement the program and do it properly. I know I got off your subject but this to me is much more important. 
Carol,
Thanks for your insight. I put together a couple posts on training school aides that will appear soon thanks to your input.
I'll be interested in your thoughts.
Carol,
What do you mean "just" a parent? Some of the best behavior analysts I know are parents. Of course, there are just as many "Behavior Analysts" who can't even parent
Melvin,
I'm with you on the "ABA Therapy" terminology. I rarely use the "branding" unless I am attempting to explain some differences between the "modalities" to parents who think ABA=Lovaas from 20 years ago, which is essentially ABA from 20 years ago. It's just simpler to explain that ABA continues to evolve and even "Lovaas" programs are no longer following the same protocols. I firmly believe that all modalities mentioned have contributed and become a part of an effective program. I don't think I have any client whose program doesn't have at least 2 different modalities within his/her treatment protocol.
Selma
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