AutismInfo.com

This article By Stacy Hultgren appeared in a recent edition of the PDD Network. It is a summary of the presentation by Dr. John McEachin at the Spring 1998 conference of the Autism Society of Connecticut in Hartford. John McEachin, Ph.D., is a clinical psychologist with 20 years of experience servicing families with autism. He worked under Dr. Ivar Lovaas (the "father" of ABA) during his graduate training and now has a private practice devoted to children with autism. He lectures extensively, develops treatment programs, and trains parents and professionals.

If you see a video on Applied Behavior Analysis (ABA) principles, you may feel that it’s not a new concept, and in a way, you’d be right. What Dr. Ivar Lovaas did in establishing the ABA program, was to take basic principals in behavior science, and emphasize the intensity that is needed for our particular kids. Dr. McEachin says that if 30 minutes two times a week of speech therapy is a good thing, imagine how much more can be done in 30 hours.

There are many "challenges to learning" encountered by children with autism. Below are some of the individual challenges and how ABA specifically addresses those issues. Again, remember that this is an extremely basic description, and if you would like further information about ABA there is a list of sources at the end of this article.

Low motivation – Reinforcers for our children tend to be on the idiosyncratic side, so the types of things used for other children in various behavior modification interventions probably will not work with these kids, at least at the beginning. You need to find what will work for this particular child to motivate his interest in completing a task. Every effort should be made to maximize the contrast between positive and negative consequences so that the concept of cause-and-effect can be learned.

Limited reinforcement repertoire – ABA principles recognize that social reinforcers (approval or disapproval) are usually not effective. Praise, in and of itself, is not enough at first, but can be paired with a more tangible reinforcer (such as grapes, a favorite toy, etc.). Eventually the tangible reward can be taken away and the continuing smiles and words of praise "come to be effective in their own right."

Short attention span – ABA breaks each task into very small, measurable steps.

Easily distracted – Teaching in a quiet environment by reducing auditory and visual distractions is important. Noise level, movement of others, windows, even air conditioners can be excessively distracting to autistic children. The goal is to begin in a very structured environment, but to move the child into more and more ordinary environments as they become more successful "so that the child becomes able to work in the presence of distracters."

Learn more slowly – Repetition is an important method for autistic children, but it should not be boring or tedious. "In fact," Dr. McEachin says, "that’s our responsibility - to make sure it’s NOT tedious". Some kids require literally hundreds of trials on order to learn a specific concept, but they also will learn it more effectively if it is practiced within a short time span. In other words, a skill that is practiced once a day is not as effective, and could take months longer to master, than one practiced twenty times a day. In order to know when a child has really mastered a skill, it is rehearsed, and then the child is distracted with other tasks. Then, they go back to the first task and see "can they still do it?" It is not repetition for the sake of repetition; it is done in a manner to maximize learning.

Difficulty understanding abstract concepts – ABA therapists use concrete examples of concepts and begin with the simplest language that the child is able to understand. Then more complex language is added as the skills and concepts are learned. "We definitely want to get the children to the point where they can understand everyday language – natural language".

Poor learning by observation – These children have difficulty picking things up incidentally, so the need is to explicitly and systematically teach each skill or behavior. ABA stresses the skill of imitating people "because if they can imitate, they are able to learn a lot of skills that they would otherwise not," says Dr. McEachin.

Poor differentiation between relevant and irrelevant stimuli - These children often do not know the difference between the essential aspect of a situation and those aspects that are trivial. Focusing attention and presenting only stimulus that is considered essential is a way of circumventing this problem. It is important to watch out for erroneous associations. They may learn to tell boy dolls from girl dolls based on the shoes that they wear rather than the more obvious differences. These associations may not be reliable and "we have to teach them to zero in on the relevant aspects of the situation". Be careful with tools like flash cards, he says, because you could find out that the child is discriminating one from another based on a bent corner or smudge on the cards. He stressed the need for using different materials and in different ways to avoid
their "making responses based on things that really are not an essential part of the concept."

Behaviors such as self-stimulation interfere with learning – "When they are stimming," Dr. McEachin tells us, "that’s often where their attention is." If 90% of their attention is invested in their self-stim activity, there’s only 10% left to focus on the task at hand, "so we have to work on suppressing those behaviors that interfere with learning."

Difficulty learning in large groups – Once the child is learning well in a one-to-one setting, they can begin moving to a 1:2 setting; 1:4; 1:8; etc. by gradually increasing the size of the environment as they are able to maintain attention and remain on task.

Does not occupy self appropriately during free time – ABA provides structure and teaches leisure skills. Dr. McEachin says to "build in play skills and other types of activities that they can do independently so that they’re not going off into their autistic world."

Sensory/motor impairments – Sometimes their reactions can be over-responsive or under-responsive. Often the visual channel works better than the auditory for obtaining information. Dr. McEachin stresses that the children who are the most successful in ABA are children who are able to use the auditory channel successfully. Therapists attempt to balance playing to their strength by using the visual channel in teaching, with pushing the child to develop better use of their auditory system. For children who don’t like touch, Dr. McEachin says, "we touch them." He believes they end up not only becoming able to tolerate it, but actually enjoying it.

Components of a Discrete Trial

Each skill is taught in very small and very brief units called "trials". Each trial consists of an instruction, a prompt, an opportunity/response, and feedback. The instruction is given in very clear language that the child can understand, and, as the child becomes able to handle more complex language, it moves toward a more natural language base. They may begin with a direct stimulus "look at me" then move to a more natural stimulus such as just saying the child’s name to get his attention.

Prompts are not always needed, but they will use "anything that will facilitate the desired response". These can be visual prompts such as a gesture or taking the child’s hand and moving it through the desired motions (a physical prompt), but the aim is to reach a point where the child can do the desired task with no prompt at all. The response should be evident within about 5 seconds. If there is no response, or an incorrect response, the trial is considered to be over and a new one begins (although it may be the same task – in fact, many people would not be able to tell where one "trial" ends and the next begins. It is broken up this way so that data can be obtained on the progress of the child).

Feedback on each trial is given immediately. The more information that is provided to a child here, the faster the learning can take place. It is important, he says, not to praise every response; some will be terrific, some barely adequate, some not quite accurate and some simply unacceptable (such as throwing things). Use the feedback, Dr. McEachin says, to indicate where the response falls. ABA has a reputation for using strong aversives because that was the way the program was originally designed years ago, however, that has changed and they no longer use very strong negative feedback. He points out though, that "some people think that merely saying ‘no’ to a child constitutes an aversive. What I would say about that is, hearing the word ‘no’ is a very common, everyday event. It is part of the world, part of life, and if you’re a person who cannot handle simply hearing the word ‘no’, you’re going to have a really, really rough go of it. I think it’s important for us to teach children to be able to handle the word ‘no’ simply at an informational level." That doesn’t, he stresses, imply that screaming at children is OK, but firmness can be conveyed without disrupting the situation. There are times, he says, to be very supportive even though they have given the wrong answer. They worked hard, they are sitting appropriately, they are careful about their response, but it is incorrect. Clear information is conveyed in the words and the vocal inflection "Oh, no. Good try." If they are not attending, it’s OK to say "No. You need to look."