Sunday, January 20, 2008

Thoughts on ABA

I've been wanting for a while to offer some thoughts about Applied Behavioral Analysis. Before I do, a few disclaimers:

I am not an expert, I do not profess to be one. This is true from both a functional and academic standpoint. This is, I would remind any reader, One Dad's Opinion.
There is a lot to write about as concerns ABA, and I will definitely not be hitting all issues in one blog post.
Comments, as always, are welcome and invited. If you disagree with any of my premises or opinions, or if you think I am marvellously well-grounded in my ruminations :), let me know.

Okay, ABA. I'm torn on this topic. I think that, first of all, the methodology and probably the very concept is highly misunderstood by parents of young autistic children. I think my first concept of ABA was something like, "They observe and record current behaviors on an ongoing basis, in an established format of record-keeping, and they use progress or lack thereof in specifically defined areas of performance to determine how best to continue to modify the behaviors." My definition has changed a bit over time, but not by much. When we first settled on this as a good idea for our son, it sounded like a marvelous approach. Not only that, but it apparently was the only treatment for autism that was backed by some science.
I have learned much over the last couple of years. Many things I've learned have caused me to not only doubt ABA's efficacy, but also to question its approaches from an ethical/humanistic standpoint. Other things that I have observed and studied have led me to believe that my son has benefited tremendously from our choice to provide him with this 'treatment'.

First of all, let me make it clear that our ABA program, administered by a really nice group of professionals, is not traditional ABA. There was record keeping, but not during interaction between Jason and the therapist (only after). We reached around 20-something hours per week and sustained that for maybe 18-20 months, but never even came close to the recommended 40-hour regimen. By virtue of these differences, it would be impossible to say that Jason received ABA in the true clinical sense.

Some people I know are critical of the process of this type of B-mod approach. These concerns are valid, but never seemed to be relevant to the situation our son was in. There was tons of positive reinforcement, there was a lot of "parent-training", and there were lots of breaks, play, and sensory-diet-type interval-based body regulation. Jason developed real relationships with his therapists, relationships that have lasted to this day. A great example: last week was our son Colin's 1st birthday. 2 of Jason's former therapists attended, and neither one of them has 'worked with' Jason for quite a long time. Jason was very happy to see both of them. One of them had Jason in her wedding - he walked down the aisle! (with my help)

So I suppose the question, at least in our son's case, becomes: Did the ABA part benefit him, or was it the relationship-based learning? I don't know the answer to that question - no one does. But I have done a lot of thinking about it, and have arrived at this thought:
Kids learn from their community, the people who surround them. Many autistic kids, regardless of their specific experience with autism, do not have the community around them that most typical kids have. This is true for numerous reasons, but I do think that in many cases it is true. Well, in Jason's case, I think these wonderful, caring people that Jason saw several times per week, people who laughed with him and did his sensory stuff and shared chocolate chip cookies with him (not as part of therapy- just because my wife makes really good cookies), people who were so excited when he passed milestones or said simple words, people who were firm but gentle when they saw a teachable moment and capitalized on it, these people became Jason's community. And he learned from them - not just skills, but how to be a friend and a kid and a student. Things all kids should learn. Maybe, because he is autistic and they were here doing the 'therapy' thing, Jason's community looks a little different than it would for typical kids. This doesn't invalidate any benefits Jason received, by my estimation, though it also doesn't lend itself to supporting ABA as an approach to improving the lives of autistic people in general.

Okay, I now realize that I have settled on a direction for the first post I am doing on ABA. I'm going to have to get into some of the other things - the things I originally sat down to discuss - at a later time. This is one thing I like about blogging: instead of going back and re-writing this post to smoothly incorporate my topical change of direction, I can simply state my human-ness and move on. How nice.

So, to summarize briefly and create a break off point for this portion of the ABA discussion: My son has, like many kids, undergone many positive changes during the time he has been exposed to behavioral therapy. There is no way to know exactly why this change has occurred, but I think it is likely that the people (not the methodology) have been the primary source of benefit to him.


VAB said...

That seems like an exceptionally valid observation. I've had similar thoughts myself, but I've never put them together in such a coherent way. Thanks you.

Ms. Clark said...

One Dad,

You switched horses in mid-stream. This is bad blogging. I personally would never do such a thing (I'd do worse). No cookie for you. No cookies again until you blog correctly 8 times out of 10. :-)

One of my big problems with ABA is that the teacher/trainer/supervisor decides based on his or her own mentalism what it is that the kid should learn next, but they deny that they use mentalism, because they are behaviorists and the brain is a "black box" and mentalism is bad, just ask any behaviorist. :-/

Then they impose that task/goal whatever on the kid and if it's done "right" they deprive the child of access to materials to explore, they confine the child to learning THIS thing, this thing now, like: you must try it until you fail so badly that we try another simpler task, but what you want to do is immaterial, we decided (through mentalism or through someone's pre-planned schedule) what it is that is best for you to learn next.

Then there's the bizarre zero-failure thing.

I have no idea why anyone needs to use the ABA framework and call a bunch of stuff (that is not ABA) ABA. I really wonder if there was any real ABA in what your son got, and if so why call it ABA?

ABA is not about recording developmental progress, it's about trying to influence what the kid is doing (his behaviors, not his thoughts) via rewards and punishments. It's the same way you train a dog. You might decide not to use the punishments or modify them so they are mild or mild compared to hitting (shaking a can full of pennies to irritate a dog), you might emphasize rewards instead (GOOD GIRL, MUFFY!!!!) but it's all about modifying behavior with rewards and punishments. Without that focus on rewards and punishments and modifying behavior, it's just not behaviorism.

It's probably teaching.

I say dump the whole behaviorist framework and go with Lev Vygotsky. You touched on Vygotsky when you said children learn from their community. That IS Vygotsky... that and "scaffolding" and a term I dislike "zone of proximal development".... which should be "proximal zone of development" in my opinion. We don't need no stinking behaviorism except for teaching pigeons to play a toy piano or teaching dolphin to get the ball and bring it to the trainer. We need more Vygotsky and more teaching.

I think the reason that behaviorism took off in autism (when it was dying well-deserved death in most of psychology) is that people thought that autistics weren't very sentient anyway, so there's no point in trying to reach their minds, just shape their behaviors like Skinner would have shaped the behavior of a pigeon or rat in a Skinner box without considering the feelings of either the pigeon or the rat.

Alyric said...

Ms Clark has said much of my comment for me:) And dang Steve - I have this post roughly blocked out in my mind, more of a ramble really on "The Perfect Intervention" and you got there ahead of me.

Since they call practically everything ABA these days, it's a bit difficult to pin down in a theoretical sense what people are doing and does it matter? Maybe, dunno. I do know that most parents should be really glad that the ABA they're getting really isn't and the more it really isn't the better. The 'real' stuff is pretty ugly in its assumptions about people and pretty stupid, not to mention vacuous in its assumptions about learning, which apropos of nothing in particular is based on nothing at all in the way of empirical evidence (for people at any rate) and certainly not on anything we know of the ways autistic children might learn. You sort of mentioned that there's some attention paid to sensory stuff - well that's got to be a recent addition to ABA land.

I'm most of the way through JA Mills " Control - The History of Behavioral Psychology" and the fascinating thing about it is how what is done to autistic children in the name of behaviour modification came about. It's not, shall we say, edifying.

Club 166 said...

I think the reason that there is so much that is called ABA is that it is the only therapy that has any "science" behind it.

Therefore if:
1) You want people to think that your therapy is science based,

2) You want to make your therapy look better than other "unproven" therapies,

3) You want a better chance of getting the therapy funded, or

4) You just want a chance of your therapy being included in the school curriculum

you call it ABA. Follow the money.


Steve D said...

Thank you all for your comments.

VAB: This one has been rattling around in my head for a while, and even still I didn't plan the post the way it came out.

Ms. Clark, I am allowed to switch horses! :)
Seriously, I really value your perspective on ABA and behaviorism. My comfort zone with the process extends a little further than yours, probably because your view is more academic and mine is more experiential. As I said, the people who "worked with" my son have become some of the most special people in our lives - this is a natural, not a contrived circumstance.
Alyric: That I beat you to the punch on anything shows I have some a long way in my understanding of autism. Thanks for the compliment :)

Joe: Excellent point. I look forward to the day we can parse the term into its component characterisitcs, thereby clarifying the issue to some extent.

mumkeepingsane said...

Yes, a very coherant observation indeed. I know Patrick has grown through his friendships with speech therapists, etc. We didn't do any form of ABA, we simply threw him (and us) into the community and it has been wonderful.