Now Playing: Engagement with Children is key
Topic: Autism Info
The Article I Wish I Had Written
Prizant, Barry, Ph.D., CCC-SLP. (Spring, 2009). "Straight Talk about Autism: Treatment Options and Parent Choices: Is ABA the Only Way?" Autism Apectrum Quarterly.
After searching the literature for weeks now for articles on effectiveness of interventions for children with autism, reading the ABA intervention literature and the DIR/Floortime literature, I finally found a single article that is clearly written and wonderfully expressed. It is “Straight Talk About Autism: Treatment Options and Parent choice: Is ABA the only way?” by Barry Prizant, Ph.D., CCC-SLP.
In this article, Dr. Prizant clarifies that ABA is not the only specific, definitive treatment or approach for children. He describes the differences between Traditional ABA and Contemporary ABA. Traditional ABA uses primarily adult-child (one to one) teaching situations to the exclusion of social instruction in various social settings, and typically does not focus on the core social-communicative and relationship challenges faced by children with autism. Contemporary ABA is more flexible, includes naturalistic teaching in natural routines and activities that focus on social initiation and spontaneity. Recently, many of the most respected ABA/ASD researchers have been openly critical of traditional ABA and have abandoned such practices in favor of more naturalistic approaches that have a strong developmental and child-centered basis.
The claim that children with ASD must receive 25, 30 or 40 hours of ABA in order to develop is not supported. The National Research Council (a committee appointed by the National Academy of Sciences, NRC, 2001) conducted the most comprehensive review of educational research to date, and concluded that given the current state of research in ASD, there is no evidence that any one approach is better than any other approach for children 0-8 years of age. “Studies have reported substantial changes in large numbers of children receiving a variety of intervention approaches, ranging from behavioral to developmental.” (NRC, 2001). The National Research Council recommended that children with autism receive a minimum of 25 hours/week of active engagement in interventions. The most important areas of focus must be:
a) Functional, spontaneous communication
b) Social Instruction in various settings
c) Teaching of play skills focusing on appropriate use of toys and play with peers
d) Instruction leading to generalization and maintenance of cognitive goals in natural contexts
e) Positive approaches to address problem behaviors
f) Functional academic skills where appropriate.
Another myth Dr. Prizant counters is that there are hundreds of studies that demonstrate that ABA works, and few or no studies that demonstrate that other approaches work. He states that this is not supported by the literature. The ABA studies demonstrate the effectiveness of specific elements of practice and these studies are cited by proponents of ABA. There are very few studies that have looked comprehensively at intervention programs, that is, those that simultaneously address a variety of domains of learning and skill development for a child and family over time. In an open-access article published in November, 2008, researchers from Canada completed a clinical systematic review (Ospina, M.B., Seida, J.K., Clark, B., Karkhaneh, M., Hartling, L., Tjosvold, L., Vandermeer, B. & Smith, V., 2008) of behavioral and developmental interventions for children with autism. Their findings support the statement that there is no one single method for improving skills of children with autism. There is evidence that the Lovaas method (Traditional ABA) improves some core symptoms of ASD compared to special education, but these findings are based on methodologically weak studies with few participants and relatively short-term follow-up. Since no definitive behavioral or developmental intervention improves all symptoms of children with autism, these authors recommend that clinical management be guided by individual needs and availability of resources.
It has come to me in my work that the core issue is engagement; children with autism need to be thoroughly engaged in activities that nurture their social, emotional, language, cognitive and relationship skills. These interventions need to be systematic, data-based to ensure progress, and fun. Children learn by having fun; we do not have any data that indicates that children with ASD are any different. In fact, the developmental intervention literature is full of citations that support the notion that children with autism are relational, in their own unique ways.
Too much of the application of ABA is just mechanistic; it’s a procedure, not a teaching technique. I’ve seen too many teachers/aides simply “Run the programs”, not investing in any relationship or engagement with the children. “Running the programs” is not teaching; it’s a substitute for teaching, which involves engaging with children.
I believe that ABA is a terrific tool and the basis for a lot of high-quality instruction of children on the spectrum, but that by itself, it is insufficient. Relationships matter. Engaging with children with ASD, using whatever interventions work, is what makes the difference.
