Notes from a Skeptical Radical Behaviorist w/ Replies
Wednesday, July 7, 2010 at 2:23PM 
I've started this with my original rant which you can read or reread or skip to get to the important point, the many thoughtful replies to this rant, posted below, in the order received.
Notes from a Skeptical Radical Behaviorist: Autism Curricula
Dick Malott
Western Michigan University
I'm beginning to think we can go along way toward improving the progress a preschool autistic child makes by eliminating much of the traditional pre-school curricula we now spend hours, and days, and weeks, and months of his and our precious time teaching. For example the omnipresent trace-line procedure; and this is just one of many examples. That procedure/skill/goal always made perfect sense to me, until I stopped to think a bit. The reason we call the kid “autistic” isn’t because he does a poor job tracing lines; it’s because he can’t talk or follow instructions, he stims, and he tantrums. So that’s what we should be busting our collective butts on, not tracing lines, etc.
And now, this really hurts, ‘cause it’s what I love the most—matching to sample and concept formation. I love those procedures; they’re my favorites. But they ain’t why the kid’s with us. “Dr., will you look at my two-year-old Suzie; she can’t match same with same.” No. “Suzie can’t talk; she could care less about anything except flapping her hands; and when I try to get her to stop, she throws a tantrum.” Maybe that’s infinitely more important than my beloved imitation and generalized imitation, unless we really know that manipulative and physical imitation facilitate vocal imitation. Oh, yes, we do want to work on activities of daily living (e.g., toilet training) and social interactions, perhaps the most important component of which is establishing clear and strong social reinforcers and effective disapprovals (e.g., frowns and head nods). Help, I'm drowning in a sea of skepticism; please help me escape by convincing me that we really should be teach all those traditional things, like bead stringing, and saying the alphabet, and counting to 10. Or join me in cutting to the chase, mainly the chase of language training (pedantically called verbal behavior); and I mean more than just labeling and requesting (pedantically called tacting and manding).
Not saying the behavior-analytic king has no clothes, just that his fly may be unzipped.
Responses:
Dale Brethower: Bravo!
Andy Bondy:Man, am I happy to see you coming around to the way! I watched in a program near Boston a teacher (in a program getting 90K per kid per year…) working with a 10 year old who has about 30-40 pictures in PECS, no speech and they’re trying to teach him to point to letters within his first name. I looked at the teacher and asked what age she thought typical kids are taught the alphabet- someone say ‘kindergarten’- I then asked, ok- how many words does a kid have at that age? Right- several thousand. So are you telling me that this kid needs to learn letters over words (pictures)? She then said- well why can’t I teach both? I had to point out that every moment spent teaching letters was time away from teacher vocabulary- and hopefully functional vocabulary- though I doubt in that setting they’d do that.Anyway, my thought of the day is- As kids, we are all on the vocational tract- only some of us take a circuitous academic route to get there…I hope you keep challenging. Wait to you hear what I tell ABAI next year…Delighted,Andy
Koji Takeshma: Funny, Dr. Malott.I love you for your pain.
Fine and gross motor skills lessons are the bottom of my priority for my programming. I do teach fine and gross motor skills, not because children are so bad at it (besides few exceptions), nor because they are so important, but because I would like to make sure that they are making progress in all major developmental areas, and because some children do so well that the lesson becomes a good tool to establish nice SD --> Behavior --> Reinforcer sequence. I won't even put so much efforts to troubleshoot (just put on hold) if the child does not do well. Too many times of "corrections" will mkae the lessons and tutors aversive and it is MO to escape from the lessons. Besides, who cares if the child can't put string through beads. I agree that establishment of social reinforcers (adults and peers) as conditioned reinforcers is the most important. I do many lessons in order to establish adults interaction as reinforcers (and correction as aversive condition), not because they are so important to teach. That is also why Mand training (Verbal Behavior program) is so important. Mand is such a strong component to establish social reinforcers (adults become SD to signale the availability of reinforcers). In my program, I do keep track of how many spontaneous mand each child has a day. It is also important to make sure the generalization of the skills. Pam taught me tons of that, too. I also start exposing children in social interactions as soon as they come to the center. Play time is a huge opportunity for pairing peers with reinforcers. Circle time is also a pairing opportunity if the child likes music. By the way, since I came to the school district program in Fremont (2 years), I realized that good portion of the children who graduated from my early intervention program went to (or going to) the integration program (where the half kids typical and half kids special ed.). Let's see how many go to regular education by kindergarten. Positive Response Training people (PRT) has also good points. I met one family who received services by Keogle's program (PRT) recently. It is interesting that they recommended only 10 hours per week and expanded to 15 hours per week recently (I think that they do only parent training, not tutoring). They try to do 2 hours a day including weekends. I provide 25 hours per week typically, mostly 1:1 tutor time with some parent training. Interesting, isn't it? The child received 6 months of services so far, and he had great eye contact, but did not have much compliance at all and did not have much expressive language at all. But the child looked more like "language delay" than Autism because of the eye contact and no stimming behaviors. They don't do fine motor and they don't teach matching. You can look into PRT book if you wish. We will keep talking, Dr. Malott.Thanks.Koji
Matt Israel:
I agree and have entered a few comments on the attached document.
So that’s what we should be busting our collective butts on, not tracing lines, etc. Agreed.
And now, this really hurts, ‘cause it’s what I love the most—matching to sample and concept formation. I think teaching a child to look at and/or listen to a sample and then make a choice from several choices is a useful skill because with it one can teach a number of skills using computerized self-instructional software.
Toilet training is a skill that most parents would want taught in preference to almost anything else.
David Eisenhart:
Hey Dr. Malott,
I have been in the same boat over here in the Philippines with setting up the practicum. I only get an hour and 1/2 with each child throughout the week so I must pick the lessons I think will have the biggest impact in the shortest time. In the end all I have is my personally feelings about what is important but these are my thoughts and opinions. If the child does not have eye contact, wont sit in a chair, or maintain quite hands long enough for me to give an SD I usually work on that. Also it's always nice to achieve quite hands maintenance outside the booth so if the child is self stimulating or touching something that is potentially harmful the parents can use it to temporary stop the behavior. I also lean towards imitation as it makes almost any lesson easier if we can get imitation of response, both verbal and physical. Anything from ADLs speaking.
Most children I do everything I can to first establish myself is the biggest reinforcer. The only way the children can have access to toys/food is through either contact with me or social interactions with me. The reason I do these first is if I'm a reinforcer, eye contact is easy, and usually the kids will attempt to run to my class instead of scream when they come in (always a plus in the parents eyes) all the staff at my site here can't figure out why all my children love me and make great eye contact when with everyone else they look everywhere but the eye's (no solid data on this one, but observation) I know coryden attempts to do this, but honestly they just set a time length of playroom time, when they really should have a set criteria and measure behavior before the child moves onto booth work. For example percentage of time spent interacting with the tutor over say self stimulation and alone play. Granted this means most tutors have to find a way to make themselves more reinforcing than say hand flapping (might be hard without food) but it's possible if they have the right skill set. If you ever write out a formal definition of this skill set I would love to see it.
As for your thoughts on fine motor skills activities like tracing line. I lean the same way with most autistic children. I have such a short time and most parents could give two S#!ts if johnny can trace a line if he is biting and screaming when they ask him to go to bed. I always ask myself with every child that comes through where can I have the biggest impact in the shortest amount of time, or do a ROI (return on investment) Most parents and co-workers are skeptics from the get go, and I have very little time with johnny so if I can get johnny to sit in a chair and work for the 45min that week without a tantrum/self-stimulation/.... most parents and staff alike are quite happy with that.
I do think that matching to sample is important if the child is on PECS, but one the skill is mastered, it shouldn't be continued. I do a lot of matching 2D to 3D matching and Matching symbolic pictures to sample. For example matching a picture of a shoe that is a different color, size appearance... all based on relational frame theory, but for non-verbal. RFT was discussing how we learn the words for shoe, the class stimulus class training, and if I'm not mistaken PECS is verbal behavior by definition so why don't we teach that verbal behavior the same way we would for speaking. Meaning teaching that the picture of a car applies to the stimulus class of car. It's not as easy as it sounds, but it works. You may want to have a graduate student do some literature reviews on this one, because I'm certain I'm not the first one who thought about this, but I have limited access to articles over here so...
Love to hear your thoughts on my comments,
David Eisenhart
---------------------------------------------------------------------David Lyon:
Dick,
I am on the outside of all of this, but what you say seems to have substantial depth. Frankly, I often worried that we talked like its was just so simple, this reinforcing the obvious behaviors.
David - one of the undisclosed ones
---------------------------------------------------------------------Sebastien Bosch:
Yes, it’s not clear in which environment(s) (outside of school classrooms and academic careers) and toward which important change(s) these curricular items should be trained.
We like to use technical terms because when training-the-trainers it is a first indication of buy-in, especially with those speech-path with a strong history at doing and saying “something else.” I love it when a speech path that has been in contact with one of our staff says “anti-learning behavior” (the Pedantic form of “inappropriate behaviors from Phil Drash). Then, they may be more likely to learn the definitions and methods to address these tacts, mand, and ALR -- these terms are our world.
Cheers
---------------------------------------------------------------------Ron Van Houten:You know I am in agreement but motor imitation is great for teaching self care and play skills once it is refined. Ron
---------------------------------------------------------------------Amy Macfarlane:
Hi, Dr. Malott!
I couldn't resist replying to this email. I am familiar with "traditional" ABA (we ran a 2-year Lovaas-style program for my son from 2000-2002.) Therefore, I know and have implemented "stringing beads" programs and the others you mentioned. (And, note, my son, at 13, still can't tie his shoes after all those years of fine motor programs.) I am also a practicing ABA consultant using VB methods. I rarely implement the types of programs you mentioned below (unless they help improve the life of the client.)
Instead, I emphasize language instruction AND addressing the behavioral issues that hamper the child's learning. I seem to get lots of clients who have had consultants who focused on implementing cookie-cutter, traditional autism curricula and failed to address the child's abberant or negative behaviors. Let's face it; the behaviors are tough. (Though I LOVE the challenge!) It's much easier to block a child into the corner and present 10 discrete trials than to come up with unique programming that reduce negative behaviors. I have attached a few reports I've written for clients (with names changed, of course.) I hope you find them interesting. My approach to behavioral programming for kids with autism is definitely not cookie-cutter!
If you get a chance, let me know what you think!
Amy
PS: I still use M-T-S programs. I find that most of my clients do very well with the matching tasks. And, if they do nothing else, they provide the "easy" programming that needs to occur to help gain and keep instructional control. (The 80% easy, 20% hard task rule specific to VB) These tasks are also good for building better attending skills (ie: use fields of 8-10 to strengthen scanning!)
---------------------------------------------------------------------Keith Miller:Hi Dick,
I basically agree with you. But the people I work with --- mostly Lovaas based --- seem to be working on language training.
Have you seen the 1995(?) NBC video called "Elizabeth's Story?" It's a 20 minute video tracing the story of developing autism and then intervention by Jim Partington with Elizabeth and then her mom. What makes this a remarkable video is that it starts with videos of the six month infant looking more or less normal, documents her developing autism, and then the intervention in which Jim teaches the mom how to systematically train her. This involves the mom in 12 hour days for every day for years! The video moves from compliance training, to shaping words and then short sentences, to broader language training. Elizabeth goes to normal Kindergarten and the video ends by a sweet interaction at about the time of second grade between Elizabeth and the narrator whose name I forget. Elizabeth looks to me completely normal and is doing well in school with no extra help. She is a skilled user of spoken and written language. She is under the social control of those around her. She would seem to meet your criteria.
I use the film in my intro class to show students how powerful our science is. If you have not seen it and can't find it I can send you a copy.
Some comments.
The training is based on what was current 20 years ago. People I work with have systematized it, learned how to teach therapists and parents, learned how to manage their behavior, systematized the curriculum, learned how to adapt it to the different strengths of each kid etc. I might add that we are working on developing procedures that will make the implementation of the intervention sustainable by therapists and parents --- but I'm sure you would guess that Krazey Keith would perseverate with that goal.
They do use MTS at times and a variety of other protocols that you question. But they seem to get the results you recommend.
It might be fun for you to view the video and then talk concretely about your general ideas in your Skeptical Radical Behaviorist rant as applied to the curricula implicit in the video.
PS: I'm amazed that you still have time to put out your Notes when you just inherited responsibility for guiding OUR WORLD (ABAI) into the 21st Century. Or are you feeling out a Presidential Address? By the way, again I congratulate you on your strong victory. I'm looking forward to what you will do with it. Your hardest hurdle may be having to follow Pat's rip roaring, evangelical, hysterically funny address. I'm confident that you will find a way...
Best wishes,
Keith
L. Keith Miller, Professor
Applied Behavioral Science Department
University of Kansas
Lawrence KS 66045
---------------------------------------------------------------------Doug Greer:
Hi DickI will get back to you on this when I have time to explain what I think is necessary and unnecessary. When some of these are necessary for subsequent learning and YES verbal development they are critical and many are not it depends on several factors. The big ones are conditioned reinforcement for observing visual stimuli, voices, faces and these determine important match to sample outcomes. Tracing lines are not smart but transcription will be important when the learner is ready to join writing to speaker extensions, etc. More later. Doug
(Please see Doug's attached file--a lot of cool info and refs.)
Reader Comments (1)
Dale Brethower: Bravo!
Andy Bondy:Man, am I happy to see you coming around to the way! I watched in a program near Boston a teacher (in a program getting 90K per kid per year…) working with a 10 year old who has about 30-40 pictures in PECS, no speech and they’re trying to teach him to point to letters within his first name. I looked at the teacher and asked what age she thought typical kids are taught the alphabet- someone say ‘kindergarten’- I then asked, ok- how many words does a kid have at that age? Right- several thousand. So are you telling me that this kid needs to learn letters over words (pictures)? She then said- well why can’t I teach both? I had to point out that every moment spent teaching letters was time away from teacher vocabulary- and hopefully functional vocabulary- though I doubt in that setting they’d do that.Anyway, my thought of the day is- As kids, we are all on the vocational tract- only some of us take a circuitous academic route to get there…I hope you keep challenging. Wait to you hear what I tell ABAI next year…Delighted,Andy
Koji Takeshma: Funny, Dr. Malott.I love you for your pain.
Fine and gross motor skills lessons are the bottom of my priority for my programming. I do teach fine and gross motor skills, not because children are so bad at it (besides few exceptions), nor because they are so important, but because I would like to make sure that they are making progress in all major developmental areas, and because some children do so well that the lesson becomes a good tool to establish nice SD --> Behavior --> Reinforcer sequence. I won't even put so much efforts to troubleshoot (just put on hold) if the child does not do well. Too many times of "corrections" will mkae the lessons and tutors aversive and it is MO to escape from the lessons. Besides, who cares if the child can't put string through beads. I agree that establishment of social reinforcers (adults and peers) as conditioned reinforcers is the most important. I do many lessons in order to establish adults interaction as reinforcers (and correction as aversive condition), not because they are so important to teach. That is also why Mand training (Verbal Behavior program) is so important. Mand is such a strong component to establish social reinforcers (adults become SD to signale the availability of reinforcers). In my program, I do keep track of how many spontaneous mand each child has a day. It is also important to make sure the generalization of the skills. Pam taught me tons of that, too. I also start exposing children in social interactions as soon as they come to the center. Play time is a huge opportunity for pairing peers with reinforcers. Circle time is also a pairing opportunity if the child likes music. By the way, since I came to the school district program in Fremont (2 years), I realized that good portion of the children who graduated from my early intervention program went to (or going to) the integration program (where the half kids typical and half kids special ed.). Let's see how many go to regular education by kindergarten. Positive Response Training people (PRT) has also good points. I met one family who received services by Keogle's program (PRT) recently. It is interesting that they recommended only 10 hours per week and expanded to 15 hours per week recently (I think that they do only parent training, not tutoring). They try to do 2 hours a day including weekends. I provide 25 hours per week typically, mostly 1:1 tutor time with some parent training. Interesting, isn't it? The child received 6 months of services so far, and he had great eye contact, but did not have much compliance at all and did not have much expressive language at all. But the child looked more like "language delay" than Autism because of the eye contact and no stimming behaviors. They don't do fine motor and they don't teach matching. You can look into PRT book if you wish. We will keep talking, Dr. Malott.Thanks.Koji