SOME LESSONS FROM GRANADA
On the way back from seeing out Lithuanian clients, we managed to divert to Granada, Spain, to the ABAI international conference which is held every 2 years outside the USA. This was the 6th, and indicates the spread and growing acceptance of ABA, with attendees from 40 plus countries.
Again Autism was the main focus, though invited presentations tended to be more of a general nature, looking at the overall development of ABA. Quite a number brought up the need for more basic research into the nature of learning and to look at consequences other than simple reinforcement, as human behaviour is complex.
There was also a general complaint about the difficulty ABA has in making itself popular, despite the strong data. Particularly in the area of education and Autism, people still are happy to do something – anything and keep themselves busy without any evidence to support the outcome. We only need to look at the proliferation of strategies to teach children to read, with a new idea every few years – often one that has already been tried a decade or two ago, while primary schools continue to send students out with 25% not reaching fluency reading levels. Yet the evidence for a phonic approach is well established. What then can we then expect for Autism where the stress levels are high and the need for improvement so pressing. This is obviously yet another aspect of human nature which needs to be studied.
Speakers from Greece, from France, from India all commented on the struggle for acceptance. In the USA acceptance is much stronger, and funding bodies are wanting to see their money not wasted. However even there the alternative so called ‘therapies’ are not only common but accepted, and an article looking into the reasons for this by a leading professor in ABA was rejected by the major Journal in Autism. It will be published elsewhere, as was Lovaas’ original, ground breaking paper also rejected by that journal in 1987.
One study pointed out that when parents could only see the therapist working, they felt that social stories were a more acceptable way of teaching when compared to prompting. However when only the child was on the screen and the teacher not visible or audible, they chose the prompting strategy as it brought visible results. Psychology students however saw it differently and did not expect the social stories to work as effectively as prompts.
One of the strongest lessons to be taken away from the conference and applied to our work, is the undeniable evidence that social Stories as defined by Mrs Grey, do not work in changing behaviours. They need to be accompanied by prompting, by visual supports, by modelling, by inclusion of activity scheduling, rule setting etc to have any effect. When isolated they do not work at all. What data there was, has always been dubious with variables poorly defined and not isolated. This does support my growing suspicion of the strategy, given the verbal nature 3 of the stories and the inclusion of emotional elements, both aspects our children have
difficulties with. It also shows us the importance of using strong evidence. How much effort has been wasted in writing these long winded statements, how much therapy time wasted in reading them over and over? So I hope to see the end of Social Story Books. This is not to say that Cool Books do not work. Cool Books aim at raising the child’s self esteem, focussing on gains and thus avoiding the depression that can come with the realisation that you are different and have both learning and social issues. They are a visual alternative to positive self statements. Rule books also have their place, reminding the child visually and succinctly what behaviour is expected or needs to be checked. We all know that the “Quiet” compic has its place as our children do respect rules. I was impressed by Isabella’s idea of having a little ceremony of moving a behaviour from the Rule Book to the Cool Book, celebrating the child’s achievement in self management.
Getting back to the conference, there were two full sessions on the Pyramid education system which gave us PECS. Pyramid has set up schools in many different countries and their approach to teaching is based on ABA principles. Staff are trained, teaching is one-to-one except where group learning is targeted. It seems to be a good alternative in countries where special schools are just not attempting behaviour change.
The Pyramid group reminded of the importance of actually teaching communication, not just language. This is done with the initial exchange of Compics, but is often not trusted by parents who are well aware of what the child wants and possibly fear that reliance on Compics will reduce the child’s potential for speech. What the exchange does is emphasis the value of communication to the child, empowers the child to ask and get, not just wait to be given. Autism does not bring any motivation to communicate or attend to language. The process of exchange develops that motivation and speech then follows if the child is physically capable of it.
They obviously have the same problems we have persuading some parents to trust a picturegraph
communication system. Evidence was sited, and there was even a paper from Monash University (Melbourne) showing that vocalizations increased considerably with PECS. Again we are reminded to trust data and not our intuitive solutions.
Bondy, the founder of Pyramid education, also had several warnings. He made the point that parents often overestimate what their children can understand. Often children cannot answer questions when these are put in a different way, or may not be able to label things they cannot see. Teaching language is not simple. He also pointed out what we all see so often that once the child goes to school skill acquisition drops, and skills can deteriorate, but the teacher may not be ware of a problem if the child behaves well. He also pointed out the danger of placing too much emphasis on academic skills at the expense of conversation and interaction. Academic skills alone will not take the child far in adult life.
There is little doubt any more as to the fact that Early Intensive Behavioural Intervention (EIBI) works. The question now that puzzles researchers is which are the key elements, how intensive is intensive enough and which children will benefit most. Meta analyses, which looks at a number of papers and combines the data indicated that a combination of intensity and duration was the best predictor of success. This is not surprising given our experience, where we so often see children getting too little and too late to achieve the hoped for gains. In such cases all we seem to achieve is depression for a therapist who can see the sad waste of human
potential. This is even sadder in cases where more achievement was easily in reach.
Again data from the meta analyses showed two groups. Children with initially more skills and higher IQs were seen as the fast learners, while those with lower IQ’s and extra issues were slower to achieve. However a third, smaller group was also identified. These were children with initially low IQ’s who then learned fast and reached the higher levels. This reminded me of Lovaas’ saying that some of the most difficult children can become the most successful.
Social skills training was also on the agenda. Social skills are needed at the primary level, at adolescence and also into adulthood, with different skills targeted as the needs change. Here video modelling seems the most effective strategy, especially for the more complex tasks we need to teach the high functioning children with ASD. Where groups were used the 4 emphasis was on individualised goals and groups included neuro-typical children. The question was asked what value does ABA have for other Developmental conditions, and
the answer is out there. They certainly can improve, but at this stage we do not know where their ceiling may be. This was interesting, particularly with ISADD being granted Federal funding to work with children with other disabilities.
In summary a good if rather short conference which reminded that we are on the right track, but will not be able to demonstrate this if we do not gather data. As always it helps us to fine tune our approach. Families and children with ASD are very similar the wide world over and we have a lot to learn from combined experiences.
Jura Tender
