SARLetterFM7-25-03

The Schafer Autism Report
Letters

"Healing Autism: No Finer a Cause on the Planet"

Letter continues below shaded text

To The SF Chronicle on ABA Referenced Article

      "Thank you for your article in the Living section of the San Francisco Chronicle on Sunday, July 20, 2003 (Joshunda Sanders, Life With Cameron). Autism has been recently receiving a fair amount of media coverage and it is likely that awareness will contribute to better solutions for families and individuals struggling with autism. Your contribution is noteworthy.
      As a practitioner with over 30 years of experience, I would like to make a few clarifying comments.
      In your article you noted that "What has worked best for Cameron is applied behavioral analysis therapy, a method also known as Lovaas, which structures the environment for autistic children and rewards them for improving." Applied Behavior Analysis (ABA) is the methodology with the greatest scientific support. It has been repeatedly demonstrated to be effective under controlled conditions in laboratory and clinical situations. Interventions that do not include ABA components - there are many - are primarily supported by anecdotes and testimonials at best.
      "Lovaas therapy" is a name given to a small subset of ABA practices more specifically known as Discrete Trials Teaching (DTT). Ivar Lovaas, at UCLA, is the pioneering researcher and educator who over the past 30 years has helped gain acceptance for DTT among those responsible for caring for individuals diagnosed with autism. DTT is a method in which a stimulus is presented (e.g., the individual is shown a cookie), a response is produced (e.g., the individual says "cookie"), and a reinforcer, sometimes called a 'reward', is provided (e.g., the individual is given the cookie to eat). ABA is a much broader discipline than DTT.

Letter continues here:

      Some of your comments, and those of Cameron's parents, reflect a poignant misunderstanding of individuals diagnosed with autism. In a caption below a photo of Cameron obviously distressed and noisy you note that Cameron "experiences sudden bursts of emotion because of his autism." You quote Cameron's mother as saying "One minute to the next, we weren't sure what would happen." You describe Cameron's mother as bathing him at night and managing his nighttime toileting, at 10 years of age. You note that on a particular occasion Cameron and his therapist "stayed in the room for about 20 minutes before Cameron needed a break." You quote Cameron's mother as saying "He never just sits down and watches a movie . . . unless it's his favorite part."
      Such descriptions seem to imply a belief that there are things about Cameron that are immutable and not subject to scientific understanding. This may be the most unfortunate belief many hold about individuals diagnosed with autism.
      There is nothing about Cameron's performance or behavior that is scientifically incomprehensible or unchangeable. ABA is the methodology most likely to provide a solution. ABA is much more than DTT and practitioners differ widely in their abilities. Cameron can be taught to bathe himself. He can learn to work for longer and longer periods, like most other children. He can become free of 'tantrums'. His behavior can become predictable. He can learn to be out in public without calling attention to himself.
      ABA is an instructional technology. Part of an analysis may be to apply scientific knowledge in the field of learning to understand why an individual performs or behaves as s/he does. Most of an intervention is devoted to teaching new skills. A photo in your article in which a therapist "asks Cameron to identify pictures on cards" well illustrates the inherent limitations of DTT. This is a good example of DTT as a poor example of ABA.
      DTT is a useful method for imparting a certain amount of information to an individual diagnosed with autism. How will asking Cameron to label pictures lead to him learning to sit still and watch a movie entirely through, sleep through the night without accidents, or get along with others? It won't. A more functional approach, direct practice of useful skills, is needed. Most of us can easily understand this. Learning about playing tennis or skiing does little good without actual practice in these sports.
      Self care, toileting, and leisure engagement are common problems for families raising children diagnosed with autism. All can be addressed successfully by application of ABA.
      An intervention I often supervise when working with families is leisure engagement. Shaping, a mainstay of ABA, is the primary methodology. Shaping means that minute progress towards a goal is reinforced systematically until a target performance is reached. One difference from DTT is that the stimulus may be continuous, such as a video, rather than discrete, such as presentation of a cookie.
      Watching a video is a common leisure engagement target. A shaping intervention involves reinforcing an individual for very short duration sitting and watching, at first. Next, the time spent sitting and watching is very gradually and systematically increased. Cameron might be asked today to watch "Goofy's Extreme Sports" for one continuous minute, then it is finished. Tomorrow, he might be asked to watch for two continuous minutes. And so on. After a month, Cameron would be successfully watching 30 consecutive minutes or more of this video, a significant improvement. The currently described structure (he watches what he 'likes') is scientifically problematic and it would be better for Cameron if it ceased immediately.
      I hope my clarifications make sense. I would be happy to speak with Cameron's family if this is their desire. In addition to the e-mail address from which I am writing, my contact information appears below.
      Thank you very much for the opportunity to comment on a very useful article.
      -Frank J Marone, PhD, MFT, BCBA 415-753-5695 B*E*T*A: Behavior Education Training Associates 3848 Judah Street, Suite B, San Francisco, CA 94122 415-564-7830 1-800-368-BETA 415-242-1302 fax beta.sf@juno.com    http://www.aintmisbehavin.com