Thursday, November 4, 2010

Far from the Truth- part 2

Continuing on from my previous entry:


"Funding"

ABA receives funding to be used in schools because it has been PROVEN over many years and countless studies to be effective.  Funding is rarely available for experimental treatments, which is what any treatment is that lacks empirical evidence.  This one, I have to say, is not our fault. ABA in no way prevents people from conducting studies to show evidence of the effectiveness of other therapies.  When other therapies prove effective, they will get more funding.  Seems pretty logical to me.

And while on the subject of money they forget to mention the HUGE number of schools that do NOT offer ABA and the huge number of families who DO seek ABA services- out of pocket- for upwards of $30,000 per year.  BUT there are also a number of organizations that are non-profit and offer services for reduced rates or offer pro bono services.

If funding in schools is upsetting them, they must be having a hay day with the fact that new insurance legislation in many states specifically requires insurance policies to cover ABA.

"Friends"

The assertion that ABA only focuses on academic and self help skills is completely false.  As is the idea that ABA always requires children to sit still.  ABA can be done on the floor, it can be done while bouncing on a ball, while taking a walk, or while sitting in a chair.  Besides the fact that the skills taught with ABA are ones that are important to be able to be independent and as successful as possible in life, the idea that ABA doesn't promote making friends is just plain crazy.  Frequently siblings and peers are included in ABA programming in order for the child with autism to learn play skills and other interactions.  There are ABA based social skills groups.  Skills used to develop social relationships are just as much of a priority in a good ABA program as communication, self-help, and academic skills.

"Training"

I would love to know where they got this information.  When I began doing ABA I was trained for weeks, full-time, before being able to work with the children.  When I did begin working with the children, I was directly observed and trained further.  I was trained on the specific children I worked with, in depth, and training was ongoing.  This video also ignores the fact that ALL ABA therapists should be directly overseen by a qualified BCBA or BCaBA, both of which require a degree (graduate for the BCBA), additional specialized coursework, and intensive on-site training for at least 1000 hours(BCaBA) or 1500 hours (BCBA), in addition to passing a board certification exam.  Non certified ABA therapists are overseen regularly and it is the BCBA or BCaBA that designs the programming based on the child's needs and the parents priorities.  Anyone who performs ABA therapy needs to not only be trained in ABA procedures but also be trained on the child they are working with.  So no, by no means is our training short.  Nor do we pump out "lots and lots of peeps."

"History"

Ok they are right, ABA was started by a behavioral scientist.  I don't know about you, but I would rather follow treatments designed by a professional.  As great as mom's home-made chicken soup may be, nothing soothes strep throat like some anti-biotics.  Additionally they are misleading when they say "some" people who use ABA have dropped using aversives.  The truth is MOST have dropped aversives.

"Social vs Academic"

Autism is a development, social and COMMUNICATION disorder.  Kids with autism do not learn in the ways that typical children do.  It is not that we do not address social deficits- as I stated in response to an earlier video WE DO.  We simply address ALL areas of need the child has.  It is a PERVASIVE developmental disorder that affects nearly every area of development- including academic.  ABA does NOT focus solely on academics.  If anything, ABA is tending recently to focus on communication

"Published Research"

I admit, there are many people who dispute the idea that ABA is the only therapy scientifically proven to benefit kids with autism.  The truth of the matter is, from what I have seen, other therapies that have research supporting them are ABA based programs that just don't call themselves ABA.  There is a HUGE amount of published, peer reviewed, research supporting the use of ABA techniques- and not only for autism.  There are entire journals dedicated to the ongoing research.  The claim that the results of the original study haven't been reproduced is just silly.  Perhaps the gains seen in further studies haven't matched the original study, but this does not mean the recent research doesn't show ABA is effective.  There have been LARGE studies being run to examine the effectiveness in recent years, government funded, which have shown SIGNIFICANT gains from ABA therapy.

"Attitude"

This video is trying to make it sound as though ABA is cold, unwelcoming, unenthusiastic, and doesn't promote hope.  As with the other videos, not true.  Excitement, positivity, and certainly hope are rampant in ABA programs.


As a final note I would like to point out that of course, not every ABA therapist is a GOOD one and not every ABA program is a good program.  Certainly, there are therapists and programs out there that are not using the current best practices, or that focus too strongly on academics, etc.  These programs are NOT the typical ABA program.  ABA programs help families and children see and make real change and great progress.  ABA helps children lead productive, happy, social lives.

~KVL

Far from the Truth- part1

I am going to outline for you the misinformation presented by the video series "ABA vs Son Rise Program" in order as it appears.  There is just so much of it, and as you can see from the comments in the videos most people are starting to catch on that those who made the videos are either greatly misinformed or intentionally spreading untruths to make themselves look better.  I will give them the benefit of the doubt, and assume that they have not had much experience with ABA beyond the outdated methodology first outlines many years ago.

Let me start with the first video, found here on "Joining":
http://www.youtube.com/watch?v=N6CWf9H7F8k

Now, this one is just silly.  For starters, and this is just purely superficial, you will be far more likely to find ABA therapists in jeans than in suits.  Why?  Because we work with kids.  Ones with autism.  Through the course of the day we will likely be joining a child on the floor or engaging in an activity that is likely to require frequent washing of our clothes.  Kids are messy.

Next they tell us the first order of business with ABA is to extinguish repetitive behaviors.  This is just ridiculous!  Do we sometimes do this?  Yes- when the behaviors are harmful or greatly interfere with the child's ability to learn and interact.  However unless the behavior is physically harmful (head banging, picking nails off of fingers, etc) they aren't likely to be the "first order of business."

Now on to scripted behaviors vs relating to people.  Yes, ABA may teach certain things in a scripted manner for some children.  However, there are many ABA techniques that teach the same skills in an un-scripted manner.  I question, as well, their definition of "relating to people."  By joining in repetitive behaviors, are they relating to us, or are we relating to them?  And will they be able to relate to other people, out in the real world, who are not going to join in their repetitive behaviors?  Which will lead to relating better to more people- joining a child in their hand flapping, or teaching them to ask and answer "how are you?"  And is there a reason we can't do both?

The second video in the series is about "Choice":
http://www.youtube.com/watch?v=SRZqOro8dmo&NR=1

ABA therapists don't necessarily want everyone to choose ABA.  We want parents to choose therapies that are EFFECTIVE and have been proven to be so.  We do not want parents wasting their valuable time and resources of treatments that have no effect or are even harmful.  If there is only one therapy available that is proven effective, then it does not seem to me that there IS a choice, however.  Not having a choice of treatments doesn't imply there is anything wrong with the current treatment.  How often do people refuse speech therapy for a child who stutters?  Chemotherapy for a kid with cancer?

This cookie cutter idea.  This is one of the craziest things I have ever heard.  ABA is a highly individualized therapy.  Skills addressed are entirely determined by what the child's strengths and weaknesses are, and specific techniques within ABA which are used to teach those skills are tailored to what works best for each individual child.

The third video in the series talks about "Motivation":
http://www.youtube.com/watch?v=fy6T7FXmnJI&NR=1

Here is where the really out-dated information comes in.  Discrete Trials is ONE of the methodologies encompassed in the universe that is ABA.  This is NOT all that ABA is all about, though this is a popular misconception.  There are other, newer, methodologies such as Verbal Behavior which really use and focus on a child's natural motivation.  We do use things other than candy and food items.  If a child, for example, is enjoying playing with a shape sorter we use that to practice learning shapes and colors.  If a child really wants to talk about monkeys today, we can use that to practice differentiating facts and opinions.


I have decided that this deserves two parts, as this entry is getting long.  Stay tuned for my response to the remaining videos!

~KVL

Wednesday, November 3, 2010

Pet Peeve

Let me be frank here.  Little cheeses me off more than coming across misinformation being presented as the truth when it comes to ABA.  Very often, people who have NO real experience with ABA programs insist that ABA is... any number of things it is not.  Harsh, cold, robotic.  Not guided by the child's interests.  Doesn't address the core deficits of autism.  None of these things is true!  It is important to note that there are a number of different techniques which are all considered "ABA."  These techniques can look vastly different from one another, however, all are guided by the principles of reinforcement and operant conditioning.  Some are child led,others more structured and scripted.  What determines this?  In a good ABA program, what determines this is what is best for the child.

I particularly dislike the videos from the Son-Rise program, which has no empirical evidence backing it (despite misleading people into thinking that there is) that compare their program to ABA in a manner mimicking the Mac vs PC commercials.

In the following entry I will point out all of the misinformation contained in these videos.  For now, I will leave you with the following link, which is an open letter to the CEO of the Son-Rise program, Raun Kaufman: http://www.asatonline.org/media_watches/41

~KVL

Saturday, October 30, 2010

Why ABA? My personal background and beliefs.

Today we had the Tidewater Autism Summit, where a ton of service providers in the area came with their information and families could come and see what there is in the area for those with autism from kids to adults.  It was my second year going and it, again, was a blast!  I really enjoyed getting to meet other providers, and especially picking up some information I can pass along to families I work with that didn't get a chance to go themselves.

Being there and seeing the different services made me again think about why it is that I choose to provide ABA therapy and how I got where I am.

How I got into ABA was entirely an accident.  I was just about to graduate with my BA in psychology, and my first ABA job was the only place I had sent a resume to that called me to interview.  I knew very little about autism or ABA at that point, all I knew was from a brief video I had seen in one of my classes that showed a few clips of discrete trial training that left me thinking what I have since heard many people say: "Isn't it kind of like training a dog?  That poor kid!"  I had the impression that kids with autism were cold and robotic, not very much fun.  I went to the interview thinking it probably would not be for me, but I went anyways since I had signed a lease and needed a way to pay my rent so I might as well give it a chance!  Luckily for me, the center conducts performance interviews so I had a chance to not only see what they did- but try it out.

It was amazing!  The kid they had be work with was adorable, easy to work with, and affectionate!  I worked with him for basic imitation and receptive instruction tasks for 5 stickers and after he earned the last one he crawled into my lap and gave me a huge hug.  After that, how could I NOT want to do this?

Eventually I realized that this was not just a job I was doing to get experience in order to apply to better grad schools, it was something I was (and am) truly passionate about.  I knew working with kids with autism would be a likely career, and started looking into what other forms of therapy were out there, the reasoning behind them, and the benefits of them.  If I was going to pursue this, I wanted to make sure I was learning the best ways to help these kids.

I'm not sure if it is the way I was raised, just a part of who I am, or the way I was educated starting in grade school and continuing without fail through my Masters degree, but I require proof before I will believe anything to be true.  Looking into what other therapies were out there repeatedly led me to wonder "ok, but where's the proof?" so many claims just seemed so unrealistic, with no good evidence to back them up.  If I am going to be helping someone, I want to be reasonably sure that what I am doing and what I am asking them to do is likely to actually be helpful.

ABA has consistently shown to be effective from the first studies of the Lovaas approach continuing to present day studies of more recent techniques such as those used in the Verbal Behavior approach.  Most importantly, by it's very nature ABA includes constant assessment of an individuals progress as well as assessment of the effectiveness of the techniques being used.  The continual, objective, data-driven  methodology allows us not only to know when something is working but to let us know when it is NOT  working so that we can try something else with minimal wasted time.

I would like to finish up by mentioning that this does not mean there are not other treatments for autism that may be effective, just that I choose ABA because I find it to be the most convincing.  Many other therapies that have empirical support are based on ABA principles.  Other therapies that may be effective simply have not had adequate (if any) well designed studies demonstrating effectiveness.  Objective data is the key to proving a change has occurred not just in studies but in every day practice.

For more information on different available therapies and which have empirical support, please visit the Association for Science in Autism Treatment (ASAT) interventions page.

Signing off for now- coming soon my responses to the "ABA vs The Son-Rise Program" video series.

~KVL

Wednesday, October 13, 2010

Correlation vs Causation

I am really frustrated by this.  There's news reports on the jaundice study that say "jaundice increases chances of autism!" WOW.
How misleading can they BE?

I am low on time so rather than rant, I'll just link Wikipedia!  How easy is that? ;)

http://en.wikipedia.org/wiki/Correlation_does_not_imply_causation

~KVL

Tuesday, October 12, 2010

Autism, Jaundice, and Sunshine

This morning I came in to work and had an email from our office manager with a link to the following article:
http://www.msnbc.msn.com/id/39580262/

I am not sure, to be honest, what I think about this article overall, however, some of the conclusions the individuals in the article seemed to be drawing were bothering me.

Let me preface this by saying I am an advocate of tanning both indoors and out.  I spent a great deal of time in past years reading scientific studies devoted to effects of UV exposure, and have made certain conclusions that are not popularly held due to biased media reports.  Through this, I have seen evidence of a number of POSITIVE effects of getting UV exposure and NEGATIVE effects of preventing UV exposure. 

It was stated in this article that individuals have wondered about a link between liver functioning and autism in the past.  While a link between autism and jaundice supports this hypothesis, I feel it is important to not jump to conclusions.  I also want to suggest an alternative hypothesis:

After reading the study I have read a little on the internet about neonatal jaundice, treatment, and causes.  The impression I got from this is that it may even be an unfounded assumption that there is in fact anything wrong with the livers of babies with jaundice.  It seems as though light exposure plays a natural and critical role to metabolizing bilirubin out of the body.  The fact that jaundice is more common during winter (darker) months supports my idea that it may in fact be a lack of light exposure that is a problem, either in adition to or instead of inadequate liver functioning.

Let us extend this hypothesis.  Does it not make sense that inadequate light exposure could cause both jaundice AND contribute to autism, rather than the link having anything at all to do with the liver?  Of course, both hypotheses need to be examined to see what is truly going on. 

It is critical, in fact, to look at ALL possible links rather than the most common/most popular.  Disproving links will help us narrow down and eliminate potential treatments that would in fact be ineffective, and potentially harmful.

My lunch is up and I am out of time but I would love to hear your thoughts!

~KVL

Introduction

Hi there!  I have decided to start this blog to post my views on different autism topics.  On occasion, I run across an article or other information that I feel either needs to be shared or needs to be re-thought.  This blog it to share my own personal thoughts.  Nothing I write in here in any way reflects the views of the organizations or individuals I work for or with.  I hope you find the entries here interesting and informative!

~KVL