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The Errors we See- Discrimination challenges in children with autism and Learning Disabilities – Part II

The author is a Board Certified Behavior Analyst working with Behavior Momentum India. The views in this blog are his own. I  hope to keep in mind parents and therapists as I write and will try to keep the jargon to a minimum. Do feel free to contact me via smbehavioranalysis@gmail.com

In Part 1 of the series we saw the types of discrimination challenges and issues we run into when teaching children with autism or other learning disabilities.  These are often a part of larger error patterns that children acquire inadvertently because of the way materials are used, the way responses may be prompted or the way they are reinforced. In this second part, we will look at inspecting and understanding error patterns. In part III we will look at strategies to avoid and overcome them.

Most of the receptive language tasks involve :

  • the teacher presenting an array of 3 or more items, asking for one of them
  • prompting and fading prompts if the child does not know the correct response
  • and rewarding ( reinforcing)  correct responses and ignoring incorrect responses.

Several potential errors creep in depending on how the training procedures are run.  Step one, in most cases, we must recognize that the student may not really interested in acquiring the discrimination between purple and Red or Tall and short. We believe, these are useful and functional and set up the teaching environment while the student could only aim to get a reward with minimum effort. The reward can be a preferred item or activity given by the therapist for correct responses or just completing the task as fast as possible and getting away from it all ( Technically. these are called reinforcers that increase future occurrence of the behavior that they follow) !! Behavior Analysts, both researchers, and practitioners have, in studies since the 1960s documented the kind of errors that could happen and newer and newer strategies are still being researched for improving outcomes. Laura & Grow ( 2013), have published a great article which details the type of errors that occur in teaching receptive language and strategies to overcome them.

Most parents and therapists miss the first step- recognizing that there is a problem. After doing a few tests it is very easy to be deluded into believing that the child ‘knows’ what is being taught though he sometimes makes incorrect responses. Some of the error patterns and how they creep in are discussed below:

I bet on a position ( Dominant position bias):

When you place pictures or dolls of cat, dog, and cow in an array and ask for one, say ‘cow’,  the student could adopt several strategies to complete the task which does not require him/her to listen carefully and make a correct selection – One is a position bias. As a student, I go for one particular position more often,  for example, the right most. Soon the therapist/mom inadvertently starts placing the target item there more often in that position, for, after all, the therapist or mom is also rewarded by students correct responses. The mistakes that happen when the target item is in other positions are overlooked and attributed to the student being ‘inconsistent’. In such a strategy, the student can completely avoid paying attention to what the instructor/ therapist/parent is asking to be selected( Technically called the Auditory stimulus presented by an adult which should serve as a discriminative stimulus for the student response).

I bet on a particular target item ( Dominant Response Bias):

Using the same example, possibly because I was taught ‘cow’ first and reinforced several times, even when the new targets of dog and cow are introduced I keep selecting cow more often regardless of what I am asked to select. On the occasions when I am correct, I get rewarded. Sometimes, this too could result in the teacher/ therapist asking for ‘cow’ more often creating an illusion of successful discrimination!

I bet on a familiar looking item :

There was a student who could identify spoon, cup, pen, socks, fork, lunch box, toy, and nearly a dozen such items from an array of 5 different objects. He never made a mistake until his teacher started presenting the array with 2 or more from his ‘known’ list. Then he started making mistakes. In the earlier procedure, the student merely had a rule that is something like ” If I see that familiar one, I will go for it”.

I respond based on body language or other inadvertent cues from the teacher:

While teaching receptive language the teacher may be inadvertently supplying additional cues which indicate where the correct responses lie. The student can be sometimes seen intently looking at the teachers face before selecting the item asked for. Some inadvertent prompts could be

  • the therapist’s eyes  dart at the target item before she asks for it (called eye-prompts or eye-gaze prompts)
  • the target item could be placed closer to the child than the other items, as the student’s hand hovers over an incorrect response the therapist’s features are taut and they relax as he switches to the correct response midway
  • the teacher uses exaggerated intonation correlated to a specific target ( Biiiiiig vs small, nineteen versus nine) but does not fade such intonation prompts.

Switching bias :

The student, after being asked to select big, switches the next response to small ( even if ‘big’ is asked for again) because historically his therapist has always switched the target from the previous teaching trial.

Random responding:

Here the student randomly selects any item without regard to what was asked. Afterall,  in an array of 3, he could be successful 33% of the times and that is fine!

Stimulus Overselectivity:

Stimulus over-selectivity or attending to one part of an item to the exclusion of all other parts of the whole could result in errors. For example, a child who looks only at wheels may find discrimination between a car, a truck and a van difficult.

Generalization Problems:

While discrimination is acquired with specific items taught it has not generalized to novel items 0r contexts.

Laura and Grow in their 2013 article talk about several evidence based strategies to avoid errors and teach receptive identification to children with autism.   These include counterbalanced assessments and presentations, requiring an observing response, avoidance of instructor errors, use of simultaneous targeting versus introducing targets one by one and use of appropriate array sizes.  In addition, Fisher, Pawich, Dickes, Paden and Toussaint (2014) conducted a very important study that explains how and why it is important to manage the consequences of correct responses in relation to errors ( they call it managing the behavior-consequence salience for children with autism who present persistent errors).

We will discuss these strategies to over come error patterns in part II of this blog series.

 

Selected References

Grow, L., & LeBlanc, L. (2013). Teaching Receptive Language Skills: Recommendations for Instructors. Behavior Analysis in Practice6(1), 56–75.

Fisher, W. W., Pawich, T. L., Dickes, N., Paden, A. R. and Toussaint, K. (2014), Increasing the saliency of behavior-consequence relations for children with autism who exhibit persistent errors. Journal of Applied Behavior Analysis, 47: 738–748. doi:10.1002/jaba.172

The Errors we See- Discrimination challenges in children with autism and Learning Disabilities – Part I

The author is a Board-Certified Behavior Analyst and works with Behavior Momentum India as a Research Associate, Faculty in teaching Applied Behavior Analysis course sequence and trains therapists who work with children with autism. He attempts to avoid jargon to make topics in Applied Behavior Analysis intelligible to parents of children with autism and learning disabilities, students, and therapists. The views in this blog are his own. This is the first blog and is expected to run into 3 parts because of the vast amount challenges in teaching receptive language to children with autism and recent advances.

David is a 4-year-old boy with developmental disabilities. One day his mom was excited. She was working at training identification of everyday objects from a small array of 3 different objects and he seemed to get it right with 7-8 objects such as a spoon, cup, top and fork wherever they are placed in an array. At the ABA center he went to during the day, his case manager was surprised by mom’s report. At the center, David would only get his identifications right only 25- 30% of the time, around a chance level of success, as if he were selecting randomly. He requisitioned videos of sessions from home and played them a few times over and found that a simplified array of stimuli was being used. There would be the target object, selecting which produced rewards and two other objects such as scissors and crayon that the parent never asked. David had figured that he needs to go for the spoon or the cup whenever they appeared in the array- he did not have to listen to what was asked for and make a discriminated selection. When probed with spoon, cup, and fork in the same array, hi correct selections dropped to chance levels as now the correct response depended on his selection also tallying with what the adult asked for.


Girls who buy nail polish need to know the difference between two shades that are close to each other in appearance- one could be “just her type” and another one not so! Children with autism and learning disabilities often have serious problems mastering discrimination tasks. One of the reasons is making a selection based on one element or feature of an object instead of attending to all the parts. This is called stimulus over selectivity. For instance, a child whose attention is only on wheels may not be able to identify a car if a truck and a van are also present in the array of vehicle pictures. Examples of making a response based on attending to an incorrect part abound. Discrimination training procedures involve the use of rewarding correct responses, prompting and prompt fading procedures and may inadvertently result in responses with errors or prompt dependence.

Let’s look at some more examples of errors. At a simple level, let us say a student is taught to respond to the instruction “touch head” by touching his or her own head. When “touch elbow” is introduced as a next target, the student could proceed to touch his head as soon as he hears the word “touch”. Similar problems exist with training to answer questions such as “what is your name” and  “What is your mother’s name”. The response “David” could be blurted out as soon as “what is” is heard. A child who is taught to answer “air” when asked what does fan give could reply with “air” when asked what does cow give”. It is quite possible that the “what” or “give” part of the question controls the students answer of “air” and not the “fan” or “cow”.

At a certain stage of learning, generalization must stop and discrimination must set in. There could also be a problem of over generalization without discrimination setting in (or being taught). A child taught to request for “hug” from parent’s could request hug from complete strangers. A child who is taught to say “daddy” with her dad’s picture (let’s say dad sports a beard in the picture) starts labeling other pictures of persons with a beard also as “daddy”. Many children on the spectrum who perform discriminative tasks with nouns well, fail when it comes to discriminating even between the basic colors of red, blue, green and yellow. I have come across students who do a perfect job of matching red card to card, blue card to blue card and so on. However, when they are asked to point at the red card or the yellow card or the blue, in an array that has all these cards things start going wrong. There is some other discrimination issue at work here. Discrimination challenges are part of everyday life with all humans. Husbands could buy the wrong gift on the anniversary day, a writer, could place too many, commas in his sentences, or cops could overlook important evidence at the crime site and obsess with non-essentials while the criminal is thriving and on the run. However, with children with autism and other learning disabilities, these problems acquire serious proportions across several areas of their learning and the error patterns could become stronger confounding parents and therapists.
Behavior Analysts use research based methods to identify error patterns, understand why they could occur in discrimination training and use specific strategies to overcome these.I will look forward to examining additional error patterns and the current state of research on how they can be overcome in the next parts of this series on discrimination training.

Your queries will help me reflect further. Do send them to smbehavioranalysis@gmail.com

Errorless learning is the way- time to think outside trial and error

Trial and error learning is often counterproductive and too often we cannot afford the cost of errors especially when teaching children with learning disabilities. The proponents of trial and error learning will show you the example of throwing a baby into water without any training and behold! it swims!!!!. This is not an entirely  accurate proposition as babies may have certain reflex actions in their repertoire that may look like they are born with an ability to swim but it  is not true. such an attempt would be downright dangerous and irresponsible. Check out http://www.babycenter.com/404_is-it-true-that-babies-are-born-with-the-ability-to-swim_10313062.bc

We see examples of the danger and disasters that trial and error learning cause all around us. Recall the girl who, while learning to reverse crashed her car into a pillar in the basement and could never learn to drive after that. Do you not come across hundreds of children who ” hate math” ? Well they tried to learn by trial and error  and came across failures that stunt learning. If this is the case with typically developing chidren ( and adults) the problem with errors is much higher in children with learning disabilities trying to learn a new skill. If you have tried to teach them or have observed them being taught and you find that they engage in escape behaviors, fright reactions , aggression or behaviors suggestive of anxiety it is very probable that error rates are high. The necessary pre-requisites for successful performance may be missing or some irrelevant aspects of teaching procedures could be dictating the child’s response.These are also true about typical population where students fail in exams or people fail in their jobs without adequate training.

Dr. Murray Sidman, a pioneering behavioral scientist in  a 2010 publication argues that the typical learning curves which show an acceleration towards a peak performance (during which period learning is progressively happening by trial and error) followed by a plateau appears like pat explanation only because  such curves are developed by aggregating data of the learning process of hundreds of individuals. If an individual’s learning is tracked there will be seen a lot discontinuities and irregularities. He then presents an alternative learning path which is that when all pre-requisite skills are taught there is an instantaneous vertical climb (no acceleration or curve) to performance with all learning and no error. He quotes two simple and elegant examples from the non-human kingdom.

B. F. Skinner, taught rats to press a lever in a chamber in a errorless fashion by teaching 5 pre-requisites. He first let them explore a chamber and experience that the environment was safe. By mixing food pellets with the rats regular food, he taught them that pellets were food too. He then dropped the pellets in a food tray occasionally and the clanking noise from the dispenser was a indication of when pellets would be available. soon the rats started going to the dispenser whenever the dispenser made a sound and they picked up their food pellets.  Next a  lever was introduced in the chamber. When the rat pressed the lever the first time, the dispenser operated making a sound, the rat went to the food tray and ate the pellet. There after it continued pressing the lever at a high rate pausing only to eat the food pellets dispensed. The rat acquired the ‘lever pressing skill’ in a immediate fashion ( see figure 2 below). Imagine another rat which was not trained in the pre-requisites being let inside a similar chamber. How long could it be before it starts pressing the lever and accessing food is anybody’s guess. The latter rat may even give up after the fist lever press and stay hungry and anxious because it does not have the pre-requisite training to look into the food tray or even identify the food pellet as a reward.

Terrace in his Doctoral dissertation in 1963 built on the foundation and demonstrated error-less learning with pigeons. The first goal was to teach them to peck a key only when red light was on and not when green light was on in a chamber. He achieved this with a set of pigeons errorlessly by having the red light on in normal intensity and rewarding lever presses. He introduced the green light ( to which the pigeons should not respond) in a gradual fashion from low intensity to eventually an intensity equaling the red light. These pigeons made no error responses – never pecked the key when green light was on and always pecked when red light was on. Compare this with another group of pigeons which were introduced to both the lights at equal intensity from the start and they made a large number of error responses before acquiring the discrimination that it is worth pecking only when red light is on. There were many other brilliant facets to the great experiments done by Terrace. Suffice to note that the pigeons that learnt errorlessly also performed better later much after the training was withdrawn. Their learning endured. Another important note is that errors do not produce rewards and hence can produce fright reactions or aggressive behaviors.

Figure from sidman (2010)

The dad who successfully manages to teach his young son to cycle was not only patient but also manipulating the learning in such a way as to avoid nasty falls or unsuccessful turns. Every successful coach works hard on pre-requisites training and minimizing errors though he may seen to be commandeering. You would have doubtless come across the story of someone who succeeded in the eighteenth attempt. If you are able to examine closely you will find that the previous 17 attempts involved gaining some new ground everytime , identifying missing pre-requisites and working on them diligently and the 18th is a success. Otherwise if the previous attempts were a utter failure with no rewards contacted or no new pre-requisites identified it would have stopped at 2 or 3?

Behavior Analysts work towards promoting error less learning by a variety  of research based procedures such as shaping, prompts combined with effective and timely prompt fading procedures, evaluating the use of time delay before providing prompts, adding cues that can be faded to stimulus materials before fading and arranging rewards in proportion to task difficulty. There is now a large body of research that confirms the efficacy of these procedures not only in effectively facilitating skill acquisition but also in minimizing  escape responses and aggression during the teaching process. Pairing of the instructor with positive experiences and rewards also plays a key role. If  errors still occur then a Behavior Analyst would go deeper into component skills and focus training on those.

Play, A., Activities, G., & Team, T. (2017). Is it true that babies are born with the ability to swim? | BabyCenter.            BabyCenter. Retrieved 3 February 2017, from http://www.babycenter.com/404_is-it-true-that-babies-are-born-with-the-ability-to-swim_10313062.bc

Sidman, M. (2010). Errorless learning and programmed instruction: The myth of the learning curve. European Journal of Behavior Analysis, 11(2), 167-180.

Terrace, H. S. (1963). Errorless transfer of a discrimination across two continua. Journal of the experimental analysis of behavior, 6(2), 223-232.

 

 

Autism – A brief historic perspective

November 21, 2016 Leave a comment

History is in the past but can help place things in perspective. While autism diagnosis strikes most parents from the blue, suddenly from no where, history says it has been around and recognized atleast 5-6 decades ago ( probably even earlier??). I will present some key milestones, the early blunders in understanding and current evolving understanding.

Retrospectively viewed, the earliest known description of symptoms of autism could possibly relate to Victor, a French feral child found in 1800 and believed to have lived alone in the woods for nearly the first 12 years of his life. Despite a young physician’s (Itard) intense efforts to teach him he only learned to speak two words but did make progress in his behavior towards other people. One day when the housekeeper was crying in grief over loss of her husband, Victor is reported to have engaged in consoling behavior and Itard reported this as progress. In 1867, Henry Maudlsey is said to have described insanity in children and his descriptions are consistent with today’s ASD.

Eugene Bleuler (1911/1950), a Swiss psychiatrist coined the term autismus to describe idiosyncratic, self-centred thinking during his work on schizophrenia.
In 1943, Leo Kanner introduced the modern concept of autism while describing 11 children with “autistic disturbances of affective contact”. He not only used it to describe children who lived in their own world cut off from normal social intercourse but also proceeded to distinguish it from schizophrenia indicating a failure of development instead of regression. Children with autism were described as inflexible, preferring sameness and rigid. In the following years, Kanner proceeded to hypothesize that autism was influenced by parenting, a dearth of maternal warmth { and this shoes how even scientists who are dead right about certain things can be equally dead wrong about certain things) and that many such children were not motivated to perform though not retarded.

In 1944, Hans Asperger used the term autistic psychopathy, now referred to as Asperger’s disorder in DSM- IV- TR and his study became widely known only in 1991 when it was translated in English by Frith.

The DSM I manual first released in 1952, classified autistic-like features under Childhood Schizophrenia. In 1967 Bruno Bettelheim popularized the theory of “refrigerator mothers” as cause of autism amongst public and medical community ( Another example of a scientist being dead wrong leading to harm in society) . These have since been disproved in research literature (Mundy etal., 1986). In 1977 the first study of twins helped change the perceptions and look towards genetics for understanding ethology of autism.

In 1987, psychologist Ivar Lovaas presented his first study demonstrating that intensive intervention can help children with autism learn. In the same year, autistic disorder replaced “infantile autism” in the diagnostic manual. Dustin Hoffman, essayed the role of a Autistic Savant in the movie “Rain man” which raised public awareness of the disorder while at the same time creating a mis-perception that all autistic individuals have savant like qualities. In 1993, Catherine Maurice’s book “Let Me Hear Your Voice: A Family’s Triumph Over Autism” brought into public view the effectiveness of use of interventions based on the science of Applied Behavior Analysis. In the same year, Jim Sinclair, an autistic adult started a neuro-diversity movement and spoke at the international conference on autism.

MMR vaccine was proposed as a cause of Autism in a Lancet study of 1998 but it was debunked and retracted though the controversy it raised continues till today.

In 2007, the US Center for Disease Control and Prevention estimated prevalence of Autism at 1 in 150 recognizing it as assuming epidemic proportions . this had climbed to 1 in 68 by 2014 ( “ Autism Spectrum Disorder: Data and Statistics” , 2014). As the prevalence figures kept climbing geometrically some researchers started questioning the validity of the prevalence figures. Gernsbacher, Dawson & Goldsmith (2005) have argued that the diagnostic criteria have been diluted, particularly between DSM III (1980) and DSM 4 (1990)  and other statistical errors contribute to a misperception of an epidemic.
In 2013 , DSM V was released and it clubbed several separate diagnosis into one diagnosis of Autism Spectrum Disorders.

Research into the cause of ASD continues to be unsuccessful in pin pointing the cause however there are advances in interventions  that can help individuals with autism acquire new skills and lead a better adapted life.

A history of Applied Behavior Analysis and evidence based interventions could be the next blog topic.

 

 

References

Autism Spectrum Disorder, (2014). Retrieved April 10th,2014 from http://www.cdc.gov/ncbddd/autism/data.html

Autism: Rise of a disorder. Los Angeles Times 06 dec 2011, Data desk n. pag. Web. 10 Apr. 2014. .

Autism Timeline | Neurotypical | POV | PBS. (n.d.). Retrieved April 10, 2014, from http:/   /www.pbs.org/pov/neurotypical/autism-history-timeline.php#.U0aH8fmSySq

Gernsbacher, M. A., Dawson, M., & Goldsmith, H. H. (2005). Three Reasons Not to Believe in an Autism Epidemic. Current Directions in Psychological Science, 14(2), 55–58. http://doi.org/10.1111/j.0963-7214.2005.00334.x

Goldstein, S., Ozonoff, S., (2009), Historical perspective and overview. In S. Goldstein, J. A.   Naglieri & S. Ozonoff( Eds.,), Assessment of autism spectrum disorders (pp 1-13). New York, NY: Guilford Press

Wing, L., Potter, D.,  (2009), Historical perspective and overview. In S. Goldstein, J. A.   Naglieri & S. Ozonoff( Eds.,), The Epidemiology of Autism Spectrum Disorders: Is the prevalence rising?.  (pp 18-45). New York, NY: Guilford Press

Walsh, Neil, and Elisabeth Hurley. The Good and Bad Science of Autism. Autism West Midlands, UK. Web. 10 Apr 2014. <http://www.autismwestmidlands.org.uk/files/epub_goodbadscienceofautism(1).pdf>.

Categories: Uncategorized

The art and science of generalization

November 8, 2016 Leave a comment

Note: The author is a Board Certified Behavior Analyst who works with Behavior Momentum India (www.behaviormomentum.com) . The views in the blogs are his own.I would like to thank a fellow Behavior Analyst,Dr. Geetika Agarwal, BCBA-D for her valuable comments and pointers on an earlier draft of this blog.

One of my  ‘aha’ moments came like this. I was teaching a boy on the autism spectrum to request (mand) information using ‘where’. Soon enough,he was asking “where are the crayons”, ” where is the scrabble box” and so on. One day, his mom came to observe his session, observed carefully, made notes and left after about 45 minutes. I was taking him around to play. He didn’t seemed very enthused about the play options and was looking a listless and a tad sad. A few more minutes later, he peered into my eyes and asked in a low sweet voice ” Sridhar, where is mummy? “. Aha…. generalization had happened and it was so functional and appropriate! We cannot always  assume that generalization will happen in due course. Rather, from the first instance of teaching any skill, generalization has to be planned for and programmed.

All of us generalize what we have learnt. Performing in practice tests to performing in a real exam, learning dining etiquette and using it in corporate dinner event, cracking jokes with friends to using humor in meetings , lectures or talks.. the examples are numerous. Generalization is important because the skill learnt in one setting needs to be used sometimes in vastly varying contexts.

Parents of children with autism and developmental disabilities are most concerned about this. We need generalization for sure.  If the child’s acquired skills do not generalize across people, different environments and across different contexts where they are meaningful the value of acquired skill is down to zero!  Like all good things , it needs to be planned for right from the beginning and when achieved  it needs to be balanced.  Over generalization or under generalization can be a problem  too. consider the following scenarios:

Image result for over generalization fallacyImage result for generalization

  1. Neeraj has learnt to wash hands independently but he does that only at home independently. In a restaurant or at a friends place, after a meal he may not proceed to wash his hands.
  2. Pranav sits and attends appropriately to task in the math class but not in the english class
  3. Keerthi a 3 year old girl has been taught to point at mummy and daddy when asked. However, when there were many visitors at home and someone asked her ‘where is daddy?’ she pointed to the nearest male – generalization without requisite discrimination?  Image result for multiple exemplar trainingA mom is not a girl? need for training with multiple examples

4.Rachel, a teenager  could fold her clothes and stack them up in her cupboard. One day, when mom tried to get her to help with folding towels and blankets at home and was surprised that Rachel could not fold blankets

5. Chris had learnt to answer questions about himself when his mom or his therapist asked. However, when was lost briefly in a mall and when people who wanted to help him asked for his parents name and phone numbers, he just sat down crying and was not able to answer questions about himself.

While it may not be possible to discuss this vast topic of generalization a look at some of the key principles and strategies behavior analysts use to program for generalization could help. Parents who see their children acquire skills in clinical setting  could focus on immediately generalizing those at home and in community settings. If there is a hurdle in generalization they should discuss it with the Behavior Analyst responsible for programming as they could plan and program for generalization better. Some strategies are discussed below:

a. It begins with target selection. Target only those behaviors and skills that will meet reinforcement in natural communities after the skill is acquired. For example, teaching to sing or play keyboard in a small group setting can generalize all the way to stage performances with potential to contact reinforcement from natural communities throughout life. Conversation skills, Social etiquette, play skills etc. too fall in such a category. A non example – would it be appropriate to teach penmanship to a child who does not read or recognize words yet?.

Image result for useless goals

need for meaningful targets

b. Teach Multiple examples or sufficient examples for every target : For instance if discriminating between clean versus dirty is being taught , multiple examples could be used  – a dirty cloth vs clean cloth, a dirty paper versus clean one, badly stained glass versus clean glass etc., all the time probing to see if generalization has occurred to other novel contexts. Teaching sufficient examples means teaching using as many examples as required until generalization to all possible variations occurs. For example teaching a child to pronounce 5, 6 or 10 words correctly with the “r” sound until he or she is able to pronounce all functional words with ‘r’ correctly.

Multiple examples of sharp:
Image result for sharp items  sharp-items

c. Teaching both context and response variations : To the question “how are you ?”different responses such as ” I am fine”, ” I am good” , ” great”, ” Ok”.. can be taught. Similarly the response “14 years” should be produced by the learner regardless of whether the question was ” How old are you? ” or it was ” whats your age”.

d. Teaching all possible situations – this involves teaching all examples that could covers all possible situations and varying responses – for example , teaching the use of every type of ATM machine in the neighborhood. This may not always be a feasible option, and nor may it be required in most scenarios.

5. Building familiarity in training setting – In the teaching setting it may be useful to introduce features of what will be out there in the natural setting where the skill has to be used. For instance, while teaching shopping skills in a dummy super market set up it may be useful to include shelves, ‘promotional signs, ‘pay here’ signs, trolleys etc., If you are teaching teaching dining with peers in a home setting with eventual goal of eating out in a restaurant, it will be useful to have cutlery, menu card, napkins and perhaps adult attending on the students and taking orders  like waiters would in a restaurant.

6.  Use some elements from teaching setting in generalization setting : For example a student who is used to a point system or a smiley reward system may benefit if the same is used in a generalization setting such as following etiquette rules in a restaurant or making a choice independently from a menu or being engaged appropriately in the back seat in a long journey. Yes, for some time, it may be a good idea to introduce rewards in the real life-generalized setting similar to the ones used during training.

7. Some children on the spectrum who have difficulties with responding consistently correctly to different people or in different locations will benefit from variations in teachers, positions, location of teaching, variety of tones , distractions being present etc.

8. Rule out dependence on inadvertent cues :  If a child performs well with one therapist but not with another, or with parent but not anyone else it is also important to see if the first therapist or parent is providing some subtle cues inadvertently which others do not provide. Behavior Analysts constantly strive to promote independence and will need to critically examine and completely fade out dependence on any type of prompts that may have emerged during training.

There are many other specific strategies but the above should provide an insight into some of the guiding principles for successful generalization. Much can be achieved by planning for generalization, conducting generalization probes before , during and after training on any skill ( “will he play the keyboard equally well in front of a small group of strangers? “, ” Will he whack the ball to the boundary line when playing in a larger field?”…) and planning and teaching taking into account variations in contexts and responses. Discrimination and generalization go hand in hand and training one would also require training on the other. That is a topic for another day.

Do feel free to send your questions via the comment window or by filling out the form here:

I know a family with a child affected by autism – I need to learn more to help

October 11, 2016 Leave a comment

On Autism and helping the children and families:autism_awareness_ribbon

Autism is a new challenge that humanity is facing. Children and adults with autism are seen to have problems in socialization,  communication and could engage in repetitive or stereotypic behaviors . Below are some examples of how autism manifests :

  • Very low or fleeting eye contact with others in environment, even when the child is being addressed 
  • Walks on toes
  • Is aloof, preferring to play with himself or herself, does not show interest in actions of others
  • Does not have appropriate peer relationships
  • Does not show empathy, may not look or offer help when someone else is in distress
  • Does not have appropriate play activities
  • Cannot communicate own needs or spontaneously comment on events around
  • Does not speak
  • Repetitive movements such as rocking, hand flapping
  • Repeatedly talking only about one or two favorite topics (dinosaurs, fire engines); limited interests
  • Non contextual speech, excessive giggling
  • Aggression causing injury to others or property destruction, Self-injurious behaviors

Autism should rank alongside epidemics such as Aids or Cancer in terms of both the devastation it causes on individual lives and families and in terms of scale.

In the United states the occurrence rate has accelerated to one in 88 children. Conservative estimates put the number of affected children at 2 Million in India.

So What could the rest of us do to help the family with a child with autism:

If you know a family who has a child with autism, apart from giving your time, moral support and showing sensitivity:

  • offer such parents hope that there are well researched and evidence based methods based on the science of Applied Behavior Analysis
  • inform them that with guidance from ABA professionals (see http://www.aba-india.org/professionals.html ) their child could learn new skills and become stronger and better adapted with consistent training

There is more information on the hope offered by Behavior Analytic interventions in

https://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba

 

 

 

Article Review highlights – Evaluation of HBOT Therapy

Some of what I have written in this review is technical – If you are interested in highlights you could check the intro and conclusion section directly

Some excerpts  from my scientific article review
Using behavior analysis to examine the outcomes of unproven therapies: An examination of hyperbaric oxygen therapy

Lerman, D. C., Sansbury, T., Hovanetz, A., Wolever, E., Garcia, A., O’Brien, E., & Adedipe, H. (2008). Using behavior analysis to examine the outcomes of unproven therapies: An examination of hyperbaric oxygen therapy. Behavior Analysis in Practice, 1, 50–58.

Introduction

Behavior Analysts are often confronted with a situation where parents of children with autism or other learning disabilities turn to other unproven, untested interventions ( also referred to as science fads, pseudo-scientific interventions etc.) in their search for improvement in their child’s rate of skill acquisition , reduction in inappropriate or challenging behaviors etc. Chelation therapy, vitamin doses, dietary restrictions etc. are some such examples. The BACB guidelines for responsible conduct enjoin Behavior analysts to study, appraise and review the likely effects of alternative treatments including those provided by other disciplines. The authors of this study have accordingly evaluated the effectiveness of Hyperbaric Oxygen Therapy – HBOT , a treatment that, while being expensive also has been gaining attention of parents of children with disabilities. Some parents have claimed that the therapy offers improvements in socialization, language, attending and compliance along with reductions in stereotypic behavior, aggression, disruption, self-injury etc. within 20 weeks. In keeping with the requirement not to turn a blind-eye but to scientifically and objectively evaluate alternate treatments or interventions, the authors have conducted this study.
The authors aim to validate their hypothesis that hyperbaric oxygen therapy does not offer any benefit beyond those offered by ongoing behavior analytic services and also lay down the procedures and challenges in conducting a behavior analytic intervention on unproven therapies.
Methods:
Particpants:
A 7year old girl and two 6 year old boys with 8months, 3.5 years and 4.5 years history of receiving behavior interventions were chosen for the study ( as the study proposes to determine if the alternative intervention can provide more benefits than ongoing behavior interventions).
Further parents of these children had requested HBOT therapy.

The setting for ongoing behavioral services was a private clinic providing behavioral services in 1:1 format as well as in small group formats. The education covered academics, communication, peer interaction, self-care and play. The HBOT therapy sessions were provided in a chamber with 88% oxygen at 1.3 ata sold for in-house use. The chamber dimensions when fully inflated were 233 cm length x 11 cm width and 86 cm diameter.

Dependent variables – Behaviors measured:
Improvements with the therapy are claimed to be in language, task engagement, compliance, socialization, as well as decreases in inappropriate behaviors. The authors used very specific and measurable behaviors as dependent variables in the study. For example, in the area of communication, spontaneous communication, defined as signs or words emitted without prompts was measured (number of occurrences per session). Task engagement was measured as exhibiting targeted response within 5 seconds of instruction with gaze directed at task materials or therapist. Problem behaviors such as hitting, throwing materials were measured in terms of responses per minute as the authors state that each such response had a discrete beginning and ending.

The intervention involved 40-60 minute HBOT sessions administered in the chamber described above upto a maximum of 40 dives per participant. Considerations in setting limits involved providing claimed minimum threshold exposures and minimizing exposure to the unproven therapy. Acclimatization procedures were used initially followed by 60 min sessions with the chamber activated to provide oxygen in specified concentration and with the child present with access to favorite toys, books etc. throughout. If for any reason the child did not get a full 60 minute exposure, the session was excluded from the study. A therapist recorded data for each dive in terms of start time, end time, pressurization start, time when full pressurization was reached and total time at full pressurization. These could be noted from the gauges in the equipment. While the authors describe the HBOT therapy implementation in detail, they have not done an independent evaluation of the accuracy of treatment procedure implementation (treatment integrity).

To study the effect on outcomes therapists videotaped 10 minute sessions  and recorded  data on spontaneous communication, task engagement and inappropriate behaviors. Handheld computers, or desktop pcs and instant data software were used for scoring the above from video tapes.
Further baseline (pre-treatment) sessions data has also been recorded for control purposes.

Results:
Two of the children showed increasing trends in task engagement in the baseline phases capturing the effect of ongoing behavioral interventions on the dependent variables. HBOT therapy did not change the level, trend or variability. For the third child while the levels of task engagement were variable throughout the baseline phase, the gradual increase continued during and after HBOT therapy again suggesting that HBOT therapy by itself did not contribute to any additional beneficial effects. A confound was identified as increase in prompt levels coinciding with withdrawal of HBOT therapy and this was addressed by rescoring to ascertain the level of increase in prompts and its effect on increased task engagement.
Similarly, for problem behaviors, with two of the children decrease in levels in baseline phase continued during intervention. A slight increase in problem with third child was observed.
Discussions and Conclusions
One firm conclusion that authors reach is that the additional cost of HBOT therapy does not result in concomitant increase in benefits. While discussing limitations, they refer to limited generality as the study involved only 3 participants, the need to evaluate the effects of more intense HBOT treatments with possibly higher concentrations, some non-controlled confounds such as a reduction in instruction time along with increased access to preferred activities during HBOT sessions etc.

References

Lerman, D. C., Sansbury, T., Hovanetz, A., Wolever, E., Garcia, A., O’Brien, E., & Adedipe, H. (2008). Using behavior analysis to examine the outcomes of unproven therapies: An examination of hyperbaric oxygen therapy. Behavior Analysis in Practice, 1, 50–58.

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