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

 

 

 

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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.

Inspect before you respect – Is your Behavior Analyst competent and do they follow their ethical guidelines

October 18, 2014 Leave a comment

This note is written specifically for parents of children who receive interventions based on Applied Behavior Analysis (ABA).A special thanks to my colleagues in the field, Dr. Geetika Agarwal, Ms. Gita Srikanth, Ms. Sheela Rajaram and  Ms. Tasneem Hegde for reviewing the draft and for their valuable feedback. I hope I have been able to do justice to their inputs.

First off : ABA is not a therapy! Rather,  it is science based on which a number of  evidence based interventions have been developed to address socially significant behaviors across the entire human spectrum regardless of age, abilities or challenge.

Would you consent to have yourself treated by a person who has learnt medicine by working in a pharmacy? You should ensure that the person has studied medicine formally, keeps up to date with research in his field and conducts himself according to certain ethical guidelines. Unquestioningly and blindly trusting “experts” and “specialists” is not the way to go and this applies especially to people with whom you trust your children with learning challenges or problem behaviors.

So, when you have decided to give your child the benefit of interventions based on the science of Applied Behavior Analyst (ABA), one of the first considerations is to find out if the therapist who is going to work with your child is guided and supervised closely by a BCBA- D /  BCBA or a BCaBA .  The first two are Board Certified  Behavior Analysts ( Former is Doctoral) and the third is a Assistant Behavior Analyst who in turn needs to be supervised by a BCBA or a BCBA-D. The final responsibility, thus  for your childs programming goals , intervention procedures  and supervision of therapists should be with a BCBA-D or a BCBA.  Once you know the name of the professional, even if they are renowned and famous, see if they are listed in the BACB registry – http://www.bacb.com –> find certificants.

For those in a hurry, let me present some  key questions  to ask  :

1. Is my child in good hands – is a credentialled Behavior Analyst designing and supervising the interventions ?

2. Are the interventions designed to ensure my child/ care giver does not come to harm – are  any risks/ risk mitigation discussed well with me and signed off?

3. Does the Behavior Analyst talk to me in plain english shorn of jargon.  Is he/she able to explain choice of teaching strategies/ interventions to my satisfaction?

4. Does the Behavior Analyst talk to me with data and graphed trends to communicate progress of my child?

5. Does the Behavior analyst respect and  maintain confidentiality  ?

6.  Is the Behavior Analyst a ” good citizen” ? For instance, is he/she  on the right side of the law in his or her dealings?

7. Is the Behavior Analyst on a continuous learning mode – does he/ she attend scientific conferences, present technical papers, disseminate knowledge

For those who would like to dwell a little deeper I’ll aim to elaborate on the above. A Behavior Analyst signs up to high standards of ethical conduct – I will list some of them that have a direct bearing for your child and yourself. You’d need to keep following and watching your behavior analysts behavior and convince yourself that he  or she displays behavior in consonance with these.

1. Do no harm , right to most effective treatment and least intrusive interventions : The primary client for the Behavior Analyst (BA) is the child or the vulnerable person receiving services. Parents / Guardians/ carers /teachers/ relatives  ( called significant others) will be secondary clients.  It is the BA’s responsibility to ensure that risks of any potential harm due to interventions are carefully analyzed, discussed with the client or significant others with risk management plans in place. Interventions covering these should be signed off in writing  with significant others to avoid any misunderstanding.

This also means, for example that in the event of your relocation or transition of services, the Behavior Analyst makes appropriate referrals and communicates status assessments to future provider to ensure the child does not suffer. Similar considerations should be seen if for some personal reason the BA is not able to continue providing services – they need to ensure presentation of suitable referrals where possible, a reasonable notice period , exit reports etc. Any information they share with third parties should be with your written consent.

2. Should maintain high standards of integrity in their personal lives and are seen as upstanding citizens . Even if they are clinically brilliant, they need to be operating on the right side of law. If you have any reasons to suspect this, stay away and consider reporting to the Behavior Analyst Certification Board ( http://www.BACB.com ).

2. Keeps up with scientific knowledge : Does the BA attend conferences/ seminars on behavior analysis, is seen making efforts to use the lastest technological advances in the field?

3. Talks to you in plain english : Behavior analysts have an obligation to explain their intervention, assessments etc. in plain English for clients, consumers and professionals from outside the field.  If there is heavy jargon in their talk thats not intelligible to you , watch out! You could be dealing with style provider than substance.

4. Recommends the most effective evidence based interventions : There are a number of effective evidence based procedures such as Antecedent intervention,Joint attention intervention,Precision teaching, modeling, peer training package, schedules, self management etc.  that are based on Applied Behavior Analysis.   The BA, while discussing interventions for your child, should be able to substantiate their choice referring to scientific evidence base (e.g. number of scientific studies published in peer reviewed journals). If you are proposing a non- behavioral intervention, they could use scientific behavioral methods to evaluate its effectiveness.

5. Assesses, measures and communicates with data : Rather than say that they have been very successful, the BA should be able to discuss progress with data and  graphs of progress pre and post intervention. Do you see the BA constantly assessing progress and making changes on the basis of data ?

6. Takes informed consent :  Knowledge derived from interventions  with your child could be useful in  helping others facing similar challenges and add to the scientific knowledge base. In certain contexts the BA will take your permission in writing with a clause that such permission may be withdrawn by you at a later date.   The typical contexts include consent for use of videos data from interventions with your child in scientific conferences/ training programs/ website,  for including your child as a participant in a scientific study ( even if it benefits your child )  which may be published in a scientific journal and for taking up an intervention that involves reduction in socially inappropriate behavior .  It is  important for you to give the informed consent without any feeling of ‘pressure’  such as a fear that your child’s intervention may be compromised if you withold consent.

7. Confidentiality : The ethical Behavior Analyst will share information about your child only with personnel directly involved in designing and providing interventions .  Information Specifically identifying children are  masked ( unless significant others have consented otherwise) when information needs to be shared with peers or the larger community of Behavior Analysts such as in journal articles, technical paper presentations etc.

8. BA’s responsibility to the field of Behavior Analysis : You may ask, how does this concern me as a parent or recipient of services for my child . However, if the BA is seen disseminating knowledge about the field in various fora, seen fighting mis-representation of the field by non-qualified personnel , is seen attending, presenting posters and papers in national and international conferences you are probably seeing a ethical Behavior Analyst.

9. No Dual relationships or conflicts of interest please :  Behavior Analysts relationships with their clients and their significant others is strictly professional in nature and guided by a written contract. Behavior Analysts becoming best friends, joining you in family holidays, accepting gifts etc., would be in violation of their code of conduct as services to the client could be compromised.

These are but a few important points and some yardsticks lay people can evaluate the Behavior Analyst on.  It may be uncomfortable to do such an evaluation as  blind faith is a lot easier. However, with your child’s interests at stake I’d recommend nothing less than a diligent and ongoing evaluation.

Beofre I close, I must say that there are a number of changes you may have to undergo to make the most of your Behavior Analysts services – yes, it is a two way street.  Behavior Analysts prefer to address matters with data and trends and will need your buy in for the interventions with reasonable modifications . They may nor promise or guarantee miracle results but are likely to share information on interventions that have an evidence base and promise on going monitoring with data to demonstrate improvements. They are more likely to concerned with an improvement from here on rather than on an impractical standard thats out there. A Behavior Analyst may not entertain long discussions involving emotional reasons or hypothetical constructs ( invisible reasons that purport to explain the cause of problem but actually do not – see an early blog of mine on mentalism and circular reasoning) but will in a scientific way be able to draw your attention to the real function of problem behavior ( what does the behavior get as a consequence that makes it relevant) and the socially acceptable interventions that should work. This approach would aim to build trust based on objective evaluation of your child’s progress rather than ‘faith’ and this could be a subject matter for another blog!

 

Join the cause – Applied Behavior Analysis based interventions for children with Autism

sm pic Jo Pnarasimhanmama1With ABA India Runners after finish 1

Saturday, 10 May 2014

For the third year running ( pun intended) , Jo a technology professional and Nara an entrepreneur will run 10 kms non-stop with Sridhar, President ABA India to raise funds in the TCK Premier world running event to be held in Bangalore on Sunday 18th may 2014.

Autism is a severe learning disability and a neuro-biological disorder ( not a disease   ) estimated to affect 1 in 88 children. The science of Applied Behavior Analysis and the technologies based on the science hold out great hope and have  50+  years record of successfully helping these children acquire new skills and integrate with the larger society.

ABA India is planning to conduct a 2 day intensive immersive learning experience for parents of children with autism and tutors and trainers who work with them.  The event is scheduled to be in Hyderabad with international and Indian experts in Behavior Analysis imparting knowledge on practical techniques to families in need of such evidence based technologies.

To give an idea, Rs. 2500.00 can part fund  the cost of attending  one parent  or tutor/ trainer.  We expect around 250-300 people to register and benefit. In this run, we are working towards a fund raising target of around 1.5 lakhs.

We encourage you to contribute whatever you can- no amount is too small. Do pass the message around. We hope giving gives as much joy to you as asking for the cause does to us.

Ways to give :

1.  Bank Transfer ( please send me transaction reference number)  : Bank – Oriental Bank of Commerce, Gurgaon, HAryana 122003,  A/c Name:  Association for Behavior Analysis India, A/c No. 51671131000593.  IFSC code for direct transfer is ORBC0105167. send us a screenshot afterwards.

2. Cheque-   You can make the donation by cheque favoring ” Association for Behavior Analysis India” and post it to:  Sridhar Aravamudhan, President , ABA India, A2- 201, L&T South City, Mico Arakere Layout, Bangalore – 5600076

3. By cash in person – let me know – I’ll arrange a visit to collect.

If any of us know you personally you may get a call to check how you are getting on and incidentally asking you for a donation ( or vice-versa!)

 

With regards and Thanks,

 

Sridhar Aravamudhan

President

Sridhar.a@aba-india.org

+91 9538001515

 

Activity Schedules for children with autism

Efficacy of Activity Schedules as Intervention for Children with Autism

 Children with autism have difficulty with the concept of time, experience anxiety relating to what events come next and have difficulty in independently planning and engaging in appropriate activities. Activity schedules visually represent a set of tasks or activities. Pictures are used for visual learners and words are used for children who have reading abilities. Sometimes it is seen that children with autism, even while competently doing their activities keep looking at an adult for a prompt to move to next or continue to stay on task. Visual schedules can help reduce dependence on adults or other people.

Activity schedules can be for a simple three or four step activity ( Dressing – wear underpants, wear vest, wear shirt, wear trouser)  they could cover a series of activities the child need to perform ( make a toast, play with iphone, finish a worksheet), it could cover events throughout the day ( breakfast,  get dressed, go to school, return by bus from school, evening meal, TV time, play at park, homework, supper, sleep) and with children that have advanced at learning schedules  even events during a month can be visually presented (  Grandma visit, long weekend stay at beach , going to a marriage…).

In my practice I come across several children who  would start their next activity which could be fixing a puzzle or going and playing on the swing only after an adult gestures or prompts.  They could move from one activity to another in a span of 3- 4 minutes but would be dependent on parent or trainer to stop an activity or start the next activity. Even in seemingly simple functional routines where they are  fluent in all the steps they could need prompts such as open the tap, rinse mouth, take toothbrush, squeeze paste on to the brush etc.,  Further, there are children who can complete the parts of the chain but will look at adult for some kind of a prompt to move on. In the context of helping such children  become atleast partly independent,  I started looking at a combination of visual schedule which can prompt the next activity to move to and and a  timer which can tell them when to stop ( in case the activity is a open ended activity like playing with ipad as opposed a closed ended activity like completing a 25 piece jigwas puzzle). I had to start with research on work that has already happened and felt I’ll share what I learnt while studying literature-  I’ll try to lighten the technical heaviness of what I am going to write but do bear with me if I am not entirely successful as I am trying to look at technical research..

According to Schopler, Mesibov (1995),  activity schedules reduce the need for adult prompts, help children transition between activities and provide a structured teaching environment. Further, the use of visual schedules also  help given the auditory deficits  of children with autism Schopler, Mesibov, and Hearsey (1995) .

Thus activity schedules are expected to transfer  control from verbal or imitative or gestural prompts  given by adults to pictures, symbols or photographs thus reducing the child’s dependence on adult prompts. Further, if correctly designed and implemented, activity schedules visually let children know their rate of progress, estimate time remaining to complete allotted activities and thus can reduce frustration.

One of the early studies by Applied Behavior Anlaysts examined teaching children with autism to be independent in emitting complex  response chains (Macduff, Krantz, & Mcclannahan, 1993).

The authors selected four youth whose interventions involved staff giving verbal instructions and physical prompts. The instructions rate were as high as 2 per minute ( Look at the level of dependence on adults and possible aversion to voice that may arise?) . The authors further reported that most of the responses had to be prompted and there was  no spontaneous emission of previously taught chains of activities. The study, after a baseline measurement went on to use photographic activity schedule depicting 6 leisure and homework activities.  The teachers stood behind and used  graduated guidance ( a procedure where initially trainers provide prompt to the extent required and reduce or fade as the child begins to gain independence)  from behind the participants to teach them to follow a schedule and be on task ( i.e., they had to teach the use of visual schedules using prompting and prompt fading procedures so that the actual performance of chain of activities may be dependent only on the photo schedules).

In terms of results, all the participants , after the training phase ( 13- 27 sessions) were found to be independent , i.e., not reliant on any teacher prompts , were on task and on schedule. They also generalized schedule following to novel chains. Anecdotally, the authors record a reduction in aberrant behavior from the participants. The effectiveness of photographic schedule training with graduated guidance was evidenced by the fact that the participants were able to independently engage in complex leisure and daily living activity chains for one full hour ( Quite a dramatic achievement is’nt it , considering the children needed 2 adult prompts per minute at baseline ).

Referring to the above study and replicating  it  Bryan & Gast (2000) taught four children with autism in a public elementary school program to  use visual activity schedules using a Graduated Guidance procedure. They measured on-task and on-schedule behaviors of the children after teaching them the mechanics of using activity schedule. The children carried the activity schedule in a book. The students not only learnt how  to use an activity schedule (with graduated guidance support from experimenters) but also maintained high levels of independent on-task and on-schedule behaviors with just the support of picture books . This had an automatic effect on reducing non-scheduled behaviors.

A contra indicator is the study by Waters, Lerman, & Hovanetz ( 2009). Transitioning from a one task to another, often from a high preference task to a low preference task can be accompanied by emotional reactions and inappropriate behaviors. A treatment package consisting of extinction plus differential reinforcement of other Behavior (DRO) was tried with and without visual schedules. In this study the authors found that problem behaviors reduced with extinction plus DRO regardless of whether a visual scheduled was used or not.

This study calls into question the usefulness of activity schedules in facilitating transitions especially preferred to non-preferred. However, I would still like to examine the value of removing adult mediation during the transition.

Bryan & Gast (2000) also report a number of prior studies which found the use of activity schedules effective . They are tabulated below:
Betz, Higbee, & Reagon ( 2008) made a first of its kind study when they studied the effect of two children ( a social pair) following the same activity schedule to play  a series of interactive games. The three pairs of children with autism chosen for the study were between 4 and 5 years of age and they were assessed to be able to follow activity schedules independently. Activities or games were chosen for them to engage in that allowed  two people to take turns ( don’t spill the beans, crocodile dentist etc.,)  and the children were taught how to play these games fluently.  While in baseline condition no joint activity schedule was used, in the intervention phase teaching was given for each of the paired children to refer to the joint activity schedule, say brief lines from script and enagage in an activity or game collaboratively.  This study found that for every pair the engagement level ( defined as being on task and taking one’s turn appropriately) that was very low in baseline phase reached to 80% in the teaching phase and was sustained in the maintenance, re-sequencing and generalization phases.  This is a higher order training method and demonstrates the utility of activity schedules in promoting peer engagement in children with autism.Heres another big breakthrough possible with activity schedules: They can be used to teach joint activities, peer play etc., especially where turn taking is involved?

As  elaborated with several examples in this paper, activity schedules have proven to be effective in teaching children to be on task, on schedule, to be independent to a higher degree, in reducing inappropriate behaviors, in facilitating peer play without adult prompts, in teaching vocational skills, home living skills, leisure skills, play skills etc.

From the foregoing discussion it can be discerned that research on activity schedules had started in the 1980s and is continuing till date. It is important to note that though the dozen odd studies referred to in this article have demonstrated effectiveness barring the study by Walters etal., ( 2009), the volume of research and replication in the three decades does not seem to be high. This relatively low volume of research activity is surprisingly at variance with widespread use of activity schedules in one form or other across special schools catering to children with autism and other learning disabilities.

In terms of recommendations, activity schedules along with training to use them should be considered as a treatment of choice to promote independence , reduce dependence on adult prompts and to promote generalization. This is on account of the fact that the studies that have been done have reported success and the treatment will gain more favour with increasing replications and novel variations.

References

Bryan, L. C., & Gast, D. L. (2000). Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Journal of autism and developmental disorders, 30(6), 553–67.

Betz, A., Higbee, T. S., & Reagon, K. a. (2008). Using Joint Activity Schedules to Promote Peer Engagement in Preschoolers with Autism. (G. Hanley, Ed.)Journal of Applied Behavior Analysis, 41(2), 237–241. doi:10.1901/jaba.2008.41-237

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89–97.

Miguel, C. F., Yang, H. G., Finn, H. E., & Ahearn, W. H. (2009). Establishing derived textual control in activity schedules with children with autism. Journal of applied behavior analysis, 42(3), 703–9. doi:10.1901/jaba.2009.42-703

Neitzel, J., & Wolery, M. (2009). Steps for implementation: Graduated guidance. Chapel Hill, NC: The National Professional Development Center on Autism Spectrum Disorders, FPG Child Development Institute, The University of North Carolina.

Schopler E, Mesibov G, eds. Learning and Cognition in Autism. New York: Plenum Press, 1995:311–334.

Schopler, E., Mesibov, G., & Hearsey, K. (1995). Structured teaching in the TEACCH system. In E. Schopler & G. Mesibov (Eds.), Learning and Cognition in Autism (pp. 243-268). New York: Plenum Press.

Waters, M. B., Lerman, D. C., & Hovanetz, A. N. (2009). Separate and combined effects of visual schedules and extinction plus differential reinforcement on problem behavior occasioned by transitions. Journal of applied behavior analysis, 42(2), 309–13. doi:10.1901/jaba.2009.42-309

Maimonides on Reinforcement

December 24, 2012 Leave a comment

Maimonides, a Medieval Jewish philosopher ( 12th century ) and a Torah scholar on the workings of positive reinforcement


. Imagine  a small  child  who  has been
brought to his teacher so that he may be taught
the Torah, which is his ultimate good because
it will  bring  him  to  perfection.  However,  be-
cause he is only a child and because his under-
standing is deficient, he does not grasp the true
value of  that good, nor does he understand the
perfection  which he  can  achieve  by  means  of
Torah. Of  necessity, therefore, his teacher, who
has acquired greater  perfection  than the child,
must  bribe him to  study  by  means  of  things
which  the child loves in a childish way. Thus,
the teacher may say, “Read  and I will give you
some  nuts  or  figs;  I  will  give you  a  bit  of
honey.” With this stimulation the child tries to
read.  He  does  not  work  hard  for  the sake  of
reading itself, since he does not understand  its
value. H e  reads in order to obtain the food. ,
As  the  child  grows  and  his  mind  improves,
what was  formerly  important  to  him  loses  its
importance,  while  other  things  become  pre-
cious.  The  teacher will  stimulate  his desire
for whatever  he wants then. The teacher may
say  to  the  child,  “Read  and  I  will  give you
beautiful shoes or nice clothes.” Now the child
will  apply  himself  to reading  for  the sake  of
new  clothes  and  not  for  the  sake of  study  it-
self. . . . As his intelligence improves still more
and  these things, too, become unimportant  to
him, he  will set his desire  upon something of
greater value.  Then  his  teacher  may  say  to
him,  “Learn this  passage  or  this  chapter,  and
I will give you  a denar or two.” Again  he will
try to read in order to receive the money, since
money  is more  important  to  him  than study.
The end which he seeks to achieve through his
study is  to acquire the money which has been
promised  him. When his understanding has so
improved  that  even  this reward  has  ceased  to
be  valuable to him,  he will desire  something
more honorable. His  teacher  may  say  to  him
then, “Study so that you may become the presi-
dent  of  a  court,  a  judge,  so  that  people  will
honor  you  and rise  before  you as  they  honor
So-and-so.” He will  then  try  hard  to  read  in
order to attain his new goal. His final end then
will  be  to  achieve  the honor,  the  exaltation,
and the praise which others might confer upon
him.
Now,  all  this  is  deplorable.  However,  it  is
unavoidable  because of  man’s  limited  insight,
as  a result  of  which  he  makes  the  goal  of
wisdom  something  other  than  wisdom itself,
and  assumes that the  purpose  of  study  is  the
acquisition  of  honor,  which makes  a mockery
of  truth. Our sages called this learning not for
its own sake. . . .”
Reference:

‘Isadore  Twersky (Ed.), A  Maimonides  Reader. New
York: Behrman  House,  1972. Pp. 404-407.


Sridhar Mudhan, Board Certified Behavior analyst, India Mobile : +91 9538001515

The Third Annual ABA India Conference that happened in Kolkata

December 17, 2012 Leave a comment

Third Annual Conference of ABA India

 

The third annual conference of Association for Behavior Analysis India was held in The Park Hotel, Kolkata on 8th and 9th Dec’2012. The  program received a tremendous response ,attended by over 200  participants around 65%  of whom were  parents of children with autism and other learning disabilities. The rest of the participants were special educators, mental health experts, occupational therapists, psychiatrists, students doing MS in psychology etc.,

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ABA India’s mission is to introduce & advance the Science of Applied Behavior Analysis (ABA) in both cities and remote locations of  India. One of the major areas where ABA based methodologies have demonstrated significant breakthroughs is in developing and delivering interventions to teach children with Autism. Given that Autism, a learning and developmental disability is now reaching epidemic proportions (Latest statistics indicate 1 in 150 new births affected) ABA India aims to :

  • Increase awareness about successful interventions to teach skills to  children with autism and empower them
  • Create a resource pool of trainers trained in the latest methodologies based on the science of ABA
  • Bring ABA as a subject of study in India to make services affordable and scaleable to meet the huge demand
  • Collaborate with parents,  special educators, mental health specialists, occupational therapists, paediatricians etc., to share knowledge and best practices from across disciplines.
  • Help spread ABA applications to shape behavior and bring positive changes in society

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In the Inaugural session, Mrs. Mita Bannerjee, state commissioner for the persons with Disabilities, West Bengal lit the ceremonial lamp and during her address stressed the importance of professionals in Applied Behavior Analysis working with frontline aanganwadi workers to reach services to the people with disabilities. She has asked that ABA India submit a proposal for collaborating with the disability commission to reach larger sections of the society and promised unstinting support from the disability commission.

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Ms. Smita Awasthi, BCBA , founder and past president of ABA India presented a retrospect on how the pool of professionals trained in ABA has grown steadily from just one person in 2004 to 18 people now . Given the large number of children being diagnosed with autism day by day she stressed the urgent and crying need for bringing Applied Behavior Analysis as a subject of study in India to make it more affordable for aspiring students who otherwise have to pay hefty fees and study with foreign universities.  While thanking parents with children with disabilities who played a pivotal role in the organisations move forward she stated unambiguously that ABA India would like to collaborate with experts from other fields such as special education teachers, occupational therapists, mental health professionals, speech and language therapists, psychiatrists  and paediatricians.

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Dr. Neil Martin, international representative from Behavior Analysis Certification Board, explained the board’s role in ensuring high ethical standards in the practice of the science and the message optimism it holds out to society.

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Dr. Samir Parikh, Director- Department of Mental Health and Behavioral Sciences made a hard hitting speech ( peppered liberally with humour) on the need to think beyond clinical diagnosis and treatment for children with disabilities given that barely 7% of such children have access to much needed expertise from qualified  and educated professionals. He also provided very interesting insights on all that is going wrong with the education system.

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In his keynote address, Dr. Per Holth from Akershus University college, Oslo, Norway presented how “ Category Mistakes”  ( first defined by Gilbert Ryle in his 1949 book , the concept of mind ) lead  the fields of psychology and even applied Behavior analysis to engage in circular reasoning  and thereby mistakenly attribute Behaviors to entities that do not exist separately.

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The conference featured 24 paper presentations from experts from India and abroad on subjects such as teaching a five year old child with autism to participate in a story telling competition, Teaching receptive identification to a 10 year old boy with autism using stimulus transfer procedures, using task analysis and prompt fading procedures to teach adaptive skills to children with autism etc.

Intensive two hour  workshops  addressed areas such as  Teaching Joint Attention skills, Teaching Play skills, Understanding and Managing challenging Behavior,  Teaching Social Verbal and Non- Verbal Behavior,  Addressing Feeding disorders  and Using the Power of Positive Reinforcement to teach new skills and build socially appropriate behaviors.

These workshops were  conducted by  eminent professionals from overseas and from India. The facilitators included Dr. Neil Martin , Phd., BCBA- D from United Kingdom, Dr. Per Holth from Norway, Dr. Joyce Tu, BCBA-D from United States, Dr. Geetika Agarwal, BCBA-D from United States, Mr. Corey Robertson, MS, BCBA, United states and Ms. Smita Awasthi, BCBA, India.

The valedictory function saw parents of children sharing success stories using principles of ABA. The presentations showed data based studies  with video vignettes on how speech emerged in a 13 year old girl with autism, how a 12 year old girl in the autism spectrum learned a variety of occupational,daily living and leisure skills such as embroidery, cutting vegetables, drying out clothes, singing and making chappathis, how a mother taught her boy to respond to instructions and his  name being called out.

In his concluding Vote of thanks, the President, Mr. Sridhar Aravamudhan thanked the parents and professionals in the field for turning out in large numbers and participating in an amazing knowledge sharing experience. He also announced Chennai as the venue for the fourth Annual conference to be held in Dec 2013.

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