Monday, May 13, 2013

The Appeal Of ABA Therapy

Tonight I attended a very informative class on ABA therapy.  The presenter's Power Point was easy to follow, and the main points were explained well.

Only thing I not like many commands adult given language simplified make easier.*

*The above was written in an easy-to-understand ABA form (without all those pesky non-content words) for those of you with processing problems.  

What I meant was:
[The only thing I did not like was that there were so many commands that were adult-given, in language which was over-simplified, to make it "easier."]

When the audience was asked if there were any questions, I raised my hand and instead made a request.  I said:

Please consider not using incomplete utterances to tell a child what to do, like:

- put in
- take out
- sit chair

The presenter's response was that it is simplified because the children might have processing problems.

I believe that more harm is done when we model this simplified language, because the child is not exposed to complete sentences

When he's a little older we will then have to train him to put in all the missing words, so that he will sound like he is using age-appropriate language.

- Put it in.
- Take it out.
- Sit in the chair.  

I suppose this is another instance of me saying, 

"Just teach the end goal right from the beginning."  

Use the right language and ALL the right words...right from the start. 

I struggled throughout the evening to try to see ABA therapy through the presenter's eyes.  

She seemed totally in love with it, and even claimed that everything was ABA. 

"Hmmm," I thought.  

I began to pull hard...stretching my mind...

trying to understand the point she was trying to make, the idea was like a swirling cloud, beginning to take form...

and then there was a crack of thunder and a blinding bolt of lightening that snapped me out of my mystical meditation... 

this happened when she said that even DIR/Floortime was a type of ABA therapy.

As my mind snapped back into reality, my inner voice shreaked,  

"Huh? What you talkin' 'bout Willis?" 

I thought about the great, late Dr. Stanley Greenspan, who introduced us to Floortime, and wondered what he would have said about that (if he could ever stop laughing)

Now, I understand that people do things in exchange for something that is pleasurable or rewarding to them.  I get that.  

I understand that ABA can get some children who are very difficult to engage to learn some foundational skills, such as, sitting at a table, putting a puzzle together, pointing to things that are named and naming things that are indicated, as well as imitating gross motor movements or using sign language to request or name things.

However, I cannot wrap my head around the idea that Floortime is a type of ABA.

The difference between Floortime and ABA, in my opinion, is that Floortime is more spontaneous, creative and usually more enjoyable for the child.  

Floortime also focuses on higher level language skills within natural, functional experiences. Then there is the most obvious difference of all...children have the opportunity to lead and contribute their ideas to the activity creatively during Floortime, a NATURAL, engaging, back-and-forth interactive activity. 

Of course, I believe in reinforcing a child's language skills.  However, I always remember something I learned in my training.

Dr. Atanasio (Montclair State University) said that if you're going to use a game for speech therapy, that it's better when the speech target is a NATURAL part of the game.

In other words, if you want the child to practice the word "go," then play a game like the card game "Go fish!" 

There will be many opportunities to say the word "go" naturally, as a part of the game.

"Who will go first?" 
"You go."  
"Do you go or do I go?" 
"I go."  
"Now, you go." 
"I will go next."  
"No, I want to go now!" 
"Go fish!"
Let's take another look at the commands mentioned previously:

- Put it in.
- Take it out.
- Sit in the chair. 

Intellectually, I could admit that saying these to a child, and having him comply, might be a good way to measure his understanding.

If he put it in, took it out, and sat on the chair (and I was careful not to give any subtle cues) then I could conclude that he understood the words contained in the commands.

From an adult's point of view this is GOLD, because:

- I can assure myself of certain information (e.g., vocabulary) that the child definitely knows. 

- I feel good because I'm starting to know where the child is "at," academically or skill-wise, so I know where I should pick up my instruction.

- I feel engaged with the child; after all, he's giving me feedback.

- I feel in control, because the child is "following" my commands.  

Note: I put quotes around the word FOLLOWING, because I recently watched a video of a therapist who claimed a little boy was "following directions" to turn around, when all the therapist was doing was saying, "Turn around" and using her hands to spin him around forcibly.

During ABA sometimes HAND-OVER-HAND ASSISTANCE is used until one gets compliance or a "positive" response.  

Now, excuse me while I take a minute to stand in the child's shoes:

- I feel like I'm being told what to do and ordered around A LOT
- I'm not able to do what I want  to do 
- I'm not able to express myself freely
- I'm not able to think about something else
- I'm not able to change the focus of the activity
- I'm not able to talk about something else
- I will do what I'm told to do, as quickly as I can, to get it over with
- I get tired of doing the same thing over and over again

Back into my own shoes.  I think about this:

If someone were to tell me what to do for 30 minutes or 60 or 90 or 120 minutes, even with play breaks in between, HOW WOULD I FEEL?


The appeal of ABA therapy is in the DATA
the numbers; 
the quantities; 
giving adults concrete proof that the child is improving (in black and white)...QUANTITATIVE improvement.


I, myself, believe that a child's real-life functioning (during play and routine interactions) is MORE important.


Think about it.  

Which of the following is the more valuable proof of improvement? 

(Focus on QUALITY...qualitative improvement)

Johnny can produce the word "cookie" 9 times out of 10 when told to "say, 'cookie.' "


Johnny takes his mother's hand and walks her over to the cookie jar, points to it and says, "cookie."
Johnny can produce 20 intelligible words within a 30 minute session.


Johnny's grandfather comes in and says, "I can understand so much more of what Johnny's saying!" 

An increase in QUANTITY may be necessary to prove improvement to ourselves, 

but an increase in QUALITY is necessary to prove improvement in the child's mind.

Improvement in the QUALITY of his INTERACTIONS

Improvement in the QUALITY of his RELATIONSHIPS

Improvement in the QUALITY of his LIFE

To me, it's that simple.

I'm Noelle Michaels, speech and learning specialist.  I work with parents to improve the QUALITY of children's lives, and I truly love my job.

I am available for families in the North Jersey area to do a FREE 30-minute in-home consultation

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