Considering Applied Behavior Analysis & Discrete Trial Training

In the early 20th century, Edward Thorndike, who gave us the Law of Effect & helped create the field of Educational Psychology, was also a proponent of eugenics & ‘selective breeding.’

James Watson, also during the early 20th century, recognized the interaction between the observable behavior of people and its connection to a given situation and established the psychological school of behaviorism. Watson also said he could take any ‘healthy infant and train him to be a doctor, lawyer, artist, merchant or regardless of his talents, preferences, & abilities; another variant of eugenics.

Even as Thorndike & Watson made remarkable and humane contributions to the then incipient field of Behavior Analysis, both also provided misunderstood representations of human behavior.

Jumping to the 1960s, children with significant developmental behavioral disabilities and autism in particular, were also and often being maltreated more often not deliberately but based on a wholesale ignorance of the need. These children were routinely not able to go to school; potentially not able to leave their homes and, frequently, put into long term residential placement.

Ivar Lovaas decided that children with autism could be taught and learn like other children; that children with autism should not require assumed institutionalization and created an initial system to teach where none had previously existed.

Lovaas also improperly treated the ‘feminine young boy’ and, as he evolved his instructional system for children with autism, recommended a single swat on their butt before the use of time out for higher end physical disruptive behavior in particular.

It is also important to recognize that the medical field used to think demons drove illness and that bloodletting and leeches were medical ‘best practice’ even though such ‘treatments’ often killed the patient far more quickly than the illness being treated.

In that Applied Behavior Analysis is in a much earlier stage of its own evolution than clinical medical practice, we see – and must continue to correct – those strategies and methods which are now considered ‘best practices’ but may not really be, and should not be, so identified.

History and context does matter and discussions such as this are exactly what is needed as a part of that process.

As a current example, the use of Discrete Trial Training (DTT) as a ‘developmental treatment’ has long been hotly debated. I have long considered it problematic that ‘ABA’ has become routinely interchangeable with ‘DTT.’ When I advise persons that my training and expertise is based in ABA (the very comprehensive field of Applied Behavior Analysis, that is) many default back to thinking I do DTT and I never hear from them again.

And I consider that to be our fault – the fault of the FIELD of Applied Behavior Analysis – based on our own too often poor communication, misunderstandings, internecine competitions and tolerance of incorrect practices being presented in our name.

DTT, in reality, is but one of a great many instructional/intervention models within the very comprehensive and expanded FIELD of Applied Behavior Analysis or, ABA. The claim that DTT = ABA has been a remarkable injustice for the field while causing deep confusion as to what we can do and the power that a comprehensive knowledge of Applied Behavior Analysis actually can bring.

I agree with those who have argued that DTT approaches can be, and have sometimes been, very badly managed while denying individuality. And I further agree that some of its more ardent proponents can sometimes attempt to mislead parents and caregivers (e.g., ‘if you don’t use DTT, the autism becomes your fault’).

An important point is that we know how to teach children to include those with learning challenges; those with and without autism. And children with autism are, first and foremost, children first rather than a ‘diagnosis.’

No competent teacher; no parent would ever presume to keep a small child at a table 1:1 for hours. No competent teacher, no parent would ever presume to force a child to do that which they clearly hate for hours at a time day after day based on the knowledge that natural motivation and generalization of skills is a key.

But even as such practices have greatly reduced over the years to very definitely include by those who identify as practitioners of the DTT/developmental model, they still are being utilized by others. This continues based on the incorrect premise that first ‘treating’ the autism should lead to ‘correcting’ the atypical child development present thereby, and only then, allowing for more progressive instruction.

So if a child really doesn’t like a certain activity and/or if the learning strategies being used don’t meld with the child’s learning style, a portion of providers are still trained/convinced that it is the ‘autism’ interfering and may, for instance, fundamentally restrain the child at the particular table/location to ‘work them through’ the autism.

Modified and minimally engaged restraint sometimes – infrequently – does become necessary across all children and hardly just those with autism. At the same time, restraint is not and should never be perceived as an instructional methodology or learning strategy.

It is critical for parents/caregivers to ask and collect information first and before making decisions for services.

I have also long disagreed with the routine use of edible reinforcement which can be easily done to a point which largely violates all we know about the Principles of Reinforcement and instruction in both, the DTT/developmental treatment and other behavior analytic methodologies. Such routine use of edibles also risk creating a host of linked behavioral, social, adaptive and, even, medical concerns. But this will necessarily be the topic for another essay!

In fact, my own long time specialty has been working with and supporting children and adults on the highest end of persistent behavior need and behavioral interference; the highest end of persisting learning challenges, their families and caregivers and I have never had to initiate use edible reinforcement to be effective.

Suffice it to say that primary grade elementary teachers do not typically walk around all day with a fanny pack full of peanuts, popcorn and broken cookie pieces for several reasons, actually, but with an emphasis on the fact that it would represent poor teaching practice.

These teachers also don’t expect their students to sit at their desks for hours at a time with almost no ability to identify their own preferences and choice. Good teachers recognize that children do not ‘learn’ in either a singular way or when the teaching strategies are not properly designed overall or, when needed, more individually.

Not wanting to go on too much longer right now…allow me to say again that DTT; which is a variant of the larger Direct Instruction model, is but a single teaching methodology among so many others in the comprehensive field of Applied Behavior Analysis.

ABA is a deep and comprehensive field. DTT is one particular strategy within that field.

With this, it is also important to recognize that DTT framed approaches can be powerful, positive and productive for a portion of children with autism (and without, for that matter) but only when individually targeted via assessment and integrated into more comprehensive and individualized instructional and intervention planning.

DTT/developmentally prioritized intervention systems become instantly problematic, however, when presumed to be a unique treatment for children with the diagnosis of autism. This, just as would be an attempt to presume that ANY pre-existing intervention or instructional system exists as a unique or standalone approach for autism (or any child) would be incorrect.

While benefits in the use of DTT absolutely exist, it cannot be considered a ‘developmental treatment’ unto itself and will not correct what is routinely identified as atypical child development in autism apart from the child. That child development can be highly variable and ‘atypical’ across all children for a host of reasons and can actually be a good thing is yet another important topic for another essay.

Above all, the child (and family/primary caregivers) must always be a seen as a participant in rather than just a respondent to instruction and intervention based on success and successful environments. That ‘success’ is a dramatically underused intervention and instructional strategy is yet another important point for further consideration.

Comprehensive assessment which includes knowing and respecting the child rather than the ‘diagnosis’ based on skilled and always individualized teaching and intervention practice combined with respectful and responsive support for the child with autism is where services should start. This is then combined with an ongoing, similarly individualized and interrelated collaboration/partnership with family/primary caregivers and providers.

Key is the ability to make informed decisions; to get real, valid and corroborated information (to include avoiding self-aggrandizing and/or sensationalist, melodramatic and/or pseudoscientific websites and resources), to know what is available and seek out recognized and true ‘best practice’ in the comprehensive and deep field of Applied Behavior Analysis

March 11, 2015

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