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Applied Behaviour Analysis & the Treatment of Autism

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Applied Behaviour Analysis & the Treatment of Autism Applied Behaviour Analysis & the Treatment of Autism 1 Autism: Incidence Rates Happe (1998) suggested the figure common to most studies was between 4-10 per 10,000 births A number of authors have reported substantive and continuous increases in incidence rates Magnusson and Saemundsen (1996) reported that in Iceland (where all cases of autism are reported to the one institution, thereby maintaining minimal variations in diagnostic practices) the incidence rate has doubled over the last 20 years 2 Autism: An Epidemic? Rimland (1995) raised the possibility of an 'autism epidemic' Year % <3 yrs No. Children 65-'69 1 919 70-'79 5 4,184 80-'89 5 4,018 90-'93 8 6,785 94-'95 17 3,916 3 California Epidemic Increases Rick Rollens of the Mind Institute: August 2002 The California Department of Developmental Services recently reported another all time record number of children entering California's developmental services system who have received a professional diagnosis of DSM IV autism, not including PDD, NOS,Asperger's, or any other autism spectrum disorder such as rare genetic diseases like Fragile X 4 California Epidemic Increases A quarterly report for April-July 2002 showed that California added 846 children with level one DSM IV autism to its system This represents an all time record number of new cases for a quarterly report in the 31 year history of the system The report represents an 18% increase in new cases over the same quarter in the previous year and established autism as the number one disability This accounted for 40% of all intakes -- a percentage that has rapidly grown over the years from 3% (prior to 1979) to 40% today 5 California Epidemic Increases California is adding on average 9 new children a day, 7 days a week When Rollens testified before Congress in August 1999, they were adding five new children a day, seven days a week From 1971, (the first year autism was added to California's system) to 1999, California brought in 10,206 cases From 1999 to 2002, California added an additional 8,554 new cases and is now serving 18,460 cases of Level 1 autism 6 Detecting Autism Early Debate concerns the earliest reliable age at which autistic-like difficulties can reliably be identified It is common practice for parents to have to wait until their child is between 3 and 5 years old before receiving a firm diagnosis of autism (Happe, 1998) A number of researchers (Baron-Cohen, Allen & Gillberg, 1992) have successfully detected communication, play and socialisation problems in siblings of children with autism as early as 18 months, using the CHAT procedure 7 Autism: A Condition? A diagnosis of autism has been broadened to an ‘autistic spectrum’ (Wing, 1988), along which it is possible to place children with similar behavioural disturbances The autistic spectrum characteristically includes abnormal responses in socialisation, communication and imagination (Wing & Gould, 1979) – the triad of impairments (see Wing, 1996) How does one behaviourally define problems in imagination? 8 Autistic Deficits Communication - no useful or non-vocal communication - some speech, but repetitive and nonsensical - well-developed speech but inability to use it socially Symbolic/Imaginative Activities - play behaviour severely delayed - play lacks spontaneity, variety and social components 9 Autistic Deficits Reciprocal Social Interaction - all social interactions marked by disinterest in, and lack of responsiveness to, other people Interests and Activities - Range of interests and activities is very restricted Autistic Excesses Repetitive stereotyped patterns of behaviour (e.g. both self-and object oriented) 10 Concomitant Difficulties • Attentional problems • Abnormally high- or low-activity levels • Disruptive behaviour towards self (self-injurious behaviour) • Disruptive behaviour towards others or property • Abnormal responses to sensory stimuli • Apparent insensitivity to physical pain and dangers 11 The Etiology of Autism Originally believing the disorder to be an ”innate defect in affective interactions” Kanner later emphasised a psychogenic basis, resulting from “emotionally cold parents” A number of authors subscribed to this view (Bettelheim, 1967) But there was little or no evidence to support this 12 The Etiology of Autism Of course, cues which initially signal problems with the potentially autistic child force parents to deal with behavioural difficulties of which they have no knowledge or experience (Schopler & Reichler, 1971) and signal the onset of an immense emotional struggle to accept the changes in their child Nonetheless, one clearly cannot implicate familial dysfunction or psychological trauma as a source of the autistic disorder 13 A Multifactorial Approach Behaviour is part of establishing biological (neurological and biochemical) operations acting within a complex physical and social environment There is a clear distinction between accepting that biology plays a role and referring to the condition as a defined biological entity The descriptive label “autism” is not a reliable explanation for autistic behaviour This verbal slight of hand relieves the professional of the onus to change the autistic behaviours 14 Treatment History - Psychoanalysing “refrigerator parents” - Facilitated Communication - Sensory Integration Therapy - Swimming with dolphins - Holding therapy 15 Treatment History - Play therapy - Higashi - Special Educational Programmes - TEACCH - ABA 16 What Works? There are many, many influences to which parents are exposed, information, misinformation, advice, opinions etc. For many decades there was an absence of clear, reliable and scientific information concerning the condition and the majority of children did not gain access to specialised intervention For those who did, there was little or no scientific evidence to determine whether it would work 17 Early Intensive Behavioural Interventions Lovaas was the first to suggest that the learning processes of the autistic child do not differentiate him/her from normal peers (see also Ferster 1961) Lovaas also suggested that autistic behaviours participate in functional relations in the same way as normal patterns of behaviour “Autistic clients . .whatever their pathology, . are not prevented from learning once special environments have been explored and activated” 18 Journal of Consulting & Clinical Psychology (Lovaas, 1987) Pre-treatment measures revealed no significant differences between the experimental group and the control groups Follow-up data from the intensive long-term experimental treatment group (n=19) showed that 47% achieved normal intellectual and educational functioning with normal range IQ scores and successful first grade performance in public schools The remaining 40% were placed in Special Education Facilities for mildly retarded / language-delayed 10% were assigned to classes for the retarded 19 Follow-Up McEachin et al., (1993) (AJMR) examined the original group of best outcome children (i.e. the 47%, n = 9) at a mean follow-up age of 11.5 years and found that 8 of these children were: “indistinguishable from average children on tests of intelligence and adaptive behaviour” 20 Expanding All Repertoires Does the Lovaas programme only raise intellectual functioning? Critics of early Lovaas programmes suggested that they were effective only with intellectual functioning but did not foster independence The Vineland Adaptive Behaviour Scales are a highly respected scientific means of assessing adaptive behaviour, including socialisation, daily living skills and communication 21 Expanding All Repertoires - Communication and language - Social skills - Gross and fine motor skills - Academic skills - Emotional and affective responding - Self-care 22 Comparative Analyses Lovaas Teacch (All ) (Hi-funct.) Mean Age: 13 yrs 14 yrs Communication: 75.1 47.6 Daily Living Skills: 73.1 49.1 Socialisation: 75.5 38.1 23 A Different Approach Contrary to the traditional 'therapist-client role’ relationship, Lovaas trained the parents as co-therapists (repositioning parents’ role from cause to curator of lasting change) This placed a huge strain on the family unit Many individual therapists were required at each home Scientific rigour may be sacrificed in the home environment 24 Weaknesses Alternative post-treatment settings did not facilitate maintenance or generalisation of skills This limited the programme’s usage especially in clinical and particularly educational settings Limited preparation for transition to school environment Children were usually treated individually 25 ABA Not all ABA approaches are the same There are wide variations on many levels between different programmes One distinctive differentiation is the extent to which current research drives the programme and the level of training provided to staff 26 ABA Teaching Commitments Teachers teach until students learn Staff and pupils should both be rewarded for pupil and staff learning All of the significant people in the children's lives should join in the efforts to teach them Teaching children to enjoy learning is as important as acquiring new skills 27 ABA Teaching Commitments The role of the school is to eliminate all obstacles that prevent learning Inappropriate behaviour is best eliminated by teaching children to gain attention for appropriate social behaviour, academic competence and enjoyment of schooling The accurate, frequent and direct measurement of learning is a critical component of instruction An effective school is a centre of inquiry for pupils, parents and staff 28 Essential
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