, etc re; ABA & DTT/IT/PRT therapy choices

[Guest guest]

I recently finished a book called " The Science and Fiction of

Autism " by Schreibman and highly recommend it. I initially

checked it out at the library and liked it so much that I asked for,

and got a copy for xmas.

Although I do not agree with some of the authors beliefs/opinions,

she did an EXCELLENT job organizing the book and providing some

incredible research references. In fact at the end of the book she

catagorizes research references by topic e.g. " Early

Intervention, " Recovery " , and " Best " Treatment " and " Developing

Treatments that Work " . It makes research a lot easier for parents I

think.

One of the topics in her book is how researchers are beginning to

look at possible profiles that may help guide parents and

professionals to which therapy(ies) will work best for a

child/person. I know when my son was first dx I was so overwhelmed

and was so frustrated that there was no one who could tell me what

tx would work for *my* child and why. Sure, there were professionals

who told me about their particular type of therapy and how great

they thought it was and why, but it was all in very general terms

which disturbed me... still does. So, I am happy to see that

research is now being done to hopefully predict which child will

succeed at which intervention. She covers 2 studies in detail. The

first and most covered was her own research w/PRT vs. DTT. She

claims her team has been successful in determining a profile of

behavioral characteristics via pre-tx video tapes of the children

who were " responds " or " non-responders " in PRT. And at least for my

son I felt it was on target. The " responders " were interested in

toys, were more likely to accept physical contact, allow adults to

sit near them, give adult toys, high rate of verbal self stim

behavior and low rates of non-verbal self stim behaviors such as

rocking, flapping arms, etc. This profile is my son to a " T " and he

does respond better to the natural environment types of therapies

such as IT, PRT, and VB.

I do think it is important to point out that even though most people

think of DTT as " Lovaas " therefore ABA, it (DTT) is or at least in

my experience used in almost every form of ABA, natural environment

based or not. Another misconception of DTT (and Lovaas)is the

therapy must occur at a table. This is certainly not true although

very often table work is DTT. As a parent the biggest difference b/t

DTT or Lovaas types of ABA and natural environment based ABA's such

as VB, DIR, PRT, IT, etc to me is the presentation and location of

therapy. When my son had a Lovaas type program it was either at the

table or in a specific room. The therapists would do trials of 10 of

the same Sd... e.g " clap your hands " and either he did it or he

didn't. There weren't aversives used other than a n0-no prompt. My

son did learn using this style but he didn't seem happy and didn't

generalize what he had learned beyond the therapists. So, we

switched to a combo of DIR, IT and PRT. He was MUCH happier and

again learned well. Then I went to a VB conference/workshop and was

hooked so we started a VB program which in many ways was like PRT

and the others but I am the biggest fan ever of the ABLLS. Plus I

love that VB is errorless. I am failing miserably at hiding my

personal preference... sorry. I love that our therapists used every

room in our house and even went to Walmart, restaurants, library,

park, grocery, barber shop, and occasionally even to ped app't to

troubleshoot or teach, and to other therapies like OT, ST to observe

and use a " team " approach. I love that when my son learned " ball " he

learned by playing with one. That a ball wasn't just a picture or 3-

d object. That a " ball " could be orange, have Dora on it, have black

and white in it, be big or small. I love that the instruction was

mixed and varied. That there was no one asking him 10 times in a row

to clap his hands. That he might be asked to " touch your

head " , " what's this.. pause as he says CAT " , " where's your tummy? " ,

and then get big ol tickles or swings as a reward vs a skittle

(although VB does use food if/when indicated). Anyway, he

generalized what he learned to other people and in a variety of

environments. The one negative I can say about our VB experience was

we constantly battled prompt dependency. Since VB is errorless if a

child does not respond correctly they are prompted to whatever level

needed to be correct. IMHO this is the toughest part of VB..

learning and remembering how and when to fade the prompts. He still

wants to be asked " what " or " what do you want " before responding. It

is a hard habit to break as his mom. We need to work on this.

Anyway, I thought I would use some real life examples of DTT based

ABA and natural environment based ABA. In the end I think my son

would do fine w/either since he is so laid back and compliant, but

for me I felt I could be more active in his therapy using the

natural environment based therapies. You mention concern about the

frequency of therapy and it seems like a lot, and it is, BUT like

someone else mentioned it is easy to fill the day w/therapy,

especially natural environment based therapies. My son made the most

progress at 31.5 hrs a week w/staff. And my husband and I carried

over the VB at home which added more hours. We used it w/dressing,

brushing teeth, eating, going to the grocery, out to eat, bath

time... everywhere. I highly suggest observing and learning as much

as you can to support whatever program you decide to do. Oh and do

not let anyone (even professionals) tell you that 20+ hours a week

is not necessary. Ask for the research and then tell me what it is

cause all the research I have found says that less than 20 hours is

basically a waste of time and money. Having said that not everyone

can afford 20-40 hours and in that case I encourage using high

school and college students, family members, friends, volunteers

from church, etc. Of course they should be trained and supervised

but I know a few moms who either did 20+ hrs a week themself (God

Bless em) and others who used family and friends. One was very

successful at using her 9 year old to work w/his brother. Of course

he didn't have in-depth training but you'd be amazed at how easy it

is to train and integrate " therapy " .

My best to you and your son. I highly suggest some form of ABA

therapy 20+ hrs a week. It is the only intervention that I am aware

of that has been scientifically proven (and duplicated over and

over) to improve 90% of our kids and " cure " 47% of our kids. Even

mainstream medicine accepts the validity and pracice of ABA. And the

Surgeon General recommends it as well.

[Guest guest]

What a great post! Thanks for sharing!

Rome, GA

> I recently finished a book called " The Science and Fiction of

> Autism " by Schreibman and highly recommend it.