September 1st, 2012

Excerpt from _The TEACCH Approach to Autism Spectrum Disorders_

Authors: Gary B. Mesibov, Victoria Shea and Eric Schopler

First, I want to say this is a really great book, about what gives every indication of being a really great program. I'm not done with it yet but I need to finish it soon to return it to the library so hopefully there will be an actual review coming.

In the meantime, I wanted to share this, because it is true in several very funny ways. Again, not making fun of anyone. Just laughing.

Starting on page 113, the authors describe various Parent Training Programs, starting with Lovaas operant learning/behaviorist methods. The Lovaas stuff worked better than sending the kids to "custodial institutions or other residential settings where behavioral methods were not used." Well, I guess that's saying something, but it doesn't sound like much.

Then they describe Lovaas' UCLA Young Autism Project, more behavioral techniques taught to the parents. Again, some improvement, but with all of these, the improvements didn't stick, the parents quit using the treatments and where there were control groups, there wasn't a difference in how parents in either group perceived matters. At a minimum, not a "difference that made a difference", to use solutions oriented speech.

More of the same from Harris et al. and Koegel et al, all teaching behaviorist techniques vs. nothing or vs. clinic sessions with teachers instead of parents. In the latter, parents preferred clinic time to DIY, unless they had to pay a bunch of money for clinic time, in which case they preferred to do it themselves. Finally, we get to where people think, aha! Maybe the stuff we have the parents teach their kids should not be such isolated, largely irrelevant skills. Now, Koegel et al start doing "pivotal response training", which is to say, let the kid do the kid's stuff and then insert yourself into the process and, say, help him when he asks for it. So, he asks for a car, he gets a car. That's the reward for communicating. Seem obvious to you? Yeah, well, to me, too. Needless to say, this is hella more fun than discrete trial training, so the parents actually enjoyed this and kept doing it.

From there, things improved. "Frea and Hepburn (1999) demonstrated in a pilot study that two parents benefitted from learning assessment and analytic skills then designing their own interventions, teaching functional equivalents of difficult behaviors (such as saying "help me" instead of becoming aggressive or self-injurious.)". When professionals and parents worked together to figure out how best to help the kiddies, everyone was happier, less stressed, had more confidence, blah, blah, bleeping, blah. Everything you would expect.

So you would be forgiven for thinking that, at this point in time, everyone is Behaving Sensibly, right?

"Sofronoff and Farbotko [possibly the best names ever] (2002) demonstrated that a psychoeducational program designed to help parents understand the perspective of their child with Asperger syndrome resulted in a decrease in the number of behavior problems." That would follow -- if you know why the kid is doing The Weird Thing, you're less likely to think of it as Behavior and more likely to think of it as The Kid Wants to Get/Accomplish Something -- it's an action or an act, not a Behavior.

"The program was in some ways more effective for mothers than for fathers, and the authors observed that several of the fathers in their study "displayed traits of Asperger Syndrome" (p 281) which might have reduced the benefits they obtained from an orally-presented psychoeducational program. The authors suggested that more visually-based or experiential training might have been more effective for these fathers."

*head* *desk*

At least everyone is still in there trying, right?

(Can I get a DUUUUUHHHHH!)