We come now to arguably the best-know individual in the field of behavioral therapy for children on the spectrum, O. Ivar Lovaas (1927-2010), and his lasting contribution to the science of Applied Behavior Analysis (ABA). ABA is the method behaviorists use to describe and manipulate human behavior; practitioners go to school to earn an advanced degree and licensure to become a Board Certified Behavior Analyst (BCBA). (http://www.bacb.com/ )
Lovaas was born in Norway; as a young man he survived Nazi occupation, and after the war emigrated to the United States, earning a PhD in psychology from the University of Washington in 1958. From 1961 until his death earlier this year, he was on the faculty of the UCLA. Lovaas was strongly influenced by JB Watson. Watson once famously claimed "Give me a dozen healthy infants....and I'll guarantee to take any one at random and train him to become any type of specialist I might select - doctor, lawyer, artist, merchant-chief and, yes, even beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors." [Behaviorism, 1930]. Echoing these sentiments, Lovaas similarly asserted that "If I had gotten Hitler here at U.C.L.A. at the age of 4 or 5, I could have raised him to be a nice person." ( http://www.nytimes.com/2010/08/23/health/23lovaas.html ). Outdoing Watson - who had described a hypothetical scenario of electifying toys and applying a shock as an aversive stimulus when one child steals another's toy - Lovaas actually used electric shock (as well as yelling and hitting), as aversive stimuli with children on the spectrum (http://neurodiversity.com/library_screams_1965.html). As late as 1981, he advised parents to "practice hitting on your friends, to see how hard you hit." (Teaching Developmentally Disabled Children: The ME book. O. I. Lovaas, PRO-ED, Austin). These physical aversives are no longer used. These methods seem harsh and even unethical today, but need to be judged against the context of their times: when Lovaas was starting out (and when I was in medical school), society regarded persons with severe disabilities as beyond help; "sub-trainable" was the official term. Lovaas was among the first to use behavioral techniques to show otherwise.
Lovaas' claim of 47% normal outcome following intensive ABA (Lovaas, O.I., Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting Clinical Psychology, 1987. 55(1): p. 3-9) has never been replicated; the paper in which he made the claim suffers from severe methodological flaws (more on that in a later post). And Behaviorism has no way of dealing with concepts such as "empathy," "understanding," or "Theory of Mind" (one of the key deficits in ASD). Nonetheless, ABA has been used successfully with tens of thousands of children with ASD - as well as children and adults with other developmental and/or behavioral problems - to eliminate unwanted behaviors (self-injury, for example), and to promote desired behaviors, including communication, adaptive skills, and at least the outward forms of social behavior. ( http://www.lovaas.com/ )
In approaching any behavior, a behaviorist asks three questions: What immediately precedes the behavior; what, precisely, is the behavior itself, and what immediately follows the behavior? These are the ABC's: the Antecedent, the Behavior, and the Consequence. (It's easy to see how the emphasis on the antecedent and the consequence build on Thorndike's law of effect, and Skinner's operant conditioning.) In a nutshell: The behaviorist sets up the child's environment to include an antecedent condition and a consequence, that are likely to increase or decrease the likelihood of occurrence of the specified behavior.
In clinical practice, ABA employs specific strategies and techniques, including:
• Shaping: the systematic manipulation of antecedents and consequences, to increase or decrease the rate of occurrence of specified behaviors.
• Prompting and Fading: Prompts are verbal or physical clues that increase the chance that the child will produce the desired behavior. When the child's responses begin trending in the desired direction, the prompts can be systematically decreased, or faded.
• Chaining and Reverse Chaining (also called "Backwards Chaining"): Breaking down a complex task into smaller units that can be shaped more easily. Depending on circumstances, the therapist may start with the first element in the sequence and work forwards, or the last element in the sequence and work backwards. (Remember from our last post how Marc Gold also made excellent use of these methods, with his "Try another way" approach to teaching a complex task to adults with severe disability.)
• Generalization: A task isn't fully learned until the child can perform it regardless of the setting or the conditions. Prompts and Tasks are both rotated, presented in different context or by different therapists, to facilitate generalization.
• Discrete trials (Discrete Trial Training; DTT): Clearly defined interactions between trainer and subject that follow a typical pattern: the trainer presents a stimulus (a request, task, or behavior to be imitated), the subject responds, and the trainer delivers a consequence.
• Consequences include:
o Positive reinforcement: Providing a desired consequence, like food, hugs, tickles, verbal praise, or access to a desired object or activity.
o Negative reinforcement: Removing an undesirable consequence. For example, removing a wet, uncomfortable diaper might be used as a negative reinforcement in a toilet-training program. Negative reinforcement still functions as reinforcement (not punishment). The word negative only refers to something being taken away.
o Punishments (also referred to as "aversive stimuli," or "aversives"): Therapists punish to decrease the likelihood that a behavior will recur. As noted above, punishments used to include physically aversive stimuli such as yelling, hitting, and electric shock, but are now limited to verbal reprimands, removal of desired objects, and overcorrection. For example, if a child throws his or her cup to the floor during a tantrum, the child might be required not just to wipe up what was spilled, but to mop the entire floor. Punishments work in the short term, but they don't accomplish as much as rewards, since they only teach the child what not to do, without providing a positive alternative.
o Ignoring. In behaviorist jargon, putting the behavior on extinction: As many times as the child turns away from a spoonful of non-preferred food, the adult just keeps presenting the food. Ignoring also includes tuning out the child's verbal demands.
We'll go into some specific examples next time.