Well once again, I must apologize for not updating this page on a timely basis. For those who have read below, you will recall how Mason was time trained for urination on the toilet in 2 days. Let’s update things. Within 1-2 weeks, Mason was time trained to 2-3 hours for urination. At this point, we began initiation training. Sight word cards for “I want potty” were placed on the wall of his work area and prior to potty time, Mason was prompted to point to each word and say the phrase. This continued for a few weeks, at which point we stopped prompting the potty. This is a difficult, but necessary step to lead to independent initiation. Mason struggled a bit with some accidents, but began to go to the wall and say “I want potty.” Soon after this, he began to say the phrase independently during trials and go to the bathroom on his own when not in trials. This was quickly generalized to public places and other’s homes. Within 1.5 to 2 months from the initial training, Mason was independently initiating all urinations without any accidents.

Bowel training for ASD children is usually another story. I’ve seen quite a few children urine trained who struggled for months and even up to another year to gain bowel control. Fortunately or unfortunately, depending on how you look at it, we had a major advantage here with Mason. He had always had gastrointestinal problems and had a history of fecal retention characterized by several day durations between bowel movements preceded by distress. Often his mother needed to help him when in distress by encouraging him to push. We began to do this on the toilet as he was no longer in diapers and highly reinforce these prompted bowel movements on the toilet. At this time, we were also beginning to supplement with fiber, probiotica, and mineral oil to assist with more frequent, softer and less painful bowel movements. One day Mason disappeared from the living room and his mother heard him in the bathroom. Thinking he had gone to urinate she followed him in to prompt him with hand washing. To her amazement, Mason had had a bowel movement. Since that time, approximately 2.5 months after the initial urine training, Mason has essentially been independent in toileting with no accidents.

The other exciting development for Mason is his upcoming introduction to a typical preschool setting. After 1 year of intensive ABA/DTT, Mason (4.5 years old) will be attending a typical preschool session 1x/week. If all goes well, he will be increased to 2-3x/week by the fall. Lets all keep our collective fingers crossed for him!

Wow! It's been quite a while since I've updated the site. Sorry to those who have come back to find nothing new. I've actually had quite a few visitors over the past month who have forwarded positive feedback about the concise, tell it like it is style. Over the past month, I've been spending lots of time reading and posting on the various autism lists. My favorite of the lists is the Me-List (the link to the home page is on my ABA links page). Due to my posts on such topics as toilet training, self-stimulatory behavior, and risperdal, I've been deluged with private emails asking for help and have been doing quite of bit of writing, however, it hasn't been here.

Recently, the grandmother of a young child diagnosed with an autistic spectrum disorder posted about the usual propaganda she received from her Sensory Integration biased preschool. She asked about SI as she thought from a layperson perspective that it appeared to be hocus pocus. I posted that I agreed that SI was hocus pocus with no empirical support . I didn't think that stating the fact that SI has essentially no foundation of controlled studies to demonstrate its effectiveness would be a controversial statement on a supposedly ABA list. It's no secret that behavior analysts have little respect for proponents of SI because they are using methods that aren't data based and that proponents of SI despise behavior analysts because they don't understand ABA and because behavior analysts have exposed SI for the hoax that it is. Essentially, several individuals reacted negatively to the post apparently seeing benefit in their children who are receiving SI. Their arguement, however, is essentially flawed.

First, they argue that why not try it and see what happens . The problem with this is without data collection(SI proponents are infamous for their suggestion that the gains are rather global and difficult to operationalize, that is, behaviorally define and measure)too often bias enters into the determination of effect. Participation in this therapy can take time and focus away from proven therapies such as ABA. While many mistakenly interchange the terms ABA and discrete trial teaching and assume that completing the 30-40 hours/week of DTT completes the ABA therapy, in fact DTT is just part of ABA. Besides the 30-40 hours of DTT, children should be involved in generalization of skills learned in DTT, supervised play, and peer modeling with typical peers. A comprehensive ABA program is a full time endeavor with little time for adjunct (not to mention unscientific) therapies.

Second, they suggest that just because controlled studies have not been done doesn't mean that SI is not effective. Wasn't ABA in its infancy untested and didn't people pursue it nonetheless . The problem with this arguement is twofold. First, SI has been around for approximately 28 years. It can hardly be described as an infant and toddler may even be stretching it. Moreover, while there are no well designed studies demonstrating SI to be effective, there are several well controlled studies that do not support its effectiveness for the behaviors of the developmentally disabled (see Behavioral Interventions for Young Children with Autism/Catherine Maurice for a review of the research on SI).

Finally, it is suggested that controlled studies are expensive. This is clearly the weakest arguement . Graduate departments that train occupational therapists have the same academic resources to conduct well designed research as the graduate psychology and education departments that train behavior analysts. The fact is that academic and applied proponents of ABA have done and continue to do the research necessary to validate and refine their methods. The proponents of SI have not.

The real tragedy here is that in the vast majority of areas, Early Intervention is dominated by proponents of Sensory Integration and its empirically related cousin, Play Therapy . While the field has had moderate success in promoting early diagnosis and early intervention, a child so identified will in virtually all cases be offered some combination of occupational therapy, physical therapy, speech therapy, and play therapy, a combination of ineffective or marginally effective interventions for autistic spectrum disorders. Some parents get lucky and are directed in a timely fashion to more effective interventions and are able to effect early intervention. Others sadly get lost in a system seemingly designed to confuse and brainwash. These are the unfortunate parents we meet who are finding out about and pursuing ABA interventions for their children who are already perhaps 4 or 5 years old, essentially having lost the opportunity for effective early intervention. I feel sadly for those parents. I feel contempt for the professionals who continue to ignore the data for purposes of professional pride and turf at the expense of children .

Hope everyone had a nice Thanksgiving and didn't eat too much. I have been corresponding most recently with the mother of a 2 year old boy with autism in New Zealand. Unfortunately, they live on a farm and have little access to appropriate services. They have been flying over a supervisor from Australia every 3 months or so for the past half year and mom has been doing about 25 hours a week of discrete trial teaching herself! I responded to her posting about a difficulty he was having with discrimination of receptive labels. For some reason, the program had been set up with the SD (directive) of "give me the (item)." The problem with this as an SD when a child is first learning discrimination is that the SD for 2 different labels is too similar ("Give me the duck and Give me the bottle"). Three out of the four words in the SD are the same and given the stimulus overselectivity often found in autism, this makes for a possible difficult discrimination. I suggested changing the SD to either "touch (item)" which increases the difference between the SDs or just "(item)" which maximizes the difference in the SDs making the discrimination easier. In addition, I made recommendations for programs such as eye contact, come here, verbal imitation, functional requesting/phrases, and choice making. It has been interesting corresponding with someone half way across the world and I hope that the ideas are employed and successful.

I recently have begun to supervise a home based program for a pair of adorable, 2 year old twin girls. The situation is one in which the children are receiving ABA services from the county where they live (early intervention services), however, the parents are not satisfied with the style of discrete trial teaching that is being employed in their daughter's programs. Some of the parent's concerns are the county team's unwillingness to comply with the parent's preference for the no-no-prompt technique, the priority of play and avoiding tantrums by giving in to task avoidance behaviors, and the lack of interest in implementing basic programs such as eye contact and coming over when called. Moreover, the parents strongly object to the team's interest in teaching alternate communication techniques such as PECS to children who can inconsistently imitate sounds without having attempted typical verbal imitation programs. The parent's have chosen to pay out of pocket to have me supervise a side program for now while they weigh their options. Unfortunately, New York State counties have no mechanism to pay for the services of a certified school psychologist due to extreme lobbying efforts of Ph.D. dominated groups such as the New York State Psychological Association to exclude MA level psychologists from reimbursable home based services. This has lead to a situation where a certified teacher with absolutely no experience with either autistic children or applied behavior analysis can be paid by a county to supervise a child's home based program using a psychology based technique, but a certified school psychologist with both schooling and practical experience with Autism/ABA cannot. The really sad part of this is that there aren't enough Ph.D. level psychologists with either the experience and/or interest to satisfy the demand leaving parents scavenging for qualified program supervisors.

If you haven't already seen it, you might enjoy the interesting writings of the Autism National Committee . Be sure to check out their position paper on the damaging effects of discrete trial teaching and their scathing review of Catherine Maurice's highly informative and inspirational "Let Me Hear Your Voice." You can find the link to their website on my ABA Links page. From their home page, scroll down to their links to their various pages. Go to section 6 (Best practices in early intervention) to access these two pages.

Well its been a while since we had a chance to update things. Don't forget to check out the addition of the Vineland Adaptive Behavior Scales scores for the 2 children receiving intensive, discrete trial teaching. Please click on the menu button "Vineland Scores" above to access this information. Also, check out 2 new links on the "ABA Links" page. The links are to the surgeon general's report recommending the use of applied behavior analysis in the treatment of autism and the New York State Department of Health's treatment recommendations for early intervention for Autism.

I'm still excited from the conference yesterday and seeing O. Ivar Lovaas present for the first time. It was a pleasant departure from the formality of most conferences and presenters. Lovaas was down to earth, humorous, and he clearly loves children. Though his presentation was broad and didn't include much of anything new, I believe there were probably a fair number of parents in the audience that benefited from hearing his matter of fact emphasis on behavior analysis as the treatment choice and intensity of treatment. Privately, after the conference, he suggested to a mother of young twins with autism that the 15 or so hours/week of rather soft ABA they are currently receiving was not going to get the results she is looking for.

The presentations of beginning and intermediate/advanced discrete trial programs were also beneficial for individuals new to discrete trial teaching. I was, however, disappointed to see a lack of attention to pretrial attending for the child working on beginning skills. SDs were presented with the child sometimes displaying sloppy sitting, looking away, and even while engaged in self-stimulatory behaviors. My experience with children is that these behaviors need to be addressed early and routinely as they usually don't clean up on their own.