In special education, and education in general, we are constantly told what to teach. We have state standards we must adhere to, goals outlined in various curricula, and of course the skills and milestones we must measure during our formal assessments. All of these guidelines are valuable for us as teachers. They provide us with a framework for teaching, assist us in developing goals and objectives, allow us to assess strengths and needs, and help us to measure progress. But there is so much more to teaching than that! There is an element of clinical judgment involved in education that cannot be found in any manual. We should not teach something because it is part of a curriculum or because it is measured in an assessment--we should teach something because it will improve our students' quality of life. In the field of Applied Behavior Analysis (ABA), we focus on modifying socially-significant behaviors. In other words, behavior that impacts an individual's daily life and functioning in the world. Put simply, we must remember to teach what actually matters.
It is important to begin by pointing out that what matters may vary from person to person and over time. We must determine what matters for each student by examining his/her current skill set, interests, relationships, environments, and daily routines.
Current Skill Set: Regarding skill set, we must ask ourselves what the person is currently able to do--this can help us to identify areas of strength and need. This also helps us to determine a logical sequence for instruction, scaffolding our students' learning. One of the first things I assess is if and how a child is getting his/her basic needs met. How is the child communicating what he wants or needs, what he does not want or need, how he feels, etc.? Does the child attend to or interact with other people? These are some, but not all, of key things I consider when assessing current skill set. We must ensure that we are teaching prerequisite skills (such as the ones listed above) before addressing more advanced skills (this sounds like common sense, but is actually a common mistake!) We must also consider the importance of skills in a person's daily life. If a person is lacking skills that affect his or her day-to-day functioning and independence, shouldn't we focus on these skills first? Ask yourself: is it important to teach a child to identify shapes or write letters if he's not able to request the bathroom or other desired objects, transition between activities independently, put on his shoes, or play with other children during recess? In the grand scheme of things, which skills are more important? For the record, I have seen these types of situations more times than I can possibly count! Sure, identifying shapes and writing letters are important in their own way, but probably not the skills that we should be focusing on for that child at that particular time. We must also consider what skills are truly relevant. Is it important for a child in New York City to identify farm animals (which he/she probably rarely sees) or to identify animals (e.g. pigeon, mouse, dog), objects (e.g. crayon, cup, car), and people (e.g. mom, dad, teacher, classmates) that are actually a part of his/her daily life? These are all factors that we must consider and that far too may therapists overlook!
Interests: It is also crucial that we evaluate a person's likes, dislikes, and interests. Each person is, of course, a unique individual! As much as possible, our instruction should be related to a student's interests. This will help increase our students' motivation to learn and will make our instruction more meaningful and relevant. If, for instance, a student is interested in cars, let's try to incorporate that into our instruction. With a little creativity, countless skills can be addressed through a child's interests! We can work on communication skills by having the child request the cars (i.e. manding), we can work on intraverbal skills such as "ready, set, go!", we can work on colors and shapes (e.g. wheels are circles), we can teach imitation skills (e.g. copying crashing cars together), following simple instructions (e.g. "push the car to me!"), social interaction and turn-taking (e.g. pushing car back and forth), prepositions (e.g. over the bridge, under the bridge), the list could go on and on! I'm sure you get the point! A little creativity can go a long way! Then, of course, we can also work to expand a person's interests based on those that already exist.
Relationships: Another key element to consider are the relationships in which our students are involved. Who are the important people in this student's life (e.g. parents, siblings, friends, babysitters, teachers, neighbors)? How does he/she interact with those people? Does the student have pets? Are there cultural norms that affect the relationships in a child's life? Family interviews and collaboration can be extremely helpful in gaining this information. Understanding the relationships in a student's life, and how he/she behaves in those relationships, can give us valuable information. One of our goals as special educators should always be to help foster healthy and meaningful relationships for our students. When working with learners on the autism spectrum in particular, the area of social-emotional development is especially important, as deficits in this area are part of the diagnostic criteria. Supporting relationship development should be a key part of any early childhood instruction, especially for students with autism. (And yes, this should be a key element in ABA therapy! Relationship building is not limited only to the fields of Floortime or RDI! Anyone who thinks so--both within and outside of the field of ABA--is simply misinformed.) Gathering information about a child's relationships can help us to determine areas of need and identify meaningful social goals. Interactions with other people are a key part of all of our daily lives and play a major role in quality of life! We must not overlook this crucial area of development!
Environments: Most people encounter multiple environments within a single day. Many of our students must transition between several settings, potentially including home, bus, school, after school program, grocery store, and more! Again, the environments a child encounters may also be culturally-linked. Each of these environments may come with a unique set of expectations and may require unique skill sets. Let's explore the example of the grocery store. Some common expectations within a grocery store are that we walk through the aisles (as opposed to crawling or running, for instance), that we pay for our food before opening or consuming it, that we respect the personal space of other shoppers, and that we stand in line (just to name a few!) This requires that our students not only understand the expectations of that particular environment but also have the skill set to fulfill them. When considering learners on the autism spectrum, a concept such as personal space may be challenging. What does this mean? When does it apply? Who requires personal space and who does not? How much space is enough space? As special educators, these are all things we can work to teach, assuming they are important for our students and their families. Understanding the various environments a student encounters can help us to identify skills and goals that are relevant to the child's life and that set him/her up for success.
Daily Routines: Similar to environments, it is also important to understand the daily routines in which a student participates. Keep in mind that this too may be related to a family's culture. We want our students to be able to function as successfully and independently as possible in their daily lives. In order to achieve this goal, we must have an understanding of what their daily lives look like (of course relationships and environments are also a part of this!) When we know the daily routines a child in which a child is expected to partake (e.g. tooth brushing, dinner time, bath time), we can then assess areas of strength and need within those routines. If tooth brushing or mealtimes are a challenge for the child and family, then those routines should be a part of our instruction. It is important that we be responsive to the specific needs of each child and family. Daily routines can also help us to promote generalization and increase teaching opportunities. For example, if a student is learning to match identical objects, then perhaps he/she can help parents when unloading the dishwasher (e.g. matching identical utensils in drawer) or doing the laundry (e.g. matching identical socks). This makes skill instruction real and relevant. When we have knowledge of a family's daily routines, we can better understand what skills are important to teach, as well as provide guidance for how to promote natural learning opportunities.
Considering all of these factors can help us to determine what is really important for each of our learners. Remember that what is important for one learner may be different than what is important for another! After all, it is highly unlikely that any two students will have identical skill sets, interests, relationships, environments, and daily routines! We must also remember to consider the entire family unit and address goals that are important to the family as a whole. Education, especially special education, is not one-size-fits-all! It makes me want to cringe when I see that every student in a classroom has the exact same programming in place, or when I see a therapist arbitrarily introduce a new program or target just because it is next on a list. This is not how we should make instructional decisions! When deciding what to teach and when to teach it, we must always take a step back and assess what is important at that time. Are we teaching skills that will positively impact a person's life? Are we teaching skills that are pivotal or prerequisite to other key skills? Are we effectively prioritizing our instruction? Are we showing sensitivity to a child's family dynamic and culture? Are we actively listening to the family's needs and goals? If something is challenging for a child, are we addressing or or avoiding it? Are we helping ourselves or are we helping our students? These are all important questions that we as educators must ask ourselves. Through this type of self-reflection we can shape our instruction and teach what really matters.
Considering all of these factors can help us to determine what is really important for each of our learners. Remember that what is important for one learner may be different than what is important for another! After all, it is highly unlikely that any two students will have identical skill sets, interests, relationships, environments, and daily routines! We must also remember to consider the entire family unit and address goals that are important to the family as a whole. Education, especially special education, is not one-size-fits-all! It makes me want to cringe when I see that every student in a classroom has the exact same programming in place, or when I see a therapist arbitrarily introduce a new program or target just because it is next on a list. This is not how we should make instructional decisions! When deciding what to teach and when to teach it, we must always take a step back and assess what is important at that time. Are we teaching skills that will positively impact a person's life? Are we teaching skills that are pivotal or prerequisite to other key skills? Are we effectively prioritizing our instruction? Are we showing sensitivity to a child's family dynamic and culture? Are we actively listening to the family's needs and goals? If something is challenging for a child, are we addressing or or avoiding it? Are we helping ourselves or are we helping our students? These are all important questions that we as educators must ask ourselves. Through this type of self-reflection we can shape our instruction and teach what really matters.
14 comments:
I always enjoy reading your posts because you like to talk about the bigger picture. I have just recently been introduced to RDI but the ABA world doesnt consider it to be an empirically validated method of treatment for autism. As ABA professionals we are told we must use evidence based best practices but I feel that this may work against the childs treatment needs at times.
Research is so specific to one case study or a sample of people, making it dificult to generalize the findings and determine application of the findings. What is your take on research and the need for empirically validated methods of treatment for autism?
Tara,
Research does not have to be hamstrung by narrow design or measurement parameters. If you can observe the behavior,count it, record it and replicate it, you have data that is research. Every time that you have a client attempt a task and you count and record the attempt, you are replicating the experiment. Day after day of improved results denote the trend the behavior is taking. If you know what "normal" looks like and you have your client learn and practice the behavior to some "normal" range, you have an acceptable applied treatment. Cut yourself a little slack and don't limit yourself to the traditional aba research design.
HI Tara and Michael--
Thank you for starting this discussion! Michael read my mind on this one. I think that, in general, we should try to utilize methods that are supported by a broad base of formal research. However, as Michael has noted, you can also conduct your own informal research. Prior to implementing a new strategy/support/intervention, begin by developing a systematic method for recording data and measuring progress. Once you have decided how you will record data, I recommend taking at least a few days of baseline data. Then, begin your intervention, continuing to record consistent data. If you analyze this data and compare it to baseline to determine the effectiveness of your intervention, as far as I'm concerned, you're using an "evidence-based approach". The evidence is in your own data. Unfortunately, it sometimes takes the formal research a little time to catch up. Now, to be clear, I am not saying to throw formal research out the window--I 100% support using research-based approaches. But, what is most important to me is seeing my students progress and having the data to prove it. If I think that a strategy is ethically sound and may benefit one of my students, I will be open to trying it, while collecting and analyzing data to determine its effectiveness.
Ashley,
Teachers should teach what matters. Their decisions about what matters should be reflected in the needs of their students. The first order of business is to help the student become a literate person. Basic reading, math, spelling, writing. reasoning etc.
Unless you do that, the rest of the journey is all uphill and plagued with problems.
This year 35% of First Grade students will leave that grade not being able to read. 85% of those children will never become readers. That is why we consistently have had a 25% illiteracy rate across North America despite increased spending, despite A Nation of Readers, No Child Left Behind and a host of other interventions and notions.
Decisions about how to make a student literate should be based on the research on basic skills. That would mean that the teacher and his or her trainer would have taken note of the largest, longest running, comparative, most expensive study ever done in education.
Teachers do not even know with name of that study, let alone anything about the data on 16 different educational models that were involved. I know that because I have presented to thousands of teachers during my career and when I ask them what the "Follow Through Study was, the only ones who respond are the few who have read my first book.
Teachers should be delivering effective instruction, not creating it. They usually have no training or expertise in instructional design. They have no field-testing capacity unless they choose to use their students as guinea pigs.
We do not expect jet pilots to maintain their aircraft. We do not expect doctors top set up operating theaters. We expect them to deliver a specific service which is supported by other professionals. Why should we expect teachers to create, test, deliver, evaluate and report on the design and implementation of course work, especially when we already have a 2.2 billion dollar, 20-year study that gives us the materials to use?
For in-depth details, check out some of my blogs at www.maloneymethod.com. I have been using the effective methods of the Follow Through research to teach 100,000 students to become literate. I even went so far as to integrate them into a sinlge system, put them into a series of books and offer them to teachers and parents. Maybe I can help you.
Michael, I have to disagree with you that teaching literacy skills are the first and/or more important skills for us to teach. Many students come to us lacking the skills that are prerequisite to literacy skills. I have also met many students who do have some early literacy skills mastered, but who are missing other skills that are vitally important to their every day lives and functioning. For instance, I once had a student enter my classroom who was able to label letters, but not able to communicate his basic wants and needs. He also was 9 years old and not toilet trained, although he presented with many potential signs of toilet training readiness. (This is just a small glimpse of his skill set and needs, obviously). My point in sharing this information is that here is a child who had been taught some early literacy skills, but who was lacking other skills that I think are more important to his daily life. As far as I am concerned, reading is not very important if you cannot communicate basic wants and needs to those around you. This is not to say that teaching literacy skills is unimportant--I do not think any teacher would argue that! It is simply to say that different students have different needs at different times, and those needs must be taken into account in determining what is important to teach at that time.
I also agree with you that we should be utilizing approaches that have a large research base. However, there are fields/approaches such as RDI (as Tara mentioned) or sensory integration that are currently lacking a large research base. My response regarding the use of research-based approaches is only to say that I do not think we should necessarily disregard methodologies simply because the research has not caught up.
Tara, I also have received training in RDI, and have at times incorporated elements of that approach into my instruction when I believed that they were behaviorally-sound (i.e. consistent with the principles of ABA) and would benefit a student. (For the record, I am not by any means an RDI expert--I have received introductory training.) I think it is important for educators to find a balance between utilizing research-based procedures and also remaining open-minded and creative, within the parameters of what we know is evidence-based. So, if I were incorporating strategies I gained through RDI training into my instruction, I would do so by applying my knowledge of Applied Behavior Analysis. This means that I would operationally define the target behavior I was aiming to address, record baseline data, systematically and consistently implement the new strategy, and continue to record data through intervention. I would then analyze my data on the target behavior to determine if the intervention was effective. In this way, you are able to implement elements of approaches such as RDI, while remaining true to empirically-based behavioral principles. I hope that makes sense!
Ashley I just want to thank you for all of these insights. I couldn't agree with you more! I only wish that the teachers and ABA providers who need to learn and implement all of these sound principles were exposed to writings like yours. The problem is that there are too many who just want to do whatever is easiest for them and won't even go out of their way to learn how to better do their jobs. And one very other important point. Parents. They are mostly responsible for social skills deficits. Like many teachers many parents just don't go the extra mile. Even the best teachers can only go so far. How can you help toilet train a child when the parents aren't able to work with their own child at home? We need parental support in order to help a child archive even the simplest goals.
Great post Ashley! I do feel that ‘what matters’ can be a really sticky topic – I’ve seen many situations where what matters to the family is not a priority to the therapeutic team and vice versa (and times when these goals aren’t priorities for the child/client!). It’s so important for there to be dialogue and opportunities for compromise, especially in the long ASD journey…
I wanted to make a comment if I may. I think that Tara’s post is an important one. At the root of questions concerning ‘what counts’ as (empirical) research, quantitative randomized control trials have long been hailed the gold standard. But qualitative, interpretive approaches to research (including single case studies), are gaining momentum, calling for broader definitions of rigor and quality criteria (i.e. generalizability, validity, etc). Just as every individual with ASD is unique, so are his/her lived experiences. What we can learn from ‘what works for many’ is useful, but no two individuals are exactly alike so even RCTs have their limits. It’s important not to overlook the fruitfulness of research that may not be traditionally accepted as “empirical” (and note, qualitative studies must be rigorous also, but should not be held against standards that are philosophically distinct). I haven’t looked into the research supporting RDI, but have encountered certain therapeutic techniques used with kids with ASD (supported by "empirical" research I'm sure) that make my stomach turn, eliciting a gut feeling that is, for me, uncomfortable. There might be all the research in the world to support their efficacy for other children, but that doesn’t erase how these techniques make me feel, nor my conviction that I do not want these methods to be used on my son. In my opinion, I think it’s useful for therapists to be exposed to/educated on a range of therapeutic methods (that are supported by ‘rigorous’ research, both qualitative and quantitative) and to take note of what is fruitful, practical from each. It is the child/family, the context of care and the well-informed clinical reasoning of the therapist that should together guide how much of each approach should be used in the design and implementation of the therapeutic plan (and in some cases, more RDI (or floortime, or ESDM, etc.) than ABA may be the best fit)…
Just my 2 cents☺
Hi MamaAnna ☺
Thank you for reading and sharing your thoughts! I agree with you that we can gain important information from a variety of research. Single case studies can be very valuable and, in fact, do make up a large portion of research in the field of ABA. As you mentioned, every individual is exactly that—an individual. You have probably heard the saying, “if you have met one person with autism, then you have met one person with autism.” This is true of all people, of course, not only individuals with autism! Anyway, education, particularly special education, should be based on this premise. All students have different strengths, needs, and interests and, therefore, should not be taught in exactly the same way. Special education is supposed to be specialized! Because every child is unique, the support or intervention we offer to each child will be different. It is unlikely that you will see identical Behavior Intervention Plans, for instance, being implemented with multiple students because it is unlikely that multiple students will have the exact same needs and skills. This is why we see a lot of single case study designs in the field of ABA—in many cases the research must use a single-case design. My point here is that I agree with you! There is most certainly value in various types of research, including single case study designs.
I also agree that professionals must keep an open mind and constantly work to be informed of the various methodologies and strategies available to us as educators. In my opinion, educators/therapists should teach what matters and do what works (within the realms of ethical behavior, of course!) Evidence, whether it is the evidence from our data on that particular student, evidence from single-case studies, or evidence from a larger participant pool, helps us to determine what works. It helps us to determine what works for most (which can give us information about what may/is likely to work for particular individuals) and it helps us to determine if what we are currently doing is working (the beauty of data). Of course there is no one-size-fits-all! There is a wealth of valuable information our there and I believe that a truly effective therapist will be able to incorporate various strategies into his or her practice.
To be continued...
(Continued)
As far as I am concerned, what people choose to call a therapy/methodology/intervention is relatively unimportant in terms of practice. Whether we call it ABA, Floortime, or RDI (or anything else!) does not really matter to me as long as it is resulting in meaningful progress for the child and family. Very often I think that professionals get too caught up in drawing lines in the sand. Rather than pitting various approaches against one another, I think that professionals from different camps can learn from one another and incorporate strengths from each approach into their practice. I also believe that I can incorporate elements of other approaches while still remaining true to ABA. I have been trained in RDI and Floortime and have learned from my education in those approaches and work to incorporate it into my teaching—this does not dilute my use of ABA principles. I should also note that when I observe RDI and Floortime professionals teaching effectively, I can identify their use of behavioral principles (even though the use of those principles is probably unintentional, and/or they call those principles by different names). At the end of the day, ABA is simply the science of modifying behavior. ABA is about identifying the principles of how people/animals/plants learn and behave, then applying those principles to modify socially-significant behavior. Unfortunately, there are a great many misconceptions and misrepresentations of what ABA is floating around out there! (For more information on this topic, you may want to look at our “What is ABA?” and “Play is Not a Four Letter Word” posts). Anyway, no matter what we call an approach, if it results in behavioral change, then behavioral principles are at work (whether or not people like to admit it!). But that’s a completely different can of worms! I will save that for a future blog post ☺
Thank you again for following and for your insightful comment! I hope that we will continue to hear from you!
I agree completely with your last paragraph about individualized teaching targets!
Leanne Page, BCBA
Www.bcbatoday.com
Great comment Ashley! I love me some healthy, constructive dialogue☺
First, I agree with your perspective (particularly your point that drawing from other methodologies makes a stronger therapist, and that doing so does not necessarily need to dilute your ABA perspective). And I honestly do see the power and potential in ABA as an effective therapy!
I guess what can frustrate me is how the definition of “science” (who gets to decide what that is?) can have practical implications that can impact how therapy is implemented, often on systemic levels that never get questioned or challenged. For example, in EI, children on the spectrum are often offered many hours of ABA as a first line of treatment. But parents (often scared out of their wits, new to the world of autism, and grateful to take whatever is available) aren’t offered other options, or educated on what these might be. And let’s be real, as a parent to a child with unique needs, who has the time to really do their research? It seems that because ABA is “scientifically” proven to be effective, other methodologies can get overlooked because their research is not considered as comprehensive and/or rigorous. This can result in an insular perspective and approach to care. It raises the question of why there is no conversation to begin with – why aren’t parents offered 15 hours of ABA and 5 hours of, for example, floortime (given that there are therapists, theorists and educators out there who believe these to be distinct and in different philosophical camps)? In an ideal world, I would have loved to have dabbled in a few different approaches to first see which my son responded to and modified his mandate at that point…at any point, really. My son is an entirely different child now than he was several months ago - should therapies change to reflect that? Are there therapies that are more effective when a child has reached a certain developmental point? (I’m not asking for answers, just talking out loud☺)
Paradigms about ‘what is best’ change when new discoveries about efficacy are made (what was used to treat autism 30 years ago is without doubt different than the face of therapy today). It’s only with new, emerging knowledge and the wiliness to first consider alternative understandings to the truths we all (sometimes unwittingly) come to believe, that any real change can happen, that worldviews can be uprooted and turned on their sides. I am weary about closing doors on emerging methodologies that may be a good fit for my son without, at minimum, learning more about them.
Don’t get me wrong, I am grateful for every minute of service that my son receives (particularly because I‘m from a country where families can wait YEARS for treatment). To no end, I am grateful. And I question every approach I come across (from ABA to floortime to specialized diets to DAN doctors, homeopathy, etc.). In the end, it’s hard for me to accept that I will never know if I made the right therapeutic choices for my son. I am in a crippled state of continuously asking myself if he’s doing too much therapy, not enough therapy, the right kind of therapy, if he has the best therapists, and if I, as his mother and only advocate, have done enough to help my sweet baby out. It’s exhausting.
In the end, I want therapists like you☺, therapists that aren’t afraid to learn, therapists who keep their finger on the pulse of what is new in the world of ASD, and seek to broaden their horizons for the sake of learning and growing as a practitioner. I want therapists that put the child and his or her progress first, therapists that don’t try to stick my son into a square box when he is so much more than that. And, if I get three wishes, I want a fairy godmother to wave her magic wand and say ‘This is the answer mama, do THIS’. But I don’t feel that one ‘this’ exists, particularly for all children on the spectrum. And as parents, I know that we ultimately have no choice than just do the best we can, given what we have. I just never want to forget that what my family is “given” may not be the “right fit” for my beautiful boy☺
This conversation would be better with wine...:)
PS. I love our ABA therapists. And so does my son!
I love your detailed commentary and hope that your perspective and participation in this blog will benefit other parents! Our blog started as a forum to "get the words out" and this is exactly the type of dialog we hoped for! The bottom line is that none of us have all the answers. None of us know what's "right" all the time. But, by acknowledging that, by sharing our thoughts, and by starting conversations, I think we can help each other along. Change and progress often begin with questioning!
So, I applaud you for questioning and challenging all services and therapists working with your family! I think that is exactly what you should be doing (and I think any qualified therapist will respect you for it). I do not ever recommend blindly accepting a form of therapy just because someone calls it science or says that it is research-based. But, I do think that these things should matter (after all, what is the point of research if we do not value it?). However, as you mentioned, what we define as "best practices" or as "ethical" have changed and will likely continue to change over time. There is a balancing act between valuing the research, trusting your gut and your instincts, and recognizing that there is always room to learn and grow. Sometimes if something does not feel easy, then that is a sign that it is not right. Other times, what is right is not what is easy. I imagine that it can be overwhelming to navigate an entirely new world of special education/autism/therapies! How do you know what is best for your child? What do you believe when different professionals tell you different things? Is something uncomfortable because it is new or because it is wrong? Who can you trust?
There are no easy answers to these questions! What I recommend is that you trust yourself—trust your own data and research. Do not believe in a particular therapy because someone else tells you that you should. Believe in a particular form of therapy because you see it working for your child. As a professional, I whole-heartedly believe in the power of ABA to change lives. I would not choose to work in this field if I believed otherwise! But, just as I am recommending to you, I do not believe in ABA because someone else told me to. I believe in ABA because I have seen that it works and I have seen it make meaningful change for my students (regardless of age, skill level, diagnosis). I hope that you will see your own child make the same growth and progress! Of course I believe that if you are getting truly high-quality ABA services, you will see this progress. But clearly I am biased ☺ My advice is just to look for progress and determine what you believe in and what therapy(ies) work best for your child based on that.
It’s hard to not have all the answers and to not have a fairy godmother who can wave her magic wand! But, what your son clearly does have is a dedicated, intelligent, and loving mother. If you ask me, that’s better than any magic wand! Keep doing what you’re doing, Mama Anna! And, again, thank you for your contributions!
You are much too generous Ashley☺ But thank you for your kind words of support – you are absolutely right, I need to (learn to) trust myself. And to get comfortable to having more questions than answers for a long time.
I recently met some mommy friends further along the process than I am in the ASD experience - they give me a lot of hope for brighter days ahead. And they have a lot of faith in ABA☺
Look forward to your future posts!
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