How Can I Tell If My ABA/EIBT Program is Any Good? (Part One)

Here are some warn signs that your child’s program may not be as effective as it should be:

Recommended service levels differ from research-based levels.

Familiarize yourself with the scientific research on EIBT. If the scientific evidence recommends 30-40 hours per week for someone your child’s age, while your agency recommends 10…


The most experienced person you see on a weekly basis has less than 12 months of experience.

Effective EIBT programs involve a curriculum of 100’s of programs delivered over the course of 2-3 years. The person responsible for the weekly management of your child’s team needs years of experience.


No focus on rapid language acquisition.

Verbal communication skills are a critical prerequisite for preschool integration and peer socialization.



Dozens (or more) of programs are concurrently on acquisition, or dozens of programs are on maintenance.


To many concurrent programs slows down children’s acquisition rates, and makes it almost impossible for supervisors to effectively manage tutors’ implementation of each program (This is usually the product of inexperienced supervisors).



Your staff does not have instructional control of your child.


If your staff spends 50% of their time trying to coax, persuade, or sweet-talk your child into working, your 40-hour-per-week program is now a 20-hour-per-week program. EIBT is about trying to help children catch up with their neurotypical peers. The first skill they need to catch up on is cooperation and following instructions.

Finding Play Dates - Approaching Other Families

For many families, finding peers for play dates turns out to be one of the most challenging aspects of maintaining an EIBT program. The process often involves approaching other parents that you don't know at all, and having to explain a fairly unusual set of circumstances. Sabrina Pedeupe, one of our parents, wrote a letter that we think is very eloquent and effective for these situations:

January 26, 2009

Dear Parents of Eric:

Our son Jason goes to preschool with Eric at KinderCare on Mondays, Wednesdays and Fridays from 9:00 a.m. to 12:00 p.m. We have a special request to ask you, but first let us tell you a bit about our son Jason.

Jason is 5 years old and just before he was 2 years old, he was diagnosed with autism. Jason has received in-home therapy services from a team of consultants and tutors ever since. Tutors accompany Jason to preschool as aides to help Jason as he transitions from activity to activity and intervene where necessary. One of the most important components of his program is the socialization skills he is learning and one of the best ways he can learn this is by interacting as much as possible with other normally developing children. Jason gets a lot of social interaction from the 3 mornings a week he attends school, but we are interested in arranging to have in-home play date sessions as well. Where our consultants have seen the greatest results with a child like Jason is if they can have these play dates with children they attend school with.

This is the special request we have of you. Two of the tutors who accompany Jason to school, Shea and Nicole, have observed Eric interacting well with Jason and while we understand your child may attend the full time day care program at KinderCare and therefore you are full-time working parents as well, we wondered if there is any way we can arrange to have a play date session with your child at our home once a week. Jason’s tutor would facilitate the play date (and let me tell you, your child would very much look forward to these weekly play dates at our house as the tutors come up with all kinds of fun activities for our children to do each week).

If you are interested, please contact me at my cell phone number 555-4454 to arrange a time where we can all meet and then discuss a time that would work for Eric to come for weekly 30 to 45-minute play date sessions. The tutors can be somewhat flexible as we come up with a time that works best for all of us.

Thank you for your time and we look forward to hearing from you soon.

Sincerely,

Sabrina

Jason’s Mom

Should Tutors Engage Children During Breaks Between Programs?

Sometimes yes, sometimes no.

Here is a general rule: Breaks should be a pleasant experience for the child.

Early in programming, when children are working on basic receptive and expressive language skills and have very limited repertoires of play skills, it generally works best to let kids do whatever they want on break. This includes stimming or just doing nothing. Why not try to encourage appropriate play skills? Because, most kids at this level will perceive these interactions as work, not fun.

The whole point of teaching discretely is to make the learning situation as clear, successful and rewarding as possible. Adding a barrage of verbal requests for relatively complex and subtle play and social skills during break time will sabotage the teaching session, and essentially make “break” time more demanding than the supposed “work” time.

However, it is entirely appropriate for tutors to engage children during break time, if these interactions are educationally or clinically valuable, and are enjoyable for the child.

Here’s a rule of thumb: If a child is less responsive to your instructions and requests during break time than during work time, you aren’t really giving the child much of a break.

Where does the recommendation for 40 hours per week of behavioral intervention come from?

In 1987, Ivar Lovaas, at UCLA, published the first study to suggest that children with autism could make significant gains with treatment. A treatment group of nineteen children received 40 hours per week of EIBT (including discrete-trial instruction; aided integration into regular preschools and kindergartens; and structured, supervised play dates with neurotypical peers). Nine of these children (47%) developed IQ’s in the average range and were able to attend regular education classrooms independently. When independently assessed at an average age of 11 years (McEachin, Smith and Lovaas, 1993), eight of these children had maintained their gains, and were no longer diagnosed with any autism-spectrum disorders. This study also included a control group of nineteen children who received only 10 hours per week of behavioral intervention. No children in this group developed average IQ’s, or attended regular education placements.

Dramatic claims about new autism treatments are made every year. However, Lovaas’ results received tremendous attention, in large part because they were from a renowned scientist whose previous two decades of findings had been successfully replicated by other researchers.

In 2005, Glen Sallows and Jane Howard published two of the most significant replications of Lovass’ 1987 findings.

Sallows and his colleagues provided children with 31-38 hours per week of EIBT services. When assessed at age seven, 48% of these children demonstrated IQs’ in the average range, and were attending regular education placements.

Howard and her colleagues compared EIBT to special education programs. Twenty-nine children received EIBT, 16 children attended a 30-hour-per week special education program, and 16 children attended a 15-hour-per-week special education program. Children in the EIBT group demonstrated an average IQ increase of 31 points, while children in the two special education program demonstrated no statistically significant improvements in IQ scores. Despite receiving twice as many hours of intervention, the 30 hour-per-week special education group did no better than the 15-hour-per-week special education group on any measure of treatment outcome.

For further information about these studies, and information about the scientific validity of a broad range of popular autism treatments, visit the Association for Science in Autism Treatment’s web site at: www.asatonline.org

References

Howard, J.S., Sparkman, C.R., Cohen, H.G., Green, G., Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-83

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral interventions. American Journal of Mental Retardation, 97, 359-372.

Sallows, G.O. & Graupner, T.D. (2005). Intensive behavioral treatment for children with autism: four-year outcome and predictors. American Journal on Mental Retardation, 110, 417-38.

What kind of data is appropriate to expect classroom aides to take on an ongoing basis?

My son is fully included in a first grade class, and has a full-time aide provided by the school district. The teacher and aide always say things are going fine, and they send home a notebook every day that is supposed to let me know what is going on. When I have asked for some kind of data at our IEP, I was told that it is not possible for the teacher or aide to take any ongoing data on a regular basis. I really want to know what is going on. What should I ask for?

Momentary time sampling is any easy way for classroom aides or teachers to take data on whether or not a student is independently on task. With momentary time sampling, aides can even collect data while they are working directly with other students.

For example, an aide might collect data on a particular student for one hour per day, at five minute intervals. Ideally, the data collector carries a vibrating timer (http://www.bindependent.com/cgi-bin/shopper.cgi?preadd=action&key=gct100). When the timer vibrates, the collector records whether or not the child is on task, at that moment. The aide then records the behavior on either a counter (http://www.tallycounterstore.com/ ) or a data sheet. At the end of the hour, you have 12 data points, that took less than 30 seconds to collect.

This data is not terribly detailed, but it is significant, and it allows you to track growth or deterioration. Knowing that a child is independently on task 90% to 100% of the time tells you a lot. Alternatively, if you see your child’s percentages decreasing, you know additional help may be required.

Data should be collected during the times of day when your child faces his/her greatest academic or social challenges. In addition to tracking on-task behavior, you may take data on appropriate play or social engagement during recess. Which observation interval you choose (e.g., once every five minutes vs. once every two minutes) will vary based on activities. For example, a two-minute interval between observations would be more appropriate than a five-minute interval for tracking engagement in appropriate play during a 10-minute recess.

Do teachers’ unions really prohibit non-public agencies from serving as children’s aides in public schools?

Some special education administrators will initially mention this as being a reason why they cannot authorize non-public agency support for a child. It is true that some districts' aides are in labor unions. However, in the past 25 years, working with at least 40 different school districts, the union issue has never affected our ability to serve children in public schools. The issue generally disappears if you ask for specific details about the exact constraints that districts are working under.

Should We Have 30 Programs on Maintenance?

My daughter’s program currently has 11 programs on acquisition, and over 30 programs on maintenance. We end up spending more time reviewing old programs to make sure my daughter doesn’t lose them than teaching new ones. Is this normal?

No. You should probably have no more than 3-5 programs on maintenance at any one time. You should definitely not have to regularly practice all old programs. Your problem is most likely due to poor sequencing in the programming of your daughter’s case.

When programming is done correctly, each new skill is only introduced if it will be used relatively soon in a higher level program. Skills that are not subsequently used in more advanced programs will typically be forgotten (though there is a critical exception to this that we will get to in a minute).

Studying math offers a good analogy to this situation. Each skill taught is used in the next, more complex skill. Counting skills are used in addition and subtraction. Addition and subtraction is used in multiplication. Multiplication is used in division. Multiplication and division are used in algebra. Algebra is used in geometry. Geometry is used in trigonometry, and so on. Children taking algebra don’t have to continually review multiplication facts, because multiplication skills are practiced in the course of doing algebra.

EIBT programming should be conducted the same way. Verbal imitation skills are used to expressively label objects and actions. Object and action labels are used to speak in complete sentences. Complete sentences are used to describe previous experiences. Descriptions of previous experiences are used to carry on conversations (we left a lot of additional skills out of this chain).

Introducing pronouns such as “I,” “you,” “he,” and “she,” too early is a common mistake. Because they are easy to say, they are often introduced before children are able to speak in complete sentences. But guess what? They don’t really have any communicative value unless they are used in sentences. Consequently, children lose them pretty quickly.

Effective EIBT requires the rapid acquisition of hundreds of skills over the course of 2-4 years. This rapid acquisition is sabotaged if programs are not sequenced appropriately.

What’s that exception we mentioned earlier? It’s the real world. It’s fine to introduce a new skill that will not be used in subsequent programming, if the skill will be used in a real-world setting. For example, we may teach a child to receptively label her own printed name, because in preschool, she has to sit on the carpet square that has her name on it.