Eye Contact: ABA, DTT, and RDI

Eye contact for children with autism is always a concern. Well, not always, but usually. I do work with one little boy that appears to love looking people in the eyes and teaching this skill took all of four days when he was two-years old. For the rest of our kids, it can be very challenging.

Different orientations go about teaching eye contact in various ways. While I've voiced my opinion on RDI in the past, I will discuss it as additional strategies here. But in summary of previous posts, behavior is behavior. If you want to teach a new behavior, like eye contact, it WILL be taught using behavioral principles, whether you are comfortable calling it that or not. RDI provides us with strategies that modify the environment and provide creative ways to elicit eye contact, but eventually that eye contact is reinforced (ABA) shaped (ABA) given differentiated reinforcement depending on quality of eye contact (ABA) elicited by modifying the environment (ABA) elicited by using a discriminative stimulus (ABA). It is all ABA.

Where ABA has fallen short on the eye contact issue, in my humble opinion, is by not exploring more creative methods to elicit eye contact, and to make giving eye contact important. I'll go over some traditional methods that have been used to elicit eye contact, and then how some RDI ideas can be incorporated into an ABA program (since they are all based on behavior principles anyway.)

DTT - Discrete Trial Instruction/Training programs tend to teach eye contact in very contrived situations. A child will sit opposite a therapist, and given the directive "look at me" or the child's name will be called. Depending on the level of the child, a reinforcer will be held at the teacher's eye to help the child understand where they should look. Contingent upon eye contact, the child will immediately receive the reinforcer, possibly providing a token, and providing praise. It make look like this.
Teacher: "Look at me" (while holding an M&M at her eye)
Child: Looks at M&M and glances at teachers eye
Teacher: "Excellent looking" and provides M&M immediately.

This is an effective method and will teach a child to look at someone at the eyes when a demand is placed, when their name is called, when a reinforcer is present. However it doesn't always generalize. Some children that I work with look at me beautifully in the eyes, but when their grandmother says hello, they are looking anywhere but her eyes. Why? Maybe because she is not holding an M&M or a reinforcer in her hand, so the MO (motivating operation) to look in her eyes is not there. The child has not generalized that looking at people in the eyes is reinforcing.

ABA - Applied behavior analysis will of course incorporate the strategies used above, slowly fading out the item at the eye, just like DTT, until the child looks at the teacher's/parent's eyes without have a reinforcer within eye sight. Other methods are always used. In my programs, I prefer not to demand eye contact, but rather to wait for the child to initiation eye contact and reinforce the spontaneous eye contact. An example of this is the following

Teacher: Holding Elmo toy that two-year-old child with autism clearly wants to play with.
Student: Pulling at the toy, while staring at the toy
Teacher: Teacher looking at child's face, not letting go of the toy
Student: Still pulling at toy
Teacher: Still holding toy....continues to hold on until child glances up at which point the toy is immediately provided with praise and excitement.

This method reinforces spontaneous eye contact as opposed to eye contact that is requested. What ABA therapists do is contrive the environment to elicit eye contact, and reinforcer the eye contact, assuring that future eye contact will occur at higher rates due to the reinforcement.

RDI? I don't think RDI strategies are inconsistent with applied behavior analysis (ABA). What I have learned by attending these seminars is how to be more creative with my children. How to give my a children cool reasons to look at me, give me eye contact and enjoy themselves while doing it. It is these cool creative ideas (reinforcing events) that when used in the environment (modifying the environment) will provide a stimulus (SD) to elicit eye contact (response). (Do you see how it all falls so nicely into behavior principles.

I tried some of these strategies with a child that I work with. RDI talks about doing the unexpected, getting creative, and making kids care about giving eye contact. Now, I don't know if I am making them care about giving eye contact as it isn't something that I can observe, but what I CAN do is note the response, which was fantastic, and it didn't include reinforcing objects, rather reinforcing people (myself). That is one of the core tenets of RDI: to keep objects out of it and build relationships with people, which is quite different from ABA and DTT which rely on tangible reinforcers heavily.

I sat opposite a five-year old child with autism, removed toys and reinforcers out of sight in the environment, I positioned myself in front of him and waited. He didn't look at me, save the occasional glance. When he would glance, I smiled. See below

Child: Glanced
Teacher: Smiled
Child: Glanced again
Teacher: Blew air in his face
Child: Giggled
Teacher: Waited for eye contact again
Child: Gave it much more quickly
Teacher: Pinged child's nose
Child: Giggled, and while maintaining eye contact, blew air in teachers face
Teacher: Giggled, and made a raspberry on his cheek
Child: Giggled, and laughed, and said "blow"
Teacher: Blew air in his face, then by his ear, then on his toes
Child: Giggled, and pinged teacher's nose.

This went on, while maintaining eye contact. This is not an RDI program, this is an ABA therapist, using some of the creativity from RDI, and reinforcing and shaping the eye contact behavior of the child. At the end of this interlude, before he got tired of the game (satiated) I laid down on my back and left him alone. Normally, he would have walked away and found a toy to stim with. This time, that didn't happen. He watched me lay down, walked over to my face, looked at my eyes, giggled, and blew air at my cheek. I had made my eye contact and interaction reinforcing to him, so much, that he was seeking it out.