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Welcome to a forum dedicated to applied behavior analysis. The purpose of this blog is to provide a forum for students, parents and professionals to access information and discuss timely concerns regarding the science of applied behavior analysis in a reader-friendly manner.

I have fallen off the blog recently, mostly due to the completion of my dissertation and spending time with my daughter. As I delve back into the home-based and consultation world, topics to discuss and share with those interested in applied behavior analysis appears endless. I hope to take this blog in a direction of bridging the gap across the various orientations towards working with and teaching children with autism and related disorders...I'm a behavior analyst through and through, but we can do better in various domains that we have been hesitant to discuss in the past. My interests are veering into the realm of self-regulation, problem-solving, relationship development in addition to working with children with substantial interfering behavior. Comments and discussion is both welcome and desired.

Tuesday, February 22, 2011

Relationship Development and ABA using DTT

The world of social and relationship development and ABA appear to always be at odds with each other, with each world poo-pooing the other. I find this unfortunate and want to bridge this gap. It goes without saying that my perspective is behavioral and therefore feel that in order to develop relationships with children that have difficulties in this arena, a behavioral approach must be utilized; however not how it has been in ABA programs in the past. This is a huge topic to undertake so rather than addressing the entire arena of relationship development, I would like to highlight the pitfalls of Discrete Trial Training (DTT) and relationship development.

I'll preface this discussion by saying that I am a strong believer in DTT and that it is incredibly effective at getting skills rammed into our little guys heads so that they can develop fluency with the mundane and save their precious cognitive energy for more taxing behaviors (i.e. problem-solving, conversations, playing, self-regulating). That being said, how DTT is used in most DTT programs seems to damage rather than support relationship development. Take the following example:

A child sits 1:1 with a therapist. The therapist implements multiple programs (verbal imitation, category sorting, labels/tacts, manding/requests) and the child receives praise and reinforcement or corrective feedback for each of these tasks. After the child has completed a set number of tasks, and has earned their time off of the table-work, they get their break, and the teacher steps back to organize her data, give the child a break, and prepare the materials for the next set of targets.

In this scenario, one that is incredibly typical across DTT programs, there is no relationship development. The child complies, gets their reinforcer, enjoys it for a limited amount of time, and then returns to the therapist and work. There are several problems here.

1. During the trials, the teacher moves quickly and rapidly in order to use momentum and establish fluency and quick responding. However playfulness is often sacrificed. The teacher maintains that the reinforcer is motivating enough and the child will complete the tasks and the tasks are paired with rewards and therefore will be positively associated. However, the teacher becomes negatively associated. Interactions with the teaches are work related, and therefore the child learns that anything involving the teacher is demand-based. The child will never want to seek out this teacher whom they may interact with the most because this is the person that places the most demands on them. The teacher becomes a stimulus/signal of "worsening events".
Solution: During the trials, non-contingent reinforcement, play, tickles, affect, and variable breaks should be incorporated. The child should giggle or smile during these sessions as should the therapists. Tokens should be paired with hugs, tickles, surprise additional reinforcement such as a surprise break with the teacher. Movement should also be included in these sessions. The child that gets fidgety will not be controlled by a token nor should they. It is the teachers job to incorporate all of their needs into these sessions. Play, affection, movement, paired beautifully and incorporated into the strict criteria with which they are presented. Some therapists do this quite well, and it is no surprise that these therapists get better responses and higher rates of acquisition from the children. Implementing technically beautiful trials may work for modeling "how to run discrete trial training" however in order to build up this relationship, the entire thing must be fun. Many of our kids spend most of their time with therapists, thus these are the people that MUST focus on establishing relationships, or else children are learning that "people" place demands. Always.

2. The teacher's agenda: In these DTT sessions, usually the teacher has a goal and an agenda. The goal may be for the child to label a set of fruits, and she/he will work diligently to get the child to label these fruits by providing cues/prompts, reinforcing approximations, and giving feedback on incorrect responses. Another observation in many schools and homes is that if the child digresses from this goal, even in an appropriate way, the child is redirected to the agenda of the teacher. This can either result in the child engaging in problem behavior because they are frustrated that they weren't heard, or the child again associating people as those who won't identify that their behavior shows interest in something else. One example is the child that while labeling his fruit, picks it up and licks it or tries to eat it. Rather than redirecting the child to replace it and label it, this is a learning opportunity that SHOULD interrupt the DTT and the skilled teacher will take this learning opportunity and expand on it. The child is showing an interest and may also be telling you in a very friendly way where you can put your trials. Another example is the child that begins staring at a toy or object in the room during the trial. They may be interested in something as a reinforcer and telling them "we aren't looking at that now" is not going to stop them from looking at it or thinking about it or wanting it. Halt the trial, and figure out what is distracting them. Either incorporate it as a reinforcer, or in play, or in the trial. If it isn't it can lead to interfering behavior, or worse, pairing the teacher (people) as someone who doesn't understand them and is not worth communicating with. Go with the child. I'm not saying "follow the child's lead" in a Greenspan manner where you join them in the stim (though i think there is some validity to that as well), but rather, use your skills as a behavior analyst and analyze behavior. What is the child communicating with their disinterest and how will you intervene so that their disinterest is abated? That is our job as teachers to figure out. If you miss this, and the child engages in a problem behavior, your DTT session is shot anyway, so it is much better to be proactive, identify the precursor to frustration and boredom and find a way to make it functional. Running a DTT session is NOT ABA. Analyzing a child's behavior while you are running a DTT session and identifying methods to improve it, what the child is communicating, and where you might be failing is...and this is a skill reserved for true behavior analysts. Anyone can run a DTT session. Not everyone can fluently analyze behavior and act accordingly to make the most out of each minute you are with a child.

Solution: use your skills as a behavior analyst and observe all of the child's behaviors, not just the ones you are targeting, and identify how you can improve this interaction by attending to their behavior. When a child sees that the person they are interacting with understands them and acts accordingly, they will pair that person more positively. I am NOT saying that if a child is tantrumming you should stop the trial and have them escape. That would be reinforcing escape motivated behavior. i AM saying that we can do better before it gets to that level, analyze what the child is communicating across all domains, and modify your agenda. You will get more out of the session, and the kid will like you more, because you "get" him.

3. Break from work: In most DTT sessions, what this means is you have earned your allotted tokens/time/tickets etc., and you are now free to roam, get your reinforcer, etc., while the teacher steps back. Here what the teacher is doing is actually pairing herself/himself as a punisher. The child is learning that FUN= No TEACHER. When getting away from the teacher is a reward, there is no relationship development. Clearly this is a time when most teachers will graph their data, organize materials, etc., but the damage is being done, in which the child gets to off on their own and not experience interaction with the person that is supposed to be covering this area as well.
Solution: Take breaks with the children, and find a way to make their break MUCH more fun through your participation. This means if they like jumping on the trampoline, you help them jump higher. This will pair you as a positive reinforcer. They will learn that jumping is cool, but jumping with you is cooler. You will know that this has happened when the child starts to take your hand and lead you to the trampoline. This is the start of a positive relationship where he needs you to have more fun (like Streisand says, people who need people are the luckiest people...:). Find a way to make yourself indespensible to the child's play and you are building a relationship. And for heaven's sake do NOT turn this into what YOU consider a learning/teaching moment where you question the child repeatedly "what are you doing? jumping!" Leave your questions/learn units/SDs out of this play. But make no mistake, this is a learning and teaching opportunity. The child is learning that you are fun. As they learn that, they are associating you as positive and not as someone that is going to put constant demands on them, and this will strengthen your relationship which will then help you get more from him in the future. They will need you to have fun, and will start manding/requesting for you. When the child can't wait to get away from you, you have done something wrong. Get creative with how to organize your materials and collect your data so that you don't need to do this on the break. During the break play, and know that you are still teaching. Challenge yourself to interact and play with the child and NOT present questions. Comment all you like, but don't demand reciprocation. Let the child play and have fun with you and they are learning people=fun, and a lot more fun than i can have on my own.

4. Time for work: When the child and teacher/therapist return to work, the therapist gets serious quickly. Yes, you want to have instructional control, but this abrupt switch from play to work, only pairs the activities at the table as more negative, necissitating more escape. Transition slowly. Use a visual support to show the child what the expectations are and what the "flow of the session" is. Let the child bring their toy to the table for a bit to pair the table more positively. Get playful and re-establish rapport at the table. Be clear as to the expectation. And please give the child the break while they are ON. All too often we "break" children when they are getting distracted, or "off". Now they have shaped our behavior, and we are reinforcing their fidgety distracted behavior by giving them a break. We should be stopping work in the middle of a fantastic trial! This way we are reinforcing fantastic responding and attention, not the opposite. It also allows the therapist MORE instructional control as she can end it on a positive note, not on an inappropriate behavior or tired child. Often teachers want to keep the child going because they are doing so well. All this becomes is "no good deed goes unpunished" Imagine this scenario with a teacher and her boss: she has a great day with her student and is now told that she did so well she has to say an extra hour. It is counter-intuitive, yet we do this to our children all the time, and this also damages our relationships.

In a nutshell, have fun, play with the kids, pair yourselves with breaks, listen to and attend to all their behavior, and end sessions on positive notes. Our children interact more with teachers, therapists and their parents than anyone else, so it is our responsibility to make these interactions as fun as possible, for them to WANT to interact with us because we are signals of "improving" not "worsening" conditions.

More to come


Þorgerður said...

Breaking off during a fantastic trial. Thanks for the reminder...This I find so hard to do. I get greedy when things are going well.

Þorgerður said...

ps really glad you started yp again. :)

Angela Mouzakitis, PhD BCBA-D said...

Thank you! i'm trying to get back into it more and being in the field more is giving me lots of fodder!