A Tale of Two ABA's.

Harri is now close to completing his first month with the new service provider and so far the love remains. I am relieved at this and feeling positive about the decision to change organisations. Another benefit, at least for my inquisitive streak, is seeing how ABA can be applied so differently from one agency to the next. This has reinforced my understanding that it is a philosophical approach to learning rather than a therapy per se'. And consequently can be applied in various ways depending on the ideology of the practitioner or service. It also helps me to see how people can misunderstand ABA based on false assumptions and old stereoptypes, that perhaps were once valid concerns. Fortunately for the children of today behavioural psychology's focus on ASD is not static, and seems to strive towards better understanding the more positive ways to engage children with Autism to help them develop life skills. And luckily for me, so far at least, the lovely women working with Harri embrace the same ideology as I when it comes to the point of therapy. Skill development yes, 'normal', no.

What has really stood out as the primary difference in how the former and current services differ is their approach to compliance. The former therapists held the opinion that Harri had to be forced into compliance in order to attend to task. What this meant in action was picking him up off the floor and placing him back in his chair despite howls of protest. When he got to the stage he was bored, frustrated, confused or had just had enough he would slump to the floor and cry or throw things, and tantrum like a two year old does. I always saw this as entirely normal behaviour for any young child who is being forced into an activity against his will. Anyway it often led to a battle of wills between Harri and the therapists that seemed to me not only futile but counter productive. And this latter outcome proved to be the case as time went on. Whereas previously he had run to the table to happily start his sessions, he began to sit reluctantly.  And when one day his most experienced therapist announced she had never met a child who whinged as much as Harri I knew we had a problem. If all behaviour is communication, and she was the one trained to assess the functionality of this whinging, yet could not see it was how she was engaging him that was leading to the behaviour, then she was putting her want of compliance above his need to learn. Although clearly the thought was that without the compliance there was no opporunity to learn. Intention was good. Outcome for a stubborn and strong willed Harri was not good however.

Enter new service. The philosophical approach underpinning all interactions with the kids is positive reinforcement. Which essentially boils down to the concept that children will want to do the tasks when they know they are working towards something they like. And while this theory was also applied by the former workers via a visual schedule, and the current by a token system, the difference is the new staff don't force anything. They ascertain from the child what they are keen to play with, then explain what they will need to do in order to get access to that toy, and then the child decides. If they are not willing to do the work, the therapist sees that as a sign they have not yet found the right reinforcer to generate motivation, so it is their job to keep seeking what it is the child will be willing to work for. And the staff have access to the most incredible array of resources. There is an entire room dedicated to holding every toy ever made that lights up, spins around or makes a noise, board games, buckets for water play, shaving cream for sensory play, play dough in every colour, I could go on and on, it really is an amazing array of toys and other great kid things. And the creme de la creme, at least for Harri, is an enormous play room, complete with trampoline, that he gets access to a couple of times per session. He is never forced to participate but he always knows that if he wants access to all these cool things he needs to do some work first. And saying that, he does a small amount of work and gets a large amount of playtime. Towards the end of the two hour sessions he gets tired, and sometimes frustrated, and is allowed to lie on the floor and roll around, but it doesnt take long for him to grow bored and seek stimulation again, at which point he is re engaged by the therapist. It seems a much more gentle and respectful approach.

So from this limited experience I can see how it's possible for every service provider utilising an ABA model to be quite different. The compliance example is one of many areas where points of difference would manifest. Use and fading of prompts would be another, as would teaching generalisation, or focus on life skills and methods for teaching speech and communication, expectation relating to eye contact, and so on. This realisation does add another layer of burden on parents trying to find effective early intervention for their child. If you decide to go with an ABA service how do you know which is best? The answer is right in front of you. Your child, and how they respond. Are they happy attending sessions? Are they learning? Are they engaged? Are they accomplishing goals?  First and foremost, is your child respected as an individual?