Tuesday, September 14, 2010

Autism - ABA , RDI - relationship development intervention , CPS and SDT

I previously looked at developmental delays in children , ADHD, and how a SDT – Self Determined Theory orientated treatment like CPS – collaborative problem solving would approach these challenges in contrast to traditional behaviorist ' behavior modification ' programs. – August 2010




The question I would like to share on this blog is whether there are effective SDT orientated interventions for autism , programs that promote autonomy , competence and relatedness. Those professionals who advocate ABA , a very behaviorist approach , claim it is the most effective program .??!!

There is an approach called RDI – Relationship Development Intervention. It is very similar to CPS focusing on promoting skills in a dynamic environment where parents are the primary teachers.

In this blog I share questions I put to Laura Hynes , a RDI consultant about ABA , RDI and whether we should try to combine the 2 approaches and use ABA together with RDI.

Laura Hynes, LMSW

RDI® Program Certified Consultant
http://extraordinaryminds.org/



347) 564-8451




AK –

Kids in the autistic spectrum are said to be literal, concrete , black and white thinkers lacking cognitive flexibility. it is unlikely that we can promote perspective taking and flexibility if parents model inflexibility and not taking kids concerns into account by focusing on obedience using reward and punishment . ABA focuses on obedience and compliance .

LH -

It is not only unlikely, it is impossible. These kids are literal and concrete thinkers due to the under connectivity of their brains, which is well researched. Years ago, when ABA was established, it was believed that the brain was not able to change. We know now, also well researched, that the brain is experience dependent and able to continuously change based on the type of information it is presented with. The application of ABA and Lovaas theory unfortunately did not change with the advances of neurological developments in research.

AK –

Ross Greene in his CPS book for schools ' Lost at School ' talks about CPS as opposed to ABA as an more appropriate intervention for autistic kids .

Ross Greene -

'It’s often assumed that the CPS model has no application to these autistic kids, and that well-known applied behavior analysis methodology is really the only option. I beg to differ. “Autism spectrum” doesn’t say anything about the kid’s general cognitive functioning, and unless you’re ready to throw in the towel on teaching the kid lagging skills or helping him learn to solve problems – and hopefully, you’re not – then CPS may well have a role to play. The most common obstacle is communication/linguistic skills. As described above, you’ll want to focus first on helping the kid develop the skills to communicate his concerns (often through pictures or hand signals) in a very rudimentary manner , and if your kid is unable to provide much information about his concerns, then your powers of observation and intuition will be crucial . Of course , because your powers of observation and intuition aren't infallible , you will need to continue observing and intuiting so you can recognize you have hit the nail on its head with your hypotheses about your kid's concerns. Then, if possible, you’ll want to focus (if it’s feasible) on helping the kid express these same concerns verbally. Along the way, you’ll be watching closely to see if there is some mechanism for the kid to participate in generating solutions.'



AK -

How does ABA work ?

If I am teaching a dog to jump over a rope , I put a rope in his way - he jumps over it , I reward him and the raise the rope etc and reward , this is the way I assume we teach dogs tricks. If we teach a kid to throw a basketball into the basket , we need to teach him the skill of throwing. Rewarding him imho won't do much to help him acquire the skill.



Is ABA like teaching a dog tricks or a kid to throw the ball into the basket. Is the kid acquiring the skill by conditioning - reinforcements or the main work is teaching the skill , the reinforcements something secondary ?

I have been checking out how animals learn tricks. It seems it has more to do with their intelligence rather than reinforcements .



LH –

ABA works primarily to teach skills that compensate for deficits in dynamic intelligence. Dynamic intelligence can be broken down into several smaller pieces.



1- Communication: not language, communication. non verbal, prosody, facial expression, gesture, body language and experience sharing language...not only labeling, answering a questions, making requests...talking about feeling, experiences, preferences etc...



2- Co regulation: The back and forth of all human interaction, social reciprocity in interaction and conversation



3- Appraisal: What is the important information for me to pay attention to here? Are you able to look at the bigger picture or are you focusing on unimportant details?



4- Flexible problem solving: The ability to appraise and decide the best course of action. There is more than one way to solve a problem, there are "good enough" solutions.



5- Episodic Memory: A memory very different than the other memories individuals on the spectrum are good at. Are you able to reflect on past experiences to better decide how to problem solve and project into the future and comprise some kind of plan...Do you have memories of competence that improve your motivation, resilience and determination?



All individuals on the spectrum are lacking in these dynamic areas. What ABA and other behavioral approaches do is teach skill to compensate for them.



Use a picture schedule because the child can't transition well.

Translation: The child is not appraising the situation well. He is unable to look at the big picture and is not thinking in a flexible way and therefore is not problem solving. If we always overcompensate and prepare a child for transitions, what will happen in the real world when something unexpected changes? It is a huge disservice to these kids to not address the deficit and continuously overcompensate for it.



Teach social skills/scripts because that child cannot interact with others

Translation: The child is not co-regulating, a skill acquired by typically developing children prior to one year of life. If this child does not understand basic back and forth reciprocal interaction, they will never be able to play a made up game on the playground. Teaching social scripts is compensating for this deficit. Teach them social reciprocity. They can learn it. I see it every day. If they don't get the answer they are expecting from a peer that they were taught in a social script, the whole thing falls apart. It is teaching them nothing and essentially setting them up to fail because there is no way to prepare them for all the possible reactions they may get.



As far as rewards, ABA is all about rewards. What happens with rewards is the motivation to interact with another person, figure things out on their own, become competent is lost because these things should be intrinsically rewarded. By offering an external reward, the intrinsic motivation is lost. There is no child that is working for a cookie that will be engaged in the process. It is about completing a task and receiving a reward.



AK

1 I read that ABA teaches \ static knowledge and skills - RDI teaches dynamic knowledge and skills. ?

2 Combination of approaches - Can or should RDI or CPS be combined with ABA ?



Despite research showing that CPS combined with contingent management procedures is more effective than CPS alone , Dr Greene discourages combining approaches



1 Because kids don't participate in deciding on consequences and their implementation , the process is essentially , Plan A = imposing parent will and not collaboration.

2 the disappointment of not getting a reward or anger or anxiety over a punishment /reward can in fact be a trigger to explosive behavior the rewards/punishments are trying to treat.

3 We want parents to become better problem solvers rather than becoming better at imposing their will and getting obedience.

4 CPS conceptualize kid's difficulties as a learning disability, lagging skills -children do well if they can - behavior modification sees behavior as manipulative, attention seeking , working for them , motivational- children do well if they want to. Combining approaches confuses both parents and kids.

5 The intrinsic reward of solving problems, communicating and improving the relationship with a parent is far more rewarding than any exterior motivator so why reward successful collaborative problem solving

LH –

I can speak to RDI and ABA...I do not recommend it. It is so difficult to uncondition these kids from static thinking....feeling like they have to produce a response, that there is a right or wrong answer, that they are working for a reward, that there is no value in the interaction, only the task, among many other things.



To provide both is confusing to a child and if you are working an RDI program, the static skills are ingrained in the natural teaching that happens between parent and child. A NT 2 year old learn animals, colors etc...through play with their parents. Kids with autism can learn this way as well, it just takes more deliberate and mindful parents and guides. There is no reason that any 2 year old should be sitting at a table receiving instruction and being expected to learn that way. It is unnatural and unfair.



It is also very confusing. There is no way to "do RDI" for a certain amount of time per day, it is a lifestyle, parents change the way they communicate and interact with their child on a day to day basis. To change information to an ABA format is very difficult for the child to accurately interpret the information being presented to him.



LH - An RDI program is also not only for autism. Dr. Gutstein has looked at typical development and broke it down into objectives that can be worked on one by one. Any child with any disability is likely lacking in dynamic development.

AK –

Over the years ABA has evolved considerably , it is far from the original strict behaviorist program.

http://www.extraordinaryminds.org/id55.html see article is ABA the only way

I think it is much easier for a behaviorist to combine approaches., Most admit that reinforcements are not something we would want in the long term but they fail to see the negative side undermines any gains.



CPS has the same approach like RDI that parents and care givers play an important role in teaching kids these skills . These skills can be taught and don't need to be compensated , there is a belief in neuro –plasticity of the brain.

ABA and Barkley ADHD believe that skills cannot be taught but only compensated .

Barkley - ADHD believes that these kids lack intrinsic motivation and this needs to be compensated - but rewards undermine intrinsic motivation .



Allan

2 comments:

  1. As a parent I have used both a behavioral approach and a CPS approach simultaneously with better success than using either alone. I actually think that the combination is more reflective of the way "real life is". Some things we do for the rewards or don't do because of the consequences- others we do for more involved reasons of understanding, empathy, long term goals, etc. sometimes in my trying to use CPS my son decides that all the problem solving in the world is not enough and he prefers to negotiate a reward for the desired behavior- ie. if he does this thing I want him to do then I will do the thing he wants me to do.

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  2. Thanks for the great explanation ~ I will save this post to pass on to others who show an interest in RDI.

    Best wishes
    Lisa O'Donnell
    Relationship Development Intervention

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