Whether we are talking about skill acquisition or the reduction of problem behavior, the treatment methods selected and utilized in the IAP are all firmly rooted in the basic principles of behavior and the science of applied behavior analysis. It may be helpful, though, in our discussion on treatment selection, to maintain the dichotomy between these two areas of instruction.
Skill Building Programs
Skill acquisition programs for our students can target language skills, play skills, social skills, pre-academic skills, and activities of daily living. The IAP not only looks to treatments that have shown clinically significant results in addressing these skill areas - it requires that such treatments have had their results published in peer-reviewed research literature. Presently, the IAP recognizes the following treatment methodologies for teaching new skills to young children with autism:
- Discrete Trial Instruction (DTI)
- Incidental Teaching
- Fluency-based instruction (Precision Teaching)
- Direct Instruction (DI)
- Visual Schedules
- Video Self-modeling
- Peer modeling/tutoring
These teaching strategies that are employed (either singly or in combination) across the IAP classrooms may vary somewhat in order to take into account individual student learning styles and to accommodate consumer/parent preference. Requests by parents, teachers, or support staff for treatment options that deviate from this list are considered on a case-by-case basis. It should be noted, however, that any new treatment would have to meet the rigorous scientific standards that are in place for the currently accepted teaching methods. Generally speaking, the IAP avoids utilizing treatments that are not supported by empirical data in the literature. This is not to say that the IAP would refuse to pilot an unproven treatment, take objective data on the child's response to it, and then make a determination as to its appropriateness for that child.
Selection of communication modality (vocal speech, picture exchange systems, or sign language) for language-delayed students is often part of the treatment selection process. The IAP's position on this issue is two-fold. First, it is our hope that all students will attain some level of functional vocal speech. Many of our initial teaching programs focus on imitative and echoic skills as a means of building the framework to later support vocal speech. Alternate systems of communication such as Picture Exchange Communication System (PECS ) or sign language with children who demonstrate significant progress in echoic skills are typically discouraged. These methods may be used with such children as an initial step in establishing an efficient mand repertoire, but programmatic efforts would be made to quickly supplant them with vocal requesting behavior.
However, if a child does not demonstrate a propensity for vocal speech, research-backed alternative modalities ( PECS or sign language) would be pursued. Selection between these two non-vocal systems is generally based on the student's fine motor imitative and cognitive abilities. Students with strong cognitive and motor abilities would be encouraged to adopt sign language as their primary mode of communication while students with more severe cognitive and/or motor impairment would be viewed as candidates for PECS.
The selection of communication modality is made by the child's team, including parents, IAP clinical supervisory team, classroom teacher, speech language pathologist, behavior specialist, etc.
Behavior Reduction Programs
Treatment selection for problem behavior reduction programs in the IAP is based on scientific and ethical factors as well as parent preference and approved Barber National Institute practices. Although considerable professional disagreement and political pressures surround the use of procedures designed to change children's behavior, we find that adopting an objective, scientific approach to a student's problem behavior while maintaining vigilance for his/her rights and personal dignity results in the selection of optimal treatment procedures.
For some time now, it has been accepted that:
- problem behaviors are learned.
- certain environmental variables are correlated with this learning process.
- in most instances, these environmental variables exert functional control over the problem behavior.
In lay terms, functional control implies that misbehavior is established and maintained by the consequences that routinely follow it. If a student's aggressive behavior has been historically responded to with adult attention, there is a good chance that access to adult attention exerts a certain amount of control over the student's aggressive behavior (i.e., increases the probability that aggression will occur again - when attention is wanting).
The functional nature of behavior disorders demands that an assessment or analysis of a particular student's problem behavior be conducted prior to selecting a treatment protocol. A functional analysis identifies the source of reinforcement for the targeted problem behavior. Once identified, the source of reinforcement can be manipulated systematically so as to alter the contingencies that are maintaining the problem behavior in the student's repertoire. Without this experimental analysis, treatment becomes mere guesswork.
For these reasons and the nearly 25 years of behavior analytic research in functional analysis (see Iwata, 1993), the IAP chooses to conduct analogue functional analyses prior to selecting behavior reduction procedures for any student exhibiting severe problem behavior. This process of analogue functional analysis involves the direct, systematic manipulation of the environmental variables surrounding the student's misbehavior. The data that are derived from these experimental sessions are analyzed and interpreted by qualified behavior analysts. Treatment is then prescribed based on the functional relations revealed by this process of scientific inquiry.
Data Collection
In keeping with the accepted standards of the field of Applied Behavior Analysis, the programs implemented within the IAP classrooms - whether they be language acquisition programs, methods for teaching activities of daily living, or procedures for reducing a student's problem behavior, all involve some form of data collection. To a great extent, educational objectives will be dictated by baseline and assessment data gathered at the beginning of the school year or upon the student's entry into the program. The student's progress toward these objectives will be monitored via the data that are collected on a daily basis during instructional sessions. And decisions as to whether a child has met the success criterion for individual educational objectives or if changes in teaching methodology are warranted will be made based on these same data.
The data collection system utilized by the IAP has been standardized to promote consistency and accuracy across program staff. Skill acquisition programs involve either limited trial-by-trial data collection or daily timed probes. Trial-by-trial data, while labor intensive, provides the IAP staff with a very accurate assessment of the student's progress during the initial stages of learning a new skill. Once more independent responding to instruction is demonstrated, the timed probes typically replace the trial-by-trial data recording. During either a 10-trial probe or a timed probe, the current target skill is presented to the child in a massed trial format during a brief (30-60 second) time period. These daily "tests" are performed without prompting and reinforcement so that the IAP staff can objectively assess independent performance of the target skill. Daily probe data is charted by our staff so that a visual display of the student's responding can used to facilitate the ongoing evaluation of student progress and provide objective rationale for programmatic changes.
Behavior reduction programs are likewise data-driven. Extensive baseline and functional analysis data is collected and used to assess problem behaviors and to develop effective programs to reduce such behaviors of concern. Once programming is in place, frequency and/or duration data relative to the target behavior(s) are collected throughout the school day. Charting of these data is completed daily so that the IAP staff has an ongoing visual display that can be analyzed for trends in relation to programmatic or medication changes.
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