Autism Partnership

What is Autism Spectrum Disorder (ASD)?
According to the most updated New CDC Report from Washington, D.C., there is 1 child in every 150 who is diagnosed with Autism Spectrum Disorder (ASD). In Canada, there are 50,000 individuals estimated with autism related disorder and in Hong Kong, the Education and Manpower Bureau showed a total of 10,000 reported cases of ASD, a commonly believed underestimated number. ASD is undoubtedly the fastest growing developmental disability in the world.

ASD is a severe disruption of the normal developmental processes that is often diagnosed in the first few years of life. While the symptoms of autism vary from child to child, the core areas of deficits include:

No or impaired language
Little or no desire to communicate & socialize
Undeveloped cognitive and adaptive functioning
Characterized by stereotypical behaviors or restricted interests

Recent conceptualization of the disorder takes a spectrum view, witnessing the different extent of disabilities described by the same term. Without proper intervention, or scientifically proven treatment, these individuals often fail to actualize their full potential. From the decades of experience, we had evidenced many sad and upsetting stories, most of them the results of inappropriate interventions. Morbidity and Mortality Weekly Report (MMWR) released on Feb 8, 2007 in Washington, D.C. by the Centers for Disease Control and Prevention (CDC)

Is Applied Behavioral Analysis (ABA) effective?
Its efficacy is proved in Lovaas (1987) and McEachin, Smith and Lovaas (1993) study which are cited as the only two comprehensive investigations on behavioral intervention with autistic children. In fact, ABA is based upon more than 50 years of scientific investigation with individuals affected by a wide range of behavioral and developmental disorders.

In Lovaas study (1987), he reported that 47% children, who received intensive behavioral treatment, significantly improved their social, self-help, play and communication skills, including the development of functional speech. Furthermore, these children were able to successfully complete first grade in regular education classes and were indistinguishable from their peers on measures of IQ, adaptive skills, and emotional functioning. This is an important study due to the significant contrast of outcome between the treatment and control group. In the control groups, only 2% of children achieved the same outcome. A 1993 follow-up study by McEachin, Smith, and Lovaas showed that treatment gains were maintained more than six years later and eight of the children continued to progress in regular education classes without support.

Why is ABA so popular?
Applied Behavioral Analysis (ABA) with autistic children has experienced a return to popularity since 1993. This popularity, in large part, can be linked to the publication of Catherine Maurice’s book, Let Me Hear Your Voice, in which she chronicles the treatment of her two autistic children. Like many professionals and parents, Ms. Maurice initially had a dim view of behavioral intervention. She believed it to be an extremely negative and inflexible procedure. Moreover, she thought that behavioral intervention had limited effectiveness and often produced children with a robotic manner. Her experience, however, proved to be far different. Most important, the intervention proved to be tremendously effective.

Since the early 60s, extensive research has proved the efficacy of behavioral interevention with autistic children, adolescents, and adults. The research has shown ABA to be effective in reducing disruptive behaviors typically observed in autistic individuals, such as self-injury, tantrums, noncompliance, and self-stimulation. ABA has also been shown to be effective in teaching commonly deficient skills such as complex communication, social, play and self-help skills. Lovaas and his colleagues (1973) published a comprehensive study that demonstrated ABA to be effective in treating multiple behaviors with multiple children.

What is Discrete Trial Training?
Discrete trial teaching is a specific methodology used to maximize learning. It is a teaching process used to develop most skills, including cognitive, communication, play, social and self-help skills. Additionally, it is a strategy that can be used for all ages and populations.

The technique involves: 1) breaking a skill into smaller parts; 2) teaching one sub-skill at a time until mastery; 3) providing concentrated teaching; 4) providing prompting and prompt fading as necessary; 5) using reinforcement procedures.

A teaching session involves many trials, with each trial having a distinct beginning and end, hence the name, “discrete”. Each part of the skill is mastered before more information is presented.

In discrete trial teaching, a very small unit of information is presented and the student’s response is immediately sought. This contrasts with continuous trial or more traditional teaching methods which present large amount of information with no clearly defined target response on the student’s part.

Discrete trial teaching ensures that learning is an active process. We cannot rely on autistic children to simply absorb information through passive exposure.

What is the difference between Applied Behavioral Analysis (ABA) and Contemporary Behavioral Analysis (CBT)?
One would think that all applications of ABA would be quite similar. However, there is tremendous diversity! Although our foundations are the same, there are extraordinary differences in how ABA is applied. There is a broad continuum of applied styles and approaches. In the extremes, approaches range from those that are dogmatic and rigid to those that are loosely, inexactly and unsystematically applied. Additionally, many claim to provide ABA, when in fact they only implement a single procedure of the field (e.g. Discrete Trial Teaching).

Behaviorists are often pigeonholed as rigid, narrow, and punitive. The fact is that many behaviorists employ methodology of ABA (including DTT) with much flexibility and are quite natural in its application. Perhaps because of the stereotype of ABA, many professionals seem to have distanced themselves from ABA and have come up with other names and variations of teaching strategies that would aptly be conceptualized as ABA!

Prizant and Wetherby (1998) suggested that more “contemporary” behavioral treatment differed from “traditional” approaches in that teaching occurs in more natural learning environments, that there is more emphasis on individualization of curriculum and “the use of more natural and balanced social transactions in which learning opportunities are initiated by the child”. They specifically, identified the methodology and strategies utilized by Autism Partnership as an example of a contemporary approach.

We concur that Autism Partnership’s approach to ABA treatment of autism greatly differs in many fundamental ways from those who have a more rigid application of ABA. Further, our model incorporates a variety of ABA methodologies (e.g. DTT, Token Economies, Systematic Desensitization, Teaching Interactions) appropriate for the treatment of persons with autism. Therefore, to distinguish our approach we identify our it as “Contemporary Behavior Therapy”.