Discrete Trial Teaching (DTT)
 

This is accomplished by simplifying requests, prompting the child to make the correct response and providing abundant reinforcement for socially appropriate behaviors. At the same time, failures are minimized. Ensuring the child's motivation to participate in the learning process is a key element in behavioral interventions

In brief, the intervention is based on operant techniques and the shaping of behavior through reinforcement of successive approximations, prompting and fading procedures, and use of positive reinforcers that are functional (i.e., serve the intent of increasing behavior). Examples of such reinforcers are small bites of food, play with a favorite toy, looking at a favorite book, and social rewards such as verbal praise, tickles, hugs and "rides through the air." As intervention progresses, food and other "artificial" reinforcers are replaced, whenever possible, by more, social, and everyday reinforcers. The intervention is structured so that "positive" behaviors are maximized through prompting and positive reinforcement. High rates of inappropriate behaviors, such as aggression or self-stimulatory behaviors, are reduced by being ignored and by teaching alternate, more socially acceptable forms of behavior. The intervention progresses very gradually from teaching beginning learning skills such as sitting in a chair, matching identical objects and basic imitation to verbal imitation skills, elementary receptive language, and establishing the beginnings of appropriate toy play. Discrimination learning plays a dominant role in teaching all skills.

Once the child has mastered basic tasks, the second stage of the intervention emphasizes the teaching of expressive and early abstract language and interactive play with peers."

The ABA Team

Your ABA team has 2 important components - the consultant (who manages the program) &  the therapists/tutors.

Consultant

• Role of Consultant is to manage the program, troubleshoot problems and guide the program with both short term & long terms goals in mind.
• Find the consultant that suits your child: Each child is unique – a consultant may be wonderful for one child and not for another eg: some consultants are very academic driven; others are very good with behavioral issues. If you have a child with major behavioral problems, your program won’t progress fast if you team up with a consultant that doesn’t know what to do about it. To find out what works for you, talk to other parents. Talk to the consultant as well to find out whether they can handle the unique challenges of your child.
• Can be local or out of area.

Local Consultants:

Advantages: will be more hands on in your case. Able to have more team meetings, do classroom observations, will be able to attend IEPs etc.

Disadvantages: Long waiting lists. Have to check quality of person you are hiring.

Out of area Consultants :

Advantages: worth it if you are able to get a really really good/famous consultant. They have the vision & know how to drive your program toward a long-term goal. The very good consultants are able to resolve the tough behavioral challenges that even most consultants are stuck with.

Disadvantages: more expensive as you have to pay for flying them in, hotel charges etc. Their visits will be less frequent and that is not good for programs that need lot of supervision & constant changes.

Therapists

• Role of the therapist(s) is to work hands on with your child.
• Some programs differentiate between senior & junior therapists.
• Therapists on the case are trained by the consultant, district or you depending on the type of arrangement you have set up.

Who provides ABA services?
 

i. Private agencies

Agencies can be both local (like CARD, Stepping Stones) or out of area/state (eg: Autism Partnership)
 

Advantages.

• Provide both consultant & therapists so it’s a total package
• Saves you searching, hiring & maintaining therapists.
• Agency is responsible for training the therapists.
• If they are NPA (non public agency) can get your district to fund them. NPA means that the district can recover some of the costs from the state.
   

Disadvantages

• No control over quality of therapists. Agencies go through lean periods and sometimes there are not enough therapists on the case.
• Cost: Typically agencies bill $100-$150/hr for consultants & anywhere from $30-$80/hr for therapists (senior & junior) + team meeting hrs + material preparation hrs etc.
• No control over who the consultant in your case is going to be. Often senior therapists are promoted to consultants, which may or may not work out well for your case.
   

ii. Consultant & Therapists: separate packages

Advantages

• This option is often more cost-effective for parents.

Disadvantages

• You/district have to find & train therapists. Therapist availability fluctuates.
   

iii. District’s in-house ABA programs.

• Lot of school districts have now started their own brand of in-house ABA.
   

iv. Supplementing School ABA hours.

• Another possible combo. If the district gives you some ABA from their in-house program, you can “supplement the hrs” by having your own therapists provide additional hrs. Make sure everyone is doing the same program so as to not confuse the child ie: the private therapists should be attending the team meeting and following the same program. (Note if you have a young child, there is no reason why the district should not be funding all the hrs the child needs).

Local ABA Providers

School Districts & ABA

• Many School districts will give ABA for ASD these days as they have been sued so many times in the past.
• By starting in-house programs districts have been able to save both money (school therapists get $15/hr) & satisfy the parents.
• By law the district may be required to give you ABA but not necessarily the “best ABA” so quality varies.
• Often the argument is that your child is “too old” for ABA. Not true – good ABA helps the kid improve at any age. Often the onus is on you to prove this.
   

Structuring ABA hrs

• ABA tutor hrs include time for following – team meetings, material preparation, tutor training. While these are necessary, focus on how many hrs of 1:1 tutor time your child actually gets. Make sure the hrs allotted to you is not eaten up by the other stuff. List 1:1 time separately in the IEP and hrs for the rest are in addition.
• Consider also that 1:1 tutor tutor time is not actually fully 1:1 time eg: it takes the tutor 15-20 mins at beginning of session to set up & same time at end to write notes & tidy up. So actual 1:1 time is a lot less than it looks on paper. If you can work these into your IEP even better.
• Some agencies distinguish between senior & junior therapists. You do need a good amount of senior therapist time. Specify the breakup in the IEP so that you don’t get shortchanged. Make sure the senior on the case is there not just to do “material preparation” but also works hands on with your child.
• Also make sure each therapist on the case works at least 2x/week with your child. Anything less would result in them spending a lot of extra time at the beginning of each session trying to read the binder to see what has happened in the last one week.
• ABA consultant hrs include time for team meetings, tutor observation & classroom visits if any. Accommodate all these. Also work in how often the consultant will visit your case. A closely supervised case is preferred so the consultant should be on the case at least every 2-3 weeks.
   

  

Getting ABA funding & getting enough Hours

• It’s a good idea to get familiar with IDEA (Individual with Disabilities Education Act). It may sound very intimidating but you don’t have to know all of it – just the parts that apply to you. A number of special education lawyers have written books with their interpretations of each section & these are easier reading as it is more in layman’s terms. PHP library would definitely have books on it. A very popular one is Special Education Law by Pete & Pam Wrightslaw.
• This is especially for parents of young children (esp under 5) trying to get ABA. IDEA does mention “40 hrs/wk ABA ” in several places – you should use this info to your advantage to get the hours you need for your child. Especially read the chapter(s) on “Infants & Toddlers”. The argument for ABA as a treatment for autism is that it is the only method that is backed by research (Lovaas’s 1973 Young Autism Project study). Again I am not a lawyer or a parent advocate so don’t take my word on it & do check what exactly the law says.
• ABA becomes a much harder case to justify with districts once the child is older.
   

   

Lawyer vs Parent Advocate
 

• A lawyer is someone who has the law degree & is certified to practice in this state.
• A parent advocate does not have a law degree. It is simply a person who is very familiar with the law, gets paperwork together, reviews your case, will accompany you to the IEP & help you secure the necessary services for your child.
• In many cases Parents of older children who have had success in dealing with districts choose to become parent advocates in order to help other parents.
• A lot of parents are able to get the services on their own from SARC/District, while others have needed the help of a parent advocate.
• A good parent advocate should be able to get you a decent amount of ABA hrs, speech & OT.
• A parent advocate is also significantly cheaper than a lawyer.
• My understanding is that you need a lawyer only if you are suing the district or going into arbitration/mediation. In which case you can directly hire a special education lawyer or the parent advocate will hire one for you.
• You need to contact a parent advocate early on. Don’t expect one to be available the day before your IEP/IFSP. They need time to review your case history, diagnosis, any evaluations, any reports etc. A number of them have long waiting lists so get them early. They should bill you only for the hrs they actually spend on your case + IEP attendence hrs etc.
• Quality of parent advocates vary & I have heard different stories from various parents about their parent advocates – from good to downright ridiculous. The general feeling I get overall is that a parent advocate is useful when trying to get funding for services like ABA, speech & OT but less useful when it comes to an appropriate classroom placements (which is usually an issue only when the child is older). However a really really good parent advocate should not have a problem with that either.
  

Local (Bay Area) Parent Advocates & Lawyers 

ABA in reality

(pitfalls to watch for)

• You rarely get so many hrs of therapy. Hours get taken away by things like classroom time, school SLP & School OT & team meetings.
• Excellent therapists are few & far between. When they become very good, they become consultants & stop working hands on with your child. But if you are fortunate enough to have a good therapist, tape each & every session & learnt what she does & duplicate it with your child.
• The supply & demand situation is such that even mundane therapists charge a lot. Training in a lot of the programs for them mediocre.
• High therapist turnover. Being a therapist is hard work – there are jobs that are less demanding – they get married, get pregnant and leave (I’ve had 5 therapists get pregnant over the last 5 years & quit)
• Too much time seems to be spent on taking data & writing notes on the parts of the therapists.
   

What is ABV (Applied Verbal Behavior)

• In short it is simply ABA with a lot of focus on the “verbal behavior”. ABV is based on Skinner’s analysis of language.
• Dr Vince Carbone, Dr Jim Partington & Dr Sunberg have done a lot of research in this area and are major proponents of this approach. Most good ABA programs do incorporate a lot of verbal behavior. The terminology used in AVB is the terminology used by Skinner. But if you look beyond the terminology, the terminology in AVB essentially refers to the same things as in ABA.
   

Christina Burk describes AVB in easily understandable terms on her website www.christinaburkaba.com

How can you learn more about ABA?

i. Websites on Autism Treatments and ABA

ii. Newsgroups

1. The me-list: Called this after Dr Lovaas’s initial book called the “me-book”. Members of this group are mostly parents & therapists and there is extensive discussion about ABA techniques on this. To join send a email to Ruth Allen at rallen@indywax.iupui.edu and state that you are a parent.
    
2. ABA-Pro List
   Maintained at the St Johns Server. Again discusses ABA. To join send email to:
   email: listserve@maelstrom.stjohns.edu
   and in the body of the text type "subscribe ABA-PRO"
    
3. DTT-NET newsgroup in www.groups.yahoo.com.
   This newsgroup that discusses AVB approach
    
4. Other newsgroups
   discuss ABA under www.groups.yahoo.com/
   

iii. Workshops & Trainings

a. PHP – keep checking on their website www.php.com & www.php.com/dosig/feat
- parent trainings on various topics
- Junior therapist & senior therapist trainings

b. Behavior Analysts Inc (located in Pleasanton in East Bay).
www.behavioranalysts.com/
They have both parent training and beginning & advanced level training for therapists.
Even if you are a parent attend the therapist trainings. In the long run you will be the best therapist for your child.

c. Other Support groups  www.jeena.org & www.osfamilies.org also hold periodic parent trainings.
 

iv. Books (to start you off with)

• Me Book by Dr Ivar Lovaas
• Teaching Individuals with Devt Delays – Basic Intervention Techniques By Dr Ivar Lovaas
• Let me hear your voice by Catherine Maurice. She is the mom of 2 recovered autistic children Anne-Marie & Michael
• Behavioral Strategies for young children with Autism by Catherine Maurice. She outlines details of drills/programs used in ABA
• A work in progress by Dr Ron Leaf and Dr John McEachin of Autism Partnership. Dr John McEachin was head of Lovaas Clinic at UCLA for 10 yrs & Dr Ron Leaf is the guy who came up with the no-no prompt concept in ABA.
  
• There are lots of other books on this subject. 

v. Materials & Catalogs

vi. Local ABA Providers

Email comments/suggestions saairam@yahoo.com