Showing posts with label behaviorism. Show all posts
Showing posts with label behaviorism. Show all posts

Saturday, March 31, 2012

Amazing Grace

I rarely rant, but a friend sent me a link that has forced me to get this off my chest.

No! I will not expose the family who created a behavior chart "sanitized" by Bible verses with a link. Since people who read my blog understand the importance of relationships, you will understand even if the family in question may not. Ironically, the post that, er, inspired this rant has no comments. Yes, ZERO! You can literally hear the crickets chirping in the background of that one.

The couple struggles with complete disrespect (a youngster yelling mean things to Mom and Pop or slamming things hard enough to break them). They consulted an autism therapist and a popular book by a Christian psychologist to develop the contract the whole family signed. Sigh. The parents gave it the Christian seal of approval: they prayed, developed rules, and backed each rule up with Bible verses. Each rule has a consequence which the couple administers with absolute consistency. After the consequence, Mom and Dad send an unruly child to the bedroom until calm. Then, they kiss, make up, and pray together.

One of their rules is "Respect All Adults." I believe giving a child with autism such a black-and-white rule may be harmful in the long run. Because social behavior is so complicated, people with autism tend to boilerplate socialization into a system of elaborate rules. Trying to reduce social skills to rules is what gets them into trouble because social behavior depends upon context and the unique characteristics of people interacting together. What is acceptable at one time and group is intolerable at another.

Moreover, all adults are not worthy of respect. Jose Salinas, a fourth grader with cerebral palsy, often came home from school sick but told his mother he had a "good day" when asked. The parents knew something wasn't right. "We knew he hated going to school. We tried every medical test we could think of, but we never could find anything wrong." His classmate tipped her off to what was happening at school. His mother caught on audio tape a teacher and teacher's aide verbally mistreating her son. The recordings made over three days document lack of one-on-one instructions, harsh verbal commands, insults, etc. The mother noted that her son "received about 20 minutes of actual instruction and spent almost the entire day sitting in silence with no one speaking to him."

The two educators are on administrative leave until the school board meets on April 9. Jose hasn't been sick lately, and his classmates have noticed that Jose is "smiling all the time, talking all the time, nothing but happy." Although some segments of tape disturbed the Superintendent of the school district, he also noted that the two educators (now on paid administrative leave) "could have been attempting to reinforce the therapist’s treatment plan [for drooling]." Just because a child has a treatment plan and a goal does not make the situation any less wrong.

Even if we homeschool and attempt to place our children out of harm's way, we cannot protect them from the ignorant, or worse people with evil intentions. What about ill-informed neighbors making life for our kids difficult? What about restaurant employees who look down on them for acting oddly? What about the stranger at the store who tells you that all your kid needs is a good spanking in the middle of a meltdown? What about the visiting couple sitting behind you in church nudging each other because your kid stood up and walked up to the deacon with the offering plate? Adults like that warrant keeping a safe distance, but not respect. What about the pedophiles who seek positions of trust such as schools, churches, scout troops, etc. to target vulnerable children?

At times, when Pamela is truly upset and unable to explain herself, she will have a fit or say something disrespectful. The other day, Pamela was adamant about staying longer at watercolor class because she wanted to finish the landscape. When she realized I wasn't caving, she went to her teacher, who is a parent of an autistic child, too. Calming her down required leaving the room, sitting on her favorite couch, breathing deeply, and counting quietly. We compromised: I promised her to finish the painting over the weekend. Later, in a calm moment, I asked her why she was so upset. Pamela told me she wanted to start something new next week: a basket of Easter eggs.

Pamela does respect me. She watches what I do during the day and helps out. We own a hybrid car, and I keep the key in the cup holder. When I am ordering drinks, she will move the key and hold it. I never have to ask her. I never taught her that, either. She enjoys cleaning up trash left in the car by her brother and helps me bring groceries into the house. Last month, I noticed how Pamela was sorting books when we finished reading them. She would put the books for the next day on the fireplace mantel, a holding spot until the daily box was empty. She would put books finished for the week on my computer desk because I prepare next week's plan in the evenings. She would put books we didn't need for a day or two in the storage box. One day, I casually told Pamela, "I think you are ready to set up the daily box." Since that day, I have not had to set up the box!

Nobody is perfect. Pamela loses her cool sometimes, and so do I. We both respect each other even though there are times when we completely disagree. Rather than playing on one another's emotions, we try to seek common ground and come to an understanding that works for both of us. Even when she was a young child, I watched her behavior carefully and respected her unique needs as a person with autism. Rather than insisting she ride elevators by brute force, I saw it as an opportunity to get some exercise by taking the stairs. In time, she conquered her fears on her own terms, which enabled her to conquer other fears.

Oh, and my Bible verse for that is:
Children, obey your parents in the Lord, for this is right. "Honor your father and mother"—which is the first commandment with a promise—"so that it may go well with you and that you may enjoy long life on the earth." Fathers, do not exasperate your children; instead, bring them up in the training and instruction of the Lord. Ephesians 6:1-4
Isn't it funny how "Children, obey your parents" comes to our mind immediately while "Do not exasperate your children" is lost in the cricketsphere?

This family has issues at meals. Children leave too soon or bring toys to the table. They do not find the experience worthy of thanks. This couple homeschools, and I will let all you non-homeschoolers in on a little secret. We spend a lot of time together. Probably too much time! We don't need meals to be the touchstone around which relationships are formed. For me, mealtime is my chance to read a book or catch up on Bible study. I'm quite sure my kids need a break from me, too. So, there you know our dirty little secret. We do not spend meals having our kumbaya moments. It would be overkill for us.

Again, the well-intentioned parents have consequences for leaving the table or bring toys to the table plus a Bible verse for good measure, "Oh, give thanks to the LORD, for He is good! For His mercy endures forever" (Psalm 107:1). And, again, I see irony in this verse: we tend to remember the command (give thanks to God) but not God's nature. So, what is mercy? Well, Merriam-Webster says, "Compassion or forbearance shown especially to an offender or to one subject to one's power" and "a blessing that is an act of divine favor or compassion." It is God's nature to treat us with love, kindness, and grace even though we have not earned it.

I like the third definition of mercy even more, "compassionate treatment of those in distress." Sometimes, what looks like inappropriate behavior communicates a feeling of distress the child cannot put into words. In the case of Jose Salinas, he came home sick all the time. He didn't want to go to school. Setting up a behavior chart for Jose would have been like giving morphine to someone with a broken arm. It fails to get to the heart of the matter: in his case, verbal abuse. His mother saw his distress, investigated into possible causes, and dealt with the real problem.

I wonder if the family with meal troubles has tried looking beyond the behavior to see what it communicates. Do the children have short attention spans? How long is their attention span? Is it possible for them to sit through a whole meal? Would they do better grazing healthy foods during the day? Do they need a fidget toy to stay on task? Are they having problems digesting food and need to be on a special diet (and picky eating is often a symptom of gut issues)? Does something about the meal frazzle them, requiring a calming toy? Our kids have quite sensitive hearing and everything from the dishwasher running to flickering bulbs to stomachs growling to utensils scraping the plates might be bothersome. Kitchens are full of other stimuli: rays of light bouncing of various surfaces, different types of light, strong smells, etc. Perhaps, they find it hard to feel thankful about such a tortuous experience as eating a meal.

Oh, and my Bible verse for that is:
In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us with groans that words cannot express. Romans 8:26
While we are human and are prone to mistakes, we can follow the model the Holy Spirit, who is the source of compassion ("But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control" Galatians 5:22-23). We can help our children in their weakness. We can try to search their hearts and find out what is really going on before we start guiding their behavior.

Monday, May 30, 2011

AO, and I Don't Mean Ambleside Online

Isn't it ironic that two things in my life have the initials AO: Ambleside Online and the Autism One conference, which has graciously posted videos. Since I am not sure how long they will be available online FOR FREE, I suggest you stop reading and start watching Dr. Nicole Beurkens' presentation on Relationship Development Intervention (RDI). She hits all the things that helped us so much when we started down this path back in 2007.

Now, I don't mean to be ugly or controversial, but I want to contrast what I know about RDI with the one on Verbal Behavior by Dr. James Partington. I admit I am biased against behaviorism, not only in how I handle autism but in how I teach children. My goal is to help people see that we must put first things first in teaching language-delayed children. Assuming that children in the autism spectrum cannot learn pre-verbal relationship skills is a mistake. Some can! Mine filled in these holes in her development after she turned 18—18 years old, not months old. She still has a long way to go but she has made progress in her social skills because of it. Autism therapies can be expensive, so it helps to learn from the school of hard knocks. This post represents that!

First Issue - Partington lost me four minutes into it when he talked about hitting language hard. I know you are dying for your child to speak, much less speak well. I know that! Both of my children talked late (David had back-to-back ear infections for two years). Pamela is still learning English as a first language (and Spanish too—the other day she constructed her own unique sentence, "God es mi padre." Muy bien, mi hija). What is so wrong about teaching your preverbal child to talk?

If they lack the nonverbal receptive and expressive skills, they will be missing vital components of communication when you focus on words only. I know! I made that mistake and I hope to help others avoid doing the same. As I am trying to be fair, I do applaud Dr. Partington for cautioning parents about academics (letters, colors, shapes) before their time, but now I must add a caution. He is skipping a vital step: broadband communication (and, if you don't know what that means, I refer you back to Dr. Beurkens).

Second Issue - I also applaud Dr. Partington at minute five for encouraging the first intellectual habit that Charlotte Mason prized above all others: attention, a sign of active, engaged minds. See, I'm fair! But—you knew that was coming, right—but, he focused on having many trials. Being fully engaged and attentive is an exhausting process, especially in the rapid drills typically found in behaviorism. The pace is so fast it often requires you to reward children with food. When allowed to work at a slower rate and given time to process and think rather than automatically act, children do not need artificial rewards.

Third Issue - I thank Dr. Partington at minute six for recognizing the importance of parent participation, the home, and other environments. I love how he contextualized asking a child to recall the word leaf by being outdoors when he pointed to one and asked the student, "What is it?" He used this anecdote to illustrate the importance of having many trials. Well, I have a much larger point. Does the child care what a leaf is? Has she pet a velvety bud? Has she watched a leaf emerge from its bud in the spring? Has she felt its smoothness, traced veins with her fingers, and smelled fresh green? Has she collected them in the fall and wondered how they changed color? Or, does she feel manipulated about having to learn a word for a thing that doesn't interest her in the least? While she may know how to label leaf through drilling, she does not know its essence. To quote Mason, "The question is not,—how much does the youth know? when he has finished his education—but how much does he care?" (page 170).

Fourth Issue - At 7:20, the speaker points out the need to vary what you are doing and not engage in the same type of activity. Mason educators know the value of short lessons and going from one style of lesson to another (doing math for ten minutes and shifting to singing when attention lags). However, we could completely avoid drilling the same kind of activity in trials if we worked with children in context and focused on developmentally appropriate tasks. Why would a child want to learn imitation if they see no point to it? If the child doesn't find it intrinsically interesting and doesn't understand why anyone would want to imitate, then it is just monkeywork.

When a child wants to eat an orange, that is the moment to work on imitation. Scaffold the child into success by scoring and partially pulling the peelings of two oranges. Sit at the table with your child and, once you have full attention (I will get to that in a bit), do one little thing like pick up the orange, smile expectantly, and wait for them to imitate you, even if it takes 45 seconds for the child to figure out what to do. Once they hold the orange, grab one pre-pulled corner, smile, and wait. This is imitation (and a whole host of other things) in context, rich in meaning for the child with a natural consequence, not an artificial reward. You can think of all sorts of opportunities for teaching imitation in daily life for things our children already need to learn.

Fifth Issue - At about 10:45, I agree with Dr. Partington's concern about social interaction. But, I want you to think very carefully about this. The ways in which VB teaches language sets up a very unnatural style of interaction: prompt, quick action, reward. What do you think repeating this cycle over and over tells the child? Other people think. Other people command. The only point to getting the right answer is a reward. It puts the child in a passive, receive mode for long periods of the day. Something interesting happens when the child learns to speak well. They have seen controlling the conversation modeled for them for years, and monologues about things that only interest them becomes their modus operandi! Conditioning any person in that manner might prepare children for schools as they are today. Will it prepare them to live for anything other than awards?

Sixth Issue - Yes, I appreciate the work of Lovaas in the 1970s, described in minute 13:30. I know that we should never give up on our children: there is always hope. Where are the Lovaas children now? They are adults. What kind of lives are they leading? Why has his original research never been followed into adulthood? Where are long-term studies of children who have graduated from ABA and transitioned into mainstream schools? (By long-term, I meant the adult years.)

Seventh Issue - The scariest quote in the first half of the presentation for me was this at minute 16:15: "We know how to make these kids to want to work for us." If what they are learning had meaning, if it was contextualized, if it was done at the pace in which they could process and think, if they were allowed to acquire missing developmental milestones rather than learn discrete skills, you wouldn't need to make them work for you! As the two of you share experiences, the child gleans knowledge and new thoughts from them.

Eighth Issue - At minute, 17:50, Dr. Partington gets into the whole expressive versus receptive language thing in his example of using the word book. He is missing some vital things about books and young children. Books are meant to be shared. Books are more than things to want and get. For a child to able to enjoy a book with you, many things must happen first. They must have joint attention. They should coordinate actions with you. They must be able to anticipate and enjoy novelty so that, when you read slightly differently to spotlight another way to experience the book, they find it fun. Children must have an idea of the context in the story, or the story will make no sense to them. Finally, I'm having a hard time remembering the last time I said to a friend in conversation, "What is something you can read?" But, I digress.

Ninth Issue - Again, I love what Dr. Partington said twenty-three minutes into the presentation about dogs. Through the window, a child sees a dog walking outside. The temptation is to go into teacher mode and ask a bazillion questions about dogs. Well, some teachers, that is. That is not what I would do from a Charlotte Mason and RDI perspective. He is right about punishing a kid with a bunch of impertinent questions about dogs. However, I disagree with his recommendation to say all you want. That is ineffective, too. What I would do is what Amy Cameron calls match plus one. To "dog," I might say, "Cute dog!" To "brown dog," I might say, "Brown like Loa," tugging at Pamela's episodic memories about her favorite dog from childhood. Then, I would smile and wait to see if Pamela felt competent enough to make another comment. In other words, give the child a chance to be an equal partner in the conversation.

Here is a sample conversation that just happened: Pamela just came into the room with a bowl of grapes that she had washed. Focused on writing this post, I ignored her. Suddenly, I heard, "Grapes." Without turning to look at her, I said, "Grapes are yummy!" Pamela said, "Grapes are healthy!" I turned to her and smiled, "Grapes are healthy and juicy." Now, that she had my-face-to-face, full attention, she laughed and started eating. Sometimes, people with autism complain about having to make small talk. We probably have been so focused on what must be done that we have not modeled chit-chat. When we have to work so hard to drill proper speech, grammar, and syntax, we lose track of little conversations with no agenda, no demands, no purpose. RDI allowed me to relax and appreciate small talk for what it is.

Tenth Issue - Twenty-five minutes into it is a slide about identifying existing language skills. What ever happened to pre-language skills? Does the child shift attention? Share joint attention? Understand facial expressions? Use them? How rich is the vocabulary of gestures? Do they understand gestures? Do they look to trusted adults when unsure? Do they watch others to learn? Words can only take a person so far if they are missing out on pre-language skills! I know because I had a sixteen-year-old who didn't have them! Verbal Behavior is missing out on a huge gap in nonverbal communication skills. If they lack these abilities, then they will not learn like other children, which is one reason why they become bully magnets in school. Of course, that is not their fault. It is our fault for not teaching them pre-language skills.

Eleventh Issue - Minute Thirty-Two. In the speaker's clinic, they make children look at every person in the room and greet them. Can you imagine what typical kids will think the first time that child gets on the bus? There is a time and place to do this sort of thing. For example, Pamela knows that, when we get together with Steve's side of the family, the Salvadoran custom is to greet and give your cheek to each person in the room. She also knows that my side of the family is more lax about greetings. In a small gathering, my family greets people individually, but, in a large gathering, a general "hi" works, too. Context makes a huge difference for any behavior that we have. A behavior in one situation is often the wrong thing to do in another. That is where our children get into trouble. They look at social interaction as following a set of rules, but context sometimes changes how we interact.

Twelfth Issue - At 33:25, the speaker talks about routines. Following a routine is usually not the problem with our kids. Transitions from one task to another is the problem. Deviating from the routine such as canceling a trip to the playground because of rain causes a meltdown. Thinking flexibly about the routine is the problem (it is okay to start lunch at 11:59 instead of 12:00). Seriously! Some kids are that locked into routine.

Thirteenth Issue - Responding is not thinking. Another scary quote for me was, "I'm never going to make those connections for them" at minute 35:06. I find this problematic in the school system for all children. Making connections for children robs them of the joy of thinking for themselves. To quote my friend Jenn Spencer, "I am not the fountain from which knowledge springs for my thirsty students. It is not my job to provide all the answers. When I do I rob my children of an opportunity to exercise their own minds, and a lack of exercise leads to atrophy.... One of the hardest things for me to let go of was the need to ask questions that pointed them to my way of thinking. This included giving 'comprehension tests' in which I drew out all the important ideas for my students and held my opinion as the correct answer. The result of leaving this behind has been that sometimes they do not get the ideas that I got at all, sometimes they come to the same ideas I had after having lots of time to ruminate on the material (making it theirs forever, since they were the ones doing the thinking), and sometimes they enlighten me with ideas I might not have thought of." If you focus on what a child thinks and how a child thinks, they will learn to make connections for themselves.

Fourteenth Issue - Finally, thirty-nine minutes into it, the speaker talks about non-verbals, and I'm glad he recognizes the importance of sign language for children who haven't developed their vocal musclelature! He also sees that having an ability means nothing to the child unless they use it spontaneously, without prompting, in a real-world context. Then he spent over fifteen minutes listening to his explanation of ABLLS before I became unglued at minute 56:05 when he equated "establish yourself as a conditioned reinforcer" to "make friends with them" and "make them want to do things to please you." While I completely support developing warm relationships with children, a danger in relying the same motivator most of the time: if you please people, you get rewards. I value helping a child (1) create meaning where there was none before, (2) feel competent about what they are doing, (3) trust you to provide enough support for them to feel successful but enough challenge to make it interesting, and (4) have just enough novelty to keep attention without overstimulating them. The intrinsic reward for the child is that "aha" moment, which in Pamela's case is accompanied by a giggle. Playing to one motivator "getting the good things faster" concerns me because people work for many reasons, not just utilitarian ones.

Fifteenth Issue - I was so glad to see footage of Dr. Partington working with a real child with autism at 1:04:00 (we are into hours now). Because he thinks the child is ready to express her needs in signs and words, I made a few assumptions. By the time an child is ready to communicate in words, he has mastered the art of nonverbal communication. He doesn't just walk into the kitchen and stand there like this little girl did. He doesn't simply walk to the refrigerator and wait, which is often what an autistic child without language does. He actively seeks your attention, follows your eye gaze, and, when you shift your face in his direction, he points and gestures. He watches for your response to see if you understand. If not, he finds another way to communicate. He is also at the stage where he is beginning to share joint attention with you. So, when Dr. Partington starts teaching the little girl in the video language, I assumed she had all of these pieces in place. She did not. I did not see any effort to work on these vital components: shifting attention to him, following his eye gaze, waiting to see if he is paying attention before signing eat, and sharing her enjoyment of the pizza with him. To put it crassly, Dr. Partington is nothing more than a pizza dispensing machine to her.

So, how would one go about eating pizza with this child? How do you feed infants? Often it is a game where you encourage the child to shift attention to you and the spoon by making novel sounds and closing the distance between the baby and the spoon. Then, you smack your lips, lick your lips, and say, "Mmm. That tastes so goood!" If you need a refresher go, check out a first spoon feeding video on youtube. You can see how the little boy is already communicating a desire for more: reaching for the bowl, kicking out with his legs, leaning into his mother, opening his mouth for more, etc. He checks his mother's face for reassurance, but, when he is no longer hungry, he turns away. The mother carefully watches what he is communicating and responds to him. Notice how much mutual enjoyment the mother and her son share.

Compare the two interactions. The baby boy is already communicating volumes more than the little girl does through his facial expressions, body language, and attention shifts. Dr. Partington and the girl completely miss out on any joy, mutual enjoyment, etc. Of course, they have no relationship because this is the first time they have worked together. That ought to be a greater aim. He is very instrumental with her: the minute she signs, he dispenses the food, and there's no effort at communicating any delight or mutual satisfaction. She is the manding machine for him, and he is the vending machine for her. Nothing else matters in the interaction.

In the swing segment (1:13:45), her father is wonderful. You can see how he focuses on experiencing sharing as well as the long e sound, the laughter, the joy. Notice what he does when she stares at her feet, he moves into her line of sight. He gets experience sharing. For him, the interaction is more than reinforcing her: it is emotions shared, the delight.

Sixteenth Issue - When Dr. Partington shifts to working with her mother, again you see the instrumental style. Even though the little girl is signing, she is completely tuned out from her mother. Think back to the baby and those moments of enjoyment between mother and child. That vital ingredient is missing here. Sharing food is more than nourishing our bodies. It is communal. There is joy and fellowship and enjoyment of one another's company. I will commend Dr. Partington for saying at 1:18:30 the importance of letting the little girl come to her and slowing down!

How did we work on face-to-face gazing without food? In the first two weeks of transitioning to RDI, I would walk up to Pamela and wait. If she did not shift to me, I would make a novel sound, each time different: "Yoo hoo!" Clear my throat. Or I might wave or do a silly dance move to encourage that shift. My final maneuver was to move into her line of sight. Once she shifted her gaze (which does not mean I expected her to eyeball me to death either). Then, I would tell her something. Anything. "I'm going to take a shower." "I'm going to call Dad." "I'm going to use the computer." Sometimes, my message contained a naturally rewarded consequence. "Dinner is ready." "I'm going shopping."

Very quickly, Pamela realized that Mom expects me to pay attention to her when she speaks. In fact, Dr. Partington mentions this point about waiting until a child looks at you before speaking later in the video (1:36:30). The big difference between what he does and what I do is the pace and intent of communication. When Dr. Partington speaks, he expects you respond quickly. When I speak to Pamela, I am telling her something that may or may not require a response. Think about it. Communicating is more than making demands of one another. Because I wasn't commanding her every time I opened my mouth, Pamela was learning that sometimes people share information without expecting you to act on it. Some of our communication is like that.

Seventeenth Issue - I appreciate Dr. Partington's take on stim toys at 1:19:45. I can drink a cup of coffee and enjoy my conversation with you. In fact, I might savor the moment more because of the aroma and my delighted taste buds. I agree with Dr. Partington that the little girl does something cool at 1:21:45. She uses her eye gaze to let them know that she wishes to eat from a different bowl. But, there is something vital missing that young children do when they communicate. The whole point of learning to shift attention to watching you is to see if you are paying attention to them. She is missing the key component called referencing here. This pre-verbal skill is when the child points to the bowl, checks your face to see if you are seeing the communication, and waits for your response. At this stage of development, being able to reference another person for a variety of reasons is far more important than using words. In this segment, the little girl broadcasts her intent for a different bowl like radio waves sent out into space. The mother and Dr. Partington move so quickly to respond, they do not give the little girl the opportunity to watch what they are doing and see if they get her message. I can see they were excited, but they missed that chance for the girl to look at her mother and see that mother understands.

Eighteenth Issue - At 1:24:00, Dr. Partington spends a lot of time on reinforcers. Why? His goal is to teach children to ask for what they want and make demands of you. Because he is ignoring the missed developmental stages, such as appreciating novelty, he must use artificial reinforcers. Think about peek-a-boo. Why do we spend so much time on a silly little game when we could be teaching infants to make demands of us!

We are teaching them foundational elements of mutually enjoying each other, which is naturally reinforcing. At first, peek-a-boo is done very slowly until the baby gets the pace and sees the fun of dad covering baby's face and slowly pulling off the blanket. Then, as the baby gets it, dad adds little variations, or novelty. If she adds them too soon, the baby cries because he doesn't understand the fun of anticipation and change. After baby learns that, peek-a-boo becomes a wild game with all sorts of unexpected events, false expectations, and surprising pops-up. Learning to appreciate anticipation and novelty naturally reinforce our social interactions. A child who finds novelty fun will not need fewer artificial rewards. Likewise, children who are making meaning (not just learning labels) and feeling competent about what they are doing (not just going through the motions) need fewer artificial reinforcers.

Nineteenth Issue - At 1:28:00, I admit I cracked up at his warning to parents to avoid teaching children to ask for things they wouldn't want in their wildest dreams (bed, toilet, etc.) Very few kids ever want to go to bed, so that makes sense. But, I do have qualms about his reasoning for not teaching children to say things you don't want to hear until they are bigger than you and can hurt you ("leave me alone" and "no"). Why wouldn't we want them to tell us that? Sometimes, our children are truly worn out and need downtime. That is just as much a need for them as food. I understand that children with autism may need treatments and therapies in their early years to help fill in developmental gaps. We also need to keep in mind as Dr. Beurkens pointed out that we are vastly overscheduling the lives of our children, whether they are autistic or typical. The sensory systems of autistic children are so easily overwhelmed. Because they process more slowly, a slow pace to us is a merry-go-round to them. We ought to be very careful about what therapies we chose for them: just because something is available does not mean we must do it.

I think what Mason wrote about the rights of children ought to apply to those with autism. We should not mistaken organized games and structured recreational activities as play. It is work to them because of everything they must filter out, filter in, process, and monitor. They need free time like any other child. We must allow opportunities for personal initiative in what they do without us taking over and ruining it (pages 36-39). Yesterday, I pulled out some pony beads to sew on eyes on a stuffed toy for a friend. A few hours later, Pamela came to me and showed me a bead necklace she made out of about 50 pony beads. I warmly acknowledged her effort and told her they were beautiful. Then I waited. Sure, I wanted her to wear them. But, I waited. About a minute later, she was proudly wearing them and twisting them around her finger like all girls do. Mind you, Pamela is not a dress up kind of girl, so it was a sweet moment that I could have ruined by doing the thinking for her.

Twentieth Issue - At 1:35:00, I loved how Dr. Partington shared a very important point about all people, including autistic ones. People don't mind unpredictable payoffs as he describes in the slot machine analogy! I would like to take this a wee step further. Unpredictability, one of the secret ingredients of peek-a-boo, is very hard on our kids, which is why they need it in small doses. When we worked on Pamela's anxiety's during the whack-a-mole campaign, we discovered that unpredictability heightened her anxiety, leading her to control people. We spent a long time working on it, and we still have to work at it. David and I discovered yesterday that he had spent too much time being predictable by watching movies in his room. When he tried watching one in the television room downstairs, Pamela had a nuclear meltdown. It took at least fifteen minutes for her to get a grip (and it didn't help that she has a nasty cold sore inside her lip). She eventually chose to sit on the back porch in the rocking chairs and wait for David to finish watching the movie before she came inside. After I calmed her down, David told me, "Mom, I have to make a point to watch movies downstairs sometimes, don't I?"

How do you start working on unpredictability? By adding little variations into a predictable routine. Even when Pamela was little, I made a point not to get trapped by routines. Pamela cried if I skipped an aisle at the grocery store. To help her prepare, I would smile, say "One, two, three, weeeee!" and push the cart really fast to the next aisle. Because we moved every few years, Pamela was forced out of the normal routine until she established new ones at the new neighborhood. In RDI, we use this term called productive uncertainty. You add just enough unpredictability to challenge a child without pushing them into meltdown. A very practical way is to set up doing chores, baking, putting groceries in a bag at the self-checkout, or any activity through interactions patterns. You get the pattern going, and you add a teeny, tiny variation.

Suppose the little girl wants some grapes. You get a bowl of water, place it at the table, and show her how to drop it in the water. You start an assembly-line pattern: mom picks off a grape and gives it to the girl, girl drops it in the water. Then, repeat. You go as slowly as she needs to go. Once she is competent and gets her role, then you add a variation. Just like you might gasp or make an alerting sound in peek-a-boo, you do that first to let her know that something different is about to happen. Then, you take an unexpected action: you drop the grape on the table and wait for her reaction with smile on your face. If she calmly picks it up and finishes her role, you go back to the pattern and then throw in a different variation: you put your hand at a higher or lower level than she expected, you gently bop yourself on the nose with it first, you gently bop her on the nose with it, etc. As long as she goes with the flow, you randomly insert a little variation into the interaction pattern. You might even do something really silly like eat the grape first! However, if she cries or gets frustrated, you help her to recover her emotions, get back to the predictable pattern, and wait until she is really confident before you try a smaller variation than the one that upset her. Basically, you apply peek-a-boo to routine activities into which you can weave an interaction pattern.

Twenty-First Issue - At 1:38:30, I like how Dr. Partington points out that we should encouraging our children with smile and warm facial expressions. That is true for all children! (A quick mathematical rabbit trail SMILE—breathe deeply for no purple math problems are on the horizon—do you want to know how to trip up a student who feels competent in math? Frown and look puzzled while they answer the question!) I also agree with him on timeout: sometimes, autistic children want to be left alone and act up just get a timeout.

Then, Dr. Partington shows some errorless training, which caused me to pause again. I can understand why we think it is necessary because autistic children often feel incompetent at everything. Even in RDI, we scaffold a child by setting up the situation to allow the child to succeed in some small way while still being challenged. However, when you are working for an external reward like food, then making mistakes are far more devastating. You didn't get what you expected (the reward) because you made an error! When discovering something new or mastering a step motivates you, then the stakes are lower. When you focus on process (learning to tie shoes) rather than product (a reward for tying them correctly), you feel less pressured by making mistakes.

Life is messy. Humans make mistakes, and, in fact, to err is human. Too many of our spectrum children are perfectionists by nature. Some require us to work hard to model the fine art of making mistakes, remaining calm and neutral when something runs astray, and figuring out what to do about the mistake. One of the most common questions I get from parents new to homeschooling is how to help their autism spectrum child stop melting down over wrongs answers! Making errors is not the issue: the issue is whether or not you make an error, you know you made an error, but you find a way to repair the situation. The video of Pamela making mistakes in learning to tie her shoe illustrates this beautifully.

Twenty-First Issue - From 1:40:00 to 1:47:00, Dr. Partington spends a lot of time labeling names with flashcards, a decontextualized way to learn labels. It reminds me of a friend whose child was drilled with flashcards: I am changing the situation somewhat for anonymity. Suppose we drill, "What do you find in a pool (common here in the Carolinas)? Water, ladder, and floats." The child memorizes the exact response and has it perfectly. One day, you see a duck in the poll and you head the child outside, point to the unexpected thing in the pool, and ask with great excitement, "What do you see in the pool?" The child misses the novelty and mechanically replies, "Water, ladder, and floats." This is the kind of thing that was happening to the child, and my friend had to work very hard to contextualize understanding.

Dr. Partington does recommend we "show them what a tape is and does" but it sure looks like "do as I say, not as I do." How do I teach Pamela new words in context? Here are two examples: copper and fungus. Because we look for meaning and connections, living books and real life offers opportunities to reinforce new words (copper kettle at the Revolutionary War encampment). I also like his point about the giraffe and zebra at 1:42:00. If a child can only express thirty words, I would certainly go for new words that have meaning in the child's life as he suggests chicken in Hawaii where they run on the road or iguana if that happens to be one of your pets. However, some people carry the concept of functional (1:45:07) too far, especially in choosing books for our children. If we only read books that spotlight functional understanding, then they will miss out on embracing fantasy and laughing at the ridiculous. I think focusing on meaning is more helpful than focusing on function because most of us hope that some day our children will have an active imagination and a lively sense of humor.

Twenty-Second Issue - The little boy at 01:47:00 is doing many wonderful things: he shares joint attention with the adult in looking at the book. He is using body language and looking at the therapist. I like what Dr. Partington suggests in having a child "tell me about the woman." That is narration in a nutshell. Where we do it differently in the Charlotte Mason world is that we teach in context: when outdoors, children sight-see and picture-paint by sharing what they observe. The art of knowing and narrating occurs in context in concrete, real-life situations. That prepares them for the shift to more abstract settings when they hit formal lessons starting in Year 1 (starting at age six or later for some children): picture study, nature study, narrating a passage from a book, etc. 

We even follow-up narrations very differently. Rather than focus on instrumental, imperative "gotcha questions," we focus on meaning and episodic memory. When a character breaks a bone, we think back to the times when I broke my arm (1974), Pamela broke hers (1999), and David broke his arm (2003 and 2005). When a character botches a recipe, we talk about culinary horror stories. When we read about a hawk, we recall our own hawk rescue and Pamela even remembers this incident every time she catches an insect in the house and gently releases it outdoors. We seek opportunities to ponder, wonder, and share what we feel, not poke holes in her sense of competency.

Twenty-Third Issue - At 1:49:00, Dr. Partington talks a bit about intraverbals (talking about things in their absence). The contextual way to do this is telling the absent parent what happened. When Dad comes home from work, children tell him about what they did while he was away. When children come home from a trip to the hardware store with Dad, they tell Mom all the things they saw and did. When Grandma calls, they tell her about the birthday party. I see a clear pattern in how Verbal Behavior approaches tasks versus a relationship-oriented way (Charlotte Mason and RDI). We seem to focus on the whole in a real, concrete context that has meaning for the child while VB seeks to fragment and decontextualize in an abstract manner. We seem to tie an unknown to a prior known, tapping into episodic memory, while VB seeks to drill unknowns until they are memorized, which is quite a different thing from known.

Twenty-Fourth Issue - At 1:57:00, Dr. Partington makes a vital point about paying attention to what people are doing. Inattention to people becomes a problem when you focus on words before nonverbal communication. Because RDI concentrates on referencing (watching what people do and think about how we might alter our actions or stay the course), children are more able to transition to social situations even when their verbal skills lag. First, we focus on teaching them to reference their parents. They discover that people with more experience provide clues on what we should do. A great example for Pamela was when she was not sure about what to do with metered mail and she referenced me to find out. Then, they learn to reference other trusted adults and eventually peers in small groups such as when Pamela took watercolor classes.

Watching what people do is not an afterthought once we have taught them language. Watching what people do is a means by which children learn to do and learn more language. Rather than focusing on discrete details about what Michael is eating and wearing at 1:58:00, we are focusing on the relationship. The kind of thought pattern we aim for our children to learn is not focused on objective details: "Michael is eating a sandwich and baby carrots. He has brown hair and eyes. He wears glasses. He wore a red T-shirt and blue jeans." We focus on subjective details: "Michael is frowning at me. I wonder why. Maybe he doesn't like my tapping the table with my finger. What happens if I stop tapping? He still looks upset. What if I move away a little? He is relaxing. I bet I was too close to him. I'll have to remember that next time."

If you have never heard of any of this heretical, completely topsy-turvy way of addressing autism, I encourage you to study Dr. Beurkens' presentation and chew on that only for awhile. Drink it in and absorb it. What sounds so simple is really a challenge in our "more is more" and "now is better" world. Think about it. Learn to live it.

Teaching our children from a developmental, relationship-oriented point of view requires a huge paradigm shift—a major change in how we interact with our children that runs counter to the culture of enlightenment thinking. In the beginning, we focus on what we are doing as parents: are we slow enough, are we more careful with our nonverbal communication, have we cut out therapy for the sake of therapy because it is available and fairly inexpensive, are we being more declarative in my language to let our children think. It may require the guidance of an RDI consultant (ask your friends for not all consultants are created equal). You may end up changing schools or homeschooling or changing how you homeschool. Change is hard!

This change in my thinking started at the turn of the century (whoa, that makes me feel old), and I am still learning as I go. Friends of mine like Jennifer Spencer and Lisa Cadora have found the change sometimes painful but worth it. We no longer worry about learning because we are learning to live and enjoying the new life we live.

Friday, November 06, 2009

The Only Tolerable Form of Behaviorism (in My Humble Opinion)

Everyone has biases: the key is whether or not you admit to them. If you want ideas about behavior modification or Applied Behavior Analysis, feel free to meander to another blog or website! I admit that I am prejudiced against these forms of treating autism, but those of you who swear by it might feel better if I admit to using one branch of this philosophy of education: Positive Behavior Support (PBS), when firmly grounded in respect for personhood (which I define as the opportunity to accept or reject ideas), natural consequences and payoffs (rather than artificial rewards), both nonverbal and verbal communication, and scaffolding within the child’s zone of proximal development.

Using PBS, we study why a child expresses frustration through challenging behaviors and brainstorm positive and proactive ways to address the underlying issues by changing something in the environment, coming to a share understanding, scaffolding the child better, etc. The goal is to improve quality of life in the naturalistic setting in a way that respects all people involved. PBS dovetails nicely with RDI when parents carefully and thoughtfully apply it in guiding their children.

Lest you fear I have turned my back against a Charlotte Mason philosophy, I have not. I plan to demonstrate my point through a case study Charlotte Mason wrote on a imaginary boy named Guy Belmont, whose meltdowns remind me very much of what children in the autism spectrum do today. If you do not believe me, check out either the original story suited for the Victorian ear, or the brilliant Leslie Laurio's modern paraphrase.

Mr. and Mrs. Belmont noticed that young Guy had developed a major problem with unpredictable, raging temper tantrums (the little tyrant even bit into and ripped his mother's dress in one fit). Mr. Belmont assessed the negative cycle by weighing his own observations with those of his wife and his son's nurse. He figured out what happened before, during, and after the outbreaks and developed a theory about how to prevent them.

Before
While many unpredictable situations set off Guy, several observable, physical signs or pending meltdown consistently appear right before the tantrum started. "If you notice––no matter what the cause––flushed cheeks, pouting lips, flashing eye, frowning forehead, with two little upright lines between the eyebrows, limbs held stiffly, hands, perhaps, closed, head thrown slightly back; if you notice any or all of these signs, the boy is on the verge of an outbreak."

During
Guy paid attention to his mother's reactions: "He eyed his mother askance through his tumbled, yellow hair, but her presence seemed only to aggravate the demon in possession."

His mother's calmness helped somewhat: "'Did you hear me, Guy?' in tones of enforced calmness. The uproar subsided a little."

Physically forcing Guy to behave made him worse: "When Mrs. Belmont laid her hand on his shoulder to raise him, the boy sprang to his feet, ran into her head-foremost, like a young bull, kicked her, beat her with his fists, tore her dress with his teeth."

Putting Guy in a timeout did not alter his behavior. "Once in [his room], the key was turned upon him, and Guy was left to 'subside at his leisure' said his father . . . Meantime, two closed doors and the wide space between the rooms hardly served to dull the ear-torturing sounds that came from the prisoner."

Novelty captured his attention and calmed him down. "All at once there was a lull, a sudden and complete cessation of sound . . . What was her surprise to see Guy with composed features contemplating himself in the glass! He held in his hand a proof of his own photograph which had just come from the photographers. The boy had been greatly interested in the process; and here was the picture arrived, and Guy was solemnly comparing it with that image of himself which the looking-glass presented."

After
As soon as his temper had ended, Guy was free to leave his time-out and acted as if nothing happened. "Guy was released, and allowed to return to the nursery for his breakfast, which his mother found him eating in much content and with the sweetest face in the world . . . You would have thought he had been trying to make up for the morning's fracas, had he not looked quite unconscious of wrong-doing."

Hypothesis

Mr. Belmont brainstormed with his friend Dr. Weissall one evening. He explained their theory to his wife and the nurse the next day. Mr. Belmont did not develop any strategies directed toward the trigger of tantrums because he found no consistent pattern. He planned to prevent them by acting the moment his son showed physical signs of mounting frustraiton. He thought that Guy was young enough to be distracted from exploding, so the goal was to guide him in changing his thoughts. "Do not stop to ask questions, or soothe him, or make peace, or threaten. Change his thoughts."

Intervention
Mr. Belmont suspected that novelty in both setting and events would distract Guy in the heat of the moment. He suggested to the nurse who watched his son during the day to think of something new to do every time Guy started to get flustered. "Say quite naturally and pleasantly, as if you saw nothing, 'Your father wants you to garden with him,' or, 'for a game of dominoes'; or, 'Your mother wants you to help her in the store-room,' or, 'to tidy her work-box.' Be ruled by the time of the day, and how you know we are employed. And be quite sure we do want the boy."

Nurse became convinced of the soundness of this hypothesis after she prevented a couple of outbursts. Even when the Belmonts were out, she found ingenious ways to distract Guy and change his thoughts. "Nurse was really clever in inventing expedients, in hitting instantly on something to be done novel and amusing enough to fill the child's fancy. A mistake in this direction would, experience told her, be fatal; propose what was stale, and not only would Guy decline to give up the immediate gratification of a passionate outbreak."

Altering Consequences
Nobody is perfect, and Nurse was no exception. One day, Nurse forgot herself and Guy blew up. Guy found pleasure in novelty, even if it was simply putting the house in an uproar. He did not see how his outbursts affected others. To help Guy come to a shared understanding with the rest of his family, Mr. Belmont asked his wife to become quietly mournful and withdrawn with a kind, tender spirit after an outburst. "We must, as you once suggested, consider how we ourselves are governed. Estrangement, isolation are the immediate consequences of sin, even of what may seem a small sin of harshness or selfishness . . . but he must never doubt our love. He must see and feel that it is always there, though under a cloud of sorrow which he only can break through."

Transferring Responsibility
The day after Guy blew up and received the loving, but silent treatment, Mr. Belmont and Guy brainstormed ways for Guy join them in helping to prevent tantrums. His father helped Guy learn to recognize pending tantrums by the physical signs and came up with an imaginary device--racing Mr. Cross-man--to avoid them in the future.

Mr. Belmont: "So my poor little boy had a bad day yesterday!"

Guy hung his head and said nothing.

Mr. Belmont: "Would you like me to tell you how you may help ever having quite such another bad day?"

Guy: "Oh yes, please, father; I thought I couldn't help."

Mr. Belmont: "Can you tell when the 'Cross-man' is coming?"

Guy hesitated. "Sometimes, I think. I get all hot."

Mr. Belmont: "Well, the minute you find he's coming, even if you have begun to cry, say, 'Please excuse me, Nurse,' and run downstairs, and then four times round the paddock as fast as you can, without stopping to take breath!"

Guy: "What a good way! Shall I try it now?"

Mr. Belmont: "Why, the 'Cross-man' isn't there now. But I'll tell you a secret: he always goes away if you begin to do something else as hard as you can; and if you can remember to run away from him round the garden, you'll find he won't run after you; at the very worst, he won't run after you more than once round!"

Guy: "Oh, father, I'll try! What fun! See if I don't beat him! Won't I just give Mr. 'Cross-man' a race! He shall be quite out of breath before we get round the fourth time."

My Conclusion
Charlotte Mason was a genius because she figured out a hundred years ago what some folks have yet to learn: kids prone to tantrums need more than a time-out . . .

Monday, November 03, 2008

Autism in Adults

With reference to adult outcomes, we do know some things and we shouldn't be all that impressed . . .
It is not an overstatement to say that adaptive behavior competencies will get you through times of no academic skills better than academic skills will get you through times of no adaptive behavior competencies.

Who do you think put these remarks in his presentation The Autism Education Network's recent Collaboration in Autism Treatment conference?

If you guessed, Dr. Steven Gutstein . . .

. . . you would be . . .

WRONG!

This speaker did cite the 2004 Howlin study that Dr. Gustein uses as well as two I do not remember seeing (Green (2000) and Cederlund (2008)). He mentions several statistics like those spotlighted by Dr. Gutstein as well:

In a group of 20 adolescentes with Asperger syndrom, Green, et all (2000) found that despite a mean IQ of 92 only half were independent in most basic self care skills including brushing teeth, showering, etc. None were considered by their parents as capable of engaging in leisure activities.
Howlin, et all (2004) surveyed 68 adults with autism with an IQ of above 50 and found a majority (58%) were rated as having poor or very poor outcomes. With regards to employment status they found
  • 8 were competitively employed
  • 1 was self-employed earning less than a living wage
  • 14 worked in supported, sheltered or volunteer employment
  • 42 had "programs" or chores through their residential provider.
Cederlund, et all (2008) followed 70 males with Asperger Syndrome (AS) and 70 males with autism more than 5 years after their initial Dx. The results indicated that while 27% of the AS group presented with "good" outcomes, 26% had a "very restricted life, with no occupation/activity, and no friends." Outcomes were considerably worse for this with an autism diagnosis.
He came to similar conclusions as Dr. Gutstein. IQ does not predict the ability to stay employed, keep friends, and live independently. In his talks, Dr. Gutstein goes further to say that neither language nor success in school predicts employment, friendship, and independence for autism-spectrum adults. So, who is the mystery speaker? Dr. Peter Gerhardt. Unfortunately, his conclusions, I fear, will produce more of the same . . .

Before I go any further, I must be completely honest. I am not a fan of ABA; I have a personal bias against ABA. In spite of all of the "evidence" (and I am a statistics hound, having earned my bachelor's degree in mathematics and master's degree in operations research), I am not impressed.

Why? Because, as these studies point out, success in school (a static system) and high IQ (a static ability) does not address dynamic intelligence, which is required for sustained employment, relationships, and independence. ABA targets static skills (learning procedures, thinking in the box, memorizing information, reacting to a prompt in a predictable way, etc.). In fact, Dr. Gerhardt points out, "in supporting adolescents and adults, there are times where previously accepted 'prompt hierarchies' may have to be modified." His answer? Prompting a la bluetooth. Hmmm . . . I am being flippant, I know--Dr. Gerhardt's presentation is full of all kinds of ideas to make an ABA parent's heart sing. However, having seen Pamela master developmental milestones that have enabled her to learn all kinds of life skills in the past 18 months--milestones I thought impossible for autistic people, I want more than direct-prompt-driven behavior.

What I like about RDI is that direct prompting (imperative teaching) is the absolute last resort for teaching problem-solving and thinking outside of the box. RDI acknowledges that the great strength of autistic children is static learning. Pamela learned her calendar skills (knowing the day of the week given the month, day, and year) through her eye for patterns, a static ability. Rather than developing that part of the brain even more, I find it more beneficial to develop the area where she is weak: dynamic thinking. It is slower and not as exciting as ABA, but I think in the long run will pay off for us!

I am not trying to bash ABA here, but to draw some clear distinctions between the two. Remediating autism means giving the child a second chance to do over what they missed the first time around. It means looking at the typical developmental profile of a typical child and letting them try to master those missing gaps. That is why ABA looks great at first because children pick up all of these wonderful static skills very quickly and you become the miracle worker. BUT, they have no idea what to do when things change or something unexpected happens. Static is easy for them, so why spend time focusing on what comes naturally? That is why you have so many highly intelligent autistic people with degrees who cannot hold down a job.

Not only that, the parents/therapists doing ABA have to engage in a completely different manner. In ABA, you expect the child to give an immediate response--in RDI, you are told to wait up to 45 seconds to allow the child to process and think. In ABA, you give the command in the same way every time. With RDI, when the child is on a roll and feeling competent in the situation (there are no commands or prompts), you add variation for which you have no prompt or target response. If they are able to go with the flow, you keep adding variations. If they freak out, you help them recover, get them going with the flow again, and challenge with a different variation. With ABA, everything is focused on verbal communication. With RDI, you are trying to be as nonverbal as you can because that is what most of our kids missed during their infant and toddler years.

If I boiled it down to one comparison, I think an ABA child is expected to do, but an RDI child is allowed to discover.

P.S. Here's more food for thought: an article called Reaching an Autistic Teen about a school started by the father of a spectrum teenager that employs Greenspan's ideas. I like this explanation of developmental theory (which is what RDI is too) on page 4:
I begin to picture the brain metaphorically as a tangled ball of Christmas lights. When you plug it in, there are strands that light up perfectly and there are dark zones where a single burned-out bulb has caused a line to go out. If the bulb for Exchanging-Smiles-With-Mother doesn’t light up, then Empathy won't be kindled farther along the strand, or Playfulness, or Theory of Mind (the insight that other people have different thoughts from yours). The electrical current won't reach the social-skill set, the communication skills, creativity, humor or abstract thinking.
I think RDI is less-child driven and tries to balance between parents and children more. I am inspired that it is the PARENT of a spectrum child (a father, no less) who started and runs the school. Very neat!

Sunday, February 11, 2007

Discrete Trial Teaching within Reason

Thanks to a comment by Mama Squirrel on an earlier blog post, I experienced an epiphany in my thinking about autism and Charlotte Mason's concept of masterly inactivity, which we are discussing at the CM Series email list. Before I can adequately explain it (in a post down the road), I need to outline my principles. Why? Unlike Pamela who is a concrete sequential thinker, I am abstract sequential and enjoying researching options, thinking through ideas, and figuring out how they relate to my principles. So, please bear with me all of you concrete and random readers!

I have found Discrete Trial Teaching useful when kept within bounds. DTT is a technique used to teach a wide variety of skills to everything from animals to people following the principles of behaviorism. Today, therapists trained in Applied Behavioral Analysis teach autistic children using methods far more sophisticated and humane than Pavlov's dog. By humane, I mean that ABA practitioners have developed ways to avoid the aversives originally used in early ABA trials with autistic children.

Here is what I like about DTT: breaking skills and tasks into the smaller steps, teaching each step until mastered, and providing lots of repetition. The word discrete means that you teach the steps in order with a distinct beginning, middle, and end. The word trial means that you repeat the steps a certain number of times per session. Part of the process involves identifying the antecedents (events, prompts, or stimuli to start the skill or task), behavior (the steps you are trying to accomplish), and consequences (feedback to let the child know if correct or incorrect).

This week Pamela needed some DTT because she did not catch on at all to her math lesson that introduced introduce inequalities like ≤ and ≥ and the language that goes with it. The first step I took was to find her baseline: what she had mastered. I found that she was able to go from back and forth from words to graphs to mathematical symbols without a struggle for simple inequalities. This meant she remembered material learned previously:
My number is seven. N=7
I have less/fewer than 10. N<10
It is greater/more than 13. N>13




I checked to see her comprehension of phrases like X or more/greater, X or less/fewer, greater/more than or equal to X, and less/fewer than or equal to X. She did not see the connection between the key words and the need to use the symbols ≤ and ≥. As her math book had not previously covered this material, I was not worried. However, the author assumed the student would immediately see the connection. Pamela did not.

Here is my strategy to teach this next week via DTT.

1. Teach her to match index cards with ≤ and ≥ to the mathematical expressions < + = for and > + = for .

2. Teach her to match index cards with the new information. The symbol ≥ goes with X or more/greater and greater/more than or equal to X. The symbol ≤ goes with X or less/fewer and less/fewer than or equal to X.

3. Make cards for the matches already mastered. The symbol > goes with greater/more than and the symbol < goes with fewer/less than. Make sure she can distinguish what symbol ≤, ≥, <, and > goes with what language.



What are my ABC's? The antecedent is the pile of index cards with information. The behavior is to match the cards correctly. The consequence will be for me to show Pamela the correct match if wrong and encourage her if right. I will teach her step one until she masters it. Then I will teach step two and, once mastered, step three.

Pamela is advanced enough in mathematical understanding that once she learns what math symbols goes with what language, I think she will easily make the leap to translating from language to number sentences and vice versa. If not, I will use DTT to teach this process. I suspect that making graphs will require more DTT.