An elephant just can't forget (#134)
Charlie's friend Tara (#136)

ABA and--not vs.--VB (#135)

In the odyssey of life with autism that began for Jim and me at the end of 1998, we have always chosen therapies and treatments based on our discernment of "what does Charlie need? how is Charlie struggling to learn and be all that he can, to fulfill his utmost potential?". We try constantly to be careful not to be distracted by academic and philosophical distinctions among different treatments. We do favor a behavior analysis-based approach as the foundation for Charlie's (and, if you need research, a recent study further confirms the efficacy of ABA in teaching autistic children). We most of all are constantly on the lookout for what might help Charlie and never hesitate to combine various methodologies, from the educational to the biomedical. (Although it is true that, as Charlie has gotten older, his education has become our dominant concern.)
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A case in point is "ABA vs. VB," that is, "applied behavior analysis versus verbal behavior"--or, "ABA vs. AVB," to add to the semantic confusion, as VB is also referred to as AVB, "applied verbal behavior." Or, "Lovaas vs. VB" or "Lovaas vs. AVB" since, as I noted yesterday, Charlie's first educational program was a Lovaas program, and he is currently again in a Lovaas program, while also attending two sessions per week of VB.

The distinctions among these therapy programs are mostly academic and, indeed, semantic, as Wade has written about in reference to how some use the word "cure" in reference to autism, while others are leery of such a term. Both ABA and VB/ABA are based on the principles of the science of behavior analysis and refer back to B.F. Skinner's work on operant conditioning, verbal behavior, and much more. (See this FAQ from Christina Burk's website for a straightforward comparison of these therapies.) The effectiveness of ABA as a methodology to teach autistic children was brought to the attention of many thanks to Catherine Maurice's 1994 Let Me Hear Your Voice: A Family's Triumph Over Autism. I learned about this book on a chance conversation with the director of a daycare center; her sister, she told me, was a special education teacher and recommended the book. I found it at a St. Paul bookstore that evening and had read it by the next day, after which I passed it on to an anxious Jim.

ABA enabled Charlie to learn how to learn (#19). Due to Charlie's having apraxia, his speech was slow to come, though his desire to communicate has always been evident, and we were more than fortunate that one member of our original therapy team, Tara, was also a speech therapist. Tara taught Charlie to use sign language to make his first independent requests and that set him on the road to learning how to talk. When we moved back to St. Louis, it seemed the right time to follow a VB program--under the protocol of Drs. Sundberg and Partington--as VB seemed to be more overtly focused on communication and expressive language. I attended one of the VB workshops by Vince Carbone; during a break, I overheard a payphone conversation in which a woman cried out words to the effect of "Those ABA people have finally figured out a better way that doesn't just involve teaching at the table!"

In truth, Charlie's ABA program was never a matter of summoning him to the table with "Come here," then doing ten drills, reinforcement and "great job!", then "go play," then taking data. From the start, our ABA therapists were encouraged to adapt their teaching to what Charlie needed at the moment, to do programs occasionally away from the table, to use play and toys to evoke his communication and socialization. Our program was well-structured, tightly organized, and a ton of fun, mostdy due to the very high level of reinforcement. What make or breaks a learning situation for Charlie is all about reinforcement, about Charlie knowing that I do this one thing, this one (super-duper excellently FUN) thing happens. (A common error is to think that reinforcement is equivalent to a reward; this misunderstanding can have the proverbial fatal consequences: I always feel a little odd Charlie is told "Do you want to earn this?" rather than letting him know that "Let's do this, then we'll get this!") Ultimately, our best therapists became his reinforcement themselves.
Sillies
Good teaching and good therapy are good teaching and good therapy and we've no time to talk about distinctions between therapies that are primarily academic and philosophical. Charlie has been taught with both ABA and VB since he was four years old and he has never had trouble with the differences (of terminology, of how the curriculum is set up). Our first goal is to teach Charlie using the best teach techniques for kids like him available and not to waste time worrying about the difficulties of coordinating ABA and AVB and a whole alphabet soup of letters. The basic behavior science principles are the same and, overall, it is good that Charlie can be flexible enough to have his teachers and therapists teach him in different ways.

So, as usual, our house today was full of Charlie manding: "I want eat brown! Rice. Burger! I want give. Daddy blue blanket. Take a walk, slide! Mommy! Daddy. I want black car, geen car." We are able to take Charlie many places thanks to the constant application of the behavior principles to teach him how to act in public. So he followed my directions to "stay by Mom" walking around the college campus where I teach, and on a hasty visit to a playground before the rain ("let's just walk here and then we'll head home," I said, as darkness fell) and in the parking lot of a store and always came back when I called, softly, "Charlie," after searching the aisles for a pack of sushi, some bags of frozen items. "Put that back, silly," I said when he tried to put in a loaf of bread that we did not need and he did so. As he waited for me to cut up a green apple, I wrote the alphabet on a sheet of paper and he identified the letters, sometimes self-correcting, as when he said i was l; I tapped the dot and he quickly said i. He has been matching letters and words as a precursor to reading; at his VB sessions, his therapist often randomly asks him about the letters intermixed with questions like "when's your birthday" and "what town do you live in." And all this teaching--and all the enthusiasm and "WOW YOU DID IT" 's of the therapists--is what Charlie needs, and what is more than his right so he be all that he can, and more.


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