Comparison between RDI and ABA ( A parents view)
Some of my thoughts with a comparison between ABA and RDI models for Autism
What is RDI http://www.rdiconnect.com/pages/Our-Programs.aspx
The RDI Program for ASD is a tailored set of objectives, extending from the Family Guided Participation Program and intended to target the core deficits of individuals with the diagnostic distinction, Autism Spectrum Disorder. Started less than a decade ago the RDI Program for ASD provides a remedial approach to this complex disorder.
A comprehensive set of developmentally sequenced steps, the RDI Program for ASD is committed to re-building the Guided Participation Relationship as the cornerstone for neural development. Families under the guidance of a certified consultant slowly and carefully construct opportunities for their child’s neural growth while adding complexity. Over time, parents create a formidable impact on their child’s ability to form reciprocal friendships, mature emotional relationships, conduct successful collaborations, engage in flexible/adaptive thought and master problem-solving abilities necessary for job attainment and success in the 21st century world.
Combining all of our tools with a unique emphasis on the needs of families with an ASD child, the RDI Program for ASD restores hope of second chance for families with an ASD child to successfully engage in this universal developmental relationship, that through no fault of their own, was not successful the first time. An inter-disciplinary bio-psycho-social approach it is critical component of treating co-occurring disorders and central learning disabilities.
What does RDI *look* like
RDI is based on a do over so how you do RDI is going to depend on your lifestyle and where your child stopped developing typically on their personal development track.
It is crucial to look at typical development with autism to identify where the child is on the developmental track. Developmental milestones are stepping stones and without those milestones children cannot progress typically.
RDI is meant to be incorporated into your family and their habits, interactions, etc. Part of the first step in RDI is to integrate that fact into the program. For example, working on RDI techniques will be integrated into your day when you can slow down and create opportunity for discoveries for your child. This is different than a skill based therapy where there is mostly prompting, drilling and imperative language. RDI, since it is based on typical development, goes back to restore the point and time when typical children can share perspective, etc. This sort of therapy is not a set of written skills. That said, RDI has a comprehensive operating system that covers developmental milestones starting at birth! Your consultant can establish where your child fell off the developmental track and start there.. so that is why it looks different for each child. RDI has steps, it is very structured in those steps as far as what to look for developmentally. The context and use may differ because of the child, but the objectives are all there for you to see once you are on the system.
What is Applied Behavior Analysis?
www.shapingbehavior.com/whatisaba.html
The purpose of ABA, according to a BCBA is as follows-
I would say the goal of ABA is to teach appropriate behaviors to help the individual function in the natural environment, while reducing inappropriate behaviors that do not allow the individual to access their natural environment.
According to both the website and the person I spoke to with a BCBA, ABA successful taught my child appropriate behaviors to function in a natural environment. And I would agree with them. My child could function and get
his needs met, but my child also had no mindfulness and lacked understanding the social world. In addition, my younger child made no progress with ABA.
My oldest mastered many programs and flew through his ABA program. We had to create different additional programs for when he got hung up on certain concepts. For example, One of the communication issues I had to undo because of the way ABA wired my sons brain, was that he thought all conversations were question and answer. When he wanted to comment on something he would ask it in a question. He obviously knew the answer so if I answered it the wrong way he would correct me. Then I would need to ask him why he asked me if he knew the answer…and round and round we went.
Behaviorism is based on the work of Skinner ( ABA) VS developmental/cognitive approaches ( based on work of Piaget, Vygotsky and others)
Some thoughts on the two
http://en.wikipedia.org/wiki/Behaviorism
http://en.wikipedia.org/wiki/Developmental_psychology
http://helpingpsychology.com/cognitive-versus-behavioral-psychology
and this one concerns behavioral psychology-
psychology.about.com/.../behaviorism.htm
Criticisms of Behaviorism
Many critics argue that behaviorism is a one-dimensional approach to behavior and that behavioral theories do not account for free will and internal influences such as moods, thoughts, and feelings.
Behaviorism does not account for other types of learning, especially learning that occurs without the use of reinforcements or punishments.
People and animals are able to adapt their behavior when new information is introduced, even if a previous behavior pattern has been established through reinforcement.
Strengths of Behaviorism
Behaviorism is based upon observable behaviors, so it is easier to quantify and collect data and information when conducting research.
Effective therapeutic techniques such as intensive behavioral intervention, token economies, and discrete trial training are all rooted in behaviorism. These approaches are often very useful in changing maladaptive or harmful behaviors in both children and adults.
The strengths of behaviorism, as per this article, is what I would like to comment on. ABA is all about collecting data. In order to collect data, as the site explains- behavior can be studied in a systematic and observable manner with no consideration of internal mental states. This data tells the story of the conditioning of the child..not the mindfulness of the child.
The Second strength, explains how behaviorism could be useful for changing maladaptive behaviors in both children and adults. Nowhere does this strength claim to help children or adults obtain mindfulness and problem solving skills.
I present you this information for this reason- I went with ABA for my children 10 years ago, because I was told that the * research* supported ABA. I was handed a study done in the 80’s talking about improvement in children with ABA through Loovas.
When my oldest on the spectrum graduated from ABA, with all the same deficits of Autism in the social and cognitive realm ….I was perplexed. Why? I did what I was told would work. 40 hours of an excellent ABA IN HOME program. I was introduced at this point to RDI. As I did my research, I realized that I was expecting behaviorism, to do something that it was never created to do. I wanted my child to be able to think without prompts and reinforcers. To understand the social world around them. As I continued to study, I saw that many children who were Dx with ASD would make progress the first year or two with ABA in learning skills, but then there was not much room for growth after that. Then what I noticed for my children was that the ABA programs turned into trying to get my child to perform like his peers. I wondered how he could do this without developmental foundations in place? I was right…he could not. When I discovered RDI, It was a huge weight lifted from me, as I knew this is exactly what I was looking for to help my children! I needed my children to be able to have the intersubjective relationship that typical children achieve before age 2!
My goal is only to clearly help those who see that their ABA program is insufficient, to a better path for their childs future.
To explain my point further-
Look at this study concerning ABA-
taken from the CF article-
http://www.ctfeat.org/articles/AmericanJournalMentalRetardationNov2005.pdf
***When re-evaluated at a mean age of 7 years, subjects in the experimental group had gained an average of 20 IQ points and had made major advances in educational achievement.
At the time of the present follow-up (1984-1985), the mean CA of the experimental group children was 13 years (range = 9 to 19 years). All children who had achieved normal functioning by the age of 7 years had ended treatment by that point. (Normal functioning was operationally defined as scoring within the normal range on standardized intelligence tests and successfully completing first grade in a regular, non special education class entirely on one's own.) ***
Notice the wording.... Read what defines normal functioning! My then 8 year old graduated from ABA, was 2 grade levels above his peers in most subjects, yet, his *autism was not remediated because Autism is NOT an behavioral/Academic disorder!
We started RDI with my son ( He is now almost 13 ) and we started at the beginning, as he had the cognitive social understanding of a 1 year old.
So their normal functioning is to be able to sit in the classroom and IQ point rose 20 points. I get that...but it is improvement on skills!! Not mindfulness. When these kids attend school all their life knowing skills and then graduate, they cannot function in the real world because the focus was on skills.... ( measuring IQ is not social understanding, it is static skills) If IQ was all that mattered, then employers would ALWAYS hire the person with the highest IQ....Employers looks for someone with excellent program solving skills too....people who work well with people...
There are no studies on ABA following children to adulthood. And there should be, since ABA has been around for 30 years. The studies that are done on adults on the spectrum are dismal…15 percent can live independently. This is not the first study that represents this number. There was a study done 10 years ago with the results just as dismal!
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2004.00215.x/abstract
If ABA was successful for quality of life, those numbers would of reflected progress. ABA is successful in teaching skills and conditioning children’s behaviors. It is time to raise the bar to help our children have a typical quality of life. Employers want people who can think on their feet, problem solve and are good with understanding and interacting with people. That only comes through mastering Dynamic Intelligence.
I don’t think anyone dispute’s that you can teach a child to set the table with secondary reinforcers and prompting. You can teach a child pretty much any skill through secondary reinforcers. You have to establish if you think skills are enough to prepare him/her for life, or if she needs the ability to take on someone else’s perspective.
We want is to foster mindfulness and this will remediate Autism. She/He will not be able to generalize mindfulness from merely learning a skill.
Nicole Beurkens, M.Ed. of the Horizons developmental remediation center has this to say-
When you look at the history of treatments in the field of autism, it has been primarily about compensation. While research on the brain and autism has continued to move forward and provide us new information, our treatment approaches have stagnated. The methods we were using 30 years ago are still the methods being used today, despite the fact that we have a whole host of new information available to us. We now have the capacity to take what we know about the disorder of autism and how it impacts brain function, and develop new techniques and approaches that move beyond compensation and actually work to remediate (correct) the primary features of the disorder. This is one of the exciting things about newer approaches such as the Relationship Development Intervention (RDI)® Program, which focuses on remediating, rather than just working around, the core deficits we see in individuals with autism and other neuro-developmental disorders.
Can ABA fill in the developmental gaps because of Autism like RDI does?
For all the reasons previously discussed, It is unlikely that a behaviorally based program can fill in a child’s developmental deficits.
RDI Mom Tammy has this to comment concerning this-
Autistic behavior is a symptom of the underlying problem: lack of intersubjectivity and difficulty with dynamic thinking. If you address only the behavior on the surface, you are only working on the symptom. If I broke my arm, you would see me behave in a socially inappropriate way: cry, scream, freak out if someone touched my arm, etc. If all you did was treat my behavioral symptoms, you would not be dealing with the problem causing my behavior. That is why diet, sensory integration, etc. is compatible with RDI because they go at the underlying problem in different ways. Behaviorism either assumes autistic people cannot learn intersubjectivity and dynamic thinking OR they are ignorant of its impact on behavior.
Can I just do RDI after my child’s ABA program to fill in their developmental gaps?
You could, as that is what is happening with some families. It happened with my one older child. However it is important to remember by ignoring developmental growth until the ABA programming is completed, you are missing an opportunity to fill in your child’s developmental gaps at an earlier age and you will need to undo learned behavior that will impede developmental progress.
RDI Mom Penny has this to say about waiting to do RDI!
The developmental gap is not that big when the child is young. Seriously consider closing the developmental gap -- not the skill gap -- now. I wish someone had explained this to me. We have not done ABA in 5.5 years, and we are still undoing some of it. The repetition of ABA can build some strong neural pathways that are not natural. At the end of our 3 years 3 months of ABA, my daughter was screaming and frustrated in every session in the last 3-6 months. She was "on stage" and always "performing" in some way, having to have the one right answer all the time. We prompted, managed her, she was passive, echolalic, couldn't "dance" at non-verbal levels - oh, I could go on and on. When I look at video from when she was 2 (we began ABA before she turned 2), I am so angry, now that I understand development.
What are some examples on the differences in actual therapy? The activities are things you would do in your day or with any child. The difference in RDI is the INTENT of the activity. Behaviorial approaches prompt for skills, RDI fosters mindfulness in order to restore that typical development.
Since I have done ABA with both my children and saw results the first 6- 9 months ( Only for the progress to stall once more advanced skills are introduced), I can give you an 2 examples that you may be able to relate too. The first example is trying to get my son to talk.....we had the say program. Say Dog, say Cat, etc etc. He started to talk, and I was thrilled. However, he would say "say" before the item so we had to create a program to get him to stop saying "say". I had to undo the residual effects of learning language out of the order of his development because he would ask me questions when he simply wanted to make comments and he would script because words were merely words to him with little meaning other then getting his needs met. If you reflect on your child, his communication is solely for her needs and not to share anything. RDI begins with Non verbal communication, the same place that neurotypical children begin!
An additional example for me was getting my son to sit down to a task. The *do this* command in ABA taught him that if he does what I say he will be rewarded with an item or to be able to go off, away from me to play. This is contrary to what we want to teach our kids. We want the reinforcer to be time with US and understanding the beauty of the dance of the give and take of relationship. Again, I had to undo the improper motivation that was taught to my son. This took a year to undo so I do not take it lightly! With RDI, we teach co regulation to help a child discover that he wants to be with us and pay attention from intruistic motivation. I realize that you see results from a skill based program immediately because skills are easily tracked....but studies AND lack of studies show it will not be long term results. If you think about typical development, a baby learns from us. We certainly are not offering reinforcers to our babies to interact with us. Again, RDI affords a child a do over instead of trying to build skills from reinforcers outide of the child’s personal developmental capability. Because RDI restored my children’s developmental path, both my children on the spectrum can share perspective, they are flexible, and they love to joke around and tease. My children have typical eye contact abilities. They can read social cues! All my children are able to interact successfully. party my son and daughter had in our house last week…..dancing around the room each taking turns changing the words to the songs to be funny words….all made possible by RDI!
How does RDI foster the development of speech!
RDI honors the child’s developmental track and therefore starts to foster development of speech by making sure all prerequisite abilities are present before talking. This will ensure that they child understands the purpose of language and does not script. Babies, are effective communicators even before they * talk* They learn communication through different channels and the last channel is actually spoken language. RDI goes back and fills in the developmental gap of communication with Non verbal’s, prosody, gestures, and if the child has no language disorder apart from Autism, that child will speak!
Penny, an RDI Mom, has this to say regarding her daughter-
Additionally, Dr Gutstein of RDI(r) teaches us that words are the last enhancement of a very complex communication system -- borrowing a concept from Barbara Rogoff in her book, "Apprenticeship in Thinking", typically developing kids are rich communicators before words are part of the currency of communication.
I was like you -- I WANTED THOSE WORDS. With ABA, we created a one-sided word machine, a demanding little mander who could answer questions we'd practiced but not have a conversation with us. She scripted all the time, reciting lines from videos over and over and over, but there was little real reciprocity.
I didn't realize that we could program words in her without getting reciprocity in the process, but we did.
Undoing that -- we're still undoing it -- has taken a long, long time.
Infants can communicate non verbally before they can communicate verbally. They can think without using words. RDI starts there. When you are able to fill in your child’s developmental gaps, and catch her up developmentally to her age, then she will learn typically. There is nothing wrong with using some behavior modification to help her with a skill as a temporary compensation...but the difference is thinking behavior modification is going to give her the ability to obtain the ability to have theory of mind.
Are the negative feelings regarding ABA therapy just from people that had bad therapists working with their child?
Both my children’s ABA therapists were excellent!! So excellent that when we decided that RDI was a complete program and ABA was insufficient, I begged them to look into it further. As they did, they were excited to believe RDI was exactly what was missing in the life…and our head therapist at the time, started training for RDI and is now our RDI consultant. She is the best of the best!! Creative, spontaneous and she said my son was the furthest she had ever seen with a child…..yet he started at the basic low stage once we started RDI. My RDI consultant has a Masters in ABA….that she no longer practices because she sees the difference! ABA is amazing to teach skills…but my goal for my children were not just for them to know skills…I wanted my children to be able to think.
Teaching skills can be done to dolphins, dogs, etc with stimuli….and it works well. Teaching skills for children have their place, but not to develop thinking, problem solving, theory of mind…I want to build a mind, not just merely have behaviors in place. Behaviorism does not teach theory of mind. The studies show this and there are no studies with a positive outcome for adults with Autism that have done ABA. Since ABA and behaviorism have been around the longest, ( 1st generation treatment options) we should be seeing positive results within the adult community. I know that within the developmental community, we are seeing great results for the future of children on the spectrum….to overcome their obstacles. What we do see as far as the *research* quoted and studies concerning ABA, is that there is improvement for their skills after a year, etc. I don’t dispute that at all. Again, knowing skills is very different then knowing how to interact in the real world. That is why time and time again, clients will say to me, he knows all he needs to know academically, but does not know how to make a friend…. Making a friend and interactions and social competence has its roots in development way back when the child is 6 months old! RDI is about filling in those developmental gaps so that the *skills and social* follow a typical path!
I only realized my son’s ABA program was merely compensative when my son graduated from it 4 years later and had no clue about relationships. he could perform any skill though....but that really does not mean much....in the world. If you are reading this, I get that you see progress because your child can now perform some skills. But if you think long term...you will realize that skills will not produce a quality of life that you would want for your child.
No comments:
Post a Comment