On Frustration

Throughout my clinical career, there have been a number of things which I've very much wanted to say, but haven't for a variety of reasons. These range from me being generally too polite to actually say them to me believing that doing so would be counterproductive.

For a variety of reasons, this post has been backdated. I won't say when -- or where -- I wanted to say these things, although I will elaborate (somewhat) on the contexts if asked. I also will freely edit this post to add additional unsaid comments as they occur -- and will not remark on my so doing. I won't necessarily add them to the end of the lists, either.

For the most part, all of this is to prevent these comments being tied to any given workplace or person. Given the nature of some of these, they could damage the reputations or careers of the people involved, and that is not my intention. It is, however, my intention to highlight some of the things that go on in the clinical field... and why I greatly prefer academia.

To professionals:

• If I'm implementing an extinction program, please don't undermine my efforts and reinforce an extinction burst.
• This goes double if the program is for aggression. Do you think it's easy to not react when a child is hitting you? Those punches can hurt.
• Damnit, when a child hits a teacher, the correct response is emphatically not to give the child cake!
• For the love of God, lady, how the Hell did you manage to pass the BCaBA exam without knowing what extinction is?
• Lady, I read the clinical research for fun. If I'm doing something you don't understand, just ask me. I'd be more than happy to explain. If you just interrupt, undermine my efforts, and then blame me when things get worse, it really isn't going to help my opinion of you or of your professional conduct.
• If you have a behavior plan to work on, please don't work on it in the classroom while the kids are just sitting there, bored. It's not only unprofessional, it's actively against the best interests of the children. This goes double if the plan isn't even for one of the kids in the classroom.
• If you work two full-time jobs which involve acting as caretaker of a mix of autistic children and adults, I am bloody well going to assume that you know what autistic literalism is. I am also going to assume that you know what autism is. Proving these assumptions wrong is not a good way to impress me with your professionalism.
• I attempt to hold myself to very high standards of both professionalism and compotence. However, I also expect certain minimum standards of these from my colleagues. If you are working as a behavior therapist, this means that I expect you to know what certain basic concepts -- like "extinction" and "reinforcement" -- are, and I do not expect you to attempt to ridicule me for using these terms.
• I had more than enough bigotry and ridicule during my secondary education, thank you very much.
• Anti-autistic bigotry and ridicule of autistic difficulties have no place whatsoever in a special education environment. Yes, I very much will complain to our boss about these things if you engage in them.
• Lady, I'm autistic -- with all that implies. I flat-out told you that well before I ever started to work with you. If you don't understand what that means, you have no business working in a school for autistic children. You have less business trying to teach them.
• If you need something, bloody tell me. I'm not necessarily going to pick up on it intuitively.
• If a child has been warehoused -- and probably abused -- for half of her life, chances are that institutional damage is a factor. More than a little sympathy and kindness is called for.
• Please stop talking in front of the children as if they weren't there.
• Your bigoted rant is making me physically ill. The fact that it is being made in front of the children is not a redeeming factor.
• ... you have two autistic sisters, work in the field, and can't deal with autistic literalism?
• "Personal style" is valid, to a point, but developing a true personal style does not consist of taking pieces and aspects of flawed therapies and methods and merging them into a personally-appealing whole. It consists of finding a way to operate within guidelines and boundaries of best practices that you are capable of and comfortable with.
  

To parents:

• If your son has stomach problems which have required him to be hospitalized in the past, and the hospital found a series of massive cysts in his stomach... please take him to a real doctor and not some natropath. I very much do not enjoy the way he screams in pain while clutching his stomach during lunch. I also very much do not enjoy trying to teach children who are in considerable pain, and I know exactly how much even a minor stomach lesion can hurt.
• (In regards to the previous) No, I do not think that some "all-natural" digestive enzymes will solve the problem.
• Lady, your nineteen-year-old starting to show an interest in pictures of scantily-clothed women is not a sign of precocious puberty or overly high testosterone levels... and certainly not a medical indication that he should be chemically castrated by the Geiers!
• (Smiling) No, I don't think that your child's motor difficulties are "the autism". I think they're a direct result of the megadoses of Vitamin B6 you've been giving him for the last few years.
• When your child starts to exhibit symptoms of acute hypervitaminosis A, you immediately stop all supplementation. You do not just reduce the dose by ten percent or so.
• Please stop feeding your child candy whenever he punches me... or you... or anyone else, for that matter. Do I really need to explain what you're teaching him by doing this?
• No, giving him a toy is not an acceptable substitute!
• Please start showing some common sense. (Over and over again...)
• No, hookworms are not a good thing for a child to have!
• Children coming to school stoned out of their mind tend not to learn much. This is not an autism thing.
• ... let me get this straight. You're doing the body ecology diet and yogurt enemas and yet you think you're not into the woo?

And I could think of plenty more...

The ABA Establishment

As a grad student, I often read research articles -- more often than not because my teachers assign them. They like to assign articles, great big stacks of them that seem to take forever to work through... and, then, when I'm finally finished, it's just in time to start on the next stack.

Every now and then, however, one of them is particularly interesting or noteworthy. A 1999 paper by Koegel, Koegel, Harrower, and Carter published in the Journal of the Association for Persons with Severe Handicaps (24(3), 174-185) is one such.

The paper is entitled "Pivotal Response Intervention I: Overview of Approach" and is interesting for a number of reasons. On one level, the basic concept behind pivotal response intervention itself is fairly interesting and quite ingenious in a way.

More importantly, however, the paper seems to make a number of the things that are wrong with the behavior analytic establishment readily apparent.

After things which are common to the autism establishment as a whole (e.g. the strict-disability model), a disturbing pattern emerges.

For instance, take the following quote:

As mentioned, over the years, a substantial amount of research has identified a specific attentional characteristic displayed by many children with autism. This characteristic has been called "stimulus overselectivity" (Lovaas, Schreibman, Koegel, & Rehm, 1971). It refers to the tendency of certain children with autism to respond on the basis of a limited number of (frequently irrelevant) components in their environment (see Schreibman, 1997, for review).... Many children with autism, however, tend to respond to fewer and more irrelevant components (e.g. a bend in a picture card, as opposed to the relevant feature of the picture). Thus, children with autism may identify a stimulus by an irrelevant cue (Schreibman, 1997).

Given the sensory issues autistic people have -- often in manifold and varied form -- it's quite likely that the issue here is one of salience, and lies on a sensory level. Despite this, none of the relevant literature is cited... and the possibility is not referenced. Were this just a matter of this paper, I'd be less concerned, but this is a systematic thing across most of the ABA literature I've read.

It is not ethical to bury your head in the sand in this manner, especially in clinical practice. The fact that past research was not behavior analytic in nature does not give behavior analysts an excuse to ignore it!

Another revealing quote is the following:

... The term motivation, as used here, refers to observable characteristics of a child's responding. An improvement in motivation is broadly defined as an increase in responsiveness to social and environmental stimuli (R. L. Koegel, Carter, & Koegel, 1998). For example, characteristics reflective of motivation include increases in the number of responses a child makes to teaching stimuli, decreases in response latency, and changes in affect (e.g., interest, enthusiasm, happiness) (R. L. Koegel et al., in press).

This is not, by any reasonable definition, what motivation is. Motivation is an internal variable; what that list includes are signs of it. Behavior analysts have often been accused of denying the existence of the mind. Items like the above are a large part of why.

Perhaps even more revealing, however, is the opening of the next paragraph:

Traditionally, interventions for children with autism did not consider these characteristics and how they may have covaried with the actual intervention goal, thus limiting the effects of such approaches. Additionally, disruptive behaviors seemed to be at lower levels or absent and greater generalization occured when motivational variables were incorporated (R. L. Koegel et al., in press).

In other words, older interventions didn't pay any attention at all to the child's happiness, interest, or enthusiasm. They didn't care about that. They didn't even look into ways to minimize boredom as an ethical issue.

The thought -- or lack thereof -- involved makes me so incredibly sick that I cannot even begin to describe it.

Also, note the dates of those citations. Behavior analytic research into autism treatment has been going on since the '60s.

Now... what does paying attention to these things look like?

These variables include the use of child choice, frequent task variation, interspersing previously learned tasks with new acquisition tasks, using less intrusive prompting, reinforcing the child's attempts, and incorporating turn taking within the interactions.

... yeah. It's worth noting that "child choice" is defined as including letting a kid select the toy he wants to play with.

I don't think I need to say anything else here.

This, of course, is not a complete list of my gripes, and it is true that the ABA establishment is changing. These are all references to older methods -- that is, ones in common use prior to the publication of this paper.

Unfortunately, those older methods are still used today... and that paper was published in 1999.