When it comes to language development, speech therapists and behavior analysts tend to hit a wall. Perspectives differ, orientations may not coincide, and discussions can get heated. The goal of this blog is to provide perspectives on language development in children with autism, language disorders, and developmental disabilities from the perspectives of a speech and language pathologist (SLP) and certified behavior analyst (BCBA), in order to show how these two domains can happily work together and collaborate. This is a new endeavor, so please be patient as we work together to address topics in language development. Questions, comments and concerns are welcomed and encouraged!

Thursday, December 31, 2009

ABA Therapists from the Perspective of a Related Service Provider- by Diana Almodovar

Angela's latest entry on this blog brought up many interesting issues. The interactions of all the therapists that are working with a child can be challenging. The importance of a cohesive team cannot be stressed enough, particularly when working with children with Autism. Consistency and structure are key, and when there is discord on the team, things are bound to fall apart.

Collaborating with Professionals:

I've had (and still do have) a good working relationship with ABA teams. I also can tell of countless negative experiences that I've had. There have been times where I have worked with ABA therapists that are as inflexible as the children they work with, and are so rooted in the theory and "rules" of the therapy, that they are not amenable to seeing another way. I've seen these therapists be dismissive of other approaches, such as incorporating sensory work performed by the occupational therapists, consulting with the speech-language pathologists on language programs, etc. A child's progress can be facilitated by incorporating an interdisciplinary approach.

How do we go about this? Here is one way not to: There have been so many times that I have worked with school-based and home based teams where the program is set by the ABA program coordinator (the lead ABA therapist on the team that creates the majority of the programs). The SLP (speech-language pathologist) then basically "runs" the programs that are created by the ABA therapist. There is some consultation, but main decisions are created by the ABA team. Everyone following the plan created by one discipline is not the way to work together.

I actually consulted once with a school-based SLP who was working with a child that I was working with outside of school. I visited her at the school to see what she had been working on and had been told that she basically follows whatever the school-based ABA team plans for her. Their focus was on teaching the child to use PECS (Picture Exchange Communication System). He had been making minimal progress. The child was 6 years old, nonverbal and completely uncommunicative. Later on in the school year she asked to observe me. I had been working on prelinguistic skills that are important precursors to acquire language- nonverbal communication (pointing, head nodding, gesturing), cause/effect, joint attention. She ignored what I was doing and basically came to my office to hand me a list of words that they were using to teach him PECS.

This child was not communicating on the most basic level, and therefore was not able to understand what the pictures were used for. There was an insistence that he learn those words, yet he still didn't understand that the picture symbol was related to a concept and that he could use these to communicate. I later met with the home-based ABA team to discuss this. They had shared my concerns. It ultimately became a power struggle between the home-based and school-based teams on what the goals should be. At some point, we came to an agreement, and the child began to (for the first time in 6 years), tap on a person to gain their attention, nod his head yes/no, and request using PECS and through pointing. A good six to eight months were lost getting to that point though.

We need to respect the knowledge that we all bring to the table, be willing to listen to each other and observe each other at work. I always make it a point observe the therapists working with one of my children so that I can incorporate their techniques into my therapy. We never should stop learning from one another. As an SLP, I can not achieve my language goals if the child's attention and behavior is not allowing the learning experience to occur. Utilizing the behavioral techniques employed by the ABA therapists provides the child with consistency and structure.

Similarly, consulting with an SLP on the appropriate course that the speech/ language goals should take is important. I've seen ABA therapists try to teach a nonverbal severely apraxic child (a child with significant difficulty in motor planning for speech) to request items using the carrier phrase "I want _____"). The child could not even babble. The only speech sound he was able to produce was "b" and some vowels. I've also seen these therapists create lists of rules and schedules without pictures, only using written language, for children who cannot read. Things like this are incredibly aggravating, and it's even more so when they are unwilling to ask for or accept advice.

Before any discipline chooses to criticize another, we should first swallow our pride and acknowledge that the only way to improve our clinical skills is to accept that there is always more to learn. Open discussions of each perspective need to occur among the therapists in order to design appropriate programs and facilitate progress. We each have something unique to offer. Many times it's not through what our schooling has taught us, but also through our individual experiences. We need to keep in mind that it's not a single person that will impact the child's progress, but all of us who interact with him/her. As soon as we begin taking a more unified approach real gains can be made.

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