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 versus the Related Service Provider - By Angela Mouzakitis (BCBA)


I've worked with many related service providers over the past ten years, and have heard many horror stories regarding the interaction between ABA therapists and Speech and Occupational Therapy providers specifically. As an ABA provider, coordinator and professor, this is very disheartening, albeit common. However, most importantly, when there is a rift between the disciplines and perspectives, it is the child and family that suffer, or rather do not achieve appropriate collaborative programming. I wanted to address why this may happen.

To be frank, applied behavior analysis, and programs based on applied behavior analysis to work with children with autism have the MOST research to show the effectiveness. (Period.) What this means is that researchers, have contrived environments and settings to (as objectively as possible) analyze the effectiveness of these programs. While some may feel that ABA is inappropriate for their child, or they don't like the methodologies, that is a different story. ABA is not a religion, and it isn't a matter of believing in ABA. You cannot choose to believe in it or not. The data is there. You may not like it, but there are many effective programs that have been based on applied behavior analysis.

While this is great, it causes a great deal of arrogance among ABA therapists, and they may charge off like gang-busters at meetings, pushing around the related service provider. This is unfortunate and wrong for so many reasons:

- Most ABA providers, have not read the research and cannot speak fluently about the research. This puts them in a position to make many claims about their therapy, and not able to defend them. By not being able to explain a program with the defense "research supports" this turns off families and providers.

- Just because a discipline hasn't researched a technique, does NOT mean the technique is ineffective. This cannot be understated. There are hundreds of strategies that have not been researched, yet are used and may be very effective. An ABA therapist may dismiss this and say "it is not research-based". I like to add "yet". Fortunately, ABA is a science that can analyze the effects of just about any discipline. The occupational therapist wants to put a weighted vest on? Maybe it isn't a published research based strategy, but that doesn't mean we can't try it, identify what we think will change, and measure and analyze the behavior to see if it had an impact.

- Because of the research leading to arrogance, some ABA providers may have a difficult time maintaining an open mind to other disciplines. This is unfortunate again and will only hurt the child. I am not a certified speech and language therapist. I do not have a fluid understanding of the speech mechanism, sound production, tongue placement, speech disorders, to create programs, etc. I don't even know enough about speech disorders to ask questions about them. It is necessary to have a speech and language provider as a collaborator on an ABA team to guide program development.

- It is the role of the behavior analyst or ABA provider to identify a way to analyze and account for behavior change. This does not mean isolating programs to a purely ABA world. It means applying the principles of behavior analysis to all measurable behaviors: preposition usage, tongue placement, feeding, referencing, joint attention. By working with related service providers, our discipline can only be enhanced. In my experience, rarely is a program on "joint attention" implemented as one of the first programs when working with a child with autism. However, this was brought to my attention by a speech therapist. Had my mind been closed to it, the child wouldn't have had the opportunity to practice this very important piece of social interaction.

The bottom line is that he collaboration and openness is necessary. If each member of the team doesn't have collaborative input, those members will slowly drop out of discussion, and slowly drop out of team meetings. ABA has a lot of research, true, but no one discipline has all the answers and they should use each other to try and find the answers to programming and language development that might be more elusive. Collaboration on teams of professionals working with children with autism and developmental disabilities is essential.

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