The Misbehaviour of Behaviourists

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Clare 300 10 May 2004 21:03:19 -0000 Michelle wrote, "While Dr Lovaas told me I was a "spontaneous recovery" on the phone (the telephone and the internet being the most common behaviourist diagnostic "instruments" for adults these days...)" Lovaas should be careful - what with all these behaviourists blithely claiming that people like you are not autistic, or no longer autistic, it starts to looks like there are an awful lot of "recoveries" around which aren't attributable to ABA ... <g> Clare 299 10 May 2004 20:45:20 -0000 John wrote, “She (Maurice) writes about so called “normalcy”, and some of her own idiosyncratic/background movement behaviors. She more or less says that she doubts anyone could stand up to continuous assessment of normalcy.” Which is perfectly respectable as a point of view - unless one is also simultaneously making large claims about “normalcy” and “recovery.” If you’re claiming “these children are now normal”, it would seem to render it meaningless to then add “well, gee, what is normal, is anyone really normal anyway?” In this case, it seems to translate into “they’re recovered because we say they’re recovered, but don’t look too closely.” Lovaas’s claim of “recovery” and “normal functioning” were so controversial in the field partly because it had already been well documented (from Kanner’s follow-ups onwards) that some people who initially presented with classical autism could go on to survive mainstream school, live independently, go to university, hold down jobs, or even sometimes get married (or whatever other external indicators of “success” you want to pick), but that they generally remained distinctly “different”. (This is why, before the boom in study of “high-functioning autism” and the rediscovery of Hans Asperger’s work, DSM-III contained a “infantile autism - residual state” diagnosis. MAAP was originally the “Residual Autism Newsletter”. Then it gradually became clear that it made far more sense to look at these people as “high-functioning autistic” and to abandon the awkward “residual, they’re sort of recovered but not quite” concept). So one of the factors that made Lovaas so controversial was that he wasn’t simply asserting that he was increasing children’s levels of functioning, or enabling kids to master mainstream academics who wouldn’t otherwise have been able to - he was claiming that they were now “normal”. Now, I know some (NT) people have asked if it really matters: if someone can survive in a mainstream school, if they can “pass” for normal, isn’t that enough to equal “recovery”? (Or, as it often gets put, if it walks like a duck, quacks like a duck, etc. etc.,). But the truth is, it does matter. From my own experiences, as well as my conversations with many other people on the spectrum, I know it’s possible to survive mainstream schooling and not be spotted as autistic while still suffering tremendously from a lack of autism-specific support and understanding. Most of the people I know who weren’t diagnosed until adulthood spent years torturing themselves under the belief that they “should” be normal, or would be able to fit in “if only they tried harder”. I have a terrible suspicion that many kids being declared “recovered” now are being set up for exactly the same thing (especially since many of them seem to have parents who are very invested in the idea that their children are now 100% Normal, and unable to accept the slightest autistic trait - think of Weintraub wanting to get rid of her son’s “quirkiness”, for example). I remember vividly one parent on a bulletin board who commented that she’d seen several “recovered” kids “crash and burn” a few years later, as the social environment of school became more demanding. And if parents can’t acknowledge differences or provide emotional support and acceptance, the harm can be enormous. Bear in mind that one out of the 9 children declared “indistinguishable” by Lovaas in 1987 was back in a special class by the time of the follow-up (another of the experimental group had by then been transitioned into mainstream, which is why the number’s still usually cited as 9). How did his parents react, having been told their child was now “normal”, when it became very clear that he wasn’t? How did he feel? Michelle Dawson 298 10 May 2004 20:20:50 -0000 It’s been pointed out accurately by many diagnosticians of various quality that if Asperger’s were diagnosed strictly, there would be almost no cases. This is because of the priority rule: if someone can be diagnosed autistic, this takes priority. They cannot be diagnosed AS. In a study where differentiating is important, the researcher must (my opinion) give the criteria by which she is differentiating. In my group, we’ve used specific aspects of one of the diagnositic instruments. I would have qualified for Dr Lovaas’ study. I have been institutionalized as an adult, though briefly, and was also threatened with indefinite institutionalization because of my appearance and behaviour. My behaviour (I am hastily obliged to add) was not dangerous to myself or others. While I was at IMFAR, among some quite friendly researchers, some people noticed my own strategies in discussions. They asked if it was better if they didn’t look at me when they spoke to me. I said yes, and please stop all your gestures. I work in a French-speaking group. These people talk with their hands and whole bodies very vigorously, even when on the phone. I think there’s been a study showing that speech becomes greatly impaired when gestures are suppressed in non-autistics. Gestures are completely distracting to me (I can’t see and hear at the same time), and clapping my hands over my eyes in actual conversation is, I realize, not okay. So I look away and get distracted by the gestures anyway. Those who tried to not gesture found the effort was exhausting and they failed anyway. This was a short experiment. I then had to point out that I was suppressing my own gestures, since mine are considered wrong, even though they are as necessary and commmunicative as non-autistic gestures. Re the nature of nature problem, another indication of stuff that shouldn’t be messed with is in the work of a guy mentioned previously on this board, John Money. This was a social construction/behaviourist view of gender, as opposed to a purely behaviourist view, but the consequences were dire. The issue of “nature” arises in those born with ambiguous gender. The ideas in this area have recently changed, as I wrote in the ABA article. They changed because of the experiences of adolescents and adults who at the time of birth were neither male nor female, and were assigned to be one or the other. This was convenient for social acceptability reasons, but it turns out it’s very hard on those who are assigned shortly after birth. In this case, there is an assertion of “nature” that seems much stronger than social norms. This might be a hint that the social norms are not based on evidence but on prejudice. Lucas 297 10 May 2004 15:27:51 -0000 Me too, and I also have an AS DX where I would have had Autism as a child. Seems to be common. Clare 296 10 May 2004 15:04:44 -0000 John wrote, "I have done very little work in DTT, with children who were diagnosed with Aspergers, because this subgroup by definition, is not supposed to have delays in speech development. You will have to confirm the veracity of that for me." Actually, that's not precisely correct. Speech delay (or lack of) is often used in practice to make a distinction between kids labelled HFA and those labelled AS (even though they may be impossible to distinguish after the former group have acquired speech). And DSM-IV stipulates for an AS diagnosis that there has to be "no clinically significant general delay in language". But you can also qualify for a DSM-IV diagnosis of "autistic disorder" without being speech-delayed. What's required is: "qualitative impairments in communication as manifested by at least one of the following: (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level". As a matter of fact, although my diagnosis is AS, I would also have met the DSM-IV criteria for "autistic disorder" when I was a child. As regards my "qualitative impairments in communication", I spoke on time - but in my own jargon language for about a year, before going straight to communicating entirely in sentences "quoted" from books or other people's utterances (which more than qualifies as "idiosyncratic", I'd say). And I certainly couldn't "sustain a conversation" as a child even once I spoke fairly fluently (except in the Aspie sense of "let me talk continuously at you for several hours about my current obsession"). Lucas 295 10 May 2004 10:44:34 -0000 Outta the way; Hyperlexic coming through... Nature: Context-sensitive noun. 1. A thing or person's innate or essential qualities or character. 2. The physical power causing all the phenomena of the material world. 3. A kind or sort of class. 4. A specified element of human character 5. An uncultivated or wild area, condition, community. 6. Inherent impulses determining character or action. 7. Heredity as an influence on or determinant of personality. 8. A living thing's vital functions or needs. Pick and choose from the list of meanings; they all seem to apply in some way here. Clare 294 10 May 2004 09:33:53 -0000 John wrote, “But now, I can ask are the things you hold most dear in danger of being removed by DTT?” Well, every DTT program that I’ve read about would certainly have a damn good try. My obsessions? “Socially inappropriate”. My stims? “Stigmatizing”. The fact that I learn much better when I can choose what I learn? Doesn’t fit into any DTT curriculum I’ve seen. The fact that I have extreme trouble learning when forced to sit still and make eye contact? Inconceivable. “And also, do these things have to be removes in the first place? If so why?” You’re the behaviourist, you tell me ... <g> I don’t know why there is this aim of eliminating anything that might make someone “distinguishable from their normal peers”. But it certainly appears to be the goal of Lovaas-style ABA. It may not be what you’re doing, but it’s what is touted as the goal by parents and professionals throughout the autism-ABA field. The premise, after all, seems to be that it’s possible to eliminate any behaviour without harm to the person in question. In which case, why not eliminate any behaviours which are socially unacceptable, whether because they’re autistic or “effeminate”? And I’m curious: do you have any explanation of why the FBP was so deeply psychologically damaging to Kraig? Is it possible to explain that without some sort of reference to his nature, or who he was? Clare 293 10 May 2004 08:48:35 -0000 John wrote, “Did the adult who was declared “indistinguishable”, go through a Lovaas program?” Yes. “I doubt that you would have been included in the study.” I never said that. My point is that if I, having Asperger’s syndrome, actually meet the criteria being used to claim “recovery”, those criteria are very far away from “normal functioning” indeed. If someone wants to say that an educational treatment has helped improve someone’s level of functioning - from classical autism to something more AS-like - that seems a far more plausible and honest claim. But it’s very far from “recovery”, and it is not radically different from what quite often happens naturally. Working at a school for autistic children, I saw quite a number of children who initially presented at 4 or 5 as classic “Kanner” types, and subsequently became high-functioning. I’m afraid you do rather simplify/misread what I was saying, by the way, e.g. “1)Adults are sometimes diagnosed with autism as well.” Actually, many of the people I was discussing were diagnosed autistic as children. In fact, I run a list for university students with autism and Asperger’s, and a number of the people currently on the list were actually recommended for institutionalization as children. “But not many people object to Lovaas either if the recent conference I presented at (I was the only behaviorist) is any indication.” Clearly, given that many people do object to Lovaas, the conference was not an indication. And if all they’d heard about Lovaas was a positive presentation from you, that doesn’t really put them in a good position to judge. John 292 10 May 2004 02:43:48 -0000 Hi Clare, Let me condense your answer (hopefully not simplistically) as to why you are skeptical on the recovery issue. 1)Adults are sometimes diagnosed with autism as well. 2)Some adults have sensory/social concerns or variations later in life only to later find that they had been diagnosed as autistic as children.. 3)At least one adult autistic was declared "indistinguishable from peers", but is actually quite distinguishable. 4)You yourself would meet qualifications for Lovaas' criteria for recovery. 5)"Recovery", seems to be a loosely (inconsistently applied/sloppily) used term. Did the adult who was declared “indistinguishable”, go through a Lovaas program? I have done very little work in DTT, with children who were diagnosed with Aspergers, because this subgroup by definition, is not supposed to have delays in speech development. You will have to confirm the veracity of that for me. They do not go into the intensive DTT program as a general rule. Although, I have worked with children dx’ed with Aspergers more intensively in some other ABA formats. I doubt that you would have been included in the study. Aspergers was added in the DSM-IV (post 1987). Kids dx’ed with Aspergers tend not to stay in intensive behavioral programs as far as I can tell. There might be exceptions but I no of none. I do not deny what you wrote on the looseness of “recovery”. Nor am I pleased about that. “Recovered”, seems to be tricky word. Since Maurice has been our poster child I will use her to talk about this. She (Maurice) writes about so called “normalcy”, and some of her own idiosyncratic/background movement behaviors. She more or less says that she doubts anyone could stand up to continuous assessment of normalcy. I very much agree with her on this issue. I doubt anyone could do this, not just autistics. But that’s all I have for this. You were waxing poetic on the nature issue (not always a bad thing). Perhaps predictably, I would not enjoy being ‘cured”, of the things I hold most dear. But now, I can ask are the things you hold most dear in danger of being removed by DTT? Also, we may ask, is this generalizable among all autistics? And also, do these things have to be removes in the first place? If so why? You said “In questioning that, I think it is necessary to invoke ideas of what it is realistic or fair to expect people to change in order to conform to others’ requirements.” I agree. You said “Very few people would object to, say, trying to teach children that picking their noses in public is not okay.” Oh,... I imagine we could find one or two if we looked, but the would be very few indeed. But not many people object to Lovaas either if the recent conference I presented at (I was the only behaviorist) is any indication. Interesting..... You said “It may be easy to dismiss the concept of someone’s nature as vague or ill-defined.” Well,.... I wouln’t say “dismiss”, as much as “disagree”. And no, it is not easy to do that. It moves against many of the things some of us were taught in grade-school, or even in University Classes. I live in a society where even a popular singer/writer (Jimmy Buffet) writes “A#$holes can’t help it, they were born that way.” But it is true that I have not read anything that particularly moved me to reconsider my current position (which is the interweaving aspects in developmental systems theory). And “nature”, seems even more ill defined than “recovery”. Nor, have you said what nature is. You said “And yet if one hypothesizes that someone’s gender identity and sexuality are deep parts of their nature, such a result is not only explicable, but heart-breakingly predictable.” But equally damaging the other way. I have read in a position paper of a certain States Autism Society that “children with autism will learn to speak when neurologically ready to.” This doesn’t hold true to my own experience (having taught a child to speak), and of supervising others to do the same. They already, were neurologically ready. The real question was, were we ready to make the environmental/teaching changes needed to bring about/allow that. John 291 10 May 2004 02:42:12 -0000 Thanks Lucas, Amanda, and Clare, for your comments on the stimming thing. Clare 290 9 May 2004 11:31:09 -0000 John wrote, “If we remove the aversives and Reker’s “bible-bashing”, the FBP may be procedurally ethical, I am less certain about the ethics of why the procedures were used and for whose benefit.” As Lovaas and co. made clear in their responses to criticism, they firmly believed that the FBP was being run for the benefit of the children involved - to save them from the stigmatized status of homosexuality, transexuality or “effeminacy”. In questioning that, I think it is necessary to invoke ideas of what it is realistic or fair to expect people to change in order to conform to others’ requirements. Very few people would object to, say, trying to teach children that picking their noses in public is not okay. But when it comes to something like teaching them that their whole gender identity or sexual orientation is not okay - many more people are going to get queasy, and to see this as something different, an attempt to change something quite fundamental about who that person is. It may be easy to dismiss the concept of someone’s nature as vague or ill-defined. But consider this: Apparently, none of the behaviourists involved in the FBP predicted the results found when the FBP “successes” were followed up. According to their evaluations, the treatment had been “successful”, and Kraig was now - well, let’s say “indistinguishable from his normal peers”. In the terms of the behaviourists who ran the FBP, it seems wholly inexplicable that at 18, he was not only questioning his sexuality, but driven to attempt suicide because of it. The treatment not only “failed”, it inflicted a huge amount of shame and self-hatred upon its unconsenting subject. And yet if one hypothesizes that someone’s gender identity and sexuality are deep parts of their nature, such a result is not only explicable, but heart-breakingly predictable. Therefore, the theory that people may have some essential nature which it is harmful and cruel to try to change would seem to have more predictive power than the theory that no such nature exists. Which, in terms of scientific method, should make it a hypothesis worthy of serious consideration and refinement. Lucas 289 9 May 2004 10:12:59 -0000 I used to smoke and it was hard to quit, but it was a damn lot easier than stopping stimming. Clare 288 9 May 2004 09:32:31 -0000 On the “nature” question - I do think that’s relevant here. Subjectively, a huge number of the things considered to be “symptoms of Asperger’s syndrome” are simply part of who I am. For example, my love for my obsessions is as much part of my personality, part of what it is to be Clare, as anyone else’s defining interests and values are. Ditto for the different ways I process information, the way I feel and experience things, etc. I can’t set aside a chunk of my personality and label it as “the autism” and not really part of me. This is who I am. OK, take whatever values and interests you hold most dear, that make you John as opposed to someone else. And imagine someone is proposing to “recover” you from them, so that you will no longer value/care about them. How would you feel about that? Clare 287 9 May 2004 09:17:55 -0000 John wrote, “Why are you skeptical of Maurice’s claims of what was termed “recovery”, for her two children? Does this relate to their nature?” I’m sceptical of any claims of “recovery”. And that’s because (pragmatic reasons first of all) I have met and interacted with an awful lot of very high-functioning people with autistic spectrum diagnoses - including people who survived in mainstream without support (as I did), who have degrees, who have PhD, people who live independently, hold down job, have friends, some who are married and have kids of their own. And none of them are “normal”, or see themselves as “normal” - they all still deal with significant social and sensory differences. Many of us can do a good job of faking “normal” or “eccentric normal” when they need to, but that’s not the same thing - it requires unconventional strategies and huge effort. Maybe there are all these ex-autistic, completely-normal “recovered” people out there - all I know is that I’ve never met any of them. But I have encountered quite a few people who only discovered in adult life, when looking for an explanation of their (very real) differences, that they’d been diagnosed as on the autistic spectrum in childhood - their parents had hidden the diagnosis from them because they thought the child had “got over it” or “recovered”. And Gunilla Gerland has had a long correspondence with one woman who was among the first to be declared “indistinguishable from her normal peers”, who considers herself to be anything but, and who has written about the serious sensory and social difficulties she’s continued to experience throughout her life. I see the term “recovery” being applied in an incredibly loose way. For example, there’s a roll-call of “recovered” kids on the net, where in almost every case there’s a qualification: this kid is “recovered” but still speech delayed, this kid is “recovered” but still does some “weird” things, that kid is “recovered” but still has trouble making friends. In other words, these kids are exactly the same sort of kids who get diagnoses of Asperger’s syndrome etc. Actually, I realized the other day that I (having a formal diagnosis of Asperger’s syndrome from one of the UK experts in autism) would meet Lovaas’s criteria for “recovery”: I score high on IQ tests, I survived mainstream without any additional support (although I am using “survived” in the literal sense to mean “didn’t actually end up dead”), and I know that in one-to-one interactions on my good days I can do a pretty good of faking “normal” when I need to. I don’t immediately strike people as obviously disabled, let alone obviously autistic. One of my standard jokes is that one day, on a whim, I’ll declare myself “recovered” - <cue Life of Brian crowd: “It’s a miracle! A miracle!!”> so that my mum can write a best-selling book about how she miraculously rescued me from the horrors of autism. </joke> John 286 9 May 2004 03:53:21 -0000 Hi Amanda, Thanks, I have the feeling that the self-stim thing, is something I should spend more time listening than talking on (at least right now). Thanks again. A M Baggs 285 8 May 2004 21:41:18 -0000 “My position on self-stim is a little unusual. I do not take the stance that so called self-stimulatory behavior should be suppressed simply because it is stigmatizing (although I have seen this). But I will not defend its use either. Nor have I seen evidence that it is critical to an autistic. This is not to say, that I do not care (far from the truth), it does mean that I am uncertain where I stand on this singular issue. I very much welcome your thoughts on this.” Basically, there are several things that get lumped under “self-stim”, but I’ll tackle a couple. One, a lot of autistics find that we are calmer and understand our environment more if we are stimming. We don’t know the reason for it, but we do know that it’s true. Some autistics find that suppressing stimming takes a toll, such that we could only go out in public for maybe thirty minutes without stimming (before reaching overload and possible meltdown), when with stimming we might last hours. Two, in a lot of autistics it’s kind of a background movement, not something we deliberately do. NTs have background movements too, but theirs are less socially stigmatized. Trying to suppress stimming is kind of like asking an NT to breathe in a specific pattern in all situations. It’s possible to exert that kind of effort, and it’s possible for it to start feeling natural, but after awhile the person will get overwhelmed with the effort and need to breathe in the way that is natural to them. That is the way that this sort of non-intentional stimming works. It can cause a great deal of physical pain after awhile of suppressing it, which then makes doing other things more difficult. John 284 8 May 2004 18:10:49 -0000 Hi again Clare, I was reflecting on the “change kids’ nature”, issue. I realized that I have a related question that has perplexed me for a while and that is related to our current discussion. Why are you skeptical of Maurice’s claims of what was termed “recovery”, for her two children? Does this relate to their nature? John 283 8 May 2004 17:55:03 -0000 Hi Clare, Sorry, no easy answers. I view the FBP as unethical for a combination of the reasons I gave, not for singular aspects. And also by consideration of the particular contexts e.g. (I have read a few case studies where I think aversives were ethical to suppress high rates of self injurious behavior) so the context is important. Although as I have already said, even then I am more inclined to use aversives as a last choice. My point is, I do not view the study as unethical so much as disagreeable in regard to its use of aversives (spanking) when this same aversive was used on typically developing school children at the same time. Though I will not support or defend the study’s use of aversives beyond that. Again I disagree with their use. If we remove the aversives and Reker’s “bible-bashing”, the FBP may be procedurally ethical, I am less certain about the ethics of why the procedures were used and for whose benefit. My position on self-stim is a little unusual. I do not take the stance that so called self-stimulatory behavior should be suppressed simply because it is stigmatizing (although I have seen this). But I will not defend its use either. Nor have I seen evidence that it is critical to an autistic. This is not to say, that I do not care (far from the truth), it does mean that I am uncertain where I stand on this singular issue. I very much welcome your thoughts on this. I did not ignore the “presuming to transform the nature of unconsenting clients through behaviour interventions”, issue. I was aware of it and excluded it. But your question was “why you think (as I assume/hope you do) that the Feminine Boy Project was unethical?” But I do not know how to answer this, without knowing what a nature is. Can you tell me, what a nature is? I have never heard an answer I thought was very good, even in me pre-behavioral days. You said “That seems to involve assuming that all DTT is good DTT, that all credentialed people in the field are competent and responsible, that it’s appropriate for every autistic child, can be used for teaching anything that needs to be taught, automatically produces results superior to any other teaching method, and never has any negative iatrogenic effects. I assume none of those things. Individual contexts matter more to me. But so does knowing the science (albeit, I know only part of it), including its faults. But if I have to make an assumption, I suppose saying “But I also see the good, because I do think DT will bring benefits for the children who are taught under it.”, seems reasonable to me. Clare 282 8 May 2004 14:02:52 -0000 John wrote, “But I also see the good, because I do think DT will bring benefits for the children who are taught under it.” That seems to involve assuming that all DTT is good DTT, that all credentialed people in the field are competent and responsible, that it’s appropriate for every autistic child, can be used for teaching anything that needs to be taught, automatically produces results superior to any other teaching method, and never has any negative iatrogenic effects. And that the evidence for all of this is so overwhelming that it should be legislated as indisputable fact. A fairly large set of assumptions, I'd say ... Clare 281 8 May 2004 13:43:19 -0000 To push this further - a thought experiment: Imagine that the FBP had been done entirely without physical aversives. (For reference, here is a description by Phyllis Burke of an “aversive-free” session of treatment in the FBP, drawn from the transcripts: “His mother was being prompted, through the earphones, by the doctor. She was told to completely ignore him, because he was engaged in feminine play. Kraig would have no understanding of what was happening to his mother. On one such occasion, his distress was such that he began to scream, but his mother just looked away. His anxiety increased, and he did whatever he could to get her to respond to him, but she just looked away. She must have seemed like a stranger to have changed her behavior toward him so suddenly and for no apparent reason . . . He was described as being in a panic, alternating between sobs and “aggressing at her,” but again, when his distraught mother finally looked at him and began to respond, she stopped mid-sentence and abruptly turned away, as if he were not there. Kraig became so hysterical, and his mother so uncomfortable, that one of the clinicians had to enter and take Kraig, screaming, from the room.”) Imagine that Rekers had adjusted his phraseology, and stuck in public to the “known” facts that the behaviours being treated were “stigmatizing” and believed likely to lead to later behaviour which was criminal (homosexuality being illegal in California at the time) or self-harming - suicide or self-mutilation being considered “likely” outcomes. (Even nowadays, you could point out that “gender-inappropriate” behaviours make it likely that a child will be bullied and rejected, and that an adult will face homophobia and discrimination. This “change the victim” logic seems to be accepted without hesitation when it comes to other “stigmatizing” behaviours such as hand-flapping). So, take out the aversives and Rekers Bible-bashing, and is the FBP ethical? Bear in mind that the criticisms of the FBP - even from “well-known” behaviourists - were not criticisms of the science. Instead, they focused on the one issue you haven’t mentioned:the ethics of (to quote Michelle): “presuming to transform the nature of unconsenting clients through behaviour interventions”. More from Michelle’s original article: “Critics barely touched on the issue of aversives, and did not split hairs over data points; instead they highlighted the problem of to whom therapists are responsible. Who do they serve: the client, or the client’s parents, or society and its values, or themselves and their own values?” The issue of including adults from the population in the review process is not simply a procedural detail - it’s there precisely because of this question. Had gay and transgender people had a pivotal role in decisions about the FBP, it’s not that it would have been modified or carried out differently - it would never have been carried out at all. Clare 280 8 May 2004 13:29:27 -0000 Michelle wrote, “I’m sure Clare is going to notice that Rekers had a co-author, etc.” Oh, I noticed .... <g> And is it necessary to point out explicitly that all of the points which John has mentioned apply equally to Lovaas (1987), with the one exception that it wasn’t criticized by “well-known behaviourists”? Used physical aversives, check. Didn’t have adults from the population involved in the review process, check. Lead investigator published highly moralized and judgemental descriptions of the behaviours he aimed to eliminate, check. Clare 279 8 May 2004 09:17:18 -0000 Actually, I’ve also been having an unplanned time-out, after burning up all my available energy talking to a parent group (which was cool but always exhausts me more than I think it will), so I’ve been comatose since yesterday morning. michelle dawson 278 8 May 2004 03:37:33 -0000 Hi John, I’m a bit geographically/temporally handicapped right now. I should be able to overcome this problem circa Monday. Since you mentioned the need for some “time outs” maybe this is serendipitous? I’m sure Clare is going to notice that Rekers had a co-author, etc., and take on the double standard stuff... Michelle Dawson Naacanada John 277 6 May 2004 23:52:09 -0000 Hi Clare, You said “Can you explain why you think (as I assume/hope you do) that the Feminine Boy Project was unethical?” I can and yes, I do consider it unethical. There is more than one reason why I have come to think of this study as unethical. First, I am very skeptical of any study that includes physical aversives. I have book studied aversives, their use and implementation (which makes me different from most psychology students). I also know that aversive control (not necessarily physical) is a part of all contingencies, even the positive reinforcing ones (even praise). Show me a situation where a person receives something desirable, and I will show you where aversive control is hiding. I can do this because I have specifically studied this (which also makes me different from most behaviorist students). I also think there may be a time and place for physical aversives. But I don’t see those situations arising easily and I find thinking of them aversive myself. Even in dire situations, I am more inclined to try other things for a long, long time. Second, Rekers seems to have persisted in his specific method even after several well known behaviorists dissented. Even if he rejects the criticisms of the laity and of his adult specific population (which he still shouldn’t have) he should have done some serious thinking after his colleagues objected. Third, and this relates to the previous reason; I object because he didn’t include adults from his population as part of the review process. We in the autism field are also guilty of this. But I have already said I dissent on this point so I will not go off on a tangent. Finally, and very high on my list when I put on my behavioral scientist hat. I object and consider it unethical that the primary worker in FBP (Rekers) would imply and later write moral and judgment based descriptions of homosexual behavior in the format of a psychological and behavioral book. I recognize that we will always have a layer of subjectivity in our science, as indeed we must, otherwise we run the risk of being inconsiderate and heavy handed to the point of injuring others. But for Rekers, there is little absolution. He should have remembered the old and deliberately ironic behaviorist motto of punishment “Justice is God’s job, yours is to make sure punishment is over as quick as possible.” Rekers broke this rule by making religious based decisions of what behaviors to physically punish, and later making judgmental descriptions of what that behavior is. John 276 6 May 2004 23:51:28 -0000 Hi Michelle, You said “I need to know what you mean by authors having “complexity”.” Ahhh...yes...misstatement on my part. What I should have written was some authors design and carry out research that involves very advanced concepts or techniques that are difficult to understand (for me at least) You said “Has anyone written about this (re research?).” Montrose Wolf wrote on social validity but this is not quite the same thing. I don’t know about other writings. I will have to go check it out. You said “I guess you can meet the needs of the those who come to you provided those people express those needs.” This is important, but with many parts that should be considered. I will take some time to carefully think about this. You said “In any case, the ethical concerns about behaviour research/treatment I mentioned above were dimissed in 1977 because the science was said to be paramount. Not just beyond freedom and dignity, but beyond ethics?” Hmmm...I will check it out. You said “I don’t see any kind of balance between the needs of the kids and the needs of the scientists in autism-ABA. Maybe it’s “creative”, but in all the writing I’ve seen, the only ethics available are those condemning all other approaches.” I would certainly be an insufficient answer without careful thought on my part. I will take, as you say “time-out”, for thought. You said “You have to straighten something out for me. Either the study subject responds predictably and consistently to manipulations of the IV, or else the study’s a bust.” True, but many other behaviors still exist. I have never seen total control or even anything close, this includes children who did several programs and certainly got more than forty hours a week of DT. There is always a level of unaccounted for action. You said “You called this manipulation yourself, but the IV is not the only thing being manipulated.” Right, the dependent variable as well. But also, other behaviors may be influenced due to a variety of factors. You said “As for your kids being excited,you’re mentalizing like crazy. I also maybe see the long term stuff more clearly.” Ahhh..yes..what I should have said was excited behavior. You said “And I don’t understand how people using the full power of ABA to get rid of behaviours as necessary to an autistic as some social behaviours are necessary to most non-autistics can be called “considerate”.” By our consideration of the particular context. I tend to look at individual situations and I am very wary of generalizations in some situations. I disagree with the suppression of self-stim behavior in this format, but I think their other work was ethical. They might well, be (very) considerate in other situations and contexts. This should not be ignored. You said “Re subjectivity, I just found it odd that you were dragging out this notion to maintain your position re Lovaas. I thought you were the objective guy.” This is something that I consider critical. I do try very hard to maintain objective standards. But I must consider many arguments. This also means I must consider some subjective influences. I can deal with this because (a) I have no choice if I am to consider more than one point of view (b) I suspect that I will always find some subjective elements within the interpretation or design of objectivity. You said "Do you know who first said "medically necessary"?" No, but I suspect a non behaviorist. You said "Nothing good has come of this, and much harm." I see the harm based on the terminology choices. But I also see the good, because I do think DT will bring benefits for the children who are taught under it. And no, I am not talking about the indistinguishable from peers thing. Thank you for the Fenske citation. I am amazed you found it. I looked high and low for it. Michelle Dawson 275 6 May 2004 15:29:34 -0000 For the sake of accuracy, apart from what's happened in public, I've received hate mail, some from "important" people. Clare 274 6 May 2004 09:58:27 -0000 OK, a question for John (and this is not rhetorical - I’m genuinely curious about your thoughts on this, and I think it may help us to think further about some of the issues here): Can you explain why you think (as I assume/hope you do) that the Feminine Boy Project was unethical? Clare 273 6 May 2004 09:39:13 -0000 John wrote, “But that still leaves the letters some of which were not anonymous.” Anyone who writes a bestseller or who becomes a public figure (let alone a conroversial one) is likely to get some hate mail, though. It’s more or less an occupational hazard. There are a lot of people in the general population who may be confused or hurt and often not good at refraining from personal attacks when they try to express their opinions. And there are also people who are seriously disturbed. My dad is a minor government minister, and he gets letters covered in strange drawings from people he’s never met claiming to be married to him. However, my point is that when reputable academics make a public response to science-based criticism, we expect them to manage somewhat higher standards ... Michelle Dawson 272 6 May 2004 04:06:36 -0000 Hi again John, The much sought-after 63% is the study I described earlier, the one with no intake measures. This is Fenske et al (1885), predating Lovaas, reporting on the Princeton program. The 63% represent 6 out of 9 children who entered the program before they were 5, and graduated into public school. No intake measures, no kidding: the children are described as having "high rates of autistic behaviours". That's it. They also tried with 9 kids over five and succeeded with one. The point of the study was to see whether age at intake meant anything. The study was published, and I looked for it for a long time, but the journal it was published in is no longer. Up to you whether you promote this one. Michelle Dawson Naacanada Michelle Dawson 271 6 May 2004 00:17:26 -0000 Hi John, You're right, I don't know if Cohen et al are actually behaviourists or just imitations of. I need to know what you mean by authors having "complexity". And also what kind of balance goes on between the needs of researchers trying to crack JABA and the needs of the study subjects. Has anyone written about this (re research?). I'm aware of stuff back around 1977 in JABA where proposed guidelines (I believe they were proposed by the Association for Retarded Citizens, but I'm working from memory here) for treatment and (I think) research were discussed. One of the bahaviourist arguments against guidelines was that (my memory again) the science itself was sufficient, and interfering with it through guidelines (they were ethical guidelines) would be wrong. I guess you can meet the needs of the those who come to you provided those people express those needs. As you know, I have trouble with non-consenting clients, and that encompasses non-consenting study subjects. My concerns aren't limited to behaviourists: general anesthesia is used on autistics in order to do structural brain imaging, and I see no possible way to justify this. In any case, the ethical concerns about behaviour research/treatment I mentioned above were dimissed in 1977 because the science was said to be paramount. Not just beyond freedom and dignity, but beyond ethics? I don't see any kind of balance between the needs of the kids and the needs of the scientists in autism-ABA. Maybe it's "creative", but in all the writing I've seen, the only ethics available are those condemning all other approaches. You have to straighten something out for me. Either the study subject responds predictably and consistently to manipulations of the IV, or else the study's a bust. In the FBP single subject design (see, I'm learning), as I mentioned before, they had the boy entirely under control. Then they overshot a bit, making the boy into kind of a rogue. But they thought this would be much easier to correct than his previous behaviour. All this done with impeccable methodology. Any behaviour study subject must, in order to fulfil research design requirements, be subject to many manipulations of the IV, with concurrent measured alterations of their own behaviour. You called this manipulation yourself, but the IV is not the only thing being manipulated. As for your kids being excited,you're mentalizing like crazy. I also maybe see the long term stuff more clearly. And I don't understand how people using the full power of ABA to get rid of behaviours as necessary to an autistic as some social behaviours are necessary to most non-autistics can be called "considerate". Yes we can be taught that our own movement, gestures, interests, etc, are useless and wrong. But again, I would not call that kind of teaching considerate, however clever the method. Re subjectivity, I just found it odd that you were dragging out this notion to maintain your position re Lovaas. I thought you were the objective guy. Do you know who first said "medically necessary"? There has not been one but many, many legal cases in Canada based entirely on ABA being medically necessary. These have been in the courts and in human rights commissions (they are tribunals). Nothin good has come of this, and much harm. I'm really going to have to track down the 63%. I have seen it somewhere. I'd be pretty careful using it, John. Michelle Dawson Naacanada John 270 5 May 2004 19:58:23 -0000 Hi Michelle, You said "I understand, having thought about it, that I have read an ABA case study. It's the one with Dr Maurice's kids. I went out of my way to find this one and was greatly disappointed. If this is a behaviourist case study, I can understand why everyone might want to distance themselves from the term." If I remember correctly the authors are not even behaviorists. We do have some case studies, just not a whole lot. Some of the more complex single subject designs obviously took immense time and effort. And some authors have such complexity (Iwata and the John Hopkins crowd) that I am pushed to the edge of my ability to keep up. When I first started it was likem reading Japanese, I knew it meant something, but I had no clue what was going on. You said "but doesn't this get a bit redundant? If you have to verify ABA for every behaviour in every setting, then you're not really testing ABA, but the skill of the researcher." It can be repetitive. It but it helps long run. If we are sharp, we will meet the needs of those who come to us, while still making sure to do so in a way that increases or replicates the previous knowledge. The challenge to me seems meeting the needs of an autistic participant while maintaining the structure and integrity of science. But this takes creative behavior and diligence. You said "I can't help but add a note of sympathy to the study subjects. I have a very hard time reading about the manipulation of variables to meet the researcher's needs. Yes you can argue that you can't otherwise know what's working, but in human terms for the study subject puppets, it can't be easy. I guess one would learn (this is a learning thing) that one is at the mercy of the manipulations of others." As you have guessed, I do argue that. I have never seen the researchers treat the participants like puppets though. While the professors and grad students I work with may not agree with me on certain ethical issues, I am always shocked how concerned they are with other ethical aspects. One of these is making sure, that participants are not treated like puppets or lab rats. One of the labs I work in is the same one that produced some of the so called self-stim suppression that was cited on the ASAT site. While I may find that disagreeable, I am generally very pleased with how considerate the same folks are to the children and the families. Some the stuff they think of, are things that I wouldn't (although I can claim naiveté for this one). For example, if the child seems to find something aversive, then we stop immediately. Just one example. They are never lab rats. By the way most of the children seem excited when they come in. Although this probably has something to do with our toy room. As far as existing for the manipulation of others. Well.....that would seem to make life pretty boring, who would want that anyway........not most folks. Can't say I have ever seen that. You said "Re your position about Dr Lovaas' elusive data, you're just showing how subjective data are when filtered through behaviourist brains." Well at least you didn't say "mind" (smiling). Clare and I discussed this a bit. There will likely be a subjective element in the data and certainly in the extrapolations we make based on these. The goal seems to try and minimize this. You said "And this medically necessary thing. Without those words, there could never have been legal cases in Canada. I take note and checked out the site. I know that for the rest of my life I will have to deal with persons reinterpreting behavioral works including my own. They will identify a concept as they see fit. This seems to me, to be what happened here. Someone reinterpreted a concept and plopped it into the medical model. I want no case (no matter how behavioral), to win based on incorrect statements. I have little doubt that good will come of Auton, but that will not include its language or descriptive features. If *that* is indeed the reason of legal cases in Canada, then there should not have been one at this time. Although I do not know much about the Auton case. John 269 5 May 2004 19:57:37 -0000 Hi Clare, Agreements first: On Dr.s Maurice and Cohen. Okay, that doesn't seem to be very gossipy, come to think of it, it isn't at all. So I will leave this alone until I read Dr. Cohen's book myself. But that still leaves the letters some of which were not anonymous. Although, these were still not as absurd as what Michelle received. I helped do a major review of AVB just recently. There are no studies comparing it to DT, but there are repeated studies that show effect. Also, AVB is often used as a part of DT programs. It is some of the unnecessary rigid aspects, sometimes seen in DT that Leaf argues against. I also push for at least thirty hours in some cases. But we must distinguish between the magic forty and many hours as possible which has often come to mean thirty. One size does not fit all, and if we are to believe Dr. Leaf, he doesn't think so either. Lovaas, is correct to be very strict about the replication thing. Especially in a present situation where the statement "we do DT", might actually mean, "we do a cross of DT and RDI." But all he can really do is not lay his blessing upon another program should he so choose. And whether his peers decide to accept another centers work as any sort of replication may not depend on what Lovaas approval. You said "(The only claim of results anywhere near Lovaas's - and that's "33% best outcomes" instead of "47% recovery" - is Sallows, which remains unpublished and unreviewed)." I could swear that there is a 63% in there somewhere. I don't know where. But that also would be unpublished too I am sure. You said "In the scientific method as I understand it, to say that an experiment has been "replicated" is to say that other, independent researchers have carried out the same procedures and got the same results." I tried to make this simple and did the best I could, it is still just a bit technical. When the IV is implemented in the identical or nearly identical way as I the original study we may call this direct replication. We check aspects of the internal validity of the research by doing this i.e. (did the IV actually cause the change). We are making sure other researchers can produce the same results. Someone once told me that provided the researcher is honest, the actual IV(s) will always produce near the exact results. The real question is; did the researcher describe the exact IV? The exact IV includes extraneous variables. You said "This is clearly not the case here." No , that's true. You said "I don't understand what you mean by "systematic" replication, but it seems to stretch the meaning of the word "replication" to the point of meaninglessness to apply it to experiments which didn't in fact get the same results." Again, my apologies for the technicality. This is my definition: Systematic replication occurs when the IV is implemented with alterations to its exact form. Potentially across settings, topography, delivery, subjects, and intensity. I recognize that this is open to subjectivity. It is not meaningless, but it may well not get the same results. That is, possibly one of the points. The point of systematic replication is to see under what various conditions a modified IV will work to produce certain results. This is a sort of measure of external validity i.e. (does the IV work in other settings in a modified way). I also have some familiarity with non behavioral special education research. A continuous concern among teachers actually working in the field and educational researchers is "does a technique work in multiple settings of various sorts". They are concerned with external validity and a fair share of educational research is done to check various techniques across settings and situations. This is their bias, and a very good one. Clare 268 5 May 2004 09:45:31 -0000 John wrote, "And like we discussed before we need to differentiate between direct and systematic replications of which we do have several examples, although no forty hour ones." There has been no published study which has replicated the conditions (including the 40 hours) which Lovaas claims are essential to produce the results he claimed. Moreover, there has been no published study which has produced the same results as Lovaas's 1987 study, or even results close to Lovaas's. (The only claim of results anywhere near Lovaas's - and that's "33% best outcomes" instead of "47% recovery" - is Sallows, which remains unpublished and unreviewed). In the scientific method as I understand it, to say that an experiment has been "replicated" is to say that other, independent researchers have carried out the same procedures and got the same results. This is clearly not the case here. I don't understand what you mean by "systematic" replication, but it seems to stretch the meaning of the word "replication" to the point of meaninglessness to apply it to experiments which didn't in fact get the same results. Clare 267 5 May 2004 09:27:12 -0000 John wrote, "It was Dr. Cohen I was referring to. And also for adding gossipy comments on Maurice's physical appearance. Which seems to me to be as unacceptable as saying that an autistic person isn't autistic." OK, let me quote this heinous attack from Cohen's book, in its entirety: "She is a slim, rather attractive dark-haired woman who speaks in a soft and tenuous voice." It's a book which is trying to be popular and accessible, and Cohen gives physical descriptions of many of the people she observes or interviews. Cohen says that Maurice writes "movingly and convincingly", and at no place does she question the original diagnosis of Maurice's children, or the claims of their "recovery". She merely expresses some gentle concern - when discussing ABA in general - that some parents may have unrealistic hopes about the likelihood of their children "recovering" through ABA, and about the presentation of Lovaas-style ABA as "the only game in town". Now, please explain to me how that in any sense constitutes a "personal attack" on Catherine Maurice. Let alone how it is remotely comparable to accusing someone of faking autism or having a "personality disorder." Clare 266 5 May 2004 09:24:36 -0000 John wrote, "But your lack of mentioning the studies of AVB was also conspicuous by its absence. " I'm afraid I don't understand what this means. I haven't cited studies of AVB because it's not an area I have detailed knowledge of. John wrote, "While I acknowledge that he is extremely influential, he should not be seen as having ownership, even Skinner did not have this." My point was simply that he is enormously influential, and certainly has the highest public profile of any behaviour analyst in the autism field. John wrote, "Ron Leaf, who helped write "A Work In Progress", also specifically spoke of the magic forty, he said in a conference I attended "Forty hours is not a magic number, we don't have to stick by it like the number itself will solve the problems." " However, "A Work in Progress" does, as far as I recall, describe teaching entirely through DTT, and on an "intensive intervention" basis - i.e. aiming for as many hours as possible. And Lovaas has repeatedly argued that studies which achieve fewer than 40 hours a week cannot be seen as "replicating" his work. Michelle Dawson 265 5 May 2004 01:28:53 -0000 Hi John, First I thought (re single subject studies) that, like I've mentioned to many people lately, doing politics makes me stupid, and I'd made a significant blooper. But, I'm afraid in my area, we do case studies. They can be extremely detailed and contain tons of data. I'm assuming that so long as the specific conditions you list aren't met, then these would not qualify as single subject design. But that doesn't really leave any leeway for behaviourist case studies. What would be the point? Why use a new term? I understand, having thought about it, that I have read an ABA case study. It's the one with Dr Maurice's kids. I went out of my way to find this one and was greatly disappointed. If this is a behaviourist case study, I can understand why everyone might want to distance themselves from the term. My experiences with reading JABA are different from yours. Maybe once outside of the single study design the standards collapse? Though my favourite piece of Dr Lovaas' writing is in a rejoinder in JABA. This is the one with Newsom. I hope I have it right. They say that, having made a very large target, they were surprised to find themselves pulling darts out of the wall. If your standards are the real standards, and I certainly believe you, you've got it made. If it's legitimate to publish single subject studies every time a new behaviour is treated, then you're in business for good. But what's the point? Can you say "generalization"? Okay, I know theory is anathema at this level, we all have to wait for serendipity, but doesn't this get a bit redundant? If you have to verify ABA for every behaviour in every setting, then you're not really testing ABA, but the skill of the researcher. I can't help but adding a note of sympathy to the study subjects. I have a very hard time reading about the manipulation of variables to meet the researcher's needs. Yes you can argue that you can't otherwise know what's working, but in human terms for the study subject puppets, it can't be easy. I guess one would learn (this is a learning thing) that one is at the mercy of the manipulations of others. Re your position about Dr Lovaas' elusive data, you're just showing how subjective data are when filtered through behaviourist brains. And this medically necessary thing. Without those words, there could never have been legal cases in Canada. I know the situation is different in the US. But in Canada, everything hinges on those words. Which are, as you point out, anti-behaviourist. Here's the splash page for FEAT BC, the folks behind the Auton case http://www.featbc.org/ This splash page is also used by FEAT Ontario, an Auton intervener. Michelle Dawson Naacanada John 264 4 May 2004 23:40:45 -0000 Hi Michelle, You said "Re John's 900, this is 900 what? "Research articles" encompasses what? Do reviews and rejoinders count? Or just case studies, since group studies are out of vogue?" No, not in this case. This also does not include case studies, since these do not prove experimental control. This does include single subject designs, which are different from case studies and do prove experimental control. You said "Just for clarity, in other fields, you must have an extremely good rationale for doing a case study, or you will be rejected." As you do in our field. JABA is often heartbreakingly difficult to get published in. Sometimes, even very, very tight studies won't make it, especially in the DD field. This was part of the rift (so I hear) between the Iwata folks and the PBS folks who got tired of not getting published under Iwata and company's' really demanding guidelines. Grad students practically throw parties when/if they make it in for the first time. Exceptions exist and often for reasons of the area having little/no research.. I don't see many (any) case studies these days in JABA. I see the vast majority being (the misleadingly named) single subject designs. These designs do prove experimental control as opposed to a case study which does not. They also involve graphical rather than statistical analysis, as was recommended by Skinner. This design has both some weak points and some strong points when compared to group design logic. You said "You have to prove that your individual is unique and no experimental group can be gathered. You also have to prove that no comparison group is available. This can and does happen, but you have to prove this is the case." Sure, that is one example but not the only. We may add the situation where a person has come in for intervention of some problem, and we still want to prove that it was the treatment that caused the change and not some extraneous variable. Single subject designs allow us to do that. Behaviorists even generally prefer it. The design logic allows us to view the efficacy of treatment by repeated manipulation of the independent variable. As opposed to comparing to a control group. Although, we also know how to do this. For a side note, some non behaviorists try to adopt this and end up not doing a good job. The study I have previously mentioned regarding social stories comes to mind. It didn't show experimental control in their learning based task. The authors did not understand single subject design well enough to know that a reversal design was inappropriate. And neither did the editors of that journal who embarrassingly included at least one prominent behaviorist. You said "Behaviourists work to radically (sorry) different standards, maybe explaining their distance from the rest of us?" Yes, it does have that effect in some cases, not in all. You said "I also previously mentioned the gazillion behavioural studies trotted out in court to "prove" ABA is beyond criticism. I don't think this approach is valid or ethical. Yes, you can prevent an autistic from flapping his hands while alone, for a period of up to ten minutes, yes this has been proven. Repeat 900 times. No, I don't agree that sheer quantity constitutes proof, especially when the standards are altered because, among other reasons, adhering to them would drastically limit the quantity of the output." Indeed sheer quantity is not sole proof. And especially when the research is sloppy, or poorly controlled. Even so, systematic replication is a critical proof of external validity. These repeated measures are absolutely essential in determining not only is a treatment replicable but under what various conditions. Every piece of research is one more chip in the scale of proof. The standards are not altered in this case. They began different and are the traditional and acceptable methods of investigating behavior from this paradigm. They are also being adopted more and more by other psychologist researchers, although not very well yet. This is especially true when considering that many professionals cite the first controlled behavioral and one of the first controlled human psychological studies as being done by the classic behaviorists (Allyon, & Michael, 1959). Even the first non-behavioral human research owed a lot to behaviorist influence. Some behaviorists are even responsible for creating certain group design analytical techniques. Of course, no technique in any paradigm is or should be beyond criticism. I just don't see the ABA/DRI thing ever happening. Dr. Greenspan has yet to my knowledge, done any formal experimental research with his method, at least nothing has made it to a peer reviewed journal. I don't think this will ever happen. Too many problems. You said "Re Dr Lovaas' elusive aversives data, there aren't am lot of choices. Either the data are good, and one concludes that aversives were an essential "active ingredient" in obtaining Dr Lovaas' big number; or the data aren't good, and Dr Lovaas cited and referenced them anyway, and drew conclusions from them. I'm not sure how conscientious journal reviewers and editors are required to be. But if the data are suspect, then Dr Lovaas would either be incompetent or dishonest, or I suppose both." Or perhaps contemporary behaviorists may form different conclusions from Lovaas. Lovaas had the luxury, of citing a non peer reviewed project of which he had (no doubt) great knowledge. We do not have that luxury and good analytical practice requires us to be skeptical of data based citations that are not based in a peer reviewed journal (excluding a few special situations). For another example I remember the case study where I had an autistic student co-teach a DTT lesson on verbs with me. The student's presence and teaching brought a higher percent correct than I was getting alone for two of three other students. I will probably cite this one day as a non published case study. And of course the data are highly suspect. There would be all sorts of things I didn't control for. But there may be a case of when this would be appropriate. You said "Your point that the data weren't published is important, but it wasn't enough for me to even comment on the veracity of the whole within-subjects-replication-design." I hear you, but as a skeptical viewer I have no choice but to say that we can not know the actual effect without seeing those data. You said "The project where the most data are easily available is the FBP. The JABA case study is awash with data. You have the actual graphs. I'm not sure I've seen an autism case study anywhere near as thorough." Never in a professional journal, but I have seen extremely detailed case studies on autism in private collections. You said "I have a question, John. I noticed your radical behaviourist rejection of the medical model. This would require you to reject the "medically necessary" label for ABA in autism. Isn't "medically necessary" kind of anti-behaviourist? I'm totally guessing here; I haven't read my radical behaviourist primer for a while, and given my advanced age, need prompting." I very much reject it. I can only assume (hope) that it was a supporter (but not professional) who first used the term. I am not happy it has caught on, it is over simplistic. It is very much anti-behaviorist, and if others haven't mentioned this previously I don't mind being the first. I have never agreed with the term, even in my earliest behavioral days. DTT is teaching, not medicine. For the same reason I dislike the term(s) therapist, and client/consumer, and use them only grudgingly, it seems inappropriate to what is going on. I wouldn't mind tutor, teacher, or trainer in some cases (toileting skills). I would prefer to call the child simply the child or maybe the student. John 263 4 May 2004 23:39:52 -0000 Hi Clare, You Said "However, as we've already discussed, ABA is used very widely - including by behaviourists - to mean Lovaas-style ABA." Yes, but when splitting hairs, as I was, we must differentiate a little or we are in danger of being over simplistic. Another example is saying a boy with Childhood Disintegrative Disorder has been diagnosed with autism. Common terminology use often over generalizes anyone who has been diagnosed on the PDDs as being diagnosed with autism. As this field is often called Autism Spectrum Disorders this is appropriate, but when splitting hairs it is good to know the differences between specific Autism Disorder and CDD. Just as it is important to know that Lovaas is only part of ABA. You said "In "Teaching Individuals with Developmental Delay", Lovaas (who has a certain authority in this field) specifically excludes PRT, incidental teaching and the natural language paradigm from his concept of "behavioural intervention"." While I acknowledge that he is extremely influential, he should not be seen as having ownership, even Skinner did not have this. You said "Indeed. The results of which rather appear to undermine the whole Lovaas protocol for language-teaching." In terms of language-teaching I would indeed call this research important to pointing out a better solution for language training. But your lack of mentioning the studies of AVB was also conspicuous by its absence. Also, I would not say undermine as much as displace, and ironically the comparative studies are still relatively few. You said "If you define it so widely as to include everything from incidental teaching to DTT, then in my opinion it becomes fairly meaningless to talk about studies supporting "ABA" as a whole (how could they?), as opposed to studies supporting particular techniques or specific treatment protocols." This is a fair, and I recall more or less saying before that we should be wary of generalizing across ABA. But you see, I don't mind discussing sub techniques within ABA, as they are still definitely part of a much larger theoretical base called ABA. My goal in the last post, and in this post, was to identify several methods that have some success within ABA. You said "Pardon me, but having read The Me Book, Lovaas's studies, Teaching Individuals With Developmental Delays, A Work in Progress, etc. etc. etc., that's exactly what orthodox Lovaas-style ABA practitioners appear to aspire to, at least for the first year or two." Well.... I can't speak on most of the authors but Ron Leaf, who helped write "A Work In Progress", also specifically spoke of the magic forty, he said in a conference I attended "Forty hours is not a magic number, we don't have to stick by it like the number itself will solve the problems." As I have only briefly looked through his book I couldn't speak as to whether he writes anything contradictory as you propose. You said "The logical implication of that statement is that many of them don't involve people with developmental disabilities, and only some of them involve autistic people. Which is unsurprising, given that JABA publishes on ABA in the wider sense, and is not autism-specific." Well, since I said "many involve persons with developmental disabilities including autism", we may conclude that a contradictory statement "many of them don't involve people with developmental disabilities", would seem like an incorrect statement. Although I agree, it is more correct to say "only some of them involve autistic people" JABA is only ABA specific (in the actual sense of the word), rather than autism or any other human situation specific. Also, JABA published more articles involving DD than any other sub interest. This is showed again as my behavioral friends who are not interested in autism always tell me (or maybe whine) that DD's get much more than their fair share in JABA. An industrial/organizational field professor again told me as much the other weekend. Although its true that JABA exists to present research of many sorts. You said "Call me obtuse, but I don't see how (for example) a research study on "Teaching safety skills to children to prevent gun play" (Himle, Miltenberger et. al., JABA, 37,1-9, Spring 2004) has any relevance to whether or not intensive discrete-trial-based teaching is or is not the most effective way of teaching autistic children." I can add a half dozen more examples of research of the same sort from JABA f the top of my head. But this is the difference from saying "all research", and my statement "many of these". You said "So citing it and other articles as part of "ABA's research base" - when it comes to "ABA" meaning Lovaas-style treatment of autistic children - seems disengenuous." Not so, I tend to work within the context of the terms that I am given. The term in this case was "ABA." You said "And when it comes to the precise topic at stake in cases like Auton - the magic 40 hours per week of Lovaas-style ABA - there have been no published replications of Lovaas's results at all, as we've discussed before." And like we discussed before we need to differentiate between direct and systematic replications of which we do have several examples, although no forty hour ones. You said "In other words, the "scientifically proven" for that boils down to one small group study and a follow-up study of the same group." For the forty hour thing, yes. For DT, no. You said "But if "mocking the notion of their recovery" means expressing scepticism about claims that any autistic child has become 100% Normal - then I for one am certainly guilty of that." So am I for that matter. This may even be our responsibility. But mocking and expressing doubt do not have to be synonymous. Although Maurice herself writes on the subject. You said "Maurice devotes a good page in the same introduction to attacking Shirley Cohen for the heinous crime of writing about Lovaas-style ABA as one possible treatment among many, and appears to accuse her of having an especially evil plan to covertly attack by "damning it with faint praise"." It was Dr. Cohen I was referring to. And also for adding gossipy comments on Maurice's physical appearance. Which seems to me to be as unacceptable as saying that an autistic person isn't autistic. You said "So I have a suspicion that Maurice's "derision" threshold may be rather low (she can also clearly give as good as she gets, given how insulting she is in that introduction towards anyone she deems to be an enemy or critic)." She can indeed be very curt and more than curt. You said "In any case, so far as I know, no authority in the autism field has gone on record in print or on the net and accused Maurice of a "personality disorder", or of, say, having conned someone in the government into thinking her children were autistic so that she could "live off" the autism field." True, but the letters she receives and Dr. Cohen's comments still stand. You said "Indeed. And I wouldn't say that there's anything inherent in behavioural theory per se that requires behaviourists to be hostile to autistic people with opinions." True again, nor should we be. You said "In fact, given the emphasis on scientific objectivity, you behaviorists should be particularly interested in being open to criticism and scientific discussion." And true yet a third time. You said "However, there does appears to be a dominant culture within the field of ABA which is very hostile, in a wholly unscientific way, to the idea of autistic people daring to disagree." Very sadly true. You said "There seems no scientific reason why the use of ABA to try to make autistic children "indistinguishable from their normal peers" shouldn't be subject to exactly the same sort of criticism by behaviourists, for exactly the same reasons.But, for whatever reason, it doesn't appear to be happening at the moment." I take note, but add that this no longer seems to be a universal DTT goal (although still common). Clare 262 4 May 2004 16:09:50 -0000 John wrote, "a student I know just completed a review of all research articles in the Journal of Applied Behavior Analysis (perhaps ABA's flagship journal). She found over 900 studies. Many of these include persons with developmental disabilities including autism. And this is only one journal..." The logical implication of that statement is that many of them don't involve people with developmental disabilities, and only some of them involve autistic people. Which is unsurprising, given that JABA publishes on ABA in the wider sense, and is not autism-specific. Call me obtuse, but I don't see how (for example) a research study on "Teaching safety skills to children to prevent gun play" (Himle, Miltenberger et. al., JABA, 37,1-9, Spring 2004) has any relevance to whether or not intensive discrete-trial-based teaching is or is not the most effective way of teaching autistic children. So citing it and other articles as part of "ABA's research base" - when it comes to "ABA" meaning Lovaas-style treatment of autistic children - seems disengenuous. I wouldn't hazard a precise guess as to the total number of those studies which are actually about discrete-trial teaching of autistic children, but they comprise only a proportion of that 900. When it comes to studies of the effects of intensive use of discrete-trial teaching with young autistic children, there are even fewer. And when it comes to the precise topic at stake in cases like Auton - the magic 40 hours per week of Lovaas-style ABA - there have been no published replications of Lovaas's results at all, as we've discussed before. In other words, the "scientifically proven" for that boils down to one small group study and a follow-up study of the same group. Because when these parents go to court demanding "ABA" for their children, they are not asking for "safety skills to prevent gunplay" <g>. Michelle Dawson 261 4 May 2004 14:21:26 -0000 Re John's 900, this is 900 what? "Research articles" encompasses what? Do reviews and rejoinders count? Or just case studies, since group studies are out of vogue? Just for clarity, in other fields, you must have an extremely good rationale for doing a case study, or you will be rejected. You have to prove that your individual is unique and no experimental group can be gathered. You also have to prove that no comparison group is available. This can and does happen, but you have to prove this is the case. One example of no comparison group being available was functional imaging of braille reading. They had the blind person experimental group. But no non-blind person who reads braille the way blind people read braille could be located. Non-blind people (as I've mentioned before) read braille visually. Behaviourists work to radically (sorry) different standards, maybe explaining their distance from the rest of us? I also mentioned the gazillion behavioural studies trotted out in court to "prove" ABA is beyond criticism. I don't think this approach is valid or ethical. Yes, you can prevent an autistic from flapping his hands while alone, for a period of up to ten minutes, yes this has been proven. Repeat 900 times. No, I don't agree that sheer quantity constitutes proof, especially when the standards are altered because, among other reasons, adhering to them would drastically limit the quantity of the output. Ralph Smith 260 4 May 2004 10:29:43 -0000 Ping - I say, PING, son. Thought I should check in, say I haven't lost the thread (just staggering in pursuit of it). Now I realise where I've seen Skinner before: Mary Midgley's The Roots of Human Nature; the dedication of which gives a clue about the general (and still ongoing) debate: To my sons, with many thanks for making it so clear to me that the human infant is not blank paper. Blank paper. I started drawing when I was three. No one taught me, encouraged me, or gave it much notice - until it was time to rip me away from it. Clare 259 4 May 2004 09:43:30 -0000 John wrote, "This is a very, very short list of single subject ABA research including some PRT and Incidental teaching, since you said "ABA". " However, as we've already discussed, ABA is used very widely - including by behaviourists - to mean Lovaas-style ABA. In "Teaching Individuals with Developmental Delay", Lovaas (who has a certain authority in this field) specifically excludes PRT, incidental teaching and the natural language paradigm from his concept of "behavioural intervention". John wrote, "Also, this is some research where DTT is directly compared to other ABA methods." Indeed. The results of which rather appear to undermine the whole Lovaas protocol for language-teaching. Again, we're back to the issue of how widely you define "ABA". If you define it so widely as to include everything from incidental teaching to DTT, then in my opinion it becomes fairly meaningless to talk about studies supporting "ABA" as a whole (how could they?), as opposed to studies supporting particular techniques or specific treatment protocols. Clare 258 4 May 2004 09:32:13 -0000 Michelle wrote, "Here's Dr Maurice giving her inspirational speech to the behaviour analysts: http://www.behavior.org/autism/Catherine_Maurice.pdf " Charming. I particularly like her attack on "glaringly ignorant statements about it, like "Oh, yes, that's where they do discrete trials for forty hours a week"". Pardon me, but having read The Me Book, Lovaas's studies, Teaching Individuals With Developmental Delays, A Work in Progress, etc. etc. etc., that's exactly what orthodox Lovaas-style ABA practitioners appear to aspire to, at least for the first year or two. Mind you, in the introduction to "Making a Difference", she also attacks Shirley Cohen for "distorting" things by saying that some children cry, tantrum and attempt to escape during the first few days or weeks of DTT. Despite the fact that Maurice herself describes this in detail in "Let Me Hear Your Voice".
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