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Author Topic: Gauging the effectiveness of behavioral treatment modalities
armando
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Post Gauging the effectiveness of behavioral treatment modalities
on: April 14, 2011, 06:35
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I have decided to blog on the effectiveness of behavioral treatment modalities in the hope that readers can gain better insight regarding current practices in the field. It is time for a public discussion of this topic and I will welcome responses from all corners. I am not nor never have been a behavioral therapist. However, I have administered programs and services that employed Board Certified Behavioral Analysts as well as Associate Analysts, Qualified Developmental Disability Profesionals and Qualified Mental Retardation Professionals (QMRP) In the days and weeks ahead I will be blogging on the variety of treatment philosophies and how they are "rated" by credentialed investigators.

Following this discussion I plan to explore an extension of my arguments by detailing the extension of these modalities as they are passed on to the men and women who actually implement the behavioral planning as they apply to the child or adult with ASD. Of particular interest to me is the economic standard that agencies apply to the direct care staff. Those who are expected to perform the tasks as designed.

Well that sets the stage. Let me know if you have an interest in these topics. Much more to follow.
aaafadmin
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 14, 2011, 19:36
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I'm very interested in this topic! Let's see if we can get people started on our discussion groups...
armando
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 16, 2011, 18:06
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Yes would be terrific.I will be back on tomorrow with an outline.
armando
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 18, 2011, 06:42
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Any attempt to explore and understand how behavioral treatment has been applied to children and adults with autism must begin with O. Ivor Lovass, Ph.D. Dr. Lovass who died in 2010 was a psychologist who taught, studied and conducted research while at UCLA. Much of his work was in some waiy remains controversial. In the 1960s, when Dr. Lovaas began studying autism, psychiatrists and psychotherapists applied the common Freudian view that the condition was a neurosis. Autistic children, if they were treated at all, were given psychotherapy. Clearly there was little impact. Most were misdiagnosed as schizophrenic or mentally retarded and consigned to institutions. In fact, an interesting study would be to research the thousands of individuals who were diagnosed with mental retardation in the 1960's and 70's and placed in the now dwindling numbers of state run instituions. Examples of this abound. In my own experience here in Southwest Florida there were a number of men and women who were placed at institutions such as Gulf Coast Center, formally Sunland Training Center located in Buckingham and later released and placed in group homes in the community. I will hold this for later chapters.

Noted Psychologists Ivan Pavlov and B. F. Skinner can be cosidered the fathers of applied behavior analysis or A.B.A. This treatment uses behavior-modification techniques to treat social and psychological problems like drug abuse and mental illness. The next session will be devoted to a very brief overview of the genisis of ABA.
armando
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 21, 2011, 06:27
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Back to Skinner...to understand behavioral modification theory one does have to look at the source of the research. This leads us to the work of B F Skinner.B.F. Skinner held a strict behaviorist viewpoint advocating that operant instrumental learning was more important than Pavlov's Classical Conditioning. Basically, Skinner believed and attempted to prove throughout his life that the "environment" is the critical element in understanding all behavior. It was his view that human personality was formed by the external environment. Because of this "operant conditioning" one could manioulate the environment to cause behavior modification.In operant instrumental conditioning, learning occurs as a result of reinforcement where specific rewards or punishments are implemented in order to achieve or dissuade the behavior to be changed. Skinner suggested that the study of learning should only be concerned with observable stimuli and responses -'thought', 'feeling', 'motivational factors' and son on were considered by Skinner to be 'unobservable' and therefore not measurable, and that mental events were themselves behaviors and not causes.

An so it begins....more to follow
armando
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 24, 2011, 02:31
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Skinner specifically addressed the applications of behaviorism and operant conditioning to educational practice. He believed that the goal of education was to train learners in survival skills for self and society. The role of the teacher was to reinforce behaviors that contributed to survival skills, and extinguish behaviors that did not. The behaviorist views have shaped much of contemporary education in children and adult learning.This is why most of the branches that grew from the trunk of the Skinner/Lovass tree are rooted in the "education" of individuals affected by ASD. We will discuss these institutions and agencies later.

Lets return to the concept of operant conditioning, one of the most essential elements of conditioning is understanding that if a consequence is pleasant, the preceding behavior will become more frequent, and if a consequence is unpleasant the behavior becomes less likely to occur.

Skinner's observations can be divided into independent variables which can be manipulated and dependent variables. Dependent variables cannot be manipulated but they can be affected by the independent variables.

There are three types of reinforcement:

1 Primary reinforcement- these are instinctive behaviors that lead to satisfaction of basic survival. These include food, water, sex, shelter. Skinner felt that there was no learning here because the behaviors emerged spontaneously.

2 Secondary reinforcement - the reinforcer is not reinforcing by itself, but becomes reinforcing when paired with a primary reinforcer, such as pairing a sound or a light with food.

3 Generalized reinforcement - stimuli become reinforcing through repeated pairing with primary or secondary reinforcers. This is where Skinner beleif that many are culturally reinforced. In human behavior the the desire for wealth, power, fame, strength, and intelligence are valued in many cultures. Thus, the external symbols of these attributes are generalized reinforcers. Therefore money, rank, recognition, degrees and certificates, etc are strongly reinforcing to many individuals in the cultures that place significant value in these symbols.

Reinforcers always follow a behavior and could be pleasant or unpleasant (noxious) and could be added to or removed from a situation.

It must be noted that behavior modification later understood as applied behavior ananlysis (ABA)entered the autism world at a time when virtually no other therapies existed. This is the treatment path tree that has Skinner and Lovass as its trunk. In tyhe 1970s the limbs grew from a small group of researchers and a few educational psychologists who founded schools or treatment models based on behavior modification.From this comes numerous branches of treament providers. Some of these behavior modification providers have remained in treatment philosophies that have not changed for four decades while other have made modifications based on the work of more modern psychological research. I will conntinue to discuss what "evidence-based" treatment means. There has been significantly more evidenced based studies done since the 2006 Combating Autism Act and the resulting work of the Interagency Autism Coordinating Committee.

Next we take a depeer look at the techniques of behavior modification. How the prionciples are applied. I will include a more detailed discusson of behavior modification techniques that includes "negative reinforcment" or punishment to modify unwanted behaviors. Unfortunately, ther are some who still ascribe to this aspect of behavioral change technique. Fortunately,during the 1980s and 1990s, non-violent behavior therapy and the use of extremely controlled learning environments came about to be the principle treatments for autism and autism-related disorders. It is within this recent past that we also find the effecetive use of psychotropic medications. Medications that were not yet available in the early history of the behavior modification treatment.
sheba
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 26, 2011, 20:32
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Armando,

I am happy to see educational information on a research-based therapy. This is really great. I have found some difficulties using only behavioral therapy techniques when there are co-morbid disorders such as depression, anxiety, social anxiety, or OCD. With these clients I use both behavioral therapy principles as well as cognitive-behavioral techniques. I also work with families to design behavioral plans as well as identify rewards (motivators)- This can also be very effective. Something that I have seen more of a need in for high-functioning adults with ASD is career counseling. I have really enjoyed incorporating career decision-making models into therapy sessions with adult clients.

Sheba
armando
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: April 29, 2011, 14:56
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Sheba
I hope to continue wrtiting on the subject as time permits. There is a lot more objective analysis of therapeutic effectiveness available. I believe it is important for parents to understand that some applications are better than others for some children on the spectrum. Clearly you face interesting challenges when presented with co-morbid disorders and the community is well served to have professionals such as yourself who can combine such modalities. I am hopeful that we at Adonis can link with Dr. Alessandri at the University of Miami. He is leading the South Florida effort to build a presence for the Advancing Futures for Adults with Autism.

Armando
armando
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: May 17, 2011, 07:46
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In an earlier blog I referenced the 2006 Combating Autism Act. Among other investments the law created the Inter Agency Autism Coordinating Committee or IACC. It is made up of 18 seats. Twelve members are government representatives and six members are from the general public. The IACC is responsible for developing and updating the Strategic Plan for Autism Research under the mandate of the Combating Autism Act. They decide which studies get funding from the $940 million that was allocated to autism research under the Act.
The members are:

Chair
Thomas R. Insel, M.D.
Director
National Institute of Mental Health
National Institutes of Health
Bethesda, Maryland
Federal Members
James F. Battey, M.D., Ph.D.
Director
National Institute on Deafness and Other Communication
Disorders
National Institutes of Health
Bethesda, Maryland

Linda Birnbaum, Ph.D.
Director
National Institute of Environmental Health Sciences
National Institutes of Health
Research Triangle Park, North Carolina

Ellen W. Blackwell, M.S.W.
Division of Community and Institutional Services
Disabled and Elderly Health Programs Group
Center for Medicaid and State Operations
Centers for Medicare and Medicaid Services
Baltimore, Maryland

Coleen Boyle, Ph.D.
Acting Director
National Center on Birth Defects and Developmental
Disabilities
Centers for Disease Control and Prevention
Atlanta, Georgia

Henry Claypool
Director
Office on Disability
U.S. Department of Health and Human Services
Washington, DC

Francis S. Collins, M.D., Ph.D.
Director
National Institutes of Health
Bethesda, Maryland

Alan E. Guttmacher, M.D.
Director
Eunice Kennedy Shriver National Institute of Child Health
and Human Development
Bethesda, Maryland

Gail R. Houle, Ph.D.
Associate Division Director
Research-to-Practice Division
Early Childhood Programs
Office of Special Education Programs
U.S. Department of Education
Washington, DC

Larke N. Huang, Ph.D.
Senior Advisor on Children
Office of the Administrator
Substance Abuse and Mental Health Services Administration
Rockville, Maryland

Walter J. Koroshetz, M.D.
Deputy Director
National Institute of Neurological Disorders and Stroke
Bethesda, Maryland

Sharon Lewis
Commissioner
Administration on Developmental Disabilities
Administration for Children and Families
Washington, DC

Peter van Dyck, M.D., M.P.H.
Associate Administrator
Maternal and Child Health
Health Resources and Services Administration
Rockville, Maryland

Public Members
Geraldine Dawson, Ph.D.
Chief Science Officer
Autism Speaks
New York, New York

Gerald D. Fischbach, M.D.
Scientific Director
Simons Foundation Autism Research Initiative
New York, New York

Lee Grossman
President and CEO
Autism Society
Bethesda, Maryland

Yvette M. Janvier, M.D.
Medical Director
Children's Specialized Hospital
Toms River, New Jersey

Christine M. McKee, J.D.
Rockville, Maryland

Ari Ne'eman
Founding President
Autistic Self-Advocacy Network
Washington, DC

Lyn Redwood, R.N., M.S.N.
Co-Founder and Executive Director
Coalition for SafeMinds
Tyrone, Georgia

Denise D. Resnik
Board Member and Co-Founder
Southwest Autism Research and Resource Center
Phoenix, Arizona

Stephen M. Shore, Ed.D.
Executive Director
Autism Spectrum Disorder Consulting and
Assistant Professor of Special Education
Adelphi University
Newton, Massachusetts

Alison Tepper Singer, M.B.A.
President
Autism Science Foundation
New York, New York

Marjorie Solomon, Ph.D., M.B.A.
Assistant Clinical Professor
University of California, Davis
School of Medicine and
M.I.N.D. Institute
Sacramento, California

Next we will discuss research completed as authotized by the IACC in 2010 on treatment effectiveness.

armando
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Posts: 17
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Post Re: Gauging the effectiveness of behavioral treatment modalities
on: July 7, 2011, 07:14
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Been exremely busy the past few weeks but just received "Cuting Edge Therapies for Autism" written and compiled by parents Ken Siri and Tony Lyons. I wanted to get back to my string by continuing the IACC 2010 report and will do so offer the weekend....God wiling and the creek don't rise!
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