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 ABA vs Son-Rise

NBC Admin - Thursday, July 10, 2014

This was originally posted on our old website a few years ago:

 

Misrepresentation and why it is not just wrong but harmful
I debated even writing this blog because I should probably just let the video slip away but I think it is my duty as a behavior analyst to educate people when I see something that misrepresents the field of behavior analysis. I received this video yesterday advertising the Son Rise Program. I am willing to admit that I do not know that much about this treatment but I do know that it is greatly misrepresenting the field of behavior analysis in this video. I am hoping to try to keep this organized but I might start to babble as this is a somewhat emotional post for me. I am going to analyze why it is wrong for Son Rise to not just advertise their program but mislead people about ABA, additionally I will explain why their statement about ABA being robotic and focusing ONLY on extinguishing behaviors is false, lastly I will attempt to show how Son Rise is most likely making use of behavioral techniques but just calling it something else.

Misleading Parents is Harmful
My first issue with this ad is how harmful it is for parents. Parents of newly diagnosed children might see this ad and then adamantly refuse to incorporate ABA. How far the parent goes with this will determine the harm caused but if a parent sees this and says "I do not want a robotic child" and absolutely refuses anything presented as "behavioral" or "aba." And this parent is fortunate enough to live in a school district that offers ABA and makes large gains with the children in their schools but the parent refuses it because of this video. I am hoping that it won't happen but it is possible.

It is one thing to advertise your program and explain what your program does. If a parent connects with the core ideas of your program and wants to use it, then that is fine. BUT trying to separate your program from ABA, put down ABA (the only established intervention for autism) and say it is better than ABA and/or that it is nothing like ABA when they have large similarities is a completely different thing (I will explain the similarities below).

The other thing that is harmful about this ad is that they are clearly ADVERTISING a treatment instead of EDUCATING about a treatment option. In an area like autism parents should be looking for the most EFFECTIVE treatment, not which treatment is advertised best. If a person is trying to choose between a mac/pc, their lives aren't going to be totally changed regardless of which computer they pick. But a if a parent is trying to choose a treatment/intervention to help their child live the highest quality of life possible, and they see an ad like this, and they shun the ONLY ESTABLISHED intervention for Autism, their lives will be changed dramatically and for the most part it won't be for the better. Obviously if the parent still incorporates the same techniques as ABA but under the guise of Son Rise, then it might not be that much of an issue but if the parent completely disregards ABA for fear of a robotic child, then they might not make the same type of progress. For instance, if they have a child who engages in self injurious behavior or severe tantrums or extreme aggression and the parent doesn't have an understanding of identifying the function of the behavior and the environmental variables preceding the behavior and doesn't have the knowledge to implement a procedure that will decrease this behavior and teach the child the functional skills he/she needs in order  to engage in a safer behavior to achieve the same result of their originally dangerous behavior, then the child will not make as much progress. Bring in a BCBA, have them analyze the situation and come up with an effective plan, and the child will make more gains because he/she is no longer engaging in the dangerous behavior. Don't bring in a BCBA and JUST focus on building a relationship, and the child is likely going to continue to engage in the dangerous behavior.

On ABA being Robotic

This is a myth about ABA that has been around for a long time. There are definitely a few practitioners out there who do not effectively apply the methods of ABA and the child may engage in scripted or robotic behavior. It is important to note that these practitioners typically received their primary training in a field OTHER THAN behavior analysis. This does not mean that ABA always leads to robotic behavior. The early application of the principles of behavior as an intervention for children with autism may have led to robotic behavior but that is hardly the case now. Basically the comparison in this commercial would be like the MAC commercials comparing the current MAC to the first ever version of a PC. Sure LOVAAS first applied the principles, they didn't look much at motivation or relationships and the parents were not involved but that was over 40 years ago and at the time the alternative was the children ended up in institutions. The fact that Lovaas was able to apply the principles and achieve 48% results of the children being indistinguishable from their peers, is HUGE. There was nothing like this at the time. And that result was PRIOR to the plethora of research that now exists on how to make the application of priniciples that Lovaas used EVEN MORE EFFECTIVE. It isn't like Lovaas achieved those results 40 years ago and then everything stopped. Lovaas didn't apply all of the current research at that time and now current research has identified hundreds of other techniques to use. It is also important to consider that for some children/adults with autism who may be robotic/scripted and they received a well programmed intervention, most likely the alternative would be no talking or interactions at all. Some language is better than no language. Especially if it allows a person to enhance their quality of life and ability to functionally communicate in their environment. I am not saying that robotic/scripted behavior is "good enough" but sometimes it is the only result. What I mean here is that sometimes multiple procedures/techniques will be used and a child still engages in robotic/scripted behavior but this behavior is better than no language or way to communicate.

On ABA only focusing on extinguishing behaviors
This statement is false in so many ways. I have mentioned many times before that if a behavior analyst comes into your house or school or other environment and tells you what will be worked on without asking for your input and your approval, then you do not have a well qualified BCBA. One of the main tenets and ethical guidelines of being a BCBA is that you must address socially valid behaviors, work on what the client/parent would like to work on, and receive approval before applying an intervention. If a BCBA is focusing on extinguishing a behavior it is either because the parent has asked them too or the behavior is interfering with the learning process (which they would still have to get approval from the parent before implementing the procedure) either because the behavior is dangerous or interferes with attending. BCBAs also don't just focus on extinguishing the behavior, they focus on determining why the behavior is occurring in the first place and how to replace that behavior with a behavior that would be more functionally appropriate. For instance if a child tantrums every time someone asks them to do something, teaching the child to say "I don't want to" or "can I do it later" or hold up a card to signal they don't want to do the task. This is much more appropriate than an hour long tantrum. Or if a child engages in stimulatory behavior and the parents/therapists are not able to work on teaching the child because of this, then BCBAs will focus on teaching the child either a replacement for the stim that is more socially appropriate if the parents want this or at least when it is "ok" to engage in the stimulatory behavior. Typically "ok" times are during breaks or in certain parts of the house depending on the stimulatory behavior.

Comparing Son-Rise and ABA
As I mentioned above I have never been trained in Son-Rise so my comparison is solely based on what they discuss on their website. I determined the best way to make this comparison is to use the "Principles" section of Son-Rise's website and compare it to ABA/Behavioral Techniques (taken from Association for Scientific Autism Treatment and Florida's Association for Behavior Analysis page about Autism and ABA and The Journal for Applied Behavior Analysis).

Principle

Son-Rise

ABA

Autism is not a behavioral disorder

Explained as a neurological disorder. "Behavioral challenges" exist because of relational deficits. *I would like to note the terminology in this heading makes it appear that people who promote a behavioral approach would be doing so in error because autism is not a behavioral disorder. To me they purposely use this terminology to separate their approach from ABA.

Autism is explained almost exactly the same way as a neurobehavioral (meaning that it is neurological but is diagnosed based on symptoms that are behavioral) disorder. The ASAT site also explains that there is an impairment in communication & social skills. BCBAs might say that a "behavioral challenge" exists because of a relational deficit but only if the child does not possess certain skills related to relationship building such as joint attention, reciprocal interactions, etc. BCBAs go way beyond just saying that everything is due to "relational deficits" they provide an actual analysis of the "challenge" to determine the environmental aspects, skill deficits, and any other factors that might result in the behavior occurring. The behavior analyst then focuses on not only teaching the skills that are lacking but also arranging the environment and other factors to set the child up for success and make skill acquisition much more likely and less frustrating.

Motivation Not Repetition Holds the Key to all Learning

Explained as determining the child's motivation and using this to teach the child the skills he/she needs. *I would also like to point out that this is statement also seems to be an attack on ABA. The site says that some interventions require endless repetition. It appears as though Son-Rise has not stayed on top of the advances made in intervention practice for ABA in the last 40 years. As I said, when Lovaas first applied the principles, this was the way he did it. But it was the only way that worked at the time and research has come a long way since then. Additionally, regardless of having the child's motivation, repetition to a degree will be necessary. It will depend on the child how much repetition is necessary but EVERYONE learns through repetition. I surely do not remember how to do calculus a class a took for 1 year in high school but I do remember how to add, subtract, multiply, and divide, skills that were practiced year after year starting in 1st grade.

Motivation has been a key focus in the field of behavior analysis since its origins. Behavior analysis heavily focuses on using positive reinforcement to acquire and maintain skills. Simply providing reinforcement after a behavior, is not nearly as effective as capturing the child's motivation prior to presenting the task in the first place. A quick search in the Journal of Applied  Behavior Analysis (JABA)for "motivation" reveals 470+ articles dating back as far as 1969 (many years before the Son-Rise program was  even developed).  In fact Keller and Schoenfeld (1950) described the establishing operation as a "motivational variable" 60 years ago. Additionally Jack Michael focused heavily on this topic starting in 1982 and to date there are many well known behavior analysts who research the area of motivation. It is very rare to find a behavior analyst who does not work off the child's motivation. People who have not been formally trained in ABA who still follow Lovaas' early work might make this error. Or you will find some behavior analysts who are not good at identifying and capturing the motivation of the child but it is still a main principle and tenet of the field and it is even a large section of the task list that we study and are tested on in order to become board certified.

Your Child's "Stimming" Behaviors have Important Meaning and Value

Explained as having deep acceptance and respect for the children. Instead of stopping repetitive behavior, it is recommended to join in the repetitive behavior. This in turn leads to the development of social skills, eye contact, and interaction. This sounds very nice and almost makes me want to try it. The problem is, there is absolutely no data to support this claim. I am very curious to know what is done if a child starts stimming during instructional time. Does the instruction end and the therapist joins in on the stimming? For some children this might be ok. But what if a child uses this as an escape from learning and never learns the skills that they need to learn? I am not saying stimming should always be stopped or that parents should not join in with their children's stimming behavior. I am simply saying that there isn't research to date to suggest that this beneficial. Based on current research though I can tell you that there are plenty of children who still developed social skills despite their parents not joining on the stimulatory behavior. I also see where it could be beneficial especially if you have a child who literally has not interests beyond stimulatory behavior. You could use their interest in this behavior as means for developing first interactions. But all you are really doing here is working off the child's motivation which is really nothing new. The parent could either work off the child's interest in a toy, or work of their interest in stimming but you are still doing the same thing. And what is recommended when the stimming is interfering with the learning process or it is dangerous?

The websites I am using as a reference do not include an explanation  of responding specifically to stimming behavior. However, behavior analysts analyze this behavior just like they would "challenging" behavior. Very specific steps are taken in order to determine why the child is engaging in the stimulatory behavior, what input the child is receiving from the behavior, if the behavior is not safe what would be an appropriate replacement behavior that would give the same sensory input, how to provide the child with the sensory input throughout the day so that when it is time to learn, play, and interact with their world the child has received enough of the sensory input that he/she is able to focus. Additionally, another search on JABA over 200 articles on stereotypy (stimming) and automatically reinforcing behaviors (stimming). Of these articles multiple interventions are recommended not just "joining" but interventions that will be effective in helping the child focus and engage in the world around them. One recent article that jumped out at me was published in 2009 and focused on rumination. Rumination is when a child regurgitates food and then chews and swallows it again. This is technically a stim because it is automatically reinforcing. I would be really curious to know how "joining" in this stim would help the child with this dangerous behavior? Rhine and Tarbox (2009) successfully used chewing gum as an alternative replacement behavior for the rumination. The autistic child's rumination decreased significantly during times where he was given gum to chew. This stimulatory behavior had resulted in the child losing several teeth because of severe decay.

The Parent is the Child's Best Resource

Explained as focusing time and energy on training the parents so that they have the skills to work with and direct their child's programming.

Parent training is a heavy focus for ABA as well. Research on how to do effective parent training dates back to 1969 as well. A JABA search revealed 330 articles on parent training. I will admit that when the principles of behavior analysis were first applied as an intervention for autism, there was very little focus on training the parents. I am not entirely sure of the reasoning for this but even today parents will receive the training so that they have the skills to work with their child but they still opt to hire behavior analysts or professionals supervised by behavior analyst to work with their children. Part of this is because of the time involved, most parents are working all day so the therapist work with the child while the parent is at work. However, it is extremely important that the parents are able to apply principles of behavior in the natural environment and can practice skills with their child even if someone else is providing most of the instruction to the child. Recent advances in parent training include the website Rethink Autism where parents can watch videos of sessions and learn more about how to work with their child. Additionally, there are several books that teach parents how to work with their children using the principles of behavior analysis. And of course there are hundreds of providers and clinics designed to teach parents how to use the principles of behavior analysis.

Your Child Can Progress in the Right Environment

Described as setting up the environment so that it is not overly stimulating and so that the play room reduces the "control" issues that often arise.

As I have already mentioned behavior analysis heavily focuses on the setting up the environment to result in optimal learning for your child. Behavior analysts provide recommendations to the parents on how to structure not only the play room/work environment to reduce distractions and "control" issues but they analyze down to the bone everything about the environment when necessary. The analyses can be as thorough as looking at the type of demand, number of demands presented, combination of demands presented, wording of the demand, presentation of the demand, prompts used, person presenting the demand, time of day, day of the week, etc. Behavior analysts are highly trained and skilled in providing environmental assessments. This is another large section on the task list for the test that behavior analysts take in order to become certified. A search on JABA turned up almost 500 articles discussing setting events and ecological assessments, which refers to setting up the right environment.

Parents and Professionals are most effective when they feel comfortable with their child

Described as having confidence in the child and focusing on the child's potential.

Behavior analysts would agree with this statement as well. All of the programming and training produced by behavior analysts focus on the child's potential and determining the most effective ways to assist the child in acquiring skills. In fact, behavior analysts are often brought in by parents and schools who have lost hope and the behavior analysts are able to regain the parents/teachers confidence in the child when they see what the child is capable of.



The last principle refers to the Son Rise program being combined with other interventions such as bio-med, sensory integration, and auditory integration. While ABA can be combined with these methods and has been, most behavior analysts will help the parent evaluate each of these interventions first to determine the effectiveness of the intervention because to date research does not support the use of these treatments. Looking at the table above, it should be quite clear that at least the principles of Son Rise are not different from ABA except that they might be lacking. By this I mean, both interventions agree with the main heading of the principle but ABA tends to go beyond the basic explanation given by Son Rise. All children on the spectrum are different so while one child's "behavioral challenges" might be the result of relational deficits, ABA recognizes that this is not the ONLY reason and can go far beyond the analysis presented by Son Rise. Additionally, simply modifying the environmental arrangement of a room might be enough for some children but for others a more in depth ecological assessment and analysis might need to be done in order to determine why a child is not acquiring a skill.

In Summary
To summarize this very long blog, when I set out to write it I honestly didn't know how similar or different from ABA Son-Rise's principles would be but after looking at their home page it is quite clear that both interventions incorporate similar principles. This makes their advertisement even more disheartening because they are trying to convince parents that Son Rise is not in any way similar to ABA and in reality their core principles are exactly some of the principles incorporated in the field of behavior analysis. To top it off, Son-Rise is not empirically validated and ABA is and Son Rise seems very basic where as ABA is not. Son Rise might work for some children who do not engage in high rates of task avoidance, self injury, etc that would call for a more in depth analysis but it will not work for the child who requires the type of knowledge that behavior analysts possess. I also don't mind that Son Rise describes the same principles and techniques of employed by behavior analysts using different terminology. I am criticizing their practice of doing that and then trying to say that Son Rise is nothing like ABA and it is better than ABA. The other sad thing to me is that while Son-Rise is trying to separate itself from ABA and say it is completely different, they are wasting their time. They are basically re-inventing the wheel by not looking at what the field of behavior analysis has known for longer than Son Rise has even been around. On the flip side of that being that the people running Son Rise do truly care and are working hard to help children on the spectrum, if they took a more collaborative approach, they could share with our field novel techniques and methods that they have discovered. Instead they are creating a divide which in the end simply results in hurting the children. Learning and skill acquisition is an area where multiple techniques and methods will be developed but if people are not collaborative in sharing the creative and innovative techniques that they have devised and the data to support that these techniques really do work, the children ultimately lose out because they are not given the most effective interventions.


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