The long road from DTT to VB

Entering the field in the mid 1990’s I hardly knew anything about autism, let alone ABA.  Autism was only one sentence in my psychology text in college, and ABA was a new, unheard-of therapy.  Thankfully, I would find along the way, that my approach to working with developmentally delayed children was similar to techniques I would learn as I grew in knowledge of applied behavior analysis.  I would naturally break down skills into smaller components; I would use repetition to teach; I would provide high levels of reinforcement; I would be engaging and fun; I would not give in to inappropriate behaviors; and I enjoyed keeping a schedule. I found comfort in the work because it fit my personality and my approach to therapy, and my approach to children in general. Very systematic, compassionate, fun, but consistent and with follow through. When working with my first clients, I collected my own data so I could measure if we were making progress and know when to move on to the next target. At the time, I did not know I was basically doing a very sloppy form of ABA, but I was.

Eventually I was assigned another client, whose parents requested ABA therapy. This little 3 yr old, blond curly haired boy had zero language, would forage in the cabinets for food, didn’t make eye contact or respond to his name, and had little to no self-help skills. He had limited play skills and would just flip toys most of the day. In our rural area, there were no Board Certified Behavior Analysts, so being trained in ABA was going to be difficult. The family was able to find a therapist from another company that had some ABA experience and hired her to “train” me. She spent an hour with me showing me how to conduct ABA therapy, specifically discrete trials. In these days, ABA therapy was conducted as Lovaas Therapy, with a no-no-prompt, lots of physical prompting, and “go play” as reinforcement. I was a bit overwhelmed after my hour of training, but I could also see how the instructional techniques would help a child on the spectrum learn.

I felt like my training was inadequate…I wanted to do better, to be better. So, I started reading everything I could. I studied the Lovaas “Me” book, I read “let me hear your voice” by Catherine Maurice several times, I searched the internet for information (remember, the internet was not what it is today!), I went to as many workshops as I could afford and would ask for copies of handouts from those I couldn’t afford. I practiced, I critiqued myself, and I practiced some more.  

It was a year before the company I worked for was able to contract a BCBA to work with me and continue my formal training. When the BCBA arrived, I almost threw up, I was so nervous. Had I taught myself correctly? Was I doing well? Was I doing right by the client? What if I was doing everything wrong? The client had been making good progress, so I was in some small way assured I was on the correct path with my skills. I soon realized my anxiety was not necessary. The consultant was amazing, he was impressed with my self-taught skills, and gently worked with me over the next few months to help fine tune my skills and make me a better ABA therapist. He would record my sessions and we would watch the sessions together and critique them. Sometimes, initially to my horror, video of my sessions would be used during staff meetings for open critique or for staff training. I became the internal staff ABA trainer for the company over time. 

In these days, the techniques I was trained in were very strict and physical. Our sessions were completely at the table with very little NET (natural environment training). We used “go play” as a reinforcer for good working at the table, as well as a lot of food reinforcers. Physical prompting for responses were the norm, and if a child made an error, we would correct by allowing for 2 more chances prior to giving a prompted sequence (no-no-prompt). When we said “no” after an error, we would also turn our head away to remove any attention from the child as well. These sessions were often 3-4 hr sessions, with children as young as 2 yrs old. After each session, I would pack up and go to the next session with another child. This was my day, I loved it, it was exhausting, and a part of me always felt there was something missing.

This was the norm when I was learning ABA. For the next eight to ten years, I provided training to other staff within the company, began writing programs for clients, and providing 1:1 therapy. I moved around different companies to gain more training and knowledge. With each company, I learned more about ABA, different ways of implementing interventions, and improved my skill set. I was blessed by being able to work with excellent consultants and BCBA’S who took the time to explain details of each skill program, why each skill was important, how the skills combined into bigger skills, how they interlinked, how they generalized, and how to break down instructions to teach parents and other therapists.

I learned by watching how to be a consultant.  I remember, as a therapist, sitting in a consultation of a new client with my BCBA, the client, and her family. The client was a little 2 yr old girl. She floated around the room, didn’t make any noises, would tantrum if she was blocked or if anything was taken from her. I watched my BCBA. I watched as he LISTENED to the parents. He let them talk. He let them express their hopes, fears, and anything they needed to say. The BCBA was an active listener, and I was completely impressed with him. Occasionally he would ask a question for clarification, or to indicate he really was listening. He showed compassion and empathy to the parents. He did not present himself as a “know it all” expert, but as someone who was there to learn from the parent about their child. Again, I was impressed. I had seen other consultants come in and act as if they knew everything and just give the parents instructions. They would give the parents orders and act as if the parents did not know what they were doing. I watched this all too often. I would watch the helplessness in the parent’s face, the embarrassment, the complete letdown. My heart broke.

So, when I saw this consultant listen and show such compassion for the parents, I made sure I paid attention. I wanted to learn. Then, when working with the child, again, his approach was different. He sat. He watched. He remained quiet. He would watch the child walk around in circles and did this for about ten minutes. Finally, the consultant started playing with a musical toy. He turned it off. When the child approached, he turned it on. When she walked away, he turned it off. She started to approach more and more often. Before long, he was able to start doing some lessons with her. It was an amazing session, and he ended by debriefing with the parents.   I learned so much that day and I try to bring those lessons to each meeting I have with parents and clients.

My growth with ABA was gradual over the years. I learned from many people. I changed my approach as I learned more techniques, or different ways to implement techniques. Starting in 2003, when I worked for the Verbal Behavior Project, we would spend weekends at the Carbone Clinic learning from Dr. Vincent Carbone. I loved his clinic and the amazing work they were doing with the children there. We also received on site trainings from Dr. Mark Sundberg and many other experts in the field on a regular basis. I learned about the Verbal Behavior approach to teaching language, and many new behavior management procedures as well as errorless learning and how to mix operants. It was during this time that a light bulb went on in my head. I had spent years doing intervention one way. I always felt something was missing. That therapy could be more fun, more reinforcing, more functional.

The floodgates opened. I saw a softer, more effective method of conducting ABA. With this new approach, the children received increased guidance, were highly reinforced, work was paired with reinforcement instead of escape behaviors, and so much more natural environment teaching!!! Yes, there was a bit of resistance on my part… I had had several years of conducting therapy in a specific way. It is hard to change. But… change I did. I saw the difference in the children, the difference in the way they made progress, the difference in the way they interacted with me. It was a much-welcomed change. It felt amazing!!!  I loved this softer, more effective approach. I switched from a Lovaas DTT therapist to a Verbal Behavior Consultant. No longer were children waiting for me to leave a therapy session… they were happily awaiting me to arrive for their sessions.

I have continued to grow and learn through the years, to follow the research, to learn and change. Because when you know better… you do better…and you can be better. I continue to do so even now. Children learn through play. ABA is a science, not a specific “intervention”.  When one realizes these two truths, the sky is no longer a limit. Learning becomes fun for the child and the therapist.

ABA is a science, it is not static. The field is based on research which is ever changing. We need to be flexible and change with it. I try to continue to learn, to change, to do better for the children and parents I work with. The field will never stop moving forward, and neither shall I.

I’m excited to think about where the field will go in the future and what I will learn!! I am always learning/changing, and our centers will always be changing as well.

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