Wake an autistic child for ABA treatment?

That’s the problem. The ABA folks far too frequently do not use a developmental framework. Too often the ABA trainers do not use anything other than the one tool they know: stimulus – response. And far too often, ABA trainers do NOT know what is appropriate developmentally or culturally for that child.

The bottom line is that the ABA folks are narrowly trained and practise a narrow technique. It is good that they stay within the boundaries of their knowledge. Thank god for that! It is not good that they think that their method is the only way to go.

For example, too often ABA trainers will train the child during a time of day that typically the child naps. Does that make sense? Not from a developmental perspective. The ABA trainer’s response? We’ve got to get more INTENSITY says the trainer so let’s keep little Johnny up during his nap time.

And how much is enough? It’s NEVER enough say many ABA trainers. Dr. Siegel mentioned a 16 year old who has had ABA almost all his life. When is time to stop? His trainers don’t want to stop. From the ABA perspective, it is always possible to incrementally make progress. That may be true. But at what cost? And who should pay for it?

I’m thinking of a case of two children – twins — with mental retardation and autism. Neither could speak more than a handful of words, if that. Their parents wanted ABA to continue indefinitely although both had plateaued years before. Incremental progress meant maybe a little more shaping towards a sound over many 40 hour weeks. Should the taxpayers pay for this kind of incremental gain?

Dr Siegel was asked how she thought FloorTime proponents might comment on her view that ABA is the best method. Frankly, I don’t remember a clearly defined answer.

So what is the Holy Grail for treating autism? Remember the elephant and everyone holding on to a different part? So does the trunk you are holding feel like the elephant’s back? The truth that people have depends on their experience.

I understand that of course ABA can be implemented from a developmental perspective. In my experience, too often it is not done in either a developmentally or culturally sensitive manner. I am interested in seeing programs such as the Early Start Denver method — that uses both the FloorTime relational approach and the ABA approach.

Dr. Siegel spoke March 11, 2010 at the Developmental Disabilities: Update for Health Professionals at the Laurel Heights Conference Center, San Francisco, CA