978-1572305441

140 A MIND APART
communication therapy.” These are not mutually exclusive and can be
seen as lying on a continuum from highly structured behavioral ABA
approaches such as discrete trial training to more naturalistic “developmental”
ones. Both ends of the continuum have been evaluated systematically
and scientifically in a number of studies and have been found to
be effective, though many unanswered questions remain. There are several
different variations to each, but the two main therapies have much
in common. They are both intensive, start early, involve twenty to forty
hours of treatment a week, though admittedly administering more than
twenty-five hours per week is very difficult in most circumstances. Both
also employ behavioral strategies to facilitate learning. They are also intrusive
to the extent that the child is not allowed to disengage from the
world entirely and to retreat into repetitive and solitary play. Staff who
deliver the treatment are highly trained, and parents are actively involved
in setting goals and in administering the treatment program, and
are also taught a number of techniques to foster social interaction, language,
and play. Both include systematic attempts to generalize treatment
gains from one setting to another. For example, if a child with
autism learns to play with a therapist, there is no guarantee that he will
be able to play with parents or siblings. These skills need to be generalized
across people but also across settings (like from school to home).
Both approaches emphasize understanding what function a certain
behavior serves, how new skills can be established step by step, how to
use rewards to reinforce more developmentally appropriate behavior,
how to use structure and a visual schedule to make transitions easier,
and how maladaptive behaviors can be eliminated.
But there are also some important differences. Discrete trial training
concentrates on promoting compliance and simple cognitive, language,
and attentional skills through a strict application of learning
principles. Therapeutic sessions are highly structured and directive, are
largely done one on one with an adult, and have a strong training component.
An example of a session using discrete trial training might involve
a child sitting behind a table with the therapist sitting opposite to
remove any distractions. The therapist puts two pictures down on the
table and asks the child to indicate whether these are the “same” or “different.”
If the child is correct, he is rewarded. If not, the trial is given
again. This procedure is done over and over again till the child can indicate
the correct answer several times in a row. Once that skill is mastered,
the child and therapist go on to the next skill in the curriculum.
That next skill tends to be a bit more developmentally advanced, but