Have you heard of the Applied Behavior Analysis Method (ABA)?

By Kasia Coe

(Editor's note: Here is a letter sent to us to forward to a NATHHAN family from Kasia Coe. She was kind enough to let us share it with you too!)

    Hi, my name is Kasia Coe. I read your letter in the NATHHAN NEWS. My children sound similar to yours except they do not have a blood disorder. They are microcephalic, severely retarded and severely speech impaired. They have global delays everywhere else too but speech is the worst. Their fine and gross motor are not very good. but my oldest is finally walking now. I should probably take the time to introduce my children.: Teddy is 3 1/2 years old. He walks but does not talk yet and does not have a good pincer grasp. He is not toilet trained. He is very friendly and outgoing. He loves to hug people. My next is Amanda. She is 2 years old. She is short and small boned. She is very cuddly. She does not walk yet but does cruise on furniture. The youngest is Tiffany . She is six months old.

    The children all have gluten intolerance and the older two have a dairy allergy, so we have to adhere to a strict diet. We are into nutrition like you are. We didn't have much choice! We tend to be naturopathic when it comes to illness but are not against medical treatment if necessary.

I'm writing to share with you some information on an education program that our son is starting in. I'm sure you must get a lot of advice from parents as I do. I try almost everything!

We have found that the only way my severely retarded son can learn is through the Applied Behavior Analysis Method (ABA) it is sometimes called Behavior Modification or the Lovass Method. It is widely used for autistic children but it is also effective with the mentally retarded. Actually, a lot of autistic and retarded have been taught with it.

    I tried teaching my son with whatever I was creative enough to invent and I never got anywhere. Then we tried preschool and my son still wasn't getting anywhere. We used a tried and proven method at home called ABA for a few months and my son FINALLY was able to progress! He is starting the program officially in June. Until them we are working with him at home. I have hired my sister-in-law to work with my son at least 3 days a week doing two hour sessions. I do the rest of the days. It helps give me a break so I don't feel overwhelmed and burned out.

    The ABA program is a home based program BUT you hire paraprofessionals to come work with your child 1-on-1 in your home six days a week, around 4 to 6 hours a day. You need at least 3 paraprofessionals, and each person has around a two-hour shift per day. The child has 3 sessions per day. It sounds like too much but it is not because of the way it is done. The reason for so many hours of instruction and therapy is that the child is severely retarded.

    A typical 2 hour session goes like this: A child is told to sit in a child-sized chair. (This is taught). Then the child is taught to imitate an action, like hitting the table. The adult says, "Do this" and the child is supposed to imitate the action. But since the ability to imitate is lacking in a severely retarded child, you do the action hand over hand with the child if the child does not copy you. Then you act like have just done it themselves. You get super-excited and praise them. Then you let them up from the table. Their attention span is only a few minutes so each activity should only last a few minutes. They are usually anxious to get up from the table anyway, and sometimes will do the activity just to be able to get up. After they imitate you, you praise them, like I said, but you also reward them with something they absolutely love, be it food or a toy or music, whatever. That will motivate them to learn how to obey.

     We have taught my 2 year old daughter to clap this way, push a car, and shake a rattle. They need to learn the concept of doing something you want them to do. Since my daughter can't put herself in the chair yet, we set her in it. Then I say "Do this" and clap my hands. Then I take her hands and clap them for her and act as if she did it and reward her. I had to do this for about a week. Then I faded the hand over hand help. (That's tricky, but it must be done because they can only learn to do it if they try it themselves). Now she does it without the hand over hand help.

You teach two different imitative behaviors this way. Then, when you have established two separate behaviors that they will imitate, you mix them during one sitting. That is another hurdle in and of itself. After that is accomplished you do a third. Then you are on a roll. Imitation is a key to learning so many skills.

     It will probably take months, but in some cases it only takes weeks before a few imitative behaviors are clearly established. Then it is time to give them a verbal command describing the action. Instead of saying "Do this," you say, "Clap hands," "Shake rattle," etc. My daughter will clap hands when we say, "Clap hands," now. It is then important not to demonstrate. This is because you are wanting them to learn how to listen to words and the cue. The imitation teaches them to watch you as the cue. Now two types of learning are established. Learning by sight, and learning by hearing.

 The programs my son is doing are listed below:

    1. NON VERBAL IMITATION:

say, "Do this." Scribbling, painting and dressing are also covered under this category.

    2. PUZZLE: say, "Do puzzle" (shape puzzle.) Puzzle has knobs and only 1 piece per sitting is done until mastered.

    3. MATCHING: say, "Put with same" (stackable type objects)

We are using 2 plates, 2 cups, etc.

    4. RECEPTIVE COMMANDS: say "Give me", "Touch", "Go to"

    5. SHAPE SORTER: say "Put in" (3 shape tall sorter with circle, square, and triangle). We do just one shape per sitting to start with.

    6. VERBAL IMITATION: say, "Say"

current sounds to be used "mm", "buh", "duh"

Total sounds aiming for:

a ("ah") b ("buh") f ("ef") d ("duh")

m ("mm") o ("oh") e ("ee") u ("uh")

and t ("tuh")

    7. BLOCK IMITATION: say, "Do this"

     Start with two blocks using a big red base block, we align on the left a smaller blue or yellow block next to the red block. After this is masted on the left, we go for the right side of the big red block.

After each program is done, you let the child up from the table. You never make them sit there for extended periods of time. That is why you need a two hour session, because there is a break after each activity. You usually get 7 -11 programs done per hour. Within a two hour session, you should always take a long 15 to 20 minute break so the child can just get away from it all and be refreshed. We take my son out to our swing set at that time or eat a snack or something.

     Teddy enjoys the 2 hour sessions. Previously he just paced the floor and hollered or whined because he was bored. He doesn't know how to play with toys and has no interest in them; therefore, he is easily bored. We take this time to teach him things he needs to know. We are helping him learn how to learn.

Teddy is finally doing verbal imitations. That comes last. He was doing 6 programs until he finally was able to do verbal imitation. I thought he'd never be able to do it! He does, "mm", "buh", and "duh" now imitatively. It is helpful to get specific instructions on how to do the speech because it is very tricky.