(Almost) Oil and Water…Why ABA and Developmental Therapies Don’t Mix

From time to time, I read comments from parents who talk about combining therapies – they hope to be working with ABA and RDI clinicians, for example. Or they are doing ABA but are using developmental strategies to round things out.  It’s a goal that seems reasonable, on the surface.  Why not pull the best from each approach?
 
There is no therapy – or parenting style – that draws on just one method. We all borrow strategies and ideas when we think they will be helpful.
 
However, it’s important to take a close look at the therapy you choose as a main approach, and the ideas behind it.
 
Behavioral (ABA) and developmental (DIR, RDI, Hanen) therapies really are coming from very different places, and in this post I’ll to share why that is the case.
 

What I Don’t Mean

First, a couple of disclaimers.
 
I’m not talking here about using behavioral strategies to focus on particular skills, as an occasional strategy. When my child isn’t listening to what I want him to do, I take his iPad away. Using consequences as a teaching strategy is behavioral. On the other side, playing with your child is a strategy used by developmental therapies, but I don’t mean that ABA folks don’t ever play with their children, or build loving, positive relationships. Those kinds of things happen in healthy families, regardless of therapy approach.
 
What I am talking about is choosing an approach to parenting or therapy, and then following it as thoroughly as possible.
 
This is important because all the research agrees that intensive early intervention is what helps children with autism. And when they study early intervention, the researchers look at people who are following the plan for many hours a day. In every kind of therapy, parents are encouraged to follow through with the same methods in the “down time.” You can’t be “on” all the time, and you might do things differently part of the time – but the benefits of any therapy come with following the recommendations with some consistency – otherwise, you can’t really say you are doing it!  
 
So choosing how you want to parent MOST of the time is important.
 
I write this post from the perspective of a parent who spent 3 years in ABA with one child, but followed a developmental therapy from the beginning with a second child (at which point we switched away from ABA with the first child as well). So our family has some first-hand experience with how different approaches play out in family life.
 
Here are some differences between behavioral and developmental therapies:
 

Compliance or Curiosity?

On a morning radio interview I heard on CBC last fall, I heard an advocate say that the first year of ABA is all about compliance training. The word may sound terrible, but the idea is to teach the child to attend to their parent or therapist, to suppress their impulses to do other things, and to be able to follow directions. It’s one of the things we need to be able to do in school, for example. As the person in the interview stated, this is necessary for the child to be ready to learn other things – they can really get started once this set of abilities is in place.
 
In contrast, developmental therapies begin with social attention, but instead of working on compliance for its own sake, recognising that children pay attention to their parents because they are genuinely curious about what other people are thinking.  We build their curiosity.  And we also listen to their ideas. Rather than having the adult do all of the directing, we are building a pattern of communication by valuing the child’s voice as much as our own, and showing them that communication is fun and rewarding.
 
One of the most satisfying things about ABA was the way our daughter very quickly learned to follow directions. I worried with our son about how he would learn to do as he was told, if we followed through with a developmental therapy that encouraged us to follow his lead when we were working with him. But what we found was that in not much more time, he also learned to cooperate with what we asked him to do – because it made sense to him and he wanted to please us.
 

Remembering or Dynamic Thinking?

ABA’s strength is that it teaches kids to remember – how to do things, as well as information. Everything from toilet training to cooking a sandwich to what to do when you misread a word – ABA has very effective ways of helping kids memorize things. What they have in common is that they are all things that you do, or remember, in the same way every time. RDI refers to this as static thinking. Teachers talk about remembering as the most basic way of understanding something. But there’s something more we want for our kids – we want them to take what they can remember and do, and find new ways of using that information – because the situations we encounter every day are never the same.
 
“Dynamic” thinking means being able to encounter a problem or a new situation and make a decision about what to do. Maybe you can tie a shoelace – but what happens if the lace breaks? What if you can make a grilled cheese sandwich, but someone comes to the door and you have to decide whether to share or make it later? Maybe you know you should hug your family when you greet them – what if you don’t feel well, or you don’t feel safe? Independent life means we need to be able to cope with the unexpected.
 
True play is all about dynamic thinking. In play, children explore possibilities through role play – what would you do if you were the mom or dad? What would life be like if you were a pirate? How can you use the Lego you have to build the most interesting vehicle? How can I do it differently next time?
 
ABA relies on repetitive practice for mastery. The same task is done repeatedly until it is done successfully. Developmental therapies don’t discount the value of practice for some tasks, but the focus on dynamic thinking means that we build in the idea of generalization to the practice. We find opportunities to try out an idea in different ways. For example, an idea we are working on right now is “perspective taking.” There are hundreds of ways to show our children that people have different perspectives as we go through our day.
 
Learning is about remembering stuff – and also understanding when you need to use it, and why, and why it’s important or meaningful to you. DIR, RDI, and Hanen all have strategies for kids to go deeper in their thinking.
 
For three years, we taught our daughter that the “right” answers were the ones we had taught her. New or different ideas were not rewarded. For example, our ABA “play” programs consisted of things like remembering how to do a tea party. Everybody sat in the same place every time, everybody got a plastic strawberry on their plate, and the same words were said as the tea was poured, every time. We couldn’t get her to budge from this routine for years – but the activity was checked off as a success by her ABA consultant.
 
Then we switched therapies, and we asked her to come up with her own ideas. As you might expect, she was visibly confused for awhile. It was hard to move out of a mindset where everything was predictable.  She wanted to give us the answers we expected. After a few months, though, she began to joyfully explore new ideas with us, and contribute her own. I thought at the time it was like driving a train down the track, and then reversing direction – it takes some time and energy to do that. There’s no way we could focus on both at the same time.
 

Reinforcement or Social Belonging?

In her book “You’re Going to Love This Kid,” Paula Kluth tells a story about a young man in a group home. His worker suggests changing up his weekend menu rotation by replacing pizza with something else, at which point he typed on his letterboard, “DONT TAKE MY PIZZA AWAY, I LOVE PIZZA.”  When they express surprise and say he didn’t seem to care about it, he replies, “That’s because if you knew, you would make me earn it.” *
 
Applied Behavioral Analysis uses external rewards as a motivation for learning. In order to have the most effective rewards, it’s best to find out what the child likes best. Especially in the early stages of ABA, those things are set aside to use as motivators – which means they are often made unavailable outside of learning time.
 
That turns everything the child likes into a currency, and behavior becomes a transaction.
 
Even emotional rewards can become a transaction. I’m sure not all ABA people would do this, but I was told in 2008 to stop hugging my distressed daughter because it might interfere with her learning – to save physical affection for a reward when she had completed her task.
 
External motivation can be a quick and efficient way to get kids to do what you want them to do.  But lots of people write about concerns with external motivation – Gordon Neufeld, Alfie Kohn, and others point out that it can lead to a dependence on reward and a lack of satisfaction in completing challenges for their own sake.
 
In contrast, developmental therapies rely on warm, connected relationships and the satisfaction of accomplishment as natural motivators.
 

Mistakes: Learning Obstacles or Opportunities?

ABA practices error-free learning. This means that the child will be supported in a task to do it correctly until they can do it independently. Mistakes, it is believed, will slow down the process of learning mastery.  This is certainly true in activities like sports and music – our muscles remember what we did, not what we meant to do.
 
But there is a role in learning for mistakes. Developmental therapies prefer to think about modelling and guiding. We show what we do, and children learn by watching, imitating, and finally by collaborating – contributing their own ideas to add to the interest and value of the activity.
 
Mistakes in this perspective, are not a concern, but an opportunity to learn about what works and what doesn’t.  Sometimes things turn out perfectly, and other times the outcome is just “good enough.”  Because we live in a dynamic world, it is not error-free – we need to equip our children for both the joys and challenges that are part of everyday life. 

Self-Regulation

Self-regulation is a buzzword right now, but all it really means is that we have the ability to manage our feelings and thoughts in response to what is happening around us.  
 
This is a really important part of social-emotional learning for kids with autism, because it also includes understanding sensory differences and needs. ABA, in my experience, doesn’t really address this, and sometimes ignores it – as when some therapists push through a child’s distress and insist on things like eye contact and “quiet hands” during learning activities.
 
In contrast, understanding a child’s sensory profile and self-regulation patterns is a cornerstone of developmental therapies (it’s the “I” in DIR, for example), and one of the most valuable things our families has learned about.
 
I had an “aha!” moment a few years ago when my daughter was crying about something while I was trying to get her into the car. I can’t remember why anymore, but I do remember thinking I could see it as an indication that she needed help learning something about coping with the unexpected or with her body’s needs, and I could either push her into compliance or stop and take that opportunity to help her calm herself and explore her thinking.
 
The last year has been a very challenging one for our family. Our son was diagnosed with a fast-growing tumor in May. He has spent the last few months going through two kinds of chemotherapy and then a 12-hour surgery to remove it and reconstruct his abdomen. He’s had countless pokes and scans, dealt with strange doctors and nurses touching him, endured weeks in hospital with IVs and drainage tubes, not to mention the discomfort and pain we can only imagine. And yet he’s coped as well or better than any child could be expected to cope.
 
I credit him first – he’s a sweet boy – but I also am very thankful that our priority has been understanding his sensory profile and how his body functions, and helping him find strategies for managing – and communicating – when things don’t go the way he hopes or needs. Because he knows that we listen to him and do our best to get him what he needs, he has learned to look to us as his source of reference and comfort, and I am so very thankful that the help we found got him ready for this challenge.
 

Different goals lead to different outcomes

When our second child was diagnosed, I tried asking, “What are the criteria I should think about when I choose whether to go with ABA or something else?”  No one would answer that question for me then. The simple answer is another question: what is it you hope your child will learn?  
 
ABA serves a purpose and does what it sets out to do – changing behavior – quite well.  There are many people who are entirely happy with what ABA did for their child, and found it helpful. The research says that ABA works for many children – but what do we mean by “works?”  If our goals don’t match ABA goals, we need to look at something different.  We wanted to encourage our child to think of and act on her own ideas, while simultaneously accepting loving guidance from us. That’s not something ABA is good at. We needed a different focus in our approach. 
For each child, we need to be clear about what exactly we want a therapy to help with, and because of that there is a need for an alternative to ABA. Mixing approaches can be done if you focus on one or the other at different times, or use a few strategies from one while you focus on the other, but fully taking both perspectives at the same time is contradictory, and confusing.
Parenting is about helping kids grow into independent, contributing, fulfilled adults.  The goals for a child should indicate the strategies, because the strategies determine the outcome.  That’s why we need to consider the strategy as well as the goals.  The journey, I believe, should look more and more like the place we want to go.
If you’re not on the right path, don’t be afraid to change what you’re doing.  You as a parent are in the best position to know what your child needs. 

 For Further Reading:
 *Kluth, Paula (2010).  You’re going to love this kid: Teaching students with autism in the inclusive classroom.  Baltimore, MD: Paul H. Brookes, p. 199.
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6 comments

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  • Melissa

    I very much respect your opinion while respectfully disagreeing. As an ABA therapist for many years, I love dispelling the notion that ABA therapy means rigid, discrete trial training all day long. Very rarely is that the case. ABA, when practiced correctly, can provide a client with skills of many different levels. The idea that an ABA therapist doesn’t shower a child with love and completely adore them as a person is insulting to me. There’s nothing I love more than to show a child they are loved and appreciated and valued. Sometimes, as the role of a teacher, that way may not look the same as you, as their parent, would expect it to be. But my clients feel loved and free to be themselves every day.

    • Deborah Dykstra

      Thank you so much for your reply! I want very much to learn from others who have different perspectives.
      Actually, I agree with almost all of what you say. If you will look carefully at my article and at the one I wrote previously (http://www.adaptmanitoba.ca/the-difference-a-year-makes/), I make it very clear that my critique is NOT about lack of love or concern for children. The people who worked with our family for three years were kind and playful and they went above and beyond every day. I am thankful for them.
      However, I was not thankful for the teaching methods that they used. We DID have discrete trial training every day all day from 2009-2011, which isn’t all that long ago. And if it happened for us, it’s happening for others. In fact, I know it is because people have told me so.
      I’d also point you to the research that is being done as an example of what is important to ABA practitioners. Yesterday I found our local research organiation retweeted a study finding that external reinforcers work best for getting kids to make eye contact. If they retweet it, they clearly wanted to share it.
      If ABA is changing, that’s good and I applaud you for doing differently. It’s for families encountering ABA that restricts open-ended thinking and pushes for compliance for its own sake that we need articles like mine.

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