Discrete trial training

Last updated

Discrete trial training (DTT) is a technique used by practitioners of applied behavior analysis (ABA) that was developed by Ivar Lovaas at the University of California, Los Angeles (UCLA). DTT uses mass instruction and reinforcers that create clear contingencies to shape new skills. Often employed as an early intensive behavioral intervention (EIBI) for up to 25–40 hours per week for children with autism, the technique relies on the use of prompts, modeling, and positive reinforcement strategies to facilitate the child's learning. It previously used aversives to punish unwanted behaviors. DTT has also been referred to as the "Lovaas/UCLA model", [1] "rapid motor imitation antecedent", [2] "listener responding", [3] [4] [5] "errorless learning", and "mass trials". [6]

Contents

Technique

Discrete trial training (DTT) is a process whereby an activity is divided into smaller distinct sub-tasks and each of these is repeated continuously until a person is proficient. The trainer rewards successful completion and uses errorless correction procedures if there is unsuccessful completion by the subject to condition them into mastering the process. When proficiency is gained in each sub-task, they are re-combined into the whole activity: in this way proficiency at complex activities can be taught. [7] : 93 

DTT is carried out in a one-on-one therapist to student ratio at the table. Intervention can start when a child is as young as two years old and can last from two to six years. Progression through goals of the program are determined individually and are not determined by which year the client has been in the program. The first year seeks to reduce self-stimulating/self-regulatory ("stimming") behavior (this includes ("stimming") in ways that pose no inherent harm), teach listener responding, eye contact, and rapid fine and gross motor imitation, as well as to establish playing with toys in what the therapist considers the "correct" way, and integrate the family into the treatment protocol. The second year teaches early expressive language and abstract linguistic skills. The third year strives to include the individual's community in the treatment to optimize "mainstreaming" by focusing on peer interaction, basic socializing skills, basic social rules, emotional expression and variation, in addition to observational learning and pre-academic skills, such as reading, writing, and arithmetic. Rarely is the technique implemented for the first time with adults. [8] [ non-primary source needed ]

DTT is typically performed five to seven days a week with each session lasting from five to eight hours, totaling an average of 30–40 hours per week. [9] Sessions are divided into trials with intermittent breaks, and the therapist is positioned directly across the table from the student receiving treatment. Each trial is composed of the therapist giving an instruction (i.e., "Look at me", "Do this", "Point to", etc.), in reference to an object, color, simple imitative gesture, etc., which is followed by a prompt (verbal, gestural, physical, etc.). The concept is centered on shaping the child to respond correctly to the instructions throughout the trials. Should the child fail to respond to an instruction, the therapist uses either a "partial prompt" (a simple nudge or touch on the hand or arm) or a "full prompt"[ clarification needed ] to facilitate the child to successfully complete the task. Correct responses are reinforced with a reward, and the prompts are discontinued as the child begins to master each skill. [8] [10] [ non-primary source needed ]

The intervention is often used in conjunction with the Picture Exchange Communication System (PECS) as it primes the child for an easy transition between treatment types. The PECS program serves as another common intervention technique used to conform individuals with autism.[ non-primary source needed ] [11] As many as 25% of autistic individuals have no functional speech. [12] The program teaches spontaneous social communication through symbols or pictures by relying on ABA techniques.[ page needed ] [13] PECS operates on a similar premise to DTT in that it uses systematic chaining to teach the individual to pair the concept of expressive speech with an object. It is structured in a similar fashion to DTT, in that each session begins with a preferred reinforcer survey to ascertain what would most motivate the child and effectively facilitate learning. [13]

Effectiveness

Limited research shows DTT to be effective in enhancing spoken language, [14] [15] [16] academic and adaptive skills, [6] [17] [18] [19] as many studies are of low quality research design and there needs to be more larger sample sizes. [20] [21]

Society and culture

In media

A 1965 article in Life magazine entitled Screams, Slaps and Love has a lasting impact on public attitudes towards Lovaas's therapy. Giving little thought to how their work might be portrayed, Lovaas and parent advocate Bernie Rimland, M.D., were surprised when the magazine article appeared, since it focussed on text and selected images showing the use of aversives, including a close up of a child being slapped. Even after the use of aversives had been largely discontinued, the article continued to have an effect, galvanizing public concerns about behavior modification techniques. [22] [23]

United States cost

In April 2002 treatment cost in the U.S. was about US$4,200 per month ($50,000 annually) per child.[ needs update ] [24] The 20–40 hours per week intensity of the program, often conducted at home, may place additional stress on already challenged families. [25]

History

Discrete trial training is rooted in the hypothesis of Charles Ferster that autism was caused in part by a person's inability to react appropriately to "social reinforcers", such as praise or criticism. Lovaas's early work concentrated on showing that it was possible to strengthen autistic people's responses to these social reinforcers, but he found these improvements were not associated with any general improvement in overall behavior. [1]

In a 1987 paper, psychologists Frank Gresham and Donald MacMillan described a number of weaknesses in Lovass's research and judged that it would be better to call the evidence for his interventions "promising" rather than "compelling". [26]

Lovaas's original technique used aversives such as striking, shouting, and electrical shocks to punish undesired behaviors. [23] By 1979, Lovaas had abandoned the use of aversives, and in 2012 the use of electric shocks was described as being inconsistent with contemporary practice. [1] [22]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized neurodevelopmental condition

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a term formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer considered a diagnosis. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language, social engagement, bowel and bladder, play and motor skills. Researchers have not been successful in finding a cause for the disorder. CDD has some similarities to autism and is sometimes considered a low-functioning form of it. In May 2013, CDD, along with other sub-types of PDD, was fused into a single diagnostic term called "autism spectrum disorder" under the new DSM-5 manual.

Ole Ivar Løvaas was a Norwegian-American clinical psychologist and professor at the University of California, Los Angeles. He is most well known for his research on what is now called applied behavior analysis (ABA) to teach autistic children through prompts, modeling, and positive reinforcement. The therapy is also noted for its use of aversives (punishment) to reduce undesired behavior.

Applied behavior analysis (ABA), also called behavioral engineering, is a scientific discipline that applies the principles of learning based upon respondent and operant conditioning to change behavior of social significance. ABA is the applied form of behavior analysis; the other two are radical behaviorism and the experimental analysis of behavior.

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but had some difficulty in communication, emotion recognition, expression, and/or social interaction. However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.

<span class="mw-page-title-main">Autism therapies</span> Therapy aimed at autistic people

Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.

Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that invented by Robert Koegel and Lynn Kern Koegel. PRT advocates contend that behavior hinges on "pivotal" behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. It's an alternative approach to ABA from the more common form, sometimes called discrete trial training (DTT).

Social Stories were devised as a tool to help autistic individuals better understand the nuances of interpersonal communication so that they could "interact in an effective and appropriate manner". Although the prescribed format was meant for high functioning people with basic communication skills, the format was adapted substantially to suit individuals with poor communication skills and low level functioning. The evidence shows that there has been minimal improvement in social interaction skills. However, it is difficult to assess whether the concept would have been successful if it had been carried out as designed.

<span class="mw-page-title-main">Muteness</span> Medical condition

In human development, muteness or mutism is defined as an absence of speech, with or without an ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or speech and language pathologists. It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma, developmental disorders, or neurological disorders. A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech (aphasia) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.

In operant conditioning, punishment is any change in a human or animal's surroundings which, occurring after a given behavior or response, reduces the likelihood of that behavior occurring again in the future. As with reinforcement, it is the behavior, not the human/animal, that is punished. Whether a change is or is not punishing is determined by its effect on the rate that the behavior occurs. This is called motivating operations (MO), because they alter the effectiveness of a stimulus. MO can be categorized in abolishing operations, decrease the effectiveness of the stimuli and establishing, increase the effectiveness of the stimuli. For example, a painful stimulus which would act as a punisher for most people may actually reinforce some behaviors of masochistic individuals.

The developmental social-pragmatic model (DSP) is a developmental intervention that focuses on initiation and spontaneity in communication and following the child's focus of attention and motivations. Developmental interventions focus on a child's ability to form positive, meaningful relationships with other people when these are hampered by autism spectrum disorders such as autism or Asperger syndrome, or developmental disorders. It aims to build on the child's current communicative repertoire, even if this is unconventional; and using more natural activities and events as contexts to support the development of the child's communicative abilities.

The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation.

Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.

The professional practice of behavior analysis is a domain of behavior analysis, the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of radical behaviorism and the research of both experimental and applied behavior analysis. Professional practice seeks to change specific behavior through the implementation of these principles. In many states, practicing behavior analysts hold a license, certificate, or registration. In other states, there are no laws governing their practice and, as such, the practice may be prohibited as falling under the practice definition of other mental health professionals. This is rapidly changing as behavior analysts are becoming more and more common.

Parent management training (PMT), also known as behavioral parent training (BPT) or simply parent training, is a family of treatment programs that aims to change parenting behaviors, teaching parents positive reinforcement methods for improving pre-school and school-age children's behavior problems.

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Autism, also called autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by symptoms of deficient reciprocal social communication and the presence of restricted, repetitive, and inflexible patterns of behavior. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across the spectrum. For example, some are nonspeaking, while others have very proficient spoken language.

<span class="mw-page-title-main">Sensory processing disorder</span> Dysfunction in ones ability to comprehend and respond to multiple sensory stimuli

Sensory processing disorder is a condition in which multisensory input is not adequately processed in order to provide appropriate responses to the demands of the environment. Sensory processing disorder is present in many people with dyspraxia, autism spectrum disorder and attention deficit hyperactivity disorder (ADHD). Individuals with SPD may inadequately process visual, auditory, olfactory (smell), gustatory (taste), tactile (touch), vestibular (balance), proprioception, and interoception sensory stimuli.

The Early Start Denver Model (ESDM) is a form of intervention directed at young children that display early signs of being on the autism spectrum proposed by American psychiatrists Sally J. Rogers and Geraldine Dawson. It is intended to help children improve development traits as early as possible so as to narrow or close the gaps in capabilities between the individual and their peers.

References

  1. 1 2 3 Spreat S (2012). "Chapter 10: Behavioral treatments for children with ASDs". In Reber M (ed.). The Autism Spectrum: Scientific Foundations and Treatment. Cambridge University Press. pp. 239–257. doi:10.1017/CBO9780511978616.011. ISBN   9780511978616.(subscription required)
  2. ↑ Tsuroi I, Simmons ES, Paul R (2012). "Enhancing the application and evaluation of a discrete trial intervention package for eliciting first words in preverbal preschoolers with ASD". Journal of Autism and Developmental Disorders. 42 (7): 1281–1293. doi:10.1007/s10803-011-1358-y. PMID   21918912. S2CID   7164416.
  3. ↑ Causin KG, Albert KM, Carbone VJ, Sweeney-Kerwin EJ (September 2013). "The role of join control in teaching listener responding to children with autism and other developmental disabilities" . Research in Autism Spectrum Disorders. 7 (9): 997–1011. doi:10.1016/j.rasd.2013.04.011.
  4. ↑ Grow L, LeBlanc L (2013). "Teaching receptive language". Behavior Analysis in Practice. 6 (1): 56–75. doi:10.1007/BF03391791. PMC   3680153 . PMID   25729507.
  5. ↑ Geiger KB, Carr JE, LeBlanc LA, Hanney NM, Polick AS, Heinicke MR (2012). "Teaching receptive discriminations to children with autism: A comparison of traditional and embedded discrete trial teaching". Behavior Analysis in Practice. 5 (2): 49–59. doi:10.1007/BF03391823. PMC   3592489 . PMID   23730466.
  6. 1 2 Rogers SJ, Vismara LA (January 2008). "Evidence-based comprehensive treatments for early autism". Journal of Clinical Child and Adolescent Psychology. 37 (1): 8–38. doi:10.1080/15374410701817808. PMC   2943764 . PMID   18444052.
  7. ↑ Waltz M (2013). Autism: A Social and Medical History. Palgrave Macmillan. ISBN   978-1-349-35819-9.
  8. 1 2 [ needs update ]Lovaas OI (February 1987). "Behavioral treatment and normal educational and intellectual functioning in young autistic children". J Consult Clin Psychol. 55 (1): 3–9. doi:10.1037/0022-006x.55.1.3. PMID   3571656.
  9. ↑ [ needs update ]Jacobson JW, Mulick JA, Green G (1998). "Cost-benefit estimates for early intensive behavioral intervention for young children with autism: General model and single state case". Behavioral Interventions. 13 (4): 201–226. CiteSeerX   10.1.1.522.9130 . doi:10.1002/(sici)1099-078x(199811)13:4<201::aid-bin17>3.0.co;2-r.
  10. ↑ McEachin JJ, Smith T, Lovaas OI (January 1993). "Long-term outcome for children with autism who received early intensive behavioral treatment". Am J Ment Retard. 97 (4): 359–72, discussion 373–91. PMID   8427693.
  11. ↑ Howlin P, Gordon RK, Pasco G, Wade A, Charman T (May 2007). "The effectiveness of picture exchange communication system training for those who teach children with autism: a pragmatic, group randomised controlled trial". J Child Psychol Psychiatry. 48 (5): 473–81. doi:10.1111/j.1469-7610.2006.01707.x. PMID   17501728.
  12. ↑ Volkmar FR, Lord C, Bailey A, Schultz RT, Klin A (January 2004). "Autism and pervasive developmental disorders". J Child Psychol Psychiatry. 45 (1): 135–70. doi:10.1046/j.0021-9630.2003.00317.x. PMID   14959806.
  13. 1 2 Frost LA, Bondy AS (2002). The picture exchange communication system training manual (Second ed.). Newark, DE: Pyramid Educational Products Inc.
  14. ↑ Kasari C, Shire S, Shih W, Landa R, Levato L, Smith T (June 2023). "Spoken language outcomes in limited language preschoolers with autism and global developmental delay: RCT of early intervention approaches". Autism Research. 16 (6): 1236–1246. doi:10.1002/aur.2932. PMC   10460274 . PMID   37070270.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ↑ Brignell A, Chenausky KV, Song H, Zhu J, Suo C, Morgan AT (November 2018). "Communication interventions for autism spectrum disorder in minimally verbal children". Cochrane Database of Systematic Reviews. 2018 (11): CD01234PMC. doi:10.1002/14651858.CD012324.pub2. PMC   6516977 . PMID   30395694.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Paul R, Campbell D, Gilbert K, Tsiouri I (February 2013). "Comparing spoken language treatments for minimally verbal preschoolers with autism spectrum disorders". Journal of Autism and Developmental Disorders. 43 (11): 418–431. doi:10.1007/s10803-012-1583-z. PMID   22733301. S2CID   263518387.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Smith T, Iadarola S (2 November 2015). "Evidence Base Update for Autism Spectrum Disorder". Journal of Clinical Child and Adolescent Psychology. 44 (6). Taylor & Francis: 897–922. doi: 10.1080/15374416.2015.1077448 . ISSN   1537-4416. PMID   26430947.
  18. ↑ Myers SM, Johnson CP (November 2007). "Management of children with autism spectrum disorders" . Pediatrics. 120 (5): 1162–1182. doi:10.1542/peds.2007-2362. PMID   17967921. S2CID   1656920.
  19. ↑ Eikeseth S (2009). "Outcome of comprehensive psycho-educational interventions for young children with autism". Research in Developmental Disabilities. 30 (1): 158–178. CiteSeerX   10.1.1.615.3336 . doi:10.1016/j.ridd.2008.02.003. PMID   18385012.
  20. ↑ Ospina MB, Krebs Seida J, Clark B, Karkhaneh M, Hartling L, Tjosvold L, Vandermeer B, Smith V (2008). "Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review". PLOS ONE. 3 (11): e3755. Bibcode:2008PLoSO...3.3755O. doi: 10.1371/journal.pone.0003755 . PMC   2582449 . PMID   19015734.
  21. ↑ Reichow B, Hume K, Barton EE, Boyd BA (May 2018). "Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)". The Cochrane Database of Systematic Reviews. 5 (10): CD009260. doi:10.1002/14651858.CD009260.pub3. PMC   6494600 . PMID   29742275.
  22. 1 2 Silverman C (2011). Understanding Autism: Parents, Doctors, and the History of a Disorder. Princeton University Press. p. 90. ISBN   978-0-691-15968-3.
  23. 1 2 Bowman RA, Baker JP (March 2014). "Screams, slaps, and love: The strange birth of applied behavior analysis" . Pediatrics. 133 (3): 364–66. doi:10.1542/peds.2013-2583. PMID   24534411. S2CID   28137037.
  24. ↑ Elder JH (2002). "Current treatments in autisms: Examining scientific evidence and clinical implications". Journal of Neuroscience Nursing. 34 (2): 67–73. doi:10.1097/01376517-200204000-00005. S2CID   145106552 . Retrieved 2007-07-23.
  25. ↑ Lovaas O.I.; Wright Scott (2006). "A reply to recent public critiques…". JEIBI. 3 (2): 221–229.
  26. ↑ Gresham FM, MacMillan DL (1998). "Early Intervention Project: can its claims be substantiated and its effects replicated?". J Autism Dev Disord (Review). 28 (1): 5–13. doi:10.1023/a:1026002717402. PMID   9546297. S2CID   7219819.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.