Historical Approaches to Developmental Disabilities

Jessica KayAssessing Autism Interventions

Caldwell College

• Histories have placed more of an emphasis on where people were served and how people were viewed, rather than how they were served and the outcomes of those treatments

• Treatments lacked confirmation because they were not systematically assessed

partially due to a lack of resources• “It was an age of trying things out to see if they

worked”

Prescientific Treatments

• Treatments were influenced by trends in society

• Advancements in educational or medical fields influenced strategies used to treat the developmentally disabled

Disorders were not well differentiated

Prescientific Treatments

• During the 1800’s, schools or residential settings were uncommon

• One early institution was the American Asylum for the Deaf and Dumb -> Hartford, Connecticut

• More common procedures included Prisons Work camps Warning undesirables away Physically loading undesirables into carts and driving

them away

Prescientific Treatments

• By the 1900’s public schools emerged in Boston, Cleveland, Chicago, NYC, Philadelphia, and Providence

Only 11% of US population• Slowly, advancements were being made Sequin stressed physiological methods to induce learning

involving generalization, memory, and perception Voisin believed that each case be reviewed on an

individual basis and that treatment should revolve around the individual

Down stressed teaching basic self-care skills, value of money, leisure skills, and moral training

Prescientific Treatments

• Science: entails systematically identifying cause and effect relationships among experiences, social interactions, and changes in behavior.

Being able to predict that an intervention has an effect on behavior

• Scientific inquiry relies on methods to find these cause and effect relationships through true experimental designs

Random sampling, random assignment to an experimental condition, and a control group

Rely on prediction, verification, and replication Applied research

Prescientific and Scientific Orientations

• Often in the case of developmental disabilities, random selection is not practical or ethical

• However, it is still possible to randomly assign and select individuals who represent a population -> purposive sampling

• Because all other requirements are met, this is called a quasi-experiment

• Interventions in the past were founded on inadequate research -> could not establish cause and effect

Prescientific and Scientific Orientations

• Late 1800’s focus of residential services shifted from short term to long term

• By early 1900’s residential institutions had been established throughout the US

• Although the importance of assessment and individualized treatment had been articulated, the actual follow through of these behaviors were largely unknown

• From 1920-1939 emphasis was placed on medicine rather than comprehensive services and development

Services from 1900 to Mid-Century

• Advancements in special education reflected growth in availability of separate classes or schools

• By 1940 special education was recognized in 16 states

• By mid 1900’s there was a growing concern that the interventions being used to treat DD were not founded on empirical evidence

Services from 1900 to Mid-Century

• During this period, we see various treatments being implemented with various success rates

Glutamic acid treatment Electrotherapy Lobotomy Vitamin therapies• All reported mixed or poor results

Services from 1900 to Mid-Century

• Presently we have more access to information about fads or pseudoscientific services

• This is due to a rise in the number of professional journals and large scale research projects due to computer technology

• The increase in people enrolled in special education classes has also increased the amount of provider organizations

Increasing the use of therapies being implemented and reported

Mid 1900’s to the Present

• Since the 1960’s there has been a growth in funding for research

• There is more skepticism to those treatments that report remarkable effects but that have no evidence to back it up with

• However, since 1960, there have been numerous amounts of fads and pseudoscientific interventions that have caught the public’s eye

Mid 1900’s to the Present

http://www.pumpkinhollow.org/therapeutictouch/workshops

http://www.youtube.com/watch?v=54drpTNIZ38&feature=related

Pumpkin Hollow Retreat Center

• Involved a series of exercises through which children are passively guided through movements of the head and limbs

• These movements were said to improve the neurological functioning and structure of the central nervous system and enhance intellectual performance

• Ultimately, these movements would restructure the brain to make it look like that of a typically developing child

• No evidence has suggested the effectiveness of this treatment

• http://www.youtube.com/watch?v=QsAl97RyuX8

Psychomotor Patterning

• SI was one of the first mainstream interventions in schools that was challenged on the basis of inadequate research

• SI therapy involves full body movements that are said to improve the way the brain processes and organizes sensations

• Multiple studies have suggested SI to be an ineffective treatment for those with autism and learning disabilities

• Direct tests of SI have also suggested that it may worsen problem behaviors

Sensory Integration

• In recent years, the classification of SI disorder has been proposed

“overly sensitive or under-reactive to touch, movements, sights or sounds, easily distracted, emotional problems, activity level that is unusually high or low, carelessness, impulsive, lacking in self-control, difficulty in making transitions, delays in speech, language or motor skills and poor self-concept.”

• There is little empirical support for grouping all symptoms together under SI

• Definition has been said to be too vague

Sensory Integration

• Attempts to reduce hypersensitive hearing of children that is said to cause problem behaviors

• Typically consists of 20 half hour sessions of listening to modulated music over a course of 10 to 20 days

• Said to normalize the way the brain processes information

• AIT has been advertised as successfully helping individuals with ADD, autism, dyslexia, PDD, depression, etc.

Auditory Integration

• Studies that have reported its benefits have not been peer-reviewed

• Scientists and professionals have actually concluded its ineffectiveness

Auditory Integration

Involves physically holding an arm or a hand of a person with a DD for the purpose of supporting them in using a communication device

The main argument against FC is that the child is completely controlled by the facilitator

In response to experimental findings that disproved FC, practitioners of FC suggested that psychologists were protecting their professional turf

Facilitated Communication

5 studies in 1995, 6 in 1996, 1 in 1997, and 2 in 1988 all reported negative findings

6 studies presented positive findings ->used qualitative methods

Mostert (2001) conducted a review of studies from 1995-2000 concluded that there was still little evidence of validity for FC

Facilitated Communication

Syracuse University has an elective course in FC for their graduate program in education

Studies favoring FC are included in graduate studies at Dominican College in NY, the University of Maryland, the University of Wisconsin, and Southeast Missouri State University

Personnel from federally funded university centers have provided training and continue to do so

Facilitated Communication

Has proposed to achieve remarkable success rates for decreasing problem behaviors

According to this philosophy every human being needs to live connected with others in an equal and reciprocal relationship

Relies on companionship, an unconditional relationship between the client and caregiver

Gentile Teaching

Promoted as the humane alternative to behavior analysis

Gentle teaching has claimed to have no treatment failures in over 600 cases -> not peer reviewed

True experiments have suggested that the universal effects of gentile teaching are false

Presently, gentile teaching has lost interest in the public eye

Gentile Teaching

Began in the early 1980’s Movement toward nonaversive treatments to

diminish problem behaviors Began in 1981 with the banning of the use of

aversives that could inflict physical or emotional stress

1987 TASH described behavior analysts as devaluing the people they sought to educate Claimed that nonaversive measures were more

effective in ALL behaviors

Nonaversive Intervention

1988 the Association for Behavior Analysis fought back with a position paper -> not welcomed by the nonaversive movement

Positives of the movement: Progress towards changing treatment

standards Focusing on antecedent control Increasing focus on nonaversive methods

Nonaversive Intervention

Negative Outcomes: Extension of the word “aversive” to include

positive reinforcement Increased used in drugs and restraint because

of the absence of treatment The promise that all behaviors can be treated

nonaversively

Nonaversive Intervention

Response to demonstrate effectiveness of nonaversive treatments

Framework for developing effective interventions through 3 features Person-centered value base Recognition of the individuality of each person Working toward meaningful outcomes

Positive Behavior Support

PBS widely embraced by governmental and educational agencies -> acceptance resulted in funding NIDRR

Did not adopt extreme positions of nonaversive movement, but did use an applied science of assessment ->balanced in its approach

Acceptable for both TASH and ABA meetings

Positive Behavior Support

Originally published articles in JASH, but then created its own journal -> Journal of Positive Interventions

This allowed PBS to not be associated with the extremeness of TASH or the scientific rigor of ABA

PBS also promotes itself as a social services support model rather than a behavior change model

Positive Behavior Support

PBS is not part of the evolution of ABA PBS is not a new science, technology, or field Despite its popularity, PBS fails to

demonstrate experimental control within its procedures

Therefore, all credibility is lost in the field of science

Positive Behavior Support

Treatments often offered to people with DD include Diets, Drugs, compounds made from “natural”

extracts, and surgery Thankfully, we have the FDA

Proof is either established experimentally or the intervention is not given approval

However, the same standards are not given to substances designated and sold as nutritional extracts or dietary advice

Alternative Biological and Medical Treatments

Some products are sold with disclaimers, but are usually hidden or in small font

These procedures are not only ineffective but can be harmful Vitamins in excess can be toxic at high doses Surgery involves a high risk Drugs should not be used unless their use is

empirically supported

Alternative Biological and Medical Treatments

People adopt fads because of their mission to find the “magic bullet”, a diminished attention to behavioral science as a source of information, and an increased focus on values as opposed to effectiveness of treatment

It is our job as behavior analysts to not only promote ABA, but make everyone aware of WHY we are effective in what we do -> EVIDENCE

The Alternative of Not Adopting Fads