Wednesday, December 23. 2009

Mands vs. Tacts - Example from ABA Therapy

Posted under: Research

One issue I have always had in the field of education is the tendency of some advocates to take a theory or preliminary research and immediately apply it to educational endeavors as a whole. Those familiar with debates concerning whole language vs. phonics, open classrooms, and even whether or not elementary school children should receive grades are well aware that enthusiasm for the theory can supersede the evidence to support it.

I hope this tendency does not surface in the field of applied behavior analysis. In the last blog, I discussed research concerning teaching mands and tacts to children with autism. One of the positive developments in the 1990's for behavioral treatment was the recognition that an early emphasis on mand training can benefit children with autism. However, the enthusiasm for emphasizing mands has sometimes resulted in rash statements such as "the most effective ABA therapy should always start with only mand training" or "Lovaas places emphasis on receptive language at the beginning of a program rather than focusing on mand training."

In a previous blog, I mentioned 5 important factors to creating the best, evidence-based ABA therapy. The first factor emphasized long-term outcome research. In terms of mand training in the Lovaas Model of Applied Behavior Analysis, Sallows (2005) makes this statement in the treatment procedures section of his long-term replication research. "Receptive language was generally targeted before expressive language. We used familiar instructions where success was easily prompted, such as ''sit down'' or ''come here.'' Expressive language began with imitation training, first nonverbal then vocal imitation, beginning with single sounds and gradually progressing to words. Requesting was taught as early as possible, initially using nonverbal strategies if necessary."

The second factor emphasized short-term, single subject design research. This research I just discussed in the previous blog. A third factor I mention is personal experience. Here's one example from a recent child I worked with. This boy was 3 years, 2 months old when he started treatment. He said 5-10 words, but never consistently. He was currently attending a developmental preschool and received speech therapy twice a week. One of the skills they were working on with him was requesting, but his responses were inconsistent. Sometimes he would spontaneously ask for an object, sometimes he would imitate a verbal model as a prompt, and sometimes he would just continue to reach for the object and whine if he didn't get it or leave after failing to be given the object. His parents identified spontaneous requesting (i.e., manding) as an area of difficulty throughout the day. He was scheduled to receive 20-30 hours of behavioral treatment during the first month.

The following programs were practiced during the initial consultation and continued for the next month. I've put in parenthesis the number of items mastered by the end of the month.

LEARNING READINESS

  • Reinforcer Assessment

PLAY

  • Task Completion (+4 activities)
  • Early Play Activities (+4 activities)
  • Beginning Toy Play (+3 actions)

REQUESTING

  • Requesting (point) (+ able to point to objects out of reach as a request)
  • Requesting (verbal) (+3 verbal requests)

IMITATION

  • Nonverbal Imitation (gross and fine motor) (+8 gross, +8 fine)

RECEPTIVE

  • Touch Same (matching) (+field of 24 pictures)
  • Receptive Labels (+6 objects)
  • Receptive Instructions (+7 instructions)
  • Receptive Room Objects (+2 objects)

VERBAL IMITATION

  • Verbal Imitation (baseline) (39 vowel-consonant sounds identified at baseline)

EXPRESSIVE LANGUAGE

  • Expressive Labels (*4 objects)

* This final program was started at the end of the first month. The child had started to spontaneously imitate instructors in some of the receptive language programs. We took the labels he said clearly (or made a good approximation for) and began to hold up the picture for him to expressively identify (i.e., tact). By the end of the next month, he was able to tact 4 objects.

This is just one example. I've worked with some children who need a lot more time on specific skills so that I may only focus on 5 or fewer programs the first month. Requesting in some format, though not necessarily verbal, is typically part of that process. So, I do include mand training, but it's always part of a comprehensive program. My experience, short-term studies, and long-term outcome research all tend to support a comprehensive approach to ABA therapy. I welcome and would appreciate the opportunity to discuss any opposing views on this subject. Please comment if you feel that solely manding should be initially addressed in an ABA program, rather than a variety of goal areas.

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