Historical Approaches to Developmental Disabilities

1. Historical Approaches to Developmental Disabilities Jessica Kay Assessing Autism Interventions Caldwell College

2. Prescientific Treatments • 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”

3. 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

4. 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

5. 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

6. Prescientific and Scientific Orientations • 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

7. 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

8. Services from 1900 to Mid-Century • 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

9. 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

10. 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

11. Mid 1900’s to the Present • 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

12. 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

13. Pumpkin Hollow Retreat Center http://www.pumpkinhollow.org/therapeutictouch/workshops http://www.youtube.com/watch?v=54drpTNIZ38&feature=related

14. Psychomotor Patterning • 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

15. Sensory Integration • 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

16. 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

17. Auditory 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.

18. Auditory Integration • Studies that have reported its benefits have not been peer-reviewed • Scientists and professionals have actually concluded its ineffectiveness

19. Facilitated Communication 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

20. 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

21. 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

22. Gentile Teaching 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

23. 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

24. Nonaversive Intervention • 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

25. 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

26. 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

27. Positive Behavior Support • 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

28. 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

29. 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

30. 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

31. Alternative Biological and Medical Treatments • 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

32. 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

33. The Alternative of Not Adopting Fads 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