Jamie

In December I knew very little about Applied Behavioural Analysis, apart from the name. Sources of information on the internet were fairly scarce, and books on the subject are hard to come by. But coming to the conclusion that experts on the subject or even tutors are extremely rare, I decided to learn enough to try to teach Jamie myself. Fortunately Behavioural Intervention for Young Children with Autism by Catherine Maurice, Gina Green and Stephen C. Luce is a very detailed manual.

Initial Difficulties

In the new term Jamie was due to start in two new nursery classes with full one-to-one support in each. He was to attend for 15 hours a week, and they would use TEACCH. Meanwhile at home I planned to teach him ABA for an hour every day including weekends. A total of 22 hours a week, barring illness and not counting school holidays, was less than ideal. But it would be a huge improvement on the six hours he had spent at a preschool that did not have the staff to cope with his behaviour.

We began by sitting Jamie down at a small table for his first lesson. Even this was a challenge. He did not want to stay for more than two or three minutes, and there was a constant struggle to keep him seated. I ended up hooking my legs either side of his chair and often holding one of his hands to prevent him from getting up and running away. There was shouting and tears, and not just on Jamie's part, as he tried to escape the demands I was placing on him.

The first programmes dealt with eye contact, imitation, and simple instructions. We gave him sweets and tickles when he got anything right, as well as praise and lots of encouraging smiles. Progress often seemed to be painfully slow, and it was frustrating for both teacher and pupil. It took over a month for him to grasp the imitation of gross motor movements using the words "Do this". Some times he seemed to be getting the idea, but the next day his scores would be back where they were when we started. But Jamie, my husband and I plugged on, determined that we would make this work.

Progress and Problems

It soon became clear that one hour was too long to expect Jamie to concentrate, even with breaks. So I split it up into two half-hour sessions, one after lunch and one at around six. This appears to have been effective, and we no longer spent fruitless minutes when it was clear his concentration was exhausted.

These ABA sessions were intensive, and demanded a lot of patience to begin with. It was out of the question to do the suggested 40 hours of it a week with him, which meant that it would be impossible to keep Jamie occupied constantly. He had several repetitive routines that had been becoming more obvious. He would lapse into these when not being directly occupied, and this could still present problems.

Gradually, over the next couple of months, Jamie's speech began to see improvements. Once he learnt "do this" he was soon able to do most of the basic imitation exercises without much trouble. Learning to say "Want milk" meant that there were fewer tantrums due to Jamie not being able to say what he wanted. Although there was little difference over the course of a week, the progress over a month was more noticeable. Other subtle changes came in his attention span, and the interest he took in his lessons. Eventually lesson time came to be associated with treats, and it was less of a struggle to keep him in his seat.

Jamie's play had been very limited and unimaginative, but some of the programmes helped to expand this. Learning the emotions, and later the programme on pretending, led to some good opportunities for role-playing. They were also particularly fun to teach. Jamie started to play spontaneously in more appropriate ways, for example by pretending a cardboard box was a lorry.

Meanwhile at school Jamie also began to make some progress. The curriculum was broad and did not concentrate on language as much as I would have liked at that time. He did a whole range of subjects including craft, number work and pencil control. I felt that some of this did not challenge him a great deal, and he did too much picture matching and simple number and letter work that he had already mastered. In general though he was learning, and by the end of the spring term he began to talk about school. This started with the names of his friends and teachers. Slowly he was able to talk more about his activities, at first with a lot of prompting but later he would mention his activities without being asked.

However Jamie's behaviour at school worsened in one respect. He would hit and pinch the other children. Was it because of frustration, attention-seeking, over-stimulation or even just naughtiness? It wasn't clear to anyone, and this made it harder to deal with. It was worse in the mainstream nursery class where there were more children and other distractions. His mainstream teachers did not manage to reduce this behaviour, so Jamie's hours of mainstream teaching were reduced and he spent longer in the specialist nursery.

Seven months on

After almost seven months of ABA Jamie was using several short sentences. He could use prepositions and some pronouns, say the function of objects, body parts and rooms, and could answer "where" and "what" questions. He knew his numbers to 20 and all his letters, and could put them in order.

However Jamie still had a long way to go before he could make normal conversation. He would still engage in repetitive routines if left to himself.

It is difficult to measure the results of TEACCH objectively, given that it doesn't rely on accurate data to the extent that Behaviour Analysis does. With ABA, on the other hand, there is a definite plan and its results can be measured. This is in spite of the fact that Jamie only did 7 hours of it a week, less than a quarter of the 40 that are recommended. At this point his behaviour was more of a concern than his language, whereas the opposite had been true to begin with. He was not yet talking normally, but it was easy to see that at some point he would be.