In 1981 O. Ivar Lovaas published his groundbreaking ABA manual, Teaching Developmentally Disabled Children: The ME Book. Countless therapists and families have been able to help their children learn life-altering skills such as socialization, language, and activities of daily living thanks to the work of Dr. Lovaas. His manual outlines how one should go about teaching basic skills to children with developmental delays. It suggests the first skills that should be taught are how to sit appropriately in a chair, how to establish eye contact, and to refrain from engaging in disruptive behaviors. The instructor should then teach the child to imitate, match identical or similar items, and follow simple instructions. Thereafter, the child should be taught to imitate simple sounds and/or words and label items/actions. It is assumed that once a child can label a preferred item/activity, he or she will spontaneously say the name of that item/activity when they want it. Sadly, more often than not, this does not happen.
All too often we teach children with autism hundreds of words only to have them stand in the middle of a room and tantrum when they want something rather than using the words they were taught as a way to request preferred items or activities. Why does this happen? If a child wants juice and can label and identify juice, why does he or she tantrum as a way to get juice rather than simply saying “juice?” According to Skinner’s Verbal Behavior (1957), the same word can have very different meanings depending on the context in which it is taught. For example, the word “juice” can function as a mand (request), a tact (labeling), an echoic (repeating someone else saying the word “juice”), an intraverbal (saying “juice” when someone asks the child what their favorite drink is), or as receptive language (the child points to juice when asked where the juice is). In other words, simply teaching a child with autism to say the word “juice” when shown a cup of juice or to point to a cup of “juice” when asked where the juice is will not ensure the child understands they must say “juice” when they want some juice.
Sundberg and Partington (1998) suggest that the first type of language a child should be taught is a mand. This line of thinking is in stark contrast to traditional ABA in which the first type of language taught is typically receptive language (identification of items and following simple directions). After the child has mastered identifying various items they are then taught to label those items. Teaching a child to request preferred items does not usually occur for quite some time, if it occurs at all. It is usually assumed that a child will request simply because he or she has been taught to label a preferred item. Sundberg and Partington (1998) propose that teaching the child to mand before anything else is most beneficial because it teaches the child how to get their needs and wants met without the use of tantrums. Furthermore, teaching children how to mand is developmentally appropriate since manding is the first type of language to develop in children. For instance, the first words spoken by a child are names of items/people/activities he or she wants such as “mama”, “dada”, “up”, or “baba” (bottle). Because many children with autism are non-verbal, mand training is usually started by prompting the child to use sign language in order to mand for a preferred item. For example, if watching television is a highly enjoyable activity for a child, the instructor would take the child’s hands, prompt them to make the sign for “TV” while the instructor says the word “TV”, and immediately turn the television on. After a minute or so, the instructor would turn the television off, prompt the child to make the sign for “TV” while the instructor says the word “TV”, and immediately turn the television on. A procedure for fading this prompt is outlined in Carbone (2007).
As a ten-year practitioner of traditional Lovaas ABA, transitioning to a Verbal Behavior format required quite a change in the way I was used to doing things, but I must admit, I have had more success and dealt with fewer tantrums since making the switch. That is why our ABA program at my agency, Los Niños Services, exclusively uses a Verbal Behavior format which we have found very successful.
For more information on this topic feel free to contact Adrienne Robek at adrienne.robek@losninos.com or go to www.losninos.com.
