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In this post, I am writing under the assumption that those who are reading this understand what ASD is and what it looks like. If you are not familiar with autism spectrum disorders, I encourage you to stop reading this right now and head on over to Autism Speaks and Autism Action Partnership for more information. Then come on back and read about DTT!
Firstly, let me say that I do not believe that there is a “one size fits all” approach to treating children with ASD. I believe there are a number of valid techniques that can work for children with ASD. There are several factors that may affect your decision on which techniques to try: 1) severity of disorder and use of stimulatory behaviors, 2) sensory needs of the child, 3) family needs, 4) parental support, etc.. I tend to use evidence based practice (EBP) and trial and error to determine “what works” for each child on an individual basis.
Over the next five weeks we will be discussing topics such as discrete trial training (today), use of DTT principles with a penny board, DIR/Floortime/PLAY project principals, ABA vs. Son-Rise program and sensory diets. So…let’s get started!!!!
What is DTT?
DTT or discrete trial training is a method of teaching small components/steps of a skills. It is a method often used successfully when providing intervention to persons with ASD. DTT is only one technique used in ABA (applied behavioral analysis) therapy. DTT has an extensive body of research (website courtesy of Autism Speaks Blog) to support its use and success.
Word of Caution: I would be remiss if I did not point out that upon review of research on past ABA studies, there have always been criticisms about the methodologies used in these studies and more recently, there are valid questions as to whether these research studies truly demonstrated the results they claimed. In addition, the difficulty and/or lack of generalization of learned skills to more natural environments has always been a concern for those who question the use of ABA. With that said there are thousands upon thousands of success stories (anecdotal research) of children who received ABA therapy and thousands of stories of children where ABA did not work. So I just make these statements to let you know, there are children who can and have improved using these techniques and ones who haven’t. No one seems to know why some children respond to ABA techniques when others do no. You as a professional or parent must conduct your own research and make your own decisions regarding the child’s direction of therapy.
Want to read more about the critiques of ABA? Check out: A Case Study in the Misrepresentation of Applied Behavior Analysis in Autism: The Gernsbacher Lectures for more information and as always…you decide!
Ok now let’s get down to talking about DTT!
What is a discrete trial? One discrete trial consists of:
- An SD: discriminative stimulus, otherwise known as the instruction (verbal, nonverbal-pointing/showing, physical-hand over hand, guide hand, etc.) given by the therapist to the child. All SDs should be:
- consistent and clear
- free of extraneous information (includes visual, auditory, kinesthetic info, etc.)
- Response or Prompt: Then the therapist waits for the child to respond, or provides help by prompting a response; follow hierarchy from MOST amount of scaffolding to least amount of scaffolding and must fade prompts (either by decreasing intensity of prompt or by checking to see if child is ready to move to next level of prompting); prompts include:
- physical-hand over hand, guide hand, etc.,
- gestural-pointing, showing,
- positional-positing materials to encourage correct response,
- verbal-vocal cues to help child,
- echo prompts-you prompt verbal answer immediately after stimulus and have child echo
- Reinforcement or correction: Finally, (after the child’s response), the child is given reinforcement for a correct response, or correction for an incorrect response.
- MUST be given immediately
- IS GIVEN regardless of whether the child responded independently or with a prompt
- should be exciting and motivating
- should be varied (decreases boardem an sustains motivation)
- What to do if the child responds incorrectly or not at all? 2 options:
- Informational “No”: say no in a neutral tone, exhibit stimulus again, provide model for correct response, when child imitates correct response, reinforcement follows. OR
- Errorless learning correction: the therapist does not say “no” but rather pauses (does not provide reinforcement), give stimulus again, immediately modeling correct response, after child gives correct response, reinforcement is given.
- research shows consistent progress for various children
- new skills can be taught in steps
- undesireable behaviors are extinguished using negative consequences
Negatives to using DTT and/or ABA therapy: (overview-there are many more than listed here)
- difficulty generalizing to other environments
- reliance on cues and prompts
- use of robotic speech
- skills taught may not be functionally observed in the child’s daily environment
- negative consequences are viewed as harsh in nature
With such high caseloads, is this really something an SLP can do in the school setting?