analysis….[can make a child with autism] indistinguishable from peers, though there are those who have critiqued that line of research on methodological grounds.” Dr. Cihon: Right, what things are going on and what’s happening afterwards? Dr. Smagner: More often than not, the parent will tell me that the child pulls or tantrums. Sometimes the children will point. But I need to know all that. Dr. Cihon: I think it also depends on where you’re coming in and the range of interventions that have been tried. If it’s a child who’s received some early intervention or is coming in a little later in the game, oftentimes we see some very different skill sets. Sometimes kids are already talking. sturtz: The programming doesn’t have to do with the chronological age of the child. You can have an individual who is 9 or 2, and they do the same things…they communicate in the same way, they have the same toileting skills, the same reading level, communication, feeding skills, ability to dress themselves. Their history can make it more challenging—the longer you’ve had things going on, the harder it is to break the habit or the pattern. But I’ve worked with individuals who are 30 who have less functional communication than kiddos that I work with that are 3 or 4. Dr. Cihon: We look at what skills are appropriate for an individual of that age, and the environment that they are in. A 3-year-old may be in a preschool setting. A 21-year-old may be in
a functional skills curriculum/ high school setting getting ready to shift into employment. We look at what the natural contingencies of reinforcement and the environment are, and then make sure that the behaviors that we are teaching are going to be maintained. Dr. Smagner: A lot of parents feel it’s very important that children go to school to be exposed to their typical peers. And once they start going to school, then they’re not available for treatment as much. And that has sort of driven some of the decisions that I’ve made, like working only with very young children. Dr. Cihon: It’s not necessarily the more time we have, the more progress the child is going to make. It’s what you do with that time. But given that it’s so important to arrange the environmental contingencies in such a way that it’s going to evoke and maintain the behaviors that we want to see, it is easier to do that when there are fewer people involved. And it’s also easier to do that before that long learning history. So, in some respects, it’s easier to start early, and you see more rapid gains more quickly. But I’m interested in also helping the kids who the system has failed.
INSIGHT: Does the potential exist for the autism diagnosis to be removed as a result of ABA treatment? Dr. Smagner: There is some
convincing data showing that intensive applied behavior analysis….[can make a child with autism] indistinguishable from peers, though there are those who have critiqued that line of research on methodological grounds. I have to say that I am a hopeful person, and so when I enter a home, my goal is for recovery. Dr. Cihon: I have a child right now, we started with him when he was 3 and he didn’t communicate much verbally, he threw tantrums, didn’t stay on task, just moved around in a fury. And now, I can’t pinpoint a new skill to teach him. He is behaving similarly to other 3-year-olds in terms of verbal behavior, as well as pre-academic skills, small group skills. He is going to preschool and is doing fine. In that particular situation, the family doesn’t want to have him reevaluated to determine whether he does or does not have autism. He is still very young, and while that diagnosis doesn’t drive services, it does in a lot of ways. So if you drop the autism diagnosis, then you have to fight again to get speech therapy services, occupational therapy services, applied behavior analytic services. There are a lot of large jumps in skills that are necessary to survive in preschool to kindergarten, from kindergarten to first grade, from fourth grade into fifth and sixth grade, and so on. sturtz: I have a similar story. I had a kiddo who started
(ABA therapy) when he was 18 months and by his third birthday had mastered out of all of the programs that were written for his age. He probably spoke more clearly and more often than many of the 3-year-olds he was going to school with.
INSIGHT: Is there a common life cycle of treatment? Dr. Cihon: My goal is to work myself out of a job as quickly as possible. It varies, it varies on what the needs of the family are, what the needs of the child are. I have cases that I’ve been involved with since 2001 and I’ve had cases for six months and it wasn’t a good fit, or I had to move…so there are a variety of different variables that can influence it. There are varying levels of involvement too, I think. We’ll fade ourselves out after a while. But every now and then I still get a phone call or an email so there’s still sometimes that level of involvement. sturtz: However many hours you spend talking about it, you are never going to get all of the information you want. The more you learn, the more you realize you don’t know. I think it’s important to remember that you’re not going to have all of the answers, and you just have to take one step at a time with one individual at a time. Have an idea for faculty Q&A? Email email@example.com.
INSIGHT MAGAZINE FALL 2008 11
“There is some convincing data showing that intensive applied behavior