Interview with a Board Member: Daniel W. Mruzek, PhD, BCBA-D
Conducted by Josh Pritchard, MS, BCBA
Co-editor, Science in Autism Treatment
Q: We’re so glad to have you on our board – could you tell us a little bit about why/how you got into autism?
A: My story goes back to my teenage days, when I developed an interest in teaching children with developmental disabilities as a Sunday school volunteer with my church. Later, as an undergraduate at the University of Toledo, I maintained this interest through course work and more volunteering. I majored in Psychology, and I was drawn to the science-grounded school of Behaviorism. As I studied behavior modification, I realized that it offered me a golden opportunity: “This is how I can study human behavior- including the behavior of persons with developmental disabilities- in a way that solves problems and gives people opportunities!”
Now, in the interest of full disclosure, I confess that, as a happy-go-lucky 22 year old, I selected Ohio State for my graduate training because I fell head-over-heals for a beautiful lady who enrolled there to pursue her training in physical therapy! (This worked out well; Maria and I have been married 20 years, and we have 4 sons!) But, from a training standpoint, I could hardly have made a better choice for graduate school. I enrolled in the Psychology of Developmental Disabilities program at the OSU Nisonger Center. I had two advisors there, Henry Leland and Dave Hammer. Henry mentored me as would a great philosopher, embedding my clinical instruction in a rich cultural and historical context. Dave mentored me like a crafts-man would an apprentice, teaching me how to build solutions to specific clinical problems. Of course, our “tool chest” was filled with applied behavior analytic (ABA) philosophy and know-how.
In my first semester of graduate training (1988), Dave sent me to an on-campus preschool with the assignment of using discrete trial instruction to teach letter recognition to a boy with autism. Imagine my excitement: amidst an instructional arrangement that (in my ignorance) initially appeared as a “buzzing confusion,” my data revealed what soon became evident to all: my student learned his letters! And, I was hooked. Before I got my “letters” (i.e., my doctorate), I had a chance to study ABA with Bill Heward and John Cooper….From a pedagogical standpoint, who could ask for more?
Q: What do you recommend for those people who are embarking upon a career as a consultant to teaching staff and families?
A: What a question! In the interest of space, I will give you 10 recommendations to “new” consultants in “David Letterman” format.
Number 10: Always eat a good breakfast. Good consultation- like good intervention- takes stamina and concentration. If it were easy, everyone would do it.
Number 9: Buy a good watch and be on time. Engage in other behaviors that show respect for your families and teams (e.g., pronounce names correctly, stow the I-Phone when meeting, avoid rude language).
Number 8: Tell corny jokes… no, you do not have to do that. But, do cultivate a good-natured sense of humor. This is tough work, and we need to laugh with each other along the way.
Number 7: Know thy reinforcement each time out. Ask yourself, “What available consequences will promote my best work in this consultation?” In addition to the progress of the individual with autism, consider team development, mutual appreciation of families, new friendships, problems that are solved (the fruits of science) and, as a scientist, the opportunity to be a scientist (i.e., a polite way of describing this when presented with tough clinical questions: “I’m wrong”, “that’s not it”, “not this either”, and, with help and persistence, “I think we’ve got it!”).
Number 6: Do not behave like a seagull (flying in and, well, flying out!). Take time to know your clients and let them know you.
Number 5: Fly with turkeys… but only if you want to gobble. Otherwise, surround yourself with others who have a passion for science-based intervention and continually improving service to persons with autism and their families.
Number 4: Carry a token board everywhere you go. No, just kidding. But do be a source of reinforcement for people whom you serve through your consultation. Develop an expert eye for those behaviors of parents and teachers that build up opportunity and independence for the individual with autism. Immediately compliment the individual as a consequence. “Shape on those behaviors.” Use those behaviors as starting point for introducing new skills.
Number 3: Don’t offer advice until you have listened to your families and other team members so well that your listening skills catch them by surprise.
Number 2: “Those who read lead.” Stay current with new developments in the field by regularly reading quality publications and attending conferences. In many settings, remaining current through reading will put you in a unique position to be of great help to teams.
Number 1: Be a scientist. Use the scientific method as a way of organizing your service to others. Analyze. Synthesize. Hypothesize. Test. Evaluate data. See your work in the context of the efforts of the broader scientific community. This is a very exciting time to be a scientist in the field of autism!
Q: What are some of the essentials for students and others first entering the field of autism intervention?
A: As mentioned in my “Number 1” recommendation (above), I recommend that people entering clinical and educational service to persons with autism hone their science skills. A great book on the topic of science (but not autism) is the late Carl Sagan’s book “The Demon Haunted World: Science as a Candle in the Dark” (1996). Here, Sagan does at least three things: 1) provides a guided tour of the scientific method; 2) shows how science is not just a “tool box”, but, rather, a framework for organizing our experience (e.g., such as our decision-making in autism intervention); and 3) offers a “baloney detection kit” that highlights several signs of possible “baloney” one can watch for when others make claims- including treatment claims. Just as important, Sagan bursts the stereotype of the “jaded scientist” who reflexively says “No” to new ideas. Rather, he explains that scientists get excited in response to new ideas. They understand that new ideas- including “breakthrough ideas” that dramatically alter our take on the world- do occur. But, for a scientist, the excitement over a new idea quickly leads to this question: “How can we test this out?”
Q: One of the most valuable contributions to ASAT is your ability to identify and analyze whether there is “science in that” and help deal with threats to science in the area of autism treatment. Could you tell us more?
A: We can all look at autism treatment claims made by marketers through the lens of science. For example, I recently ran across a product called the “Miracle Belt” (http://www.miraclebelt.com/), described by the marketer as a “therapeutic weighted belt” for children with autism (or any one of 15 other developmental concerns). The cheapest Miracle Belt (the smallest one for infants) costs $45.95 US dollars. That’s real money, especially for a family budget! Is it possible that this belt “increases body awareness”, “dramatically reduces hyperactivity”, “increases focus and concentration”, “enhances comprehension and learning”, “improves balance and coordination”, “maximizes benefits of therapy sessions,” and “increases therapy carryover”, as claimed by the marketers? The testimonials found on the website certainly endorse effectiveness. But, we know that testimonials are an exceptionally good way to push a product but an exceptionally poor way to discover the truth. From a scientific standpoint, we know that the sensory integration community has by-and-large failed to demonstrate that any of their treatments are actually helpful for persons with autism, and, to the best of my knowledge, there are no studies specifically on the Miracle Belt.
We can look at the science, or lack thereof, behind the Miracle Belt claims more closely in a future edition of “Science in Autism Treatment”; but, for current purposes, it is suffice to say that a healthy dose of scientific skepticism is in order. In other words, we should test the marketer’s claim that a vest wrapped around the torso of a child with a pervasive developmental disability results in incredible cognitive and adaptive advances. By the way, “skepticism” does not mean “close minded”, “angry” or “rude”. Rather, it means that, as good scientists, we are going to maintain an expectation that treatment claims be evaluated objectively. It is up to the marketer making the treatment claim to provide evidence that it is actually helpful. And, if there is no scientific evidence regarding the effectiveness of the treatment, I think marketers should avoid deceptive practices, like glowing testimonials, contrived blogs, emotional appeals, phony “press releases” and science-like claims. As we regularly say in this newsletter, families deserve nothing less than honest, direct information regarding possible autism treatments. This is what puts them in a position of strength in making decisions about treatments for their children.
Q: Is it reasonable to expect parents who do not know the field of autism treatment to sift through the options with an appreciation for the science? What are our options then?
A: I can imagine that, for many parents, the task of sifting through all of the available treatment options is a daunting task. I know how bewildered I get outside of my area of expertise. I am regularly at a loss in conversations about many topics, such as computers, car repair and finance. I just avoid these conversations, for the most part. So, I can intuit the anxiety that parents must feel when confronted with the life-changing news of their child’s diagnosis of autism and the unavoidable task of making decisions about treatment!
Parents do not have to be experts in autism treatment, but they can develop the skills to be savvy consumers. First, they can develop a skeptical mindset as described above (e.g., “Does this therapy sound too good too be true?”). They can ask the marketer, “What’s the research evidence behind your intervention?” They can develop a relationship with a trusted practitioner in the field (e.g., physician, psychologist, behavior analyst) who can partner with them in evaluating treatment claims. And they can refer to objective resources in their evaluations. As mentioned on these pages in previous issues, a good resource is a well-written “State of the Evidence” report available through the Maine Department of Education (www.maine.gov/dhhs/ocfs/cbhs/ebpac/asd-report.doc). Of course, our mission at ASAT is to provide a trusted resource for parents and practitioners (e.g., clinicians, educators). Our section “Research Synopses”, available at our website (http://www.asatonline.org/resources/resources.htm), is designed as a quick, up-to-date reference site for many of the treatment options that parents regularly encounter. So, we are in this together. No parent should have to wade through treatment options alone!
Q: Scientists (especially behavioral scientists) are quite familiar with the "bad rap" we have as being cold or disinterested in the human element. How do you deal with this? Do you think it’s true?
A: Well, to a certain extent, as scientists, we probably bring this upon ourselves. At times, we do get lost in our research questions or get so invested in a clinical problem that we seem to have temporarily lost sight of the person. Like any person immersed in a particular culture, we love to speak the language of science (i.e., the jargon). Like rude tourists, there may be times when we simply expect others to keep up with our particular brand of rhetoric. So, we need to own up to this and fix it when we see it or do it! When I see good research or clinical work, I inevitably see good partnering with families. That means that, as scientists, we should remain grounded in our science, but, at the same time, relate to our families and other constituents in a way that is accessible- void of unnecessary jargon and pretense. Not only is this partnership good for the family, but it offers the scientist a critical benefit: our partnering families point out to us what we otherwise might not recognize. At the University of Rochester, Steve McAleavey (a UR biomedical engineer) and I, along with the help of UR postdoctoral fellow Suzanne Engel, have been conducting clinical trials of a toilet training procedure for children with autism and other developmental disabilities that uses a wireless moisture sensor that sends a “page” to parents and teachers when a child’s trip to bathroom should commence. Imagine the countless ways that this procedure has been improved by virtue of the observations and good advice of participating families!
Also, as suggested in my “Top 10” list above, I recommend to newly minted clinicians that they view their professional efforts as part of the broader efforts of teams in which we each bring something to the table and each have responsibilities (e.g., parents, teachers, and consultants). A “my way or the high-way” attitude will not work, even when the alternative view is not science-grounded. So, if a team decides to adopt an intervention for a child that is outside the bounds of science (e.g., auditory integration therapy), the consultant might say, “I understand your interest in trying this out. Let’s set up a method of measuring any treatment effects.” Single subject research methodology offers relatively simple ways of evaluating treatments for individuals. Using this methodology and bringing the resultant data back to the team- with related interpretation of results- is a great contribution that consultants can make!
Thank you, Josh, for this opportunity to share a few thoughts about science and autism. I wish all the members of ASAT, the readership- and especially families- an enjoyable and fruitful new year!