Dear Ms. Roberts and Ms. McAfee,
On behalf of the Association for Science in Autism Treatment (ASAT), we are writing in response to your article, “‘Life Animated’ Parents Describe How Animated Characters Helped Son with Autism Connect.” We value the encouraging message this story evokes, as well as the focus on individualizing and utilizing interests to help individuals with autism. In an effort to further support individuals with autism, our intention is to disseminate accurate, science-based information regarding the treatment of autism, and as such, we are hoping to educate both the ASAT community, the ABC News community and audience, and beyond.
In April of 2014, the NY Times published an online article titled, “Inside the Mind of a Child with Autism” (Carey, 2014). In this article the reporter describes a “new therapy” in the treatment of autism. The approach is based on the premise that children with autism may present with strong interests or obsessions and that these interests (or the related behaviors) might serve as the foundation for promoting social development. The article is based on the report by Ron Suskind, a parent of a child with autism, who described how he and his family were able to connect with his child through the use of Disney characters (Suskind, 2014). The approach has since been coined, “Affinity Therapy” to represent the therapeutic use of the interests, or even obsessions, with which children with autism might present. In 2014, Mr. Suskind published a book titled, “Life Animated,” and now over two years later, as your article describes, a documentary of the same name has been released telling of the family’s journey.
As mentioned by Carey and others, Affinity Therapy has some similarities to other treatment approaches such as Pivotal Response Training, a naturalistic intervention based on principles derived from applied behavior analysis. An essential component of these approaches is to use a child’s interests as the foundation for building other skills and meaningful interactions. Although important, the inclusion of the preferences and interests of the learner into his/her educational and treatment program is not new and has an established evidence base for its status as a standard of practice. For example, assessing a child’s preferences is among the initial steps for developing effective motivational/reinforcer systems (e.g., Fisher et al., 1992). Additionally, different methods for assessing preferences exist for different purposes (e.g., Deleon & Iwata, 1998; Deleon et al., 1999; Ringdahl et al., 1997; Roane et al., 1998). The technology of assessing preferences continues to evolve and grow with continuing research (e.g., Groskreutz & Graff, 2009; Jerome & Sturmey, 2008; Kodak et al., 2009; Nuernberger et al., 2012; Sturmey et al., 2003; Snyder, Higbee, & Dayton, 2012). In addition to identifying stimuli that can be incorporated into intervention programs, other studies have investigated the impact of preference on academic and vocational tasks (e.g., Cobigo, Morin, & Lachapelle, 2009; Lattimore, Parsons, & Reid, 2003; Worsdell, Iwata, & Wallace, 2002). Thus, when it comes to assessing preferences, one size does not fit all and specific situations might call for a specific assessment method. In fact, reinforcer assessment is an integral part of the Task List published by the Behavior Analyst Certification Board.
In addition to the benefits of incorporating preferences into instruction, the effects of facilitating opportunities for instruction using preferred stimuli have also been well-established. Treatment packages such as Naturalistic Instruction, Natural Language Paradigm, and Pivotal Response Training emphasize providing teaching opportunities following the spontaneous behavior of the learner. While these packages might espouse different treatment priorities, they share a common foundation in the use of a well-established technique referred to as incidental teaching. First described by Hart and Risley (1968) with disadvantaged preschoolers and later extended to children with autism (McGee et al., 1983; McGee, Krantz, & McClannahan, 1985; McGee, Krantz, & McClannahan, 1986; McGee et al., 1992), this technique involves following a learner’s initiation (e.g., movement towards an item, a reach, point, grab, or request) with a request by the instructor for the learner to elaborate. For one learner, the target elaboration might be to name or describe the item. For another learner, it might be to state the location of the item using prepositions. For still others, it might be to use social niceties such as saying, “Please” and “Thank you.” Ultimately, the elaborations are individualized and targeted for improvement. Because incidental teaching opportunities are initiated by the learner, the instructor might set up the environment in such a way to promote more frequent initiations; a strategy sometimes referred to as behavior trapping. Frequently, these techniques occur within the context of semi-structured play sessions where the instructor will make frequent modifications to the environment based on the initiations (or lack of) by the learner. Similar methods are often found in current communication-training packages. The extensive research base in the areas of preferences and incidental teaching can lead us to the conclusion that not only can the interests of children with autism be used to promote and reinforce desired behavior but when combined with other structured behavioral techniques, such as discrete-trial training, it is a vital component to the overall treatment of learners with autism (Weiss, 2001).
Aside from assessing and incorporating preferences into the structure of instruction, Affinity Therapy also describes specific reinforcement procedures. For example, Carey describes the common approach of providing access to favorite materials contingent upon other desired behavior (i.e., a reinforcement procedure). To rephrase more broadly – can access to favorite animated characters be an effective reinforcer for those children with autism who demonstrate this particular interest? Although this assumption might be intuitive, the reinforcing properties of a stimulus can be influenced by a variety of factors. For example, the reinforcing properties of a stimulus can change based on contextual/environmental attributes. This is referred to as motivating operations, and includes, among other things, the person’s degree of deprivation from the activity or material. Thus, something that is reinforcing at one moment might not be reinforcing at another. This is also related to the fact that reinforcers are defined by the effect that they have on behavior rather than how it appears (i.e., the form they take). Thus, a stimulus only functions as a “reinforcer” when it succeeds at strengthening or increasing behavior and not because it is presumed to be reinforcing to an individual. Again, this alludes to reinforcing effectiveness as a dynamic property. As a result, although a child with autism’s interest in animated characters persists across a variety of situations, the reinforcing effectiveness of those animated characters may be less reliable. That is, the animated characters may serve as reinforcers in one situation but not another, or may be more valuable as reinforcers in one situation and less in another.
Second, there are numerous other factors that can influence the effectiveness of a reinforcement procedure. These include, but are not limited to, 1) the contingency of reinforcement, 2) the schedule of reinforcement delivery, 3) the immediacy with which it is delivered after a desired response, 4) the (relative) magnitude/duration of the stimulus, and 5) other concurrently available reinforcers. These factors, motivating operations, and other variables make the question of whether a specific reinforcement procedure will be effective much more complex than identifying the stimulus to be used as an interest.
Mr. Carey’s article and the report by Mr. Suskind should be appreciated for the attention that they bring to the importance and utility of using a child’s interests within their treatment programs. We should all be reminded that it is an ethical responsibility to provide a therapeutic environment: one that incorporates leisure and instructive materials (Van Houten et al., 1988). In contrast to some of the directions taken by Affinity Therapy, however, it may be of greater value to parents and practitioners to ask why such strategies are effective rather than whether they can be effective. Studying the effects of an intervention based on only animated characters narrows the field of potential reinforcers to this one class of topographical stimuli. As a result, such interventions will be limited in terms of their generality to others. In other words, if the focus is placed too intensely on any one stimulus or stimulus class as a reinforcer, other equally or more effective reinforcers and/or reinforcement procedures may be obscured. Additionally, problem-solving those procedures that do not produce desired or expected outcomes may also be hindered. Thankfully, there is an already extensive body of research that continues to grow that can help practitioners from all fields address these problems.
The Suskind’s story is one of positivity, persistence, and hope. It is important for families of people with autism to hear these messages. As importantly, we hope that Mr. Suskind and others describing Affinity Therapy or similar techniques, will take the mechanisms responsible for behavior change into consideration so that treatments incorporating the interests and passions of people with autism can be individualized and utilized in the most effective and efficient manner. Ultimately, an understanding of the principles that govern behavior based on established research will lead to the best individualized treatment choices for all people with autism. This is of paramount importance when parents of children with autism and other consumers are bombarded with “new treatments” every year.
Sincerely,
Ronald Lee, Ph.D., BCBA-D – William James College
and
Renee Wozniak, Ph.D., BCBA-D – Association for Science in Autism Treatment
References
Carey, B. (2014, April 7). Inside the mind of a child with autism [Blog post]. Retrieved from http://well.blogs.nytimes.com/2014/04/07/inside-the-mind-of-a-child-with-autism/
Charlop, M., H., Kurtz, P. F., & Casey, F. G. (1990). Using aberrant behaviors as reinforcers for autistic children. Journal of Applied Behavior Analysis, 23, 163-181.
Cobigo, V., Morin, D., & Lachapelle, Y. (2009). A method to assess work task preferences. Education and Training in Developmental Disabilities, 44, 561-572.
DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of a multiple-stimulus presentation format for assessing reinforcer preferences. Journal of Applied Behavior Analysis, 29, 519-532.
DeLeon, I. G., Iwata, B., A., Conners, J., & Wallace, M. D. (1999). Examination of ambiguous stimulus preferences with duration-based measures. Journal of Applied Behavior Analysis, 32, 111-114.
Fisher, W., Piazza, C. C., Bowman, L. G., Hagopian, L. P., Owens, J. C., & Slevin, I. (1992). A comparison of two approaches for identifying reinforcers for persons with severe and profound disabilities. Journal of Applied Behavior Analysis, 25, 491-498.
Groskreutz M. P., & Graff, R. B. (2009). Evaluating pictorial preference assessments: The effect of differential outcomes on preference assessment results. Research in Autism Spectrum Disorders, 3, 113–128.
Hanley, G. P., Iwata, B. A., Thompson, R. A., & Lindberg, J. S. (2000). A component analysis of “stereotypy as reinforcement” for alternative behavior. Journal of Applied Behavior Analysis, 33, 285-297.
Hart, B. & Risley, T. R. (1968). Establishing use of descriptive adjectives in the spontaneous speech of disadvantaged preschool children. Journal of Applied Behavior Analysis, 1,109-120.
Jerome, J. & Sturmey, P. (2008). Reinforcing efficacy of interactions with preferred and nonpreferred staff under progressive-ratio schedules. Journal of Applied Behavior Analysis, 41, 221-225.
Kodak, T., Fisher, W. W., Kelley, M. E., & Kisamore, A. (2009). Comparing preference assessments: Research in Developmental Disabilities, 30, 1068-1077.
Lattimore, L., Parsons, M.B., & Reid, D. H. (2003). Assessing preferred work among adults with autism beginning supported jobs: Identification of constant and alternating task preferences. Behavioral Interventions, 18, 161-177.
McGee, G. G., Almeida, C., Sulzer-Azaroff, B., & Feldman, R. S. (1992). Promoting reciprocal interactions via peer incidental teaching. Journal of Applied Behavior Analysis, 25, 117-126.
McGee, G. G., Krantz, P. J., Mason, D., & McClannahan, L. E. (1983). A modified incidental-teaching procedure for autistic youth: Acquisition and generalization of receptive object labels. Journal of Applied Behavior Analysis, 16, 329-338.
McGee, G. G., Krantz, P. J., & McClannahan, L. E. (1985). The facilitative effects of incidental teaching on preposition use by autistic children. Journal of Applied Behavior Analysis, 18, 17-31.
McGee, G. G., Krantz, P. J., & McClannahan, J. E. (1986). An extension of incidental teaching procedures to reading instruction for autistic children. Journal of Applied Behavior Analysis, 19,147-157.
Nuernberger, J. E., Smith, C. A., Czapar, K. N., & Klatt, K. P. (2012). Assessing preference for social interaction in children diagnosed with autism. Behavioral Interventions, 27, 33-44.
Ringdahl, J. E., Vollmer, T. R., Marcus, B. A., & Roane, H. S. (1997). An analogue evaluation of environmental enrichment: The role of stimulus preference. Journal of Applied Behavior Analysis, 30, 203-216.
Roane, H. S., Vollmer, T. R., Ringdahl, J. E., & Marcus, B. A. (1998). Evaluation of a brief stimulus preference assessment. Journal of Applied Behavior Analysis, 31, 605-620.
Robert, D. & McAfee, M. (2016, June 29). “Life Animated” parents describe how animated characters helped son with autism connect. Retrieved from http://abcnews.go.com/Entertainment/life-animated-parents-describe-animated-characters-helped-son/story?id=40203705
Snyder, K., Higbee, T. S., & Dayton, E. (2012). Preliminary investigation of a video-based stimulus preference assessment. Journal of Applied Behavior Analysis, 45, 413-418.
Sturmey, P., Lee, R., Reyer, H., & Robek, A. (2003). Assessing preferences for staff: Some pilot data.Behavioural and Cognitive Psychotherapy, 31, 103-107.
Suskind, R. (2014, March 7). Reaching my autistic son through Disney. Retrieved from www.nytimes.com/2014/03/09/magazine/reaching-my-autistic-son-through-disney.html
Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Foxx, R. M., Iwata, B. A., & Lovaas, O. I. (1988). The right to effective behavioral treatment. Journal of Applied Behavior Analysis, 21, 381-384.
Weiss, M. J. (2001). Expanding ABA intervention in intensive programs for children with autism: The inclusion of natural environment training and fluency based instruction. The Behavior Analyst Today, 2, 182-186.
Worsdell, A. S., Iwata, B. A., & Wallace, M. D. (2002). Duration-based measures of preference for vocational tasks. Journal of Applied Behavior Analysis, 35, 287-290.
