Discrete Trials Training

little girl wavingAnalyzing the antecedent of the behaviour, the behaviour itself and the consequences of the behaviour is a big part of ABA therapy. However, my main responsibility is to motivate children with autism to learn about the world around them through Discrete Trials Training (DTT).

I engage my clients in DTT, performed one-on-one at a table, during each session. It’s a structured training procedure that provides successive learning opportunities to the client by delivering an instruction. If the instruction delivered is a skill the child is working on acquiring, the therapist will give the child a reinforcing stimulus so the child understands that their response is appropriate.

If I’m teaching receptive gross motor movements to my four-year-old client, I will tell them to “show me waving,” and give them social praise or maybe some candy if they wave their hand. If they don’t, I will physically prompt them to wave their hand, and fade this prompt when I can. Hopefully, by the end of the day, week or month, the client will wave independently, relearning a skill they lost to regressive autism two and a half years before.

All day, we collect data on whether or not the client engages in the skill independently. Later in the week, the results are graphed to see whether or not they’re progressing. If not, the target is revised to help them succeed.

I work hard during a session, and I am simply the instructor. My clients receive between 20 and 40 hours of therapy per week. For some, they put in effort from 9 a.m. to 5 p.m., Monday to Friday—they work a standard adult work week. The entire time, they are actively engaged in developing skills that will allow them to have rewarding peer-to-peer interactions, communicative abilities and independence.

The Discrete Trials Training aspect of ABA therapy can be extremely frustrating for a child. Imagine being asked, repeatedly, to do something you have no idea how to do.

I can’t wiggle my ears. No matter what I do, I don’t know how to make them move. Even if you held up a $100 bill and offered it to me if I wiggled my ears, they’d stay perfectly in place on either side of my head.

However, if you gave me a smaller reward, such as a toonie ($2 coin), and helped me wiggle my ears by moving them for me, I’d be much more motivated to keep trying. If you touched my ears less the next time, but still reinforced me, I would be even more motivated to learn how to wiggle my ears independently.

The hope is that, eventually, I will wiggle my ears more independently each time, and I’ll be reinforced more each time so that I don’t lose the motivation to learn the skills. One day, I will be wiggling them all by myself.

The skills we teach our children are more important to interpersonal relationships and developmental milestones than wiggling ears, but the sentiment remains the same: ABA is hard for these children, and some of them are there for 40 hours a week, every week. I have learned the meaning of ‘determination’ by working with children on the spectrum.

Six months, 100 times a day

young boy learning the alphabet by listening to musicI have a client who is five years old. At two and a half, he was typically developing. He could identify a red versus a blue car, and could say “Mommy.” He waved goodbye to her on video when she told him that the camera was going “bye-bye.”

At five, he has no words. He struggles to make eye contact, and can only tell us what he wants by pointing his index finger. We have taught him how to wave, clap his hands and touch his nose, all on receptive command. He can now use visual skills to scan and match identical stimuli in a visual field of six. He has relearned how to take his slip-on shoes off and put them back on independently.

Imagine having to work that hard, just to maintain the ability to wave your hand at someone who says “Hello!” to you in the morning.

All of these basic skills, and many more, were taught to this client intensively through Discrete Trials Training. Through rigorous repetition, fading prompt levels and the reinforcement of his current abilities, he became independent in regard to these skills. We have to practice them almost every day, though, so that he doesn’t forget how to do certain tasks.

Imagine having to work that hard, just to maintain the ability to wave your hand at someone who says “Hello!” to you in the morning.

This client also completes a rigorous echoics program to try to gain echoic control over the phonemes we have heard him emit during play. One hundred times a day, I hold a red circle in my mouth as a prompt. He gets a red circle as well.

I model, with the shape in my mouth, the noise, “Buh.” If he echoes the model, he gets highly reinforced immediately. If he does not echo, I continue to model, with breaks in between to aid with attention and effort.

After six months of this program, we were able to gain echoic control over this phoneme, “Buh.” Six months. 100 times a day. I don’t know anyone else with the ability to stay that determined—so determined that they push themselves every day to complete a skill that is almost impossible for them to even comprehend performing, let alone independently perform.

AHA! moments

heap of lightbulbsI remember this client when I don’t feel like going to work. Before he spoke, it felt pointless to do 100 trials of echoic programs for a child who wasn’t aware that he possessed a mouth that could make any noise besides laughter. At first, I felt that gaining echoic control with him was nothing short of a miracle. Realistically, it was a product of consistent effort, day in and day out.

Now, when a child has trouble with a particular program, I have faith that it will click one day, as long as we are both patient and persistent. I no longer dread running these more challenging programs, because it’s a new opportunity for a client to have an “Aha!” moment, and that reminds me why I do what I do.

If a non-verbal child can will himself to speak again by practicing 100 times a day for six months straight, then surely, we all can gain skills that are difficult to learn: speaking French, learning guitar, coding, swimming, photography.

I have learned, from my clients, how to be more determined and patient with myself when I’m working on learning something new. I don’t give up anymore when I can’t play a difficult piano bridge, or if I fail to perform a new deadlift variation perfectly. I speak to myself the way I do my clients—I tell myself “good try,” and do it over and over and over again until I have my own “Aha!” moment.

I wish the world had a better sense of the gains these children with autism are capable of making through ABA therapy, because I can confidently say that I view the world differently as a result of my work.

I am not just the instructor. I am also the learner.

«RELATED READ» THE ACCEPTANCE OF AUTISM: What autistic individuals can teach us about authenticity»

Jessica Kohek

image 1 Playing the piano by Juhan Sonin via Flickr (CC BY 2.0) 2 Painting Bert by Charlene Croft via Flickr (CC BY-NC-ND 2.0) 3 Scarlett waving to the camera via Flickr (CC BY-NC 2.0) 4 Pixabay 

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