HOW TO START A HOME-BASED ABA PROGRAM

Educational needs of children with Autism are unique and required unique responses. Programs have to be intensive and individualized on the level and learning style of the learner. Teachers need specific training on a number of teaching procedures (reinforcement, shaping, chaining, etc.). Curricula needs continuous updates and adjustments on the base of progresses and difficulties. 


Home-based programs are an educational option to meet these requirements. ABA home programs have been constantly growing in popularity in the last 20 years becoming the standard for the education of children with Autism and severe language delays. 

ABA Home Program structure

An in-home ABA/VB program is typically run for approximately 25 to 40 hours per week. The majority of the instruction is provided in a structured format (discrete trials) at the child's home but most of the programs also involves NET (Natural Environment Teaching) sessions that may take place in community setting (e.g. play ground, play groups, school). 

The program is run conjointly by:

•  a Consultant who assesses a child’s needs, trains the Tutors, designs and periodically (e.g. weekly, every 2 weeks, monthly) monitors  and update the curriculum of the home program.

•  Tutors/Therapists who provide the direct instruction to the child during home teaching sessions. Typically sessions are 2 to 4 hours long. Depending on the total amount of hour per week, 1 to 4 tutors may take turns over the day or the week to run the program. Therapists are trained and closely  supervised by the consultant in the implementation of the curriculum. The position usually suits college students and fresh graduates who are interest in special education. Former experience in ABA is not usually required as intensive training and supervision is provided by the consultant. The tutors' role involves also to prepare educational resources for the program (e.g. pictures, visual boards) 

The diagnosis of Autism: one, no one, 100.000 autisms

Autism (or autistic) Spectrum Disorders (ASDs) refer to 3 conditions: 

• Autistic Disorder 
• Asperger Syndrome 
• Pervasive Developmental Disorder not otherwise specified(PDD-NOS) 

These conditions are classified as Pervasive Developmental Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) together with Childhood Disintegrative Disorder and Rett Syndrome (see figure).

ASDs are typically characterized by social deficits, communication difficulties, stereotyped or repetitive behaviors and interests.

The principle of operant conditioning from the laboratory to real life

The principle of operant conditioning

As Skinner argued throughout his work it is essential to any possible adequate explanation of behaviour not to rely on mentalistic terms. Any explanation based on mentalistic terms, in fact, presupposes the rationality of the agent. 
Citing reasons, intentions, beliefs, etc. does not provide an explanation of what makes behaving that organism according with those reason, intention, beliefs, in other world why the behaviour of the agent is rational and what makes his behaviour so adequate to the environment (Palmer, 2009).

Inevitably a scientific account of behaviour will replace with mechanistic explanations the intentional terms usually adopted. “Science seems to be inevitably iconoclastic. It usurps the place of the explanatory fictions which men have invented as pre-scientific devices to account for nature (Skinner, 1957, p. 234). The Copernican system, astronomy, Darwinism, chemistry, anthropology, carry on Skinner, shows that inevitably “as science advances, it strips men of fancied achievements”. “It was inevitable” concludes “that psychology should enter these lists”.(Skinner, 1957).

Will new definition of Autism exclude people in need from services?

The American Psychiatric Association (APA) has proposed new diagnostic criteria for for autism. The new criteria may be include in the 5th edition  of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) due to be published in 2013. The DSM is used worldwide by clinicians and researchers to diagnose and classify mental disorders.

The new definition should incorporate under the label of Autism Spectrum Disorder previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

Last week, the New York Times on front page story reported Dr. Fred R. Volkmar's claim that DSM 5 changes would dramatically reduce rates of diagnosis of autism and would ultimately result in reduced school and health services.

The claim produced an uproar in the autism community and instigated a petition against DSM 5.

The experts working on the manual’s new definition strongly disagre with Dr Volkmar's conclusions and in a response to his claims published on the APA website stated that "...field testing has not indicated that there will be any change in the number of patients receiving care for autism spectrum disorders in treatment centres -- just more accurate diagnoses that can lead to more focused treatment".

Descriptive diagnosis are not natural but social entities, they are valuable only if lead to better research and treatment ultimately improving the quality of services. Further studies are needed to ensure that these diagnostic changes may not deny services to whom in need providing at the same time reliable categories to the clinical research.