Still on Discrete Trial Teaching (DTT) for Children with Autism...

When working with children with special needs, it is always important to note that progress could be gradual or immediate, but consistency with adopted practice is key. Parents become worried when they realize that their kids have been going through sessions of intervention and they can see little or no progress. However, when the change is obvious, they complain that it is inconsistent.

I get lots of phone calls from parents and caregivers with such concerns and I try to provide professional recommendations to the best of my ability particularly when I'm given adequate information, observations works better for me though.
The other day, I got these three different phone calls from the same parent in less than 15 hours.

4:00pm on Thursday...

Mum: Hey Lola, Uche (pseudonym) was with me in my bathroom early this morning  while I was trying to clean up. He noticed the toothbrushes on the rack and said “brush teeth” (ordinarily, he throws lots of tantrum when it’s time to brush his teeth) so I hurried to get his tooth brush and we had fun brushing his teeth together. See?  I didn’t have to reinforce him! Yay!!! We are making progress. I just wanted to say "thank you," I’ll talk to you later…bye.

(As I listened patiently, I was super-excited for Uche’s mum)
Lola: Happy for you! Bye.

7:00pm same Thursday...

Mum: Hello Lola, We’ve been trying to get Uche to brush his teeth for the past hour and it’s been tough!

Lola: You should try using the reward system.

Mum: We did! I told him he will get to watch Barney after brushing but he refused, I even showed him his favourite chocolate and was willing to let him eat it after brushing but it didn’t work! I think he is regressing. I have tried everything I know to do, I think I’ll just let him  be…I am tired, I pray he’ll agree to brush tomorrow. Goodnight.

Lola: Okay. Have a good one!

8:30am on Friday...

Mum: Lola, we had a good time brushing his teeth this morning and all Uche wanted was to hold on to his toy phone while brushing...this boy is so unpredictable, I pray that everything goes well in the evening.

There are several reasons why most people working with children with disabilities may not see desired changes in these children. The above conversation and other experiences  leads me to some very important topics that I will be sharing on my blog for the next couple of weeks. First of these topics is 'Motivation.'

Motivation.

Everyone loves to be motivated. The reason most people go to work every day is because they expect to get paid. I wouldn’t embark on a 20 minutes drive to the cinema or pay money for a movie that does not feature at least one of my favorite actors. This is the same for little children too (with or without disabilities). When a little child says “dada” for the first time, everyone around that child cheers him up and get all excited, this kind of attention serves as a form of motivation for the child to say more words.

Motivation is a major factor for all children when learning. Motivating a child with autism can be rather challenging for a number of reasons. For instance, I have found that children with autism are often not motivated by social reinforcement such as attention, praise, affection or other activities that interest other typical kids. However, this is not enough reason for parents, therapists, teachers and other caregivers to conclude that nothing motivates these children. Every child has unique interests and preferences but it requires creativity, time and dedication to determine such interests especially when the reinforcers may appear inefficient or limited. (Read more on the types of reinforcement and the common challenges of reinforcement in my next post).

Discrete Trial Teaching (DTT) for Children with Autism

As a special education professional, my job description entails observing, supervising, training, providing recommendations, counseling parents and so on. I have realized while doing all or some of these that DTT is a common topic of discussion. Many of my clients (teachers, therapists and parents) confirm that they use this method and still do not see the desired result in their children and I usually have to go through the process of explaining what DTT is all about. 

  

This morning while driving down from church, three words kept resounding, in my head "comprehension", "application" and "manifestation." And then it all started coming together, "Comprehension" - understanding; "do these people really understand what DTT is? "Can I possibly give what I do not have? Application- how is this applicable, and what is their level of fidelity to the practice? Response to these questions will bring about the desired result in the children, that is: ''manifestation."

What is Discrete Trial Teaching?

The DTT is a method that is generally used to provide intervention for  young children (ages two through six) with autism in order to maximize learning. It is also used with older children, especially those with significant developmental delay. This method is based on the principle of Applied Behavioral Analysis (ABA). DTT is simply good teaching for developing communication skills, cognitive skills, play skills, social and self help skills. It involves teaching in simplified and structured steps rather than teaching a whole skill all at once.

The Format

The format for DTT involves the following steps:

a.  Breaking a skill into smaller parts.

b.  Teaching one small part of the skill at a time until it is mastered.

c.  Allowing repeated practice in a concentrated period of time.

d.  Providing a prompt for the correct response and fading the prompt as necessary.

e.  Using positive reinforcement procedures.

    

In DTT a small amount of information is given to the student, and the response is immediately reinforced or not reinforced as the response would determine. DTT involves numerous trials in order to strengthen learning. Each small bit of information given must be mastered before moving to the next.

Here is an example of what a session may look like:

The special education teacher/therapist gives the child an instruction (antecedent) e.g "touch your nose." The child responds (behavior) by touching his/her nose, since the response was correct, the child receives a positive reinforcement as the consequence of his/her behavior. If the response (behavior) is incorrect, a prompt replaces the reinforcement, once the prompt leads to a correct response a reinforcement is then administered. If the child still does not give a correct response after prompting, the teacher would have to withdraw the instruction ("touch your nose") and replace it with an easier skill that has already been mastered by the child such as "hands up." It is important to watch against frustrating the child and to ensure that each session ends with success (Read more on types of reinforcement and prompts in my subsequent posts).

   

Other important factors in using DTT are setting up the session environment, regular data collection in order to monitor progress, fading of prompts and reward, and generalization of learning or skills taught to other materials, environments and people.

The Family's Role in Special Education Intervention

In the course of my interactions with parents having children with Autism Spectrum Disorder (ASD), I often encounter those who want to "dump" the child on a therapist and expect "miraculous" changes in the child. I must emphasize that active involvement of parents and siblings is very important in special education intervention for a child with autism or any related special needs. No one knows a child better than the parents. Remember that you as the parent will in the end be the one who cares the most for, and is affected the most by your child's condition. Besides, you spend more time with your child than anyone else. You can use that precious time to generalize the teaching goals into everyday living situations and activities.

Parents are positioned to provide direct therapy to their child. However, as parents better understand, having a child with autism takes a huge emotional toll and coordinating the treatment team can be a daunting task. Therefore, whenever possible, it is recommended to use hired therapists to do most of the intensive work. This allows parents to have some respite and the remaining time spent with their child can be more enjoyable and productive.

Parents can use the child's time that is not spent in intensive programming to develop play, social and self-help skills. Spending time outdoors by visiting the park, shopping mall, close friends and relatives' homes are opportunities to generalize skills and work on improving  behavior. Similarly, brushing their teeth, having a bath, getting dressed, and having a meal are just a few examples of everyday routines that serve as opportunities for teaching.

As a result of these, the child's day if filled with activities that become part of the therapy process. More importantly, the parents become an integral part of the special education intervention team. Therefore, it is important to involve the child in the family daily routine of living, this will reduce any form of isolation for the child.