Blended Naturalistic and Discrete Trial Intervention
The Oxford English Dictionary defines the verb “blend” as, “Mix (components) intimately or harmoniously so that they are inseparable and their individuality is obscured.” (Brown, L. 1933/1993). When providing Intensive Early Behavioral Intervention to chidlren with autism, we combine elements of Pivotal Response Treatment (Koegel and Koegel, 2006), Milieu Language Teaching (Kaiser and Hester, 1994), Incidental Teaching (Hart and Risely, 1975), Activity-Based Early Intervention (Pretti-Frontczak and Bricker, 2004) with Discrete Trial Intervention (Lovaas, 1987) in various proportions, depending on the child’s needs. Of the children receiving
services from the Minnesota Early Autism Project, about 25% each receive Discrete Trial or entirely Incidental Teaching therapy, and half receive a Blended Combination.
A somewhat skeptical colleague asked me if Blended Intervention means the same thing as eclectic. Eclectic usually means a practitioner incorporates a little bit of this and a little bit of that depending on their personal preference, usually whether there is any evidence of efficacy or not. Choice of eclectic interventions is usually highly subjective. I refer to that as the “Little Dab’l Do Ya’” approach, drawing on the old Brylcreem hair grooming commercial, for those of you old enough to remember those ads. The notion is that some people believe a little dab of lots of things is better than two or three interventions implemented in a much more focused fashion.
An ecclectic approach leads many parents to conclude that the more and varied interventions to which they expose their child the better her or his chances of developing typical skills and overcoming autism symptoms. I know of no evidence whatsoever that this is a good idea. It will guarantee the child will be confused trying to learn to adjust to the way numerous adults speak with her or him and socially interact while implementing their interventions. Everything we know about young children with autism suggests this is a bad idea. It also assures parents will be exhausted as a result of transporting their child from lesson to therapy to school and back home again, often frenetically rushing from one to the next.
In addition to 20-35 hours per week of one to one behavioral intervention with each child (including time working with parents) during the first year of our intensive behavioral therapy, all of the children we have treated receive speech therapy and nearly all of them are enrolled in Early Childhood Special Education for anywhere from 3-15 hours per week depending on their stage of intervention.
We are currently statistically analyzing and summarizing outcomes for children who have received one or more year of MEAP autism services and plan to submit the findings to publication within the next few months. I can report that thus far, they are very encouraging, indeed.
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Brown, L. (1933/1993) The New Shorter Oxford English Dictionary (2 Vol). NY: Oxford University Press
Hart, B. and Risley, TR (1975) Incidental teaching of language in the preschool. Journal of Applied Behavior Analysis. 8: 411-20.
Kaiser, AP. and Hester, PP (1994) Generalized effects of milieu teaching. Journal of Speech Hearing Research. 37:1320-40.
Koegel, RL and Koegel, LK. (2006) Pivotal response treatments for autism: Communication, social and academic development. Baltimore: Paul H. Brookes Publishing Co.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
Pretti-Frontczak, K. and Bricker, D.(2004) An Activity-Based Approach to Early Intervention. Baltimore: Paul H. Brookes Publishing, Inc.