IN THIS ISSUE: CT FEAT Newsletter, Vol.3, No. 2, Spring/Summer 2000

Note: The content of this newsletter is, unless otherwise indicated, the property of Connecticut Families for Effective Autism Treatment, Inc. (CT FEAT) and is copyright protected. It may be used only with attribution. Copyright © 2000, CT FEAT, Inc.

The Surgeon General of the United States recently issued a comprehensive report on the diagnosis and treatment of mental health disorders among children. The Report, which is available online (see Editor’s note on page 2), validates the research supporting ABA as the leading treatment for autism:

"Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. A well-designed study of a pyscho-social intervention was carried out by Lovaas and colleagues (Lovaas 1987; McEachin et al., 1993). Nineteen children with autism were treated intensively with behavior therapy for two years and compared with two control groups. Follow-up of the experimental group in first grade, in late childhood, and in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling. Up to this point, a number of other research groups have provided at least a partial replication of the Lovaas model (see Rogers, 1998)."

Times certainly have changed for the better. Just a few years ago, parents seeking ABA treatment for their children usually encountered enormous resistance and ignorance among early intervention providers and school systems. The familiar refrain was that the Lovaas research was "controversial" and "unproven." Parents routinely were told that "eclectic" intervention programs (which were much less expensive than intensive ABA) were best. These vaguely defined programs lacked any solid research basis and didn’t even purport to achieve outcomes comparable to the Lovaas model.

The tide has changed decisively. In early 1999, the New York State Department of Health (DOH) issued its report recommending intensive behavioral intervention including "a minimum of approximately twenty hours per week of individualized behavioral intervention using ABA techniques" (emphasis in original). This report is available online (see Editor’s note at the end of this article).

Not too long after New York published its report, a task force convened in Maine made similar findings: that only one intervention was "substantiated as effective by the scope and quality of the research": applied behavior analysis. An executive summary of this report is available online (see Editor’s note at the end of this article.

Now that the effectiveness of ABA has been validated by various impartial evaluators, perhaps we can move on to the next great challenge: developing adequate ABA resources in our state. There is a tremendous dearth of qualified personnel at every level, from program consultants and supervisors to tutors and classroom aides.

There also appears to be fairly widespread ignorance about the level of skill and training needed to deliver competently a bona fide ABA program. Many so-called "ABA programs" bear little resemblance to the model described in the Lovaas research. One hopes that these governmental reports will spur the development of both heightened consciousness and increased resources. v

(Editor’s note: All of the reports discussed in this article also can be accessed through direct links at the CT FEAT web site under "Related Sites." The URL for the Surgeon General’s report is www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html#autism. The New York report can be found at www.health.state.ny.us/nysdoh/eip/menu.htm and an executive summary of the Maine report is at http://mainetoday.koz.com/servlet/maine_ProcServ?DBPAGE=cge&GID=04001010150903118184110616.)

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CT FEAT's web site has a new look and lots of new material. We’ve added two years’ worth of back newsletters, many of which contain extensive reviews of important resources like A Work in Progress (Leaf & McEachin), Teaching Language to Children With Autism (Sundberg & Partington), Teach Me Language (Freeman and Dake), the Autism Academy ABA training software (Eden II), and the Help Me Be Good children's book series (Joy Berry). There also are parent-authored articles about such diverse topics as diagnosis and treatment issues, understanding the PPT process, handling video talk, and promoting peer play.

The site will continue to grow and expand this summer, with overhauls of the outdated "legal" and "ABA professionals" sections. We also plan to add some new material, such as information on ABA treatment for Asperger's children. And we're hoping to set up a bulletin board where parents and professionals can exchange information regarding employment opportunities.

Like everything else CT FEAT does, maintaining and improving the web site is purely the work of dedicated volunteers. If you would like to help in some way, please don't hesitate to contact us. And be sure to check in with us periodically, at www.ctfeat.org, to see how we are doing!

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Research has demonstrated that children with autism can make dramatic progress in intensive treatment programs based on the principles of Applied Behavior Analysis (ABA). The prognosis is best for those children who begin receiving treatment at a very early age, at or prior to the age of four. In fact, if one thing is universally agreed upon in the world of autism, it is that the earlier intervention begins, the better.

To start intervention at an early age, it is necessary to detect and diagnose children with autism as soon as possible. How to increase the probability that children with autism are detected and diagnosed is an area of keen concern. In an ideal world, a medical test would exist that would identify children with autism at birth, or soon thereafter. But while there has been promising research along this avenue, there is currently no such test. Instead, a screening instrument is the only method currently available to detect signs of autism in a random population of children.

With this in mind, researchers in Britain developed what is called the Checklist for Autism in Toddlers, or the CHAT test. The CHAT is a test that can be used by pediatricians to screen children at their 18 month pediatric visit, and consists of 9 yes/no questions that the pediatrician requires the parent of the child to answer. An answer of "no" on 5 of the 9 questions triggers the pediatrician to recommend that the parents have the child fully evaluated by a qualified diagnostician. In addition, there are five items which are observed by a home health visitor (part of the health system in the UK).

The CHAT test was a major step forward in the fight for early detection of autism, but has been found to be less than perfect. While initial data showed that children who "failed" the CHAT test were subsequently diagnosed with autism or other developmental delays, follow-up data showed that there were a significant number of children who did not fail the CHAT test who were later diagnosed with autism.

Researchers at the University of Connecticut’s Department of Psychology are currently working on an improved screening instrument for autism called the Modified Checklist for Autism in Toddlers, or M-CHAT. According to the graduate student in charge of the M-CHAT project, Diana Robins, the goal of their research is to increase the sensitivity of the screening device so that there is a greater probability of detecting children with autism at a younger age.

The M-CHAT incorporates the original 9 yes/no questions found in the CHAT plus an additional 14 items that are derived from clinical instruments used to evaluate older children. A "no" answer on 3 of the 23 questions triggers follow-up evaluation for the child. The M-CHAT's less stringent cutoff point and additional questions are designed to lower the chance of failing to detect children with autism.

Another difference from the CHAT test is that the age of screening is set for 24 months. While this may delay identification of some children, it makes the screening procedure more likely to detect those children who appear to develop normally for a period of time and then regress later.

In the current M-CHAT project, all results are sent to the University of Connecticut for evaluation and follow-up. The follow-up consists first of a phone call to the family to confirm the original M-CHAT responses, and then a free and complete developmental evaluation of the child at the University of Connecticut’s Psychological Services Clinic. All a pediatrician or other early service provider is required to do is have the parents fill out the M-CHAT and forward the results.

Thus far, the M-CHAT test has been used to screen 1100 children. Of that number, 40 children were referred for further evaluation and 28 were diagnosed with autism/PPD. None of the 40 children sent for further evaluation were found to be developing typically.

Based on this data, the M-CHAT test shows great promise for the early detection of autism. According to Robins, future areas of research include a follow-up study of all children originally screened to judge the effectiveness of the M-CHAT further, and a study of the questions used in the M-CHAT to determine which have the greatest discriminative power between children with autism and their typical peers.

Another goal of the M-CHAT project is to get 100% participation from all the pediatricians in the state of Connecticut. Currently, Robins estimates that there are only about 100 Connecticut pediatricians implementing the M-CHAT. According to the Department of Public Health, there are 1,893 pediatricians practicing in the state of Connecticut.

CT FEAT would like to urge you to help in this important effort by contacting your pediatrician and strongly recommending that they implement the M-CHAT, if they haven’t already. For further information on the M-CHAT program, contact Diana Robins at the University of Connecticut at (860)-486-5767 or by email at dlr96001@uconnvm.uconn.edu.

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Discrete Trial Teaching, the new instructional video produced by New York Families for Autistic Children (NYFAC, 1999), provides an informative overview of the basic terms and teaching techniques used in intensive ABA programs.

Focused mostly on the very initial stages of treatment, the material is geared toward parents and professionals who are unfamiliar with ABA concepts and terminology. It should be particularly useful as an introduction to the subject for those who haven't yet received any training from a qualified ABA professional. Of course, ongoing professional supervision would be necessary to implement competently this type of treatment program for a young child.

The information is presented primarily in lecture format. Interspersed throughout are video clips showing how tutors implement these techniques in their work with real children. While not all of the tutors manage to convey the fun and enthusiasm typically found in a successful ABA program, the teaching demonstrations do help to illuminate and demystify what can sometimes be rather technical terminology.

Two of the featured presenters are certified in ABA, one as a Certified Behavior Analyst (CBA) and one as a Certified Associate Behavior Analyst (CABA). Topics covered include: discrete trials, SDs, reinforcers, gross motor imitation, receptive and expressive language, teaching a new skill, prompting, modeling, errorless learning, no-no prompting, shaping, generalization, and data taking. Data forms, which correspond to the ones shown in the video, are available at the NYFAC web site: www.nyfac.org.

We were disappointed that the video footage was shot exclusively "at the table." Perhaps it was more difficult to film children working "away from the table." But a more representative sampling of the activities in a typical, professionally supervised ABA program would have shown the children working and playing in lots of different kinds of settings. The video also didn't address the topic of "play skills," which has such an important place even in the earliest stages of an ABA program.

Perhaps these important aspects of a successful ABA program will be emphasized more in other videos in this series. Future titles include: behavior management, improving play skills, increasing language, toilet training, activities of daily living, teaching social skills, teaching academics, and classroom management.

NYFAC is to be congratulated for having responded to the tremendous demand for solid introductory training materials in a video format. The extent to which parents, individually or working together, have produced some of the most critically needed teaching resources is a truly extraordinary phenomenon. Catherine Maurice, Sabrina Freeman, and the various FEAT groups come readily to mind. NYFAC's Discrete Trial Training is yet another example of this principle at work in the autism treatment word.

The video runs about sixty minutes long and costs $59.99 plus $5 shipping. To order, call (718) 641-6711. For more information, visit NYFAC's web site at: www.nyfac.org. v

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My nine-year-old son has an autism spectrum diagnosis. After about four years of intensive ABA treatment, he now attends second grade in a small, private, mainstream elementary school where the teachers and staff do not know his diagnosis.

Due in part to his late start with ABA, my family has had to work especially hard to find ways to help him catch up with his peers. Two programs we have found very helpful have been Fast ForWord and the sequel program, Step ForWord (formerly called FastForWord II). Basic information about these programs can be found on the Scientific Learning Company's web site, at www.scilearn.com.

After providing an overview of how Fast Forword and Step ForWord work, I'll provide some specific examples from my family's experience that may help you decide whether your child might benefit from such a program.

The Fast ForWord (FFW) program consists of about a half-dozen "games," each of which works on a particular set of skills. Some of the games focus on auditory discrimination while others target comprehension.

Several of the games train the child to discriminate between similar sounds. For example, in one game, the child listens to two sounds, then a third. Then he has to decide which of the first pair of sounds matches the third. This exercise presents many combinations of sounds ("b" vs. "d," "t" vs. "d," etc.) and can seem quite repetitive.

Sometimes the drill may reveal a deficit area that was previously undetected. For example, I was very surprised to discover my son had trouble hearing the difference between "r" and "v" — a problem that didn't show up until he had been playing the game for days and easily discriminating among other sounds.

Another game resembles the card game "Concentration." The child matches pairs of sounds by clicking on pairs of "cards" on the computer screen. This game was supposed to build sound discrimination as well as auditory memory skills. But my son had a very hard time with it. It appeared that the starting level was too high for him and his completion percentage quickly hit a low plateau. Several other games trained attention and auditory discrimination of simple sounds (rather than words or sentences).

Two of the games focused on language comprehension. These games would ask increasingly challenging questions. For example, the "Block Commander" game started with directives such as "touch the circle." The screen would show something like a chess board, with a couple of shapes of different colors, and the child would click on the correct object. The instructions got increasingly difficult, ending with directives like "remove the small purple square and the large yellow circle," and "put the small blue circle between the large green triangle and the large blue square."

The other language comprehension game was called "Language Comprehension Builder." It asks the child to click on the appropriate picture for a given statement. The game starts with easier statements such as "the girl wears shoes." In this example, the child chooses between one of two pictures, where one shows a girl with shoes and the other shows the same girl without shoes. This game progresses in difficulty up to some very challenging items, like "the girl kissed the clown who was hugged by the boy," with the screen showing four possible selections. Each choice shows a girl, clown, and boy in some combination of each one kissing or hugging another.

"Language Comprehension Builders" also teaches specific grammatical constructs. After the child has completed a set of five questions regarding a specific construct, the program would move on to another construct. For example, to teach the significance of adding a certain suffix to an adjective, the child is asked to choose from successive pairs of pictures in response to a series of statements like: "the girl is dirtier," "the child is smaller," "the tree is bigger," "the man is hairier," and finally "the child is wetter."

A typical twenty-minute session of "Language Comprehension Builders" would give the child approximately eighty trials, which is a tremendous amount of practice! I suspect my son’s gains from doing Fast ForWord came mainly from his twenty minutes per day doing "Language Comprehension Builders."

The second program we did, Step ForWord (Step), differs from the original FFW in several ways. For example, Step has a reading component, as well as a story comprehension game. Step also handles differently the sound discrimination exercises, using real sounds where FFW uses "exaggerated" computer-enhanced sounds.

Also Step has fewer games — only five games total. And they can be done in any order the child wishes. All games are played every day, until some games are mastered and drop off the menu. In the original FFW, by contrast, the child keeps playing all the games, in seemingly random order, even if they have been mastered.

Step ForWord seemed easier and less burdensome for my son, and he seems to have gained at least as much from it as he had from the original Fast ForWord. I understand, however, that children are not permitted to do Step ForWord until they have been through Fast ForWord.

The outcome data provided by Scientific Learning Corporation relates to children who have followed a set exercise protocol, and their results are quite impressive. So we tried to adhere to that protocol, doing all the games exactly as specified. Hence, Mike always worked at least five days per seven-day week, and didn't take breaks of more than two days at a time.

Every two or three days we would upload my son’s game data to Scientific Learning (via modem). This is how we kept track of my son’s progress and completion data. We were also able to obtain detailed information on items missed as well as patterns of errors in my son’s performance.

We got started with FFW in the fall of 1998, when Mike was in first grade. He did the program in the afternoons, after he came home from school. Each day he would do just five of the games. The games were approximately twenty minutes long, and had to be played straight through without a break (although he could take breaks between games).

Unfortunately, and unlike in Step, Mike couldn't choose the order of the games. It would have made things a lot easier to know what games were going to come up that day, and when, and to have had some control over this. Some of the games were very tiring for him, which meant he needed significant breaks between games. Sometimes it took us three or four hours to get through the five twenty-minute games. Some nights he was up past his bedtime completing the program.

We kept to this schedule for almost eight weeks, whereupon we decided that Mike had had enough, even though he had not yet achieved the desired mastery percentages in a couple of the games. We quit the games when we saw that the scores seemed to have been stuck at a plateau for some time. Also, my son seemed to be reaching the limit of his patience with the exhausting schedule (school plus homework plus hours of computer exercises).

We found the FFW program highly beneficial to my son. But it was something of an ordeal to stick to the strict training protocol (required for best results). The sequel program, Step ForWord, was much easier. The games were more fun, and my son could do them in whatever order he chose. Also, since he did the sequel in the spring of second grade, my son was more advanced developmentally, with better attention and as well as general coping skills.

We were lucky to find a provider who would permit us to do the program at home. I cannot imagine how my son would have coped if we had been constrained to work in a provider’s office. On the days when my son needed lengthy breaks between games, this would likely have been impossible in an office setting. Also, by doing the program at home, we saved thousands of dollars (typically charged by those professionals who oversee the program at their own facility).

The licensing fee for a single child to do FFW or Step (which has to be paid directly to Scientific Learning Corp.) is around $850 dollars for each program. Our ABA provider supervised the program at no additional cost, so we managed to avoid paying any additional fees (beyond the two $850 fees to Scientific Learning). I know one parent who is looking into the possibility of becoming a certified provider of FFW herself, so she can avoid paying thousands of dollars to another professional to oversee her child’s progress. This may be a viable possibility for some families. Scientific Learning seems somewhat flexible concerning whom they will certify to administer their programs.

Throughout my son’s work on FFW, he still had several behavioral tutors coming over after school. They often watched Mike play the games, providing him with additional reinforcement for good effort and compliance. This could be viewed as an additional cost of doing the program.

Though the games are designed to provide reinforcement to the child, the built-in reinforcement is not always adequate. This is especially the case where the child has limited attention skills, as my son did, especially in first grade. I doubt Mike could have done the full eight weeks of FFW without such external reinforcement and support. I know several children who did not require this support, however, so it depends on the child.

My son’s listening and conversation skills have improved noticeably with both these programs. We also noticed that his ability to listen in on OTHER people’s conversations (even those taking place elsewhere in a room) improved dramatically after FFW.

We also noticed, after the first 10 to 14 days of FFW, that my son’s sentences got longer and more complex including, for example, more dependent clauses.

After Step, we continue to see many wonderful improvements in my son’s receptive, as well as expressive, language. He is not only listening in, but asking for the meanings of words he overhears. He now breaks into conversations to disagree or ask questions relating to the conversation. He can now say something to his brother like "The REASON you aren’t allowed to have that candy is Dad said we can’t eat any more junk before dinner." This type of complex, compound sentence used to be far above my son’s expressive language level.

My son used to have trouble following simple stories, but since Step he now enjoys "story time" at school and also at home. (I read to my children every night before bed.) Also, his reading has become more automatic and fluent. With Mike's improved story comprehension and reading fluency, we are now in a position to work intensively on his reading comprehension.

Mike never had much success with traditional (non-ABA) speech therapy. However, we have also struggled within the ABA program to find enough high level language drills for a child who is no longer a preschooler. He needed help to bridge the gap between his language level (which was perhaps at an age five or six developmental equivalent) and the level of his typically developing peers (who are now eight and nine years old). By boosting his language comprehension, these programs made it easier for Mike to tune in socially to what is going on around him.

FFW and Step have been an extremely valuable addition to my son’s therapy program. However, they do require a significant investment of time and energy, as well as money. I am not sure they would be suitable for children who are not already functioning at a level of at least a four or five-year-old (in terms of language as well as attention). However, for the slightly older child who still needs help to "bridge the gap" with typically developing peers, Fast ForWord and Step ForWord are wonderful resources.

(Editor's note: The names of the author and her child have been changed to protect "Mike's" privacy.)

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"Stressful" and "bewildering" are among the words that parents often use to describe Planning and Placement Team (PPT) meetings. The new Wrightslaw Tactics & Strategy Manual should make the whole PPT experience a lot easier.

The Manual is written in reader-friendly language, not legal jargon. Even parents who are veterans of PPT meetings will wish they'd read it sooner

While not geared specifically to autism spectrum disorders, the book does use examples that make reference to parents seeking ABA programs for their children.

The Manual is divided into three sections: "Obstacles and Problems"; "Tactics and Strategy"; and "Legal and Advocacy Information." The "Obstacles and Problems" section begins by describing that sense of emergency (which will be all too familiar to many parents) occasioned by some crisis in the child's educational program. There's been some sort of "last straw" and the parents feel betrayed.

The chapter goes on to recommend a "prevention model of special education advocacy" that can defuse conflict situations and maybe even eliminate the need for a lawyer. Some of the things parents can do to resolve these kinds of disputes is to become more knowledgeable about the underlying issues, such as: a parent's legal rights and responsibilities; special education; how to measure educational progress; and how schools work.

Parents might also consider joining a special education organization. Sometimes it will be a good idea to consult with a private sector expert. The Manual emphasizes the basic but often overlooked point that: "children with disabilities learn differently. Because they learn differently, they must be taught differently. When they are taught correctly, they can and do learn"(p. 10).

Chapter 2 leads the readers through all the various emotions they may experience upon learning that their child has a learning disability --shock and denial, anger, hard choices, sadness and guilt, and acceptance. The chapter also maps out the roadblocks parents may face, such as intimidation and over-protectiveness. The Wrights stress the importance of learning how to control emotions so that they don't interfere with doing the best job for our children.

Chapter 3 describes how certain dynamics built-in to "school culture" may result in a distorted view of the child's problems and needs. This section refers extensively to a study by Dr. Galen Alessi ("Diagnosis Diagnosed: A Systemic Reaction" in Professional School Psychology, 3(2), 145-151), which surveyed a group of 50 school psychologists who had evaluated approximately 5,000 children. The psychologists attributed ALL of the children's learning problems to parent/home and child factors. They completely overlooked or disregarded other important factors such as: inappropriate curriculum, ineffective teaching, and ineffective school management practices.

Chapter 4 explains the nature of conflict and gives some negotiating tips.

The second section of the Manual provides an overview of litigation, including suggestions that may avert the necessity for legal conflict. It outlines concrete steps on how parents can organize information, make a contact log, and gather information about their children. It also describes, in great detail, how to write effective letters, and how to prepare for meetings.

The final section of the book, "Legal and Advocacy Information," is geared toward the child's lawyer or advocate. It summarizes much of sections 1 and 2, and goes on to cover other information an attorney may need.

The Manual's authors are Peter W.D. Wright, Esq. and Pamela Darr Wright, MA, MSW. Attorney Wright has represented children with disabilities for more than 25 years. He represented Shannon Carter before the U.S. Supreme Court in Florence County School District IV v. Shannon Carter, where he won a landmark victory that benefits all children with disabilities. Ms. Darr Wright is a psychotherapist in private practice. She has written dozens of articles about special education advocacy for parents and attorneys, and designed the Special Education Advocate web site at www.wrightslaw.com.

The Tactics and Strategy Manual is 140 pages long unbound. Its first chapter, along with the table of contents, is available as a free download at www.wrightslaw.com. To order it, go to www.wrightslaw.com/store/index.html, or send a check for $19.95 plus $3.95 shipping to Harbor House Law Press, P.O. Box 480, Hartfield, VA 23043.

Another related book that parents may find helpful is Wrightslaw: Special Education Law. It includes the text of key special education laws and regulations, including IDEA 1997, Section 504 of the Rehabilitation Act, Family Educational Records and Privacy Act (FERPA), US Supreme Court Decisions, and analysis and interpretation. Its detailed index (also available as a free download) makes it easy for the reader to find where various topics, such as audio-taping IEP meetings and the "stay-put" provision, are discussed in the laws. It is 384 pages long, and is also published by Harbor House Law Press for$29.95 plus $3.95 shipping. If both books are ordered, the total cost is $45.00 plus #3.95 shipping.

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Tuesday, June 13^th - 7:00-9:00 p.m. "Surviving the Summer: Tips for Leisure Activities"

Presented by: Rebecca Ludlow, B.A.

I recently had the opportunity to attend a one-day workshop given by Vincent Carbone, Ed.D., CBA, on teaching language to children with autism, and to see what this approach entailed and how it differed from that used in a "typical" ABA program. The workshop was held on April 30, 2000, in Sturbridge, Massachusetts as part of 4-day conference (including other speakers) sponsored by an organization called Children Making Strides.

The methodology used by Dr. Carbone is referred to as "discrete trial training, natural environment teaching" (dtt-net). The focus is on the use of intensive discrete trial training but in a more naturalistic setting, with more natural presentations (SDs) and using more naturalistic reinforcers to teach skills. Carbone uses "errorless" teaching methods, as opposed to other error correction procedures like the "no-no-prompt." He places a heavy emphasis on the rapid presentation of instructional demands and the fluent (accurate and quick) responding of the child.

While these components can be found in varying degrees in ABA programs throughout Connecticut, it was Carbone’s approach to teaching language that I found to be most interesting. There has been a great deal of excitement and debate in the ABA community over the work of Dr. Carbone and his colleagues, James Partington, Ph.D., and Mark Sundberg, Ph.D.

The three have been at the forefront of a movement to teach language based upon the theories of noted behaviorist B.F. Skinner. Drs. Partington and Sundberg have published a contemporary manual outlining this approach and its teaching methods in Teaching Language to Children with Autism or Other Developmental Disabilities. For an extensive review of this book, see the Fall 1999 edition of the CT FEAT Newsletter, available online at www.ctfeat.org.)

Carbone focused his workshop on three of Skinner’s basic verbal behaviors: the mand, the tact and the intraverbal. A mand is a request for a reinforcer. It is a tendency to say "water" when you want it. A tact is the labeling, naming or identifying of objects, actions, etc. It is a tendency to say "water" when you see water. An intraverbal is answering "wh" questions or having a conversation when what you say is determined by what the other person says. An example of an intraverbal is saying "water" when someone else asks, "What’s your favorite drink".

Many traditional ABA programs focus initial language acquisition on labeling (tacting) and receptive language skills. SDs are generally kept simple, using minimal language (e.g., "Touch car" or "What is it?"). These skills are often taught at the "table" using pictures rather than three-dimensional objects.

Carbone instead focuses on initial language acquisition through manding. In this approach, the environment is arranged so that the child is highly motivated to mand, and when they ask, they get. This accomplishes two things. First, the child is initiating language. According to Carbone, the prevailing methods used to teach language in ABA programs results in many children speaking only in response to someone else’s initiation. His approach emphasizes teaching children to initiate through requesting. Second, because the request results in immediate reinforcement (they ask, they get), the teacher is strongly paired with the reinforcer. Thus, the child learns that interacting with the teacher is rewarding.

Carbone looks to have children in his program manding as often as possible, up to 1000 times a day if possible. Mands begin as one-word requests ("Water" when asking for water) and build to more complex and natural requests ("Can I have some water please?"). For children who initially do not have the oral motor skills to imitate or model spoken language, sign language is taught and used to begin the manding process.

Once a certain level of manding has been achieved, tacts and intraverbals are introduced and taught simultaneously. Drills are mixed and mass trialing is avoided. Carbone mixes language drills by following the acronym RFFC (Receptive by Feature, Function and Class). A child may be asked to "hand me the yellow vehicle," "show me what kids take to get to school" and "touch the thing that has tires" all in rapid succession. SDs are varied and delivered using natural, everyday language.

Because drills are varied and children are not allowed to give wrong answers (errorless teaching), Carbone maintains that motivation remains high and avoidance behaviors are minimal. The video examples Carbone showed during his presentation seemed to support this contention.

As instruction is designed to be fast-paced and fluency is emphasized, teachers are not required to collect data during instruction. Instead, a baseline assessment of the child’s skill acquisition is performed at the beginning of each day. Another notable difference from typical ABA programs is that Carbone does not immediately require or teach attending skills, such as eye contact. He prefers to let eye contact and attention develop as a natural by-product of the instructional methods.

As an experienced and generally skeptical ABA parent, I found myself very excited about the Carbone/Partington/Sundberg approach to language and some of their program ideas. I would recommend attending one of their presentations and reading the Partington/Sundberg manual to help parents get new ideas for their child’s program.

CT FEAT is currently in contact with Dr. Carbone regarding bringing him here to Connecticut for a workshop in the near future. We will publish more details as they become available. Check our website, ww.ctfeat.org and future issues of this newsletter for further information.

CT FEAT’s quarterly Parent Resource meetings provide parents with an opportunity to network with each other in a confidential setting. The first half-hour, from 1:30-2:00, is dedicated to orienting newcomers. This is followed by a presentation (speaker, video, etc.) pertaining to treatment or advocacy issues. The only requirement for participation is that parents agree to respect each other’s confidentiality.

These meetings usually take place on Sunday afternoons, beginning at 1:30 p.m., at the Rocky Hill Congregational Church on 805 Old Main Street, in Rocky Hill, CT. The next meeting will take place on September 17^th. Please visit the CT FEAT web site  or call the CT FEAT hotline (860-571-3888) to request directions or any further information.

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