A review of Mary Lynch Barbera & Tracy Rasmussen's the verbal behavior approach: how to teach children with autism and related disorders.

This is an informative and important addition to the books that exist for parents of children with autism spectrum disorders. While the interest in Verbal Behavior programming for learners with autism has mushroomed over the past few years, there is a paucity of books outlining how to implement the approach, and this book addresses that need. Furthermore, it is a very easy-to-read and parent-friendly book . Families will find the specific "how-to" approach to be extremely useful.

Ms. Barbera clarifies for readers that VB is part of Applied Behavior Analysis. There is widespread consumer confusion on this relationship, and this clarification is a service to the parent community. The book offers a number of excellent concrete suggestions, and provides rationales and background information substantiating those recommendations.

Understanding ABA and a VB approach

This book serves to educate family members exceptionally well on several of the most important concepts and foundational ideas of ABA. Ms. Barbera does an outstanding job of explaining why the ABC's (Antecedents-Behaviors-Consequences) of behavior are so important to understand. She is especially good at explaining the importance of determining the function of challenging behaviors. This will help parents as they try to unravel the seeming mysteries of their children's behaviors. She also clearly outlines how treatments must match the functions of behaviors, and how appropriate replacement skills must be taught to address the same function.

Reinforcement is also well explained. Parents will appreciate the author's concrete suggestions, which are thorough. For example, she suggests increasing the ratio of reinforcing to corrective statements made to a child with autism. Specifically, she encourages families to aim for a ratio of 8:1 (reinforcing to corrective statements); this is exactly the kind of concrete and specific recommendation that families can use. She also gives excellent suggestions about identifying potential reinforcers, which is a constant struggle for many families.

The author's discussion of Verbal Behavior and its utility as a classification system for teaching language is well thought out and clearly written. There is a very easy-to-follow approach and explanation of verbal and non-verbal operants. She also does an excellent job of orienting the reader to speaker behavior, listener behavior, and other important core skills critical for learners with autism.

The chapter on manding is full of excellent "how-to" suggestions for families seeking to increase requesting behaviors. In particular, the clear emphasis on pairing is superbly outlined and explained. Step by step suggestions for mand training via sign are offered. There are excellent suggestions on integrating manding into the curriculum, both in the form of integration into work sessions and as separate manding sessions. In the context of integrating manding into work sessions, she highlights the importance of the gradual increase in demands. Other major contributions in this section include suggestions on how to take data on prompted and independent mands, recommendations for data collection within sessions and throughout the day, and thoughts on how manding skills can be continually deepened, expanded, and improved.

Other areas that are very useful include her discussions of errorless teaching and her recommendations for building independence in self-care skills. In errorless teaching, she clearly helps parents to understand the importance of teaching skills well and of preventing errors. In the self-help area, she outlines successful well-known strategies that may assist in achieving success in this area. She also highlights the importance of developmental readiness and of attempting to effect change first through positive reinforcement based procedures alone.

In general, the book is an excellent source of information on Applied Behavior Analysis and on Verbal Behavior. It serves to clear up some major sources of consumer confusion, most notably about VB's embeddedness within ABA. There are countless helpful and well-grounded suggestions for parents who are interested in using this approach with their children.

Cautions

It is important in considering this book to also look to potential misunderstandings. While the author does an excellent job of describing and attempting to prevent the further fueling of divisiveness in the field, it is still possible that consumers could be confused on a few points. While it is the case, for all of the reasons cited, that VB programming is an excellent means of building skills and that a VB approach (or other naturalistic ABA methods of teaching) is superior to DTI (Discrete Trial Instruction) for increasing spontaneity and initiation, it is important (for us as clinicians) to also underscore the role and utility of DTI.

As is well-known to ABA practitioners, discrete trial instruction (DTI) uses repetition and sequenced instruction to build a variety of skills in students with autism (Lovaas, 1981; Lovaas, Koegel, Simmons, & Long, 1973; Smith, 1993). It has been effective in teaching a wide variety of core skills in a structured, formalized context. Elements of effective use include errorless learning procedures (e.g., Etzel & LeBlanc, 1979; Lancioni & Smeets, 1986; Terrace, 1963; Touchette & Howard, 1984) and task variation and interspersal (e.g., Dunlap, 1984; Mace, Hock, Lalli, West, Belfiore, Pinter, & Brown, 1988; Winterling, Dunlap, & O'Neill, 1987; Zarcone, Iwata, Hughes, & Vollmer, 1993). It is important as clinicians that we continue to utilize effective methods of instruction to build skills, and to report accurately to consumers about the evidence and utility of instructional approaches.

It is true that naturalistic ABA instruction, such as Incidental teaching, will lead to more generalization (than DTI). Skills taught more naturalistically clearly generalize much more readily and with far less effort than those taught through discrete trials (e.g., Hart & Risley, 1982; Fenske, Krantz, & McClannahan, 2001; McGee, Krantz, & McClannahan, 1985). It is also true that naturalistic approaches (Such as Incidental Teaching or mand training) are generally better suited to increasing initiation and spontaneity (e.g., Fenske, Krantz & McClannahan, 2001; Sundberg & Partington, 1998.). DTI and naturalistic ABA instruction target different deficits, and may be best suited to teaching different skills.

At times, consumers fail to appreciate the need for the integration of the approaches of DTI and naturalistic methods, and may fail to understand how a comprehensive ABA program may best meet the needs of learners. It is possible that readers may fail to understand how important DTI still is in teaching skills, and may fail to understand which skills are best taught through which instructional approaches.

In a similar vein, it is important for clinicians to also underscore the potential relevance and utility of PECS (Picture Exchange Communication System). While Ms. Barbera clearly has a preference for sign (as do many of the best known VB clinicians), data on the comparative efficacy of sign and PECS approaches is limited. A rejection of PECS is simply not warranted from a scientist/practitioner perspective. PECS is based on Skinner's VB classification system, and relies heavily on it in teaching the functions of language (Frost & Bondy, 2002; Bondy, Tincani, & Frost, 2005). Furthermore, many children are currently communicating efficiently and effectively and independently with PECS, and should continue to build communicative ability within that system. As clinicians, it behooves us to be as individualized and data-based as possible in decisions about things as central as communication modality.

One shortcoming of the book is in the description of the origins of VB theory. The author fails to describe how it is an extension of both the philosophy of radical behaviorism and of basic laboratory science. Students of the field may be frustrated with the incomplete description of the theoretical origins of the approach. Similarly, students of the field may be disappointed by the incomplete treatment of the research within VB. The book does not purport to explain the existing literature within VB. However, the lack of attention to fully explicating the research in VB leads to an incomplete rendering of the approach.

Furthermore, within ABA as a field, we need to be careful about creating and adopting new terminology which is not conceptually systematic. While it is clear what the author means when she discussed doing "cold probes" or when she describes "ITT (intensive therapy teaching)", it is important to distinguish those terms from ABA core definitions and concepts, to help students of the discipline and consumers to think and communicate more clearly about the field of study. There are several examples of terms (such as those given above) that are not part of the basic science, are not used in descriptions of VB research, and are not utilized in common clinical applications/uses of VB in programming for students with autism.

Finally, Ms. Barbera's enthusiasm for the field and personal experience as a consumer of services are two of the variables that make this book so compelling and so on-target. Nevertheless, there are times when it makes for potential misunderstanding. For example, when she talks about seeing vocal progress in Dr. Carbone's videos (which are compelling, impressive, and moving), her enthusiasm could lead some parents to misunderstand the likely outcomes. While 14 year olds do occasionally become vocal communicators, more often they do not. We have to be responsible in presenting the range of outcomes to consumers. Also, while the stories of what worked for her son are interesting and excellently placed throughout the book, we should also remember that those remain strategies that worked for one individual child, and which should not be broadly applied to the population at large.

Messages for parents

The messages for parents in the final chapter are especially compelling. It is here that one can really see the benefit of her experience on both sides of the parent-professional partnership. Her advice to focus not on recovery, but on maximizing a child's potential is wise indeed. The ambiguity of the early years of autism is perhaps the greatest stressor for families, and the narrow focus on recovery may obscure the importance of celebrating all of the successes a child achieves. There are not enough discussions in the professional realm about the negative effects of the focus on recovery, and her articulation of these points is very much needed. While hope is essential in helping families to mobilize and to obtain the best quality services, we must also be sensitive to the ways in which black and white thinking harms families and clouds our view of each child's progress. Her message to avoid the high vs. low functioning trap is also on target. Each child's skills and deficits need to be evaluated in detail, and a comprehensive assessment will inevitably identify both areas of great strength and areas in need of attention. Identifying children in global evaluative terms such as high or low functioning does not focus the treatment team on what needs to be done, and may prevent the team from identifying the most salient needs and successes.

Ms. Barbera advises parents to be ready to advocate and to learn all they can. These are good pieces of advice, as they will lead to parents being effective and fully participating members of their child's educational team. She also advises parents to take care of themselves. For many families, this particular piece of advice will fall on deaf ears, at least for the first year or two of intervention. But the message is an important one. As she says, for most families this is a marathon, not a sprint. Families need to store their energy, shore up their reserves, and plan for a longer haul. These words are so much more powerful for having been spoken by someone who has been there.

One of her pearls of wisdom to parents in this section is to make just one change at a time in a child's treatment program. This is very practical and intelligent advice. It is true that many families will stumble across and try a number of different strategies to help alleviate their child's symptoms. While we can debate the scientific merit of any or all of these approaches, the fact is that the majority of families will pursue one or more of them. Given that reality, her advice is excellent, as it will help to ensure that data can be evaluated to assess the impact of such approaches in an objective manner. In this way, families can make sound decisions about the merits of a given approach, based on objective data about how it helped (or failed to help) their child.

Finally, she talks of making lemonade out of the lemons life has offered. This seems to represent the ultimate coping model for parents. Individuals who not only rise to their challenges, but who also find meaning and joy in them, are those who fair better in the long run. They acknowledge their lives as forever altered, but recognize that some of those alterations are precious and positive.

Summary

This book is an important one. Parents will be delighted with its easy and practical approach. It fills a void that currently exists for families trying to figure out how to do a VB approach. Furthermore, it explains a great deal about how ABA approaches behavior and teaching. The sections on rapport building, the importance of motivation, errorless teaching, and reinforcement are well-written, accurate, and perfectly suited to the needs of parents and professionals new to this approach. Her words of advice to families are spoken from the heart and are very wise.

Professionals and students of ABA will find this book less useful (than families will) as a resource, as it provides little information on the theoretical foundations of VB or on the existing research on using a VB approach with individuals with autism. However, they will find it to be a useful reference for families seeking concrete, how-to information on working with their children.

Families may be confused as they grapple with the complexity of the field and the specifics of the approach. Clinicians should be available to help families in understanding the most important elements of the approach, in individualizing the program for any given child, and for ensuring that misconceptions do not impede the development of a maximally effective program.

References

Bondy, A., Tincani, M., & Frost, L. (2004). Multiply controlled verbal operants: An analysis and extension to the picture exchange communication system. The Behavior Analyst, 27, 247-261.

Dunlap, G. (1984). The influence of task variation and maintenance tasks on the learning of autistic children. Journal of Experimental Child Psychology, 37, 41-64.

Etzel, B. C. & LeBlanc, J. M. (1979). The simplest treatment alternative: The law of parsimony applied to choosing appropriate instructional control and errorless learning procedures for the difficult-to-teach child. Journal of Autism and Developmental Disorders, 9, 361-382.

Fenske, E. C., Krantz, P. J., & McClannahan, L. E. (2001). Incidental teaching: A not-so-discrete-trial teaching procedure. In C. Maurice, G. Green, & R. M. Foxx (Eds.), Making a difference: Behavioral intervention for autism. Austin, Texas: Pro-Ed.

Frost, L. & Bondy, A. (2002). The Picture Exchange Communication System Training Manual. Newark, DE: Pyramid Educational Products.

Hart, B. M., & Risley, T. R. (1982). How to use incidental teaching for elaborating language. Austin, TX: Pro-Ed.

Lancioni, G. E., & Smeets, P. M. (1986). Procedures and parameters of errorless discrimination training with developmentally impaired individuals. In N. R. Ellis & N. W. Bray (Eds.), International review of research in mental retardation, 14 (pp. 135-164). Orlando, FL: Academic Press.

Lovaas, O. I. (1981). Teaching developmentally disabled children: The ME book. Baltimore: University Park Press.

Lovaas, O. I., Koegel, R. L., Simmons, J. Q., & Long, J. (1973). Some generalization and follow up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6, 131-160.

Mace, F. C., Hock, M. L., Lalli, J. S., West, B. J., Belfiore, P., Pinter, E., & Brown, D. F. (1988). Behavioral momentum in the treatment of noncompliance. Journal of Applied Behavior Analysis, 21, 123-141.

McGee, G. G., Krantz, P. J., & McClannahan, L. E. (1985). The facilitative effects of incidental teaching on preposition use by autistic children. Journal of Applied Behavior Analysis, 18, 17-31.

Smith, T. (1993). Autism. In T. R. Giles (Ed.), Effective psychotherapies (pp. 107-13). New York: Plenum.

Sundberg, M. L. & Partington, J. W. (1998). Teaching language to children with autism or other developmental disabilities. Pleasant Hill, CA: Behavior Analysts, Inc.

Terrace, H. (1963). Discrimination learning with and without errors. Journal of the Experimental Analysis of Behavior, 6, 1-27.

Touchette, P. E. & Howard, J. (1984). Errorless learning: Reinforcement contingencies and stimulus control transfer in delayed prompting. Journal of Applied Behavior Analysis, 17, 175-181.

Winterling, V., Dunlap, G., & O'Neill, R. E. (1987). The influence of task variation on the aberrant behaviors of autistic students. Education and Treatment of Children, 10, 105-119.

Zarcone, J. R., Iwata, B. A., Hughes, C. E., & Vollmer, T. R. (1993). Momentum versus extinction effects in the treatment of self-injurious escape behavior. Journal of Applied Behavior Analysis, 26, 135-136.

Author Contact Information:

Mary Jane Weiss, Ph.D., BCBA 

Research Associate Professor &

Director of Research & Training

Douglass Developmental Disabilities Center

Rutgers University 

151 Ryders Lane

New Brunswick, NJ 08901

[e-mail]

[phone] ext. 158