Real life, real progress for children with autism spectrum disorders: Strategies for successful generalization in natural environments.
Real life, real progress for children with autism spectrum disorders: Strategies for successful generalization in natural environments is edited by Dr. Christian Whalen, a licensed psychologist and Board Certified Behavior Analyst who specializes in autism spectrum disorders. According to Whalen, in addition to difficulty communicating and disparities in abilities, the third characteristic common to almost every person on the autism spectrum is lack of generalization. Generalization is defined as the ability to "learn certain skills and functions, how to interact and relate to others, and how to take these learned abilities to matrix into or craft new seamless skills and experiences" (p. xv). Without generalization, a laundry list of "mastered" skills may have no social significance. Throughout the book, it is lamented that "train and hope" is both the least effective and most often implemented generalization strategy, if it can even be considered a strategy. Given that generalization has been recognized as the most advanced stage of skill development in the field of applied behavior analysis (ABA) for years, Whalen notes, "It is about time someone wrote a book about generalization in autism spectrum disorders (ASDs)" (p. xiv). The underlying theme of this book is that generalization is critical and it must be planned and measured.
Real life, real progress is divided into two sections. Part I reviews popular autism interventions and intervention-specific generalization strategies. Each chapter is devoted to increasing generalization through a specific intervention: Pivotal Response Training, Discrete Trial Instruction, Picture Exchange Communication Systems (PECS), social stories, and computer-assisted interventions. Within each chapter, easy-to-read lists and tables summarize how to enhance generalization both within and outside of teaching sessions.
It is important to note that some interventions have a stronger research base than others. For example, while well-designed research studies have demonstrated support for the efficacy of Pivotal Response Training, the evidence supporting computer-assisted interventions is weaker and does not allow for full confidence in their effectiveness. According to the National Autism Center's National standards report, three of the treatments discussed in Real life, real progress (DTI, PRT, and story-based interventions) are categorized as "established treatments," while two (PECS and technology-based treatments) are considered "emerging" (National Autism Center, 2009).
The chapter on Discrete Trial Intervention (DTI) is particularly interesting, as DTI has a strong research base and is proven effective, but is also inflexible and specific by nature. The authors confirm, "disadvantages of a DTI approach to instruction include an exclusive emphasis on responsivity and limited generalizability" (p. 43). Real life, real progress highlights some modifications to traditional DTI, called "state-of-the-art characteristics," that promote generalization, including fast-paced instruction, use of natural tone of voice, and variability of wording in instructions (p. 44). Despite these suggestions, it is still important to note that DTI consists of one-to-one training that occurs in a tightly-controlled learning environment. DTI alone is unlikely to encourage children to initiate or generalize use of skills across environments (Smith, 2001). However, more recently developed interventions (some of which are detailed in other chapters) are both effective and naturally promote generalization, and may be complementary or superior to DTI regarding generalization.
Part II addresses generalization applications to parents, schools, and community. These chapters emphasize the fact that generalization is not likely to occur if a child is exclusively taught by a specific individual (e.g., teacher) in a specific environment, (e.g., classroom). The home and community is a child's most natural environment and parents, caregivers, and even peers can be valuable teachers. Importantly, the lines of communication must be open among everyone who interacts with the child. Chapter 9, "Generalization in school settings," includes a nice appendix: "School-home communication and data sharing sheet." This one-page form is completed by the teacher and parent, and includes information about things that happened at home and information about things that happened during the school day so parents and teachers can follow up with the child about events they were not present for.
The strengths of Real life, real progress lie primarily in its organization. Especially in Part I, it is easy to locate an intervention and find specific tips relating to promoting generalization. Each chapter has tables where the main takeaway points are easily accessible. Yet, the book is comprehensible as a straightforward read. Basic strategies are reinterpreted for each intervention; ideas and strategies build on each other as the underlying thread of generalization weaves through. In addition, pictures and diagrams help to make the text readable. Most chapters also have several appendices where concepts from the text are demonstrated and/or blank, photocopyable templates are available.
The book has some weaknesses as well. While in general the book is cohesive, chapter 7, "The JumpStart Learning-to-Learn Model: Parent training in naturalistic teaching for children with autism spectrum disorders," seems out of place. This chapter is an evaluation of a relatively unknown program that lacks a research base, unlike the Part I chapters that address interventions that are widely known and available. In addition, this chapter lacks a clear focus on generalization. A final, general critique is that the size of book is significantly smaller than a standard 9.5 x 11 piece of paper. Therefore, the appendices, which are intended to be photocopied, leave a lot of empty space on the page.
This book is relevant for parents, caregivers, and therapists, and clearly has value for anyone who works with children with ASDs. It provides a way to quickly find guidelines to improve generalization through the interventions already in place, (e.g., a therapist who specializes in PRT can browse through chapter 2, "Enhancing generalization of treatment effects via pivotal response training and the individualization of treatment in protocols," and find valuable pointers through the tables and section headings), and a reference for those who are frustrated with the challenges of teaching generalization and looking for new ideas or interventions. Both a novice and an expert can pick up this book, browse through a given chapter, and identify behavioral strategies to assist in generalization.
Despite the fact that generalization is considered an essential part of learning, Real life, real progress is the first book to discuss the necessity of planning for generalization in children with autism spectrum disorders. Without generalization, "mastered" skills are irrelevant. What good is the ability to initiate play if a child can only do it in his bedroom with his sister and not at school or a birthday party with his peers? Hopefully, this is the first of many resources to speak to methods of addressing and improving this important skill.
National Autism Center. (2009). National standards report. Randolph, MA: Author. Retrieved from: http://www.nationalautismcenter.org/pdf/NAC%20NSP%20Report_FIN.pdf
Smith, T. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Other Developmental Disabilities, 16 (2), 86.
Reviewed by Jamie Schutte, MS, CRC, University of Pittsburgh