No!

ABA relies on the principles of reinforcement to build important skills. What serves as reinforcing is different for all of us. For example, money in the form of a paycheck is universally valuable to those in the workforce, but other forms of feedback also dictate our performance. Some of us are motivated by opportunities for growth in our careers, some by positive feedback from colleagues or customers, and some from the pride they get in their own work. All of these variables impact how hard you work, what is “worth doing,” and the quality of your performance.  The same is true for individuals recieving ABA therapy to directly build skills. There are certain consequences that are much more immediate (like food, access to an activity or location, or the immediate removal of something nonpreferred) that often serve as more impactful consequences. How a therapist identifies what will be reinforcing for any individual client depends on many variables, including how difficult the skill is to for the individual to build, the context in which the skills is being learned or will be utilized, and the total amount of highly preferred things that individual shows interest in. Oftentimes, food being used as reinforcement occurs when a skill is extremely difficult for the client, when the total list of things the client interested in is limited to a small set (in these instances, expanding interests should be a therapy goal), and how important it is for the reinforcement to be immediate and consumable after the skill is demonstrated.

At baseline, these are two distinct therapy disciplines. Speech therapists go through rigorous and specialized training in the development of communication skills, which includes the physical development of the motor skills required to use spoken language, different processing pathways to developing communicative skills, and different systems through which an individual can communicate if they aren’t using spoken language (sign language, picture exchange, electronic augmentative communication devices). In the school system, these are the professionals trained in the types of broader speech and language assessments required to assess communication systems and provide individualized therapy to build these skills.

Behavior analysts are also trained in communication but in a different way. This training looks primarily at the function of communication, what purpose do individual types of words or phrases serve, and how can you improve these skills based on their function and the individual’s current skillset. Behavior analysts look at things like labeling vs. requesting as functions for the same exact word (e.g., saying “apple” when you see a picture of an apple has a different function than saying “apple” to request an apple to eat). While these disciplines are distinct and most often function separately, the best outcomes come from collaboration between ABA therapists and speech therapists. Both can work on language and communication based skills in different ways and collaboration always leads to the best outcomes. Often ABA therapists are involved most heavily in helping to strengthen individual communication skills that have been identified, either through ABA assessments or speech and language assessments. ABA therapists can work on communication skills without a speech language therapist, the collaboration and requirements for both depend on the individual client’s needs, funding for those therapies, and the environment that the skills are being worked on (e.g., school vs. just at home vs. in an adult post-education setting).

This comes down to application vs. the foundational principles. Discrete trial teaching, which is one of many strategies employed by BCBAs, can seem and appear more “robotic” due to the simplicity of the teaching structures and how repetitive they can be. That being said, that strategy is utilized due to the needs of that individual client. Many individuals with autism or developmental disabilities may require much more repetition to acquire and maintain a skill than would be available in a general education environment. Discrete trial teaching in and of itself is a way to conceptualize learning by breaking down a skill into its small component parts and buildling them slowly together. For example, something as simple as waving back to someone requires many foundational skills including visual attention, the ability to imitate the motion of others, and to understand the cues in the social interaction that make it appropriate to wave back. In a “typical” learning pathway, these skills would be learned all at the same time. For many individuals with autism or developmental disabilities, isolating which of these component parts are missing from the individual’s skillset, or how many skills can be learned at the same time, is critical to them making progress.

I have personally worked in spaces where you would have a hard time telling that discrete trial teaching was taking place from observation. It’s all about the practitioner and their ability to apply these concepts in a meaningful and socially significant way. Sometimes there is a need for very simple, repetitive and seemingly “robotic” instruction to build foundational skills. Most often, these teaching strategies can be employed in a more naturalistic way. 

No!

The field is ever evolving, course correcting, and improving in its ability to effectively train practitioners to implement assent-based care. There have absolutely been practicioners and practices that historically have not looked at instruction following with the nuance it requires. The ability to understand and follow instructions is a critical skill for all humans, especially when it comes to health and safety. That being said, there are also instances when blindly following instructions can be extremely dangerous. An ethical and effective BCBA is responsible for building trust, rapport, and buy-in with their clients. This looks and feels different based on the client’s skillset,  the context of the skills being taught, and the cultural norms and practices that are relevant to that client and their community. Differentiating when to demonstrate a skill, and more so when not to, can be extremely difficult to teach especially for individuals with autism or developmental disabilities. This complexity makes it necessary for the therapist to work closely with the client, the caregiver, and their communities to identify what assent looks like for that individual, what skills are necessary for the client’s health and safety, and to always be looking for how the skill will generalize across contexts and be teaching to this from the beginning. Communication skills should always be targeted to help teach clients how to say no and to effectively articulate their wants and needs. Similarly self-regulation skills are also critical to teach, as there will always be times when we have to do something we don’t want to do, but need to do for our health or safety (I personally always have a hard time when I go to the dentist and will always choose the couch over exercise). It’s all about the application.