Renato Gentile

Autism: my shredded paper

Pronominal mand with autistic children

ABA Conference. Venice, 30/11/2001

PRONOMINAL MAND WITH AUTISTIC CHILDREN (Renato Gentile, et al)
(Edited by Gary Novak)

Experimental researches on verbal behavior are fundamentally pursued to improve our scientific knowledge in two main fields: a) how language develops (what are the environmental variables that control the development and emission of verbal behavior and b) how is it possible to design intervention or rehabilitation strategies.
Deficits and delays in language development, that characterize the behavior of disadvantaged or handicap individuals, can be faced and solved only through verification of empirical data that continuously drive new research.
The fundamental function of verbal behavior is to practice determined effects on the environment. As we know, a very strong relationship exists between the behavior of the speaker and the listener’s, and the occasion in which the episode occurs.
One of the most critical problems in special education is the absence of spontaneous verbal production in developmentally disabled subjects, above all those with autism. It is frequently observed that the form of verbal interaction acquired in rehabilitation settings remains often under the control of well defined, but very, very limited environmental and contextual conditions. Probably this is due to the “excessive control” by the unique variables established in the educational setting. In this setting the behavior is not under the contextual factors that exist in a natural interaction and that represent the “real situations”.

The verbal production, so-called spontaneous, that a child develops in a natural context of growth, is formed in maximum part by mands relationships. In special education settings, what we normally observe, at least in Italy, instead of mand teaching, is that some specialists promote above all tact or ecoic emissions (rarely intraverbal ones), that do not drive, automatically, to the production of mands , since these two are independent operants (Skinner, 1957). [that are defined as “voluntary”].

The present work is developed on the basis of these theoretical considerations and on the methodological principles of the “missing pieces” teaching procedure elaborated by Carr and Kologinsky (1983). But it proposes an original conforming development to the demands of the educational interactions of a trial in progress. The methodological issue contributes to the development of the process of generalization in the re-education of the subjects with autism. There were three needs that our research tried to address:
¨ first of all the need to establish manding (we must not forget that trough mand we can control the environment)
¨ second, the need for establishing a response repertoire that could supplement the lackness of specific vocabulary
¨ third, the need to avoid establishing a stereotipical response if general one was learnt

METHOD: Material

The training material consisted of two wooden puzzles composed respectively of 4 and 5 parts that fit in a 25 x 25 cm. panel. The parts of the first puzzle showed some details of a factory house (roof, wall, window/flowers and door). Each of these items could be labeled. According to the methodology of “mand for lacking parts”, previously described by Hall, the subject had been previously trained to utter mands for asking each part of the first puzzle in order to complete the assignment of reassembling the picture of the house. The second puzzle, composed of 5 parts, represents a butterfly, the single parts were not easily “named”: the body and the wings were divided in 4 quarters (upper right and left, lower right and left). Finding an easy name for these parts was very complicated, even if not impossible, but for our purpose, this feature was suitable to what the child to demands parts through a generic issue, pronominal, like “this one”. Every part of the puzzle had its forced seat and had to be inserted in the correct place in the sense that the right wing and that left were not interchangeable.

Subject
The subject of our work is a 4 year-and-half-old child with a history of various diagnosis and medical checks. The first diagnosis was of ipoacusia, with bilateral loss of 35%. Such diagnosis was subsequently turned down by an examination on the Evoked Potential. A careful diagnosis, done by a psychoanalyst was: “congenital afasia derived from autism born and maintained by liberation authority. The last diagnosis pointed out Childish Psychosis and it suggested psychoanalytic therapy handled for two years. At the beginning of the rehabilitation project, the child exhibited a wide repertoire of inadequate and disruptive behaviors. Any attempt of approach and interaction was vain. He showed impatience: he screamed and threw himself down on the ground and yelled. He was trying to go out of the room.
Frustration derived by result in failure to avoid the environment. He finished this reaction after about 15 minutes, and he began to play with his shadow reflected, as broken, on the wood sliding-board that was in the room. From the observation and from the assessment emerged a pattern of remarkable delay in the development of the language and, above all, a high deficit in verbal “comprehension” (he answered in right way only to the volume of his father’s voice when said “keep-silent”, “keep-still”, “take that, give me”). The basic skills were completely absent.
Above anything else was the incapability to remain seated for an appreciable enough time.

The behavior repertoire was very characteristic.

The behavior of the child was rich with ritual and obsessive schemes.
His principal activity was to hide small objects in some places of the house.
He did not leave the house if his pockets were not full of objects that he collected, like small cars, wheels, filberts, pieces of toys, and other.
During lunch he required that all objects on the table were arranged according to the symmetry; he smelled the foods before eating and ate pale (light) foods namely not “colored” like tomato sauce, fried food, vegetables, fruit with the peel etc.). He showed suffering if he saw a bottle without cork. He stopped eating if the cork was not set in the bottle.
The glass from which he drank had to be filled up to the edge otherwise he would not drink.
At school he lived in complete isolation, he spent time placing the toys in the shelves, also removing them from the hands of other children.
When he discovered “Play-Dough”, he began the following unique activity: He plugged the holes of any toy; as soon as he saw an empty part he filled it up with the “Play-Dough”.

The management of the behavior was altered strongly by a continuous and excessive administration of candies by the mother. This produced two minutes of silence and peace from the child. According to a functional model of behavioral analysis, the disruptive behaviors has been analyzed and then extinguished. We obtained suitable behavioral patterns, like activation and maintenance of attention and motivation. After 12 months, we moved on specific programs of verbal education.

PROCEDURE
The complete training is composed of four phases. The first phase was meant to familiarize the subject with the material, either to understand the structure of the composition, or to set up an establishing operation. In this phase the subject draw up a personal sequence to reassemble the puzzle. The order was: the body (central part), the right wing (first the upper part and then that lower), and finally the left wing. The second phase required the assembly of the puzzle of the house following a mand training. This task was familiar to the subject and allowed us to control his anxiety in the following assignment in which he would have met difficulties in answering. In the third phase he received the panel of the butterfly puzzle. The tiles were arranged on the table, in a line according to a random order.

Therefore the child was asked “which one do you want?”, if the child did not answer verbally but lengthened the hand to take the item he wanted to fit, his behavior was gently stopped. The experimenter suggested the verbal answer “this one”, and contemporarily to this utterance he closed the hand of the child, and let the finger (index) pointed out and touched the item the child wanted to take.
If the child did not answer at all, the experimenter behaved in the same way, he grasped the hand of the child, closing it but for the index and repeated “this one” touching the item with the finger. If child remained mute, or wanted to get up from the chair showing impatience and refusing the task, the experimenter took the item and showed it saying “do you want this?”. The child was able to answer “yes”, therefore he got the item to insert. The procedure continued until the puzzle was complete. During the procedure we increased the distance between the items and the panel so to make less easy for the child to grab them rapidly. Naturally the distance was not such to create the condition to transform “this” in “that”. Again this distance was lately progressively decreased while maintaining the procedure effective.
The child learned in short time to answer to the request of the experimenter adequately but we became aware that the answer had become like a stereotypic one, it was too fast. Maybe too easy. Perhaps ecolalic. The danger of a generalized answer, not controlled by environmental variables, but controlled by a variable ratio schedule, was likely (see our old papers) to occur. So we began the fourth phase whose goals were to put the correct answer under the control definite verbal antecedents and contextual cues. In this phase the child received the two panels of the puzzles, both put on the table close to each one. All the 9 items were lined up on the table, in a random order.
In the first trial of this phase, the child had to recompose the pictures, choosing the item from left to right without skipping any one. Then the experimenter moved the items, a few centimeters away from the panel and asked the child “what do you want?. The subject had to ask for the item, within 5 second from the request, verbalizing the name of the object if it was a part of the puzzle house (roof, door, wall and flowers) or to point out the item and say “this one” if the item belonged to the picture of the butterfly. The session went on until both pictures were reassembled. An error of 20% was allowed for two consecutive trials.

RESULTS: The results show the cumulative record for mands and the pronominal mands during the sessions. – Insert figure of the cumulative graph
On the abscesses it is reported the casual sequence relative to the disposition of the material according to which the child could uttered the verbal requests.
On the other axis the answer that the child uttered at each trial.
On the first line a wrong answer is pointed out (-), on the second (0), no answer, on the upper line the correct answers (+).
We show some samples of data. Insert graphics

COMMENTS
The subject had to utter 9 correct answers to complete the task.
Each session finished when the subject reached 78% of the correct answers two times consecutively (only two errors within each trial were allowed):
The subject entered a training session every two days.
The training was concluded when the subject emitted the correct answers 100% of times.
We do not show the data of the sessions during which the behavior has been shaped and in which the verbal request was modeled.
Modeling the application has been relatively easy thanks to the preceding mand for missing pieces training.

Conclusions: Autistic children does not develop this kind of verbal behavior;
Their behavior is poorly controlled by the environment, and by the verbal behavior of the others. Moreover they do not control the environment with their own verbal utterance, but they interact preferably with no verbal ones.
In these years we have tried to analyze complexity (that source from rehabilitation necessity), of the contextual factors in some kind of verbal relationships. The target is to isolate, analyse and therefore try to check the contextual factors (external and internal antecedents), that act.
Our proposals have been always oriented to the contextual teaching of the two terms of relationship during the same training. We suggest to teach the different relationships between antecedent events (verbal e not verbal) and its own consequences.
The contingencies, in such way, are made explicit time after time in turned by the contextual situation. We escape from the “trap” of the variable ratio schedule of reinforcement, that works very hard with stereotypic behaviors of the autistic children.
The same answer (see Yes, No), for example, can originate different consequences based on the relationship between verbal stimulus and setting events.
The Verbal response controls two listeners’ behavior: the experimenter (who give) and the subject (who grab).
This cunning conducts to the extinction of the stereotypic verbal answer, the only form of answer they usually uttered.
Finally the phase of generalization works very well if compared with published data on autistic syndrome. This opens a widen view (panorama) of the situations of every day life.
We have also underlined some probable intrinsic factors (we might say organic), that can hinder the learning of these discriminations.
The stereotypic verbal utterance, the overselectivity but also external factors, relative for instance to the schedules of reinforcement that don’t put in evidence adequately the contingencies during the learning procedures, may affect the learning of the relationship. Is our opinion that:
The dynamics of the verbal interactions with autistic children can and we should say must be analyzed within a behavior analytic framework.

Thank You For Your Kind Attention
Renato Gentile
Licenza Creative Commons
Quest’ opera è distribuita con licenza Creative Commons Attribuzione – Non commerciale – Condividi allo stesso modo 2.5 Italia.

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