Facilitate That: Part II of a Two-Part Interview with Dr. James Todd
Conducted by David Celiberti, PhD, BCBA-D
President, Association for Science in Autism Treatment
We have received wonderful feedback on the first part of our interview which was featured in the Spring 2010 issue of this newsletter. I am grateful for your willingness to respond to a few more questions that are less relevant to facilitated communication and more related to how we can address the proliferation of pseudoscience in general within the autism community. It clearly takes a village to counter the influences of pseudoscience.
Q: Given the significant impact that pseudoscience has had on our field, what should ABA organizations do to better address this issue? In your view, what are they not doing?
A: We should start with the working assumption that pseudoscience flourishes in a vacuum. It is a creature of opportunity. If there is something better than the pseudoscience, and people can see it, the pseudoscience will wither and die. We also need to remember that bad science drives out good. You will not be able to sustain high scientific standards after you become willing to endorse autism interventions based on the most marginal evidence, or, after you succumb to empirical fatigue, when you actually believe that any treatment claim must be accepted by default until there is direct experimental evidence against it. Under those circumstances, why would anyone who has a treatment to sell, bogus or not, risk subjecting their stuff to experimental test? Thus, if those who promote science-based solutions could do anything, they need to show to non-scientists that what they have is better than what is claimed on behalf of the pseudoscientific alternatives. At the organizational level, they must avoid the situational empiricism that often besets specialty organizations when they discover that diminished and selectively applied scientific standards often result in a a larger membership and expanded influence. How do you know when empirical fatigue has set in? It's when you resign yourself to asking, “What could it hurt?” instead of “Why not the best?”
But we can't just say it. As good as our data are, just throwing them out there won‘t convince very many people. People need to see in clear and tangible ways that evidence-based practices are better. Popularization is necessary. Unfortunately, most of us are no good at engaging the public. Our talent lies in speaking to the single-digit percentages of people who actually enjoy things like a 50-minute lecture on the relative merits of no-prompts and errorless procedures. And, for its part, the public is not all that interested in the technical details of what we do. Thus, we need to recruit celebrities willing to become knowledgeable and serve as spokespeople, establish some good media contacts who will call us for sound bites, develop strong relationships with wealthy science-favoring foundations, find people among us who can speak and write for the general audience, and develop some memorable hooks. A big group read of Dale Carnegie's How To Win Friends and Influence People probably wouldn't hurt. We need to be attractive, fun, interesting, and credible from the outset. We need to lead with our results, not our technology.
Consider this. Skinner published “How to Teach Animals” in 1951 in Scientific American. Everyone wants to teach his or her dog a trick, and that‘s an audience of millions. But Skinner led with his technology. It took almost 40 years for reinforcement-based animal training to become the norm. If it hadn't been for things like Karen Pryor‘s popularization efforts, reinforcement-based training procedures would still be called “experimental animal training.” The name “Clicker Training” is genius. Because of it, we see clickers for sale by the cash register in all the big pet stores.
The historian John Burnham, the same John Burnham mentioned in my earlier interview, reminds us that classical behaviorism was little more than an academic curiosity until Watson published his 1919 popular book, Psychology from the Standpoint of a Behaviorist. Our version of behavior analysis is not dominant right now because of Skinner's The Behavior of Organisms (1938), which historian Terry Knapp (1995) reminds us originally sold only a few hundred copies. Walden Two (1948), Science and Human Behavior (1953), and Beyond Freedom and Dignity (1971), each written for the general audience, were the catalysts for that. ABA might be a much smaller dot on the autism map but for Let Me Hear Your Voice, which provided an opportunity for the public to learn about behavior analysis, perhaps for the very first time.
Technical exposés of bogus treatments and theories are not the way to go with the public, except maybe the science nerds. You certainly do not convert the rank-and-file with that approach--essentially telling them they're wrong. Try it as an experiment. See what happens. Reactivity is a real behavior, and a highly probable one. This advice also applies to what we say about their leaders. Simply criticizing Jenny McCarthy for not knowing what she‘s talking about -- or Andrew Wakefield for that matter -- is more likely to consolidate support for what they say than to cause people to listen to you. McCarthy may seem like a soft scientific target. But in reality she is a public relations genius. Think about it. McCarthy is a college drop-out who used to have a website called “indigomoms.com” that recommended Angel Therapy and Quantum Resonance treatments for autism. She seems to believe that polio outbreaks are good things (Time, April 1,2009; http://tinyurl.com/d5msxt). She shills modern-day patent medicines on her Generation Rescue website. Despite all this, she has convinced physicians and PhDs that she should be the keynote speaker at their conferences. If we are going to try to compete in her arena, we have to know what we are doing.
A caveat: We must absolutely keep up our science. It has served us well and will continue to do so. Our stuff is so good that others either make it the main target of their criticisms, plagiarize and repackage it as their own, or endorse it as an adjunct to whatever it is they do. However, when we do give our science away, we should never let the contingencies of popularization supersede the contingencies of excellence and methodological rigor. That has been the fate of many people and organizations. The American Psychological Association (APA) talks a good game about science, and I think many in the APA are sincere about it. But at the 2009 APA convention in Toronto, one of the more popular sessions (with an audience over 100) included one talk about using brain scanning technology to determine which ancient Central American priest a medium was channeling. It was followed by about improving upon William MacDougall's theories about the psychic carrying capacity of the universe. In comparison, my Facilitated Communication talk had almost 25 in attendance, including me and one heckler. The Autism Society of America, apparently fearing a loss of membership, dares not take a stand against even the most scientifically-repugnant autism interventions.
Of course, it is also entirely appropriate for our experts and professional organizations to call out their counterparts for their misinformation and forays into pseudoscience. Much of my published work does just that. If nothing else, ASAT, ABAI, and any other group or individual who cares about being accurate and honest, need to tackle the popular but false meme that ABA treatments are “cookie cutter” or “one size fits all,” produce robotic kids who have “skills” but no socialization, involve long stretches of boring repetitive drilling, and are devoid of love, fun, and natural social interaction. The purveyors of Floortime, DIR, FC, Sensory Integration, Auditory Integration Therapy, Gentle Teaching, Rapid Prompting, and their kin are not telling the truth when they say those things about ABA. Well designed ABA programs are nothing if not individualized, varied, enriching, engaging, social, and effective.
If we weren't trying to be individualized and effective, why do they suppose behavior analysts still read Sidman's 1960 Tactics of Scientific Research, the classic reference on single-subject experimental designs – the exact methods needed to evaluate individualized interventions? Well, most of them aren't supposing anything because they aren't that aware of our, or any other, scientific literature. But, if they were aware, they'd not just know about the importance of individualization within ABA programs. They'd also know that good ABA programs move as quickly as possible to the most natural contingencies possible. It would not take them long to find out why--that ideas like those in Stokes and Baer's “Toward an Implicit Technology of Generalization,” which is all about how to successfully transfer treatment effects to the natural environment, are foundational to our tradition, not theirs. Additional observation would show them that social skills are actually fundamental components of good ABA programs, especially for kids with autism who have so much difficulty with seeing other people as sources of social reinforcement. They'd know, if they cared to look, that variety and interpersonal engagement are hallmarks of well-conceived ABA programming. They'd see, first hand, that “reinforcing” is just another word for “fun,” and that any ABA program worth its salt maximizes reinforcement because doing so will maximize learning. What they already do know — and I hope this is a source of considerable embarrassment for them- is that not only don;t they have the data to show their treatments are better than ABA, they don't even have the data to show that their stuff does what they say it does! Misrepresentation is an important competitive tactic in the developmental disabilities wars,and for obvious reasons. The people with the least effective treatments need to use it the most.
Here's the thing: Although we can‘t forget Charlie Ferster's work on autism in the early 60‘s, probably the earliest example of the use of ABA with autism as we know it today was published in 1964: “Application of Operant Conditioning Procedures to the Behaviour Problems of an Autistic Child” by
Mont Wolf, Todd Risley, and Hayden Mees. This is the last sentence of that classic article:
According to a report from the mother six months after the child's return home, Dicky continues to wear his glasses, does not have tantrums, has no sleeping problems, is becoming increasingly verbal, and is a new source of joy to the members of his family.
“A new source of joy”— that’s vintage Mont Wolf. Any endeavor launched with an amazing affirmation like that is entitled to point out, as often as is necessary, that it long ago figured out what is fundamentally important: real joy is worth a whole lot more than false hope.
Q: You offer excellent insights that should be considered by the larger organizations in the field. What about individual behavior analysts working on multi-disciplinary teams?
A: That's a tough one. I tried to encourage some ethics experts to address that very question in a session at the BAAM convention in February. They were very good at resisting my efforts as session chair to get them to talk about it. Of course, beyond saying “hold the line on science,” there is no easy answer. The basic problem is that these multi-disciplinary teams are often creatures of politics, legislation, expediency, accident, and even superstition. Treatment decisions can be, and usually are, controlled more by social contingencies than scientific evidence. The works of social psychologists such as Solomon Asch, Stanley Milgram, and William Whyte thus become more important for understanding treatment decisions than the behavior analytic works of Mont Wolf, Todd Risley, and Don Baer. The rationalization for the multidisciplinary approach is that autism is a constellation of problems best treated with a multiplicity of approaches. While good behavior analysts know that they must be broadly knowledgeable about development, psychopathology, pharmacology, and other relevant content even from outside their own discipline, they also know that the evidence does not support “eclectic” treatment approaches to autism--except in the very specific areas that other disciplines do have bona fide evidence of effectiveness. Behavior analysts, finding themselves in such straits must make themselves believe that they are at least getting something important and effective injected into the treatment mix, modeling, hopefully with humility and tact, objectivity and data-based decision-making. However, they then lose sleep wondering where it will end. To what extent are they just doing the best that can be done under circumstances they cannot control, and to what extent are they compromising their scientific principles, and even their ethical ones? Once you've decided to strategically overlook the inclusion of the ineffective, time-wasting fancy that discipline X insists on, how hard will it be to stop dangerous dalliances into things like chelation, facilitated communication, or rapid prompting?
What to do on the IEP? General advice is hard because IEPs are like snowflakes. No two are alike. Obviously, a good scientist offers the best, most scientifically-valid recommendations available, consistent with ethical principles and laws. Thus, you must first decide if you can participate at all, particularly if the IEP decisions are likely to be ineffective, dangerous, or unethical. If your participation is enough of a net good, the next step is to carefully study and understand the limits of the system in which you are working so that you can scale your recommendations and expectations appropriately. An unimplementable suggestion is just a waste of time, and undermines your credibility. Likewise, figure out who the other members are, learn their backgrounds, beliefs, and read their works (if they have them). You might avoid stepping on a few land mines if you know the particular sensitivities of the others in the group. Disagree in a constructive manner, and avoid being summarily dismissive. Try to build sound principles into the other interventions whenever the opportunity arises. If someone wants a chewy, rubber “sensory” item used, and won't be dissuaded, you might suggest that systematically fading it out would be good next step toward further habilitation and social integration. A constructional approach is generally more acceptable in these arenas. So if the behaviors are not simply so dangerous as to require quick elimination, lean toward building new replacement behaviors.
You will encounter people who believe that changing any behavior is an inappropriate affront to “individuality.” It is OK in those circumstances to gently suggest that bizarre mannerisms, aggression, and such things will, if nothing else, interfere with social integration. It is nice to dream about a Nirvana where everyone accepts everyone unconditionally. But we're usually talking about integrating children with fragile adaptive skills into one of the most difficult, punishing, and aversive settings known to all of humanity: a school full of children. Most of the group will agree with you. Consider how you present scientific treatments. Technical language is a turn-off in many groups, especially words like “control.” Try saying something like this when someone objects to the supposedly horrible, dehumanizing application of ABA--which will happen sooner or later: “It's not like that really. ABA begins by making the needed social, academic, and living skills as easy and rewarding as possible for the child. It then works to make those newly learned skills fit naturally and increasingly well into everyday settings.” I am not talking about dumbing things down. Your colleagues, even the ones who believe in pseudoscience, are as smart as you are, maybe smarter. You can be sophisticated, just not incomprehensible. Be nice--which is always puzzling to people who believe that scientists are cold and insensitive. If you have substantive issues with something, say so politely so that your specific concerns can be put on the record. Also, keep your own record of your recommendations and observations in a secure, HIPAA-compliant, journal. By all means, always avoid sounding ignorant about other disciplines. Get a mainstream negotiations book, such as Getting To Yes (Fisher, Ury, & Patton, 1991), being careful to separate the good advice from the managerial chatter. And, of course, line your shelves with everything Aubry Daniels has written.
Q: Those are excellent suggestions. At IEP meetings, I used to worry that I would sound too predictable by asking questions such as “How will you measure that?”, “How will you ensure that you are not wasting Johnny's precious time?”, “What data are you basing that upon and can we see it”, “Are there any published research articles to support what you are suggesting?”, and so on. I then realized that I was already making inroads if the team knew how I would respond to vague goals or unsubstantiated methods. What are the three most important things needed to bolster a shared commitment to science and to attenuate the influence of pseudoscience?
A: The first requirement is a broad, and comprehensive knowledge of scientific method. That means reading Sidman, Skinner, Campbell and Stanley, John Stuart Mill, books by conjurers-scientists like James Randi and polymaths like Martin Gardner, and everything else that reinforces the methods of science in making decisions about the way the world works. It means knowing all there is to know about your own subject matter. It means knowing all about those things you intend to challenge.
Apply scientific methods and your knowledge of content, to the greatest extent possible, to any decision you make, especially if it involves the well-being of other people.
You must always and without reservation regard yourself as being even more susceptible to biases and fallacies than your subjects and co-workers. As far as objectivity is concerned, you have met the enemy and he is you (to paraphrase Pogo, that famous marsupial of an earlier time). Perhaps repeating this 1993 statement by Paul Meehl at the beginning of each day might not be a bad idea:
“It is absurd, as well as arrogant, to pretend that acquiring a PhD somehow immunizes me from the errors of sampling, perception, recording, retention, retrieval, and inference to which the human mind is suspect. In earlier times, all introductory psychology courses devoted a lecture or two to the classic studies in the psychology of testimony, and one mark of a psychologist was hard-nosed skepticism about folk beliefs. It seems that quite a few clinical psychologists never got exposed to this basic feature of critical thinking. My teachers at Minnesota … shared what Bertrand Russell called the dominant passion of the true scientist – the passion not to be fooled and not to fool anybody else … all of them asked the two searching questions of positivism: 'What do you mean?' 'How do you know?' If we clinicians lose that passion and forget those questions, we are little more than bedoctored, well-paid soothsayers. I see disturbing signs that this is happening and I predict that, if we do not clean up our clinical act and provide our students with role models of scientific thinking, outsiders will do it for us” (pp. 728-729).
Q: Can you provide our readers with some specific homework? What titles would be good reads and why?
Thank you for asking. I recently gave a presentation called “Some Books Behavior Analysts Should Be Reading But Probably Aren't” and a sequel, unimaginatively titled, “Even More Books Behavior Analysts Should Be Reading But Probably Aren't.” Thus, I have some ideas.
First, we need to get our own house in order. I meet a surprising number of behavior analysts who have read little or no original behavior analytic literature aside from a few assigned journal articles, and it shows. Anyone who calls himself or herself a “behavior analyst” had better get a copy of Science and Human Behavior, read it, and understand it. I'm not talking here about an exercise in textual devotion. Skinner figured out a lot, and his work is an important resource. The same applies to Skinner‘s Cumulative Record (1972), which is essentially a “best of” collection. Cumulative Record has the advantage that its chapters can be read in any order. Given that we‘re dealing with pseudoscience, and FC in particular, readers of Cumulative Record should consider starting with “Has Gertrude Stein a Secret?” That article is about Stein's use of “automatic writing” to compose parts of some of her books. Automatic writing is relevant because it is essentially writing without being aware of what you are writing – or even that you are writing at all. Behaviorally, automatic writing is an important phenomenon because it shows that the activity we call “awareness” is controlled by a different set of contingencies than those that control the other things we do. Thus, it should hardly be a surprise that facilitators, like automatic writers, can compose meaningful verbal behavior while being entirely unaware that they are the authors of it.
Always investigate deeper and further. For instance, read the original Solomons and Stein 1896 article on automatic writing (http://tinyurl.com/346v5tz). It is a fascinating account of how people can learn to be unconscious of their own writing movements, and how they come to attribute their own movements to external forces. You probably didn‘t know that the answer to FC was already in the psychological literature almost a century before FC showed up as a practice!
Anyone who thinks they are doing “verbal behavior analysis” (aka VBA), or anything else with behavior, needs to read and understand Skinner's Verbal Behavior. And don't let me catch you saying it's a book about language. Verbal Behavior is a work of social psychology, using examples from discourse to show how interacting and interlocking contingencies of reinforcement between the speaker and verbal community can establish behavior of astounding complexity and subtlety. It applies to language, but to almost everything else humans do as well. And, germane to our discussion here, practically every important methodological bias, logical fallacy, and bizarre belief we encounter is the result of social contingencies establishing behavior that is inconsistent with the instructional control we call “rationality.” Additionally, once in possession of a copy of Verbal Behavior, get a copy of John Platt's 1973 article “Social Traps.” Verbal Behavior shows how people come to believe weird things; “Social Traps”shows why it is so hard to “unbelieve” them.
Don't be scientifically xenophobic. If you are, do some informal exposure therapy by reading Daniel Wegner‘s 2002 book, the Illusion of Conscious Will. It proves two things: (1) Some people don‘t know that they are really behaviorists; (2) cognitive psychologists may be doing better and more broadly-relevant research on verbal behavior than behavior analysts are. Nearly 40 years ago, Kurt Salzinger told us to pay attention to cognitive psychology in his review of Neisser's Cognitive Psychology. I am quoting his 1973 statement in the hopes we might now get the message:
It behooves us, as good citizens of the science of psychology, to shirk no area of psychology as long as we can apply scientific method to it. The research in cognitive psychology is certainly interesting, on the whole well executed, and very challenging. It is well within the scope of a behavioristic approach. It merely awaits more attention from behaviorists. (p. 369)
Starting from different premises, Wegner comes to basically the same conclusions as Skinner did about the nature of private verbal behavior. We feel like our thinking directly controls our more outward behavior even when that is usually not what happens. Because we like to feel in control, the illusion of "agency" or free-will is reinforced, and we learn to strategically downplay, misidentify, or ignore the things that actually control our behavior--making all of those mistakes that social psychologists call "attributional errors" in the process. Germane to the present discussion, Wegner describes some very clever experiments he has done on FC that nicely show how facilitators come to mistakenly attribute the output to the subject. But he also covers mediumship, dowsing, and other fancies that directly inform our broader understanding of pseudoscientific thinking. A behavior analyst might say that Wegner has done a good functional analysis of the contingencies that establish and maintain pseudoscientific behavior.
Don't disregard the past. Some of yesterday‘s follies are today‘s faux-therapies. For a good sample of these things, check out and read Joseph Jastrow's 1935 Wish and Wisdom: Episodes in the Vagaries of Belief. Jastrow, a psychologist of the late 19th and early 20th centuries, covers many pseudoscientific phenomena, including Ouija Boards, clever horses, psychic dogs, the placebo effect, all kinds of biases, conscious frauds, sincere frauds, and especially foolish scientists. One of my favorite stories is the case of Lola the talking dog (pp. 211-213)--one of a whole pack of talking dogs that appeared in Germany in the early 20th century. Lola's putative communication method, described in detail in a 1922 book by Henny Kindermann (available online, http://tinyurl.com/29wrgpl), will be immediately seen as a hybrid of Facilitated Communication and the Rapid Prompting Method--the latter essentially being a version of FC in which the cues for pointing do not involve physical contact. Lola's hidden literacy, supposedly representative of the latent cognitive talents of all canines, was revealed through careful tutelage in a communication system in which Lola tapped out an alphabetic code in her owner‘s hand, sometimes her owner holding Lola's paw to prevent impulsiveness. In standard FC fashion, Lola even supposedly complained of being insulted when someone proposed a controlled test of the validity of her communication! In recounting the tale of Lola, as he did with the rest of his targets, Jastrow quickly cut through much bunk with an incisive understanding of basic experimental methodology. He did not usually spend a lot of time on exhaustive analyses. For Jastrow, one fatal methodological flaw was usually fatal enough. In recommending a book now almost 80 years old, I am trying to show how ossified these superstitions are, how many of them are still with us, and how the rationalizations supporting them have remained the same despite the advance of science all around them.
Add to your reading of Jastrow a perusal of Milbourne Christopher‘s 1970, ESP, Seers, and Psychics. It includes a fascinating account of Lady Wonder, a Richmond Virginia typing horse. Lady Wonder tapped out her messages on a large keyboard, illustrating, as did Lola, many of basic features of the Rapid Prompting Method. As noted by Christopher, among Lady Wonder‘s methods was scanning her head back and forth across the keys while being cued for the correct letter to press by subtle movements of her owner. (Watch for something similar apparently happening when you see Rapid Prompting done with children pointing at letter boards.) Just as FC and Rapid Prompting have fooled PhDs today, Duke University psychic investigators Joseph and Louisa Rhine, helped by James McDougall, were unable to figure out exactly what was happening. They eventually concluded that the horse might actually be psychic (Rhine & Rhine, 1929a, 1929b)—sort of like Paul Haskew and Anne Donnellan (1993, pp. 12-14), unable to grasp the significance of failed double-blind tests of FC, concluding that their subjects must be directly reading the minds of the facilitators. Like James Randi—whose book Flim Flam is a dated but valuable read—Christopher shows that magicians can be better methodologists than many who claim to be scientists. The advantage may be that magicians are better prepared than scientists to assume that their subjects could be conscious frauds. Scientists, it seems, are often far too trusting and naive, thus getting duped with fair regularity by the purveyors of false claims.
Read Robert Rosenthal's 1966 Experimenter Effects in Behavioral Research. We don't hear as much about “experimenter effects” as we used to. But now that behavior analysts are mostly studying human behavior in relatively poorly-controlled natural settings, they really need to pay more attention to the fact that we and our subjects are important and troublesome biasing elements in our own research.
In the same vein, I would suggest getting Rosenthal and Sebeok's 1970 Clever Hans Phenomenon: Communication With Horses, Whales, and People and Sebeok and Umiker-Sebeok's 1980 Speaking of Apes. All of the problems associated with FC were previously encountered by the researchers, and described in detail in these books—expectancy biases, inadvertent authorship by observers, sloppy procedures, statistical anomalies leading to erroneous conclusions, and even rationalizations by researchers unwilling to accept their own methodological failures.
Of course, anyone interested in these matters must own a copy Pfungst's Clever Hans. It can be downloaded free in PDF and EPub format from Google, and available in hard copy from at least one reprint service. It is difficult to believe that in the early 1900s, the double-blind methodology used by Pfungst to show that the horse was responding to unconscious anticipation cues was a relatively new thing. It is amazing to read about a top-notch functional analysis being worked out in real time, leading to the resolution of a problem that evaded efforts of all previously sent to solve it.
Without question, if you‘re interested in FC itself, read Howard Shane's 1994 Facilitated Communication: The Clinical and Social Phenomenon and Herman Spitz's 1997 Nonconscious Movements: From Mystical Messages to Facilitated Communication.
Closing with more practical matters: Run, don't walk, to your computer and download Baer, Wolf, and Risley's “Some Current Dimensions of Applied Behavior Analysis.” Read it and know it. Too many seem to see this article as merely defining the fundamentals of applied behavior analysis. But it is far more than that. The seven dimensions of applied behavior analysis together comprise a comprehensive rubric for therapeutic program evaluation and quality control. Any good clinical effort should possess all seven dimensions, regardless of whether it is a large center-based effort or an individual toilet training program. Can you take your treatment, whatever it is, and show that it passes each of the seven tests? Is what you do actually applied, behavioral, analytic, technological, conceptual, effective, and general? If not, you are drifting away from behavior analysis, and toward those things that are not science-based. Set aside a few minutes and apply the same seven rules to Floortime, DIR, FC, Rapid Prompting, Son-Rise, and all the other things that claim to treat autism. I can assure you that to one significant degree or another, none will pass the test.
Your final points are well taken. No intervention should get a “pass” on these important dimensions. Until proponents with broader treatment community embrace these dimensions as their own, the onus will continue to fall on consumers to separate the wheat from the chaff. Thank you for another incredible interview.
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