A Good Place to Start: A Review of Right From the Start: Behavioral Intervention for Young Children with Autism (2nd ed.), by Sandra Harris and Mary Jane Weiss

Abstract

A child's diagnosis of autism often presents parents with an overwhelming and seemingly unmanageable list of questions, tasks, and predicaments. In this second edition of their book, Right From the Start: Behavioral Intervention for Young Children with Autism, Harris and Weiss present clear and concise answers to many of the questions posed by parents and offer in-depth information about early intensive behavior intervention and effective behavior analytic practice.

“Every parent should have this book!” is a declaration many behavior analysts have in their repertoire when meeting parents who are beginning the journey with a child just diagnosed with autism or a related disability. We all have our favorites; for example, no library should be without such texts as Behavioral Intervention for Young Children with Autism: A Manual for Parents and Professionals (Maurice, Green, & Luce, 1996) or The Power of Positive Parenting (Latham, 1994). Sometimes, however, book recommendations made by professionals are accompanied by such disclaimers as “It is a bit scientific,” “It is a bit long,” or “I don't agree with everything in this book, but most things are relevant.” These are familiar comments I have heard and, dare I say, have made about several other books that offer guidance and suggestions about autism or other disability-related topics, parenting skills, or teaching verbal behavior. Another book has emerged on the list of “must-haves” that can be recommended to parents without such caveats.

In the second edition of Right From the Start: Behavioral Intervention for Young Children with Autism, Harris and Weiss (2007) successfully cover a broad range of topics regarding the use of applied behavior analysis (ABA) for treating young children with autism. They do so in a brief, easily readable format for parents who are looking for quick, research-based answers to their questions. The authors provide just enough knowledge to enlighten readers without delving so deeply into each subject area that they risk overwhelming those new to ABA. This edition improves upon the first edition, with attention towards early intensive behavioral intervention (EIBI; Chapters 1 and 2), credentialing of related professional services such as speech therapy and at-home consultants (Chapter 3), and teaching methods, such as direct instruction and natural environment teaching (Chapter 6). Additionally, updated information is offered about the most recent research efforts in the area of EIBI (Chapter 2) and the different types of school programs that offer EIBI services (Chapter 4). These helpful and instructive additions support the purchase of the second edition, even for those who have read the original text.

This book is particularly suited for parents and other caregivers interested in the ABA approach to autism therapy. Questions about where parents should seek treatment, how many hours of treatment are enough, and how to get support from the public school system are answered within this text. Importantly, the answers are supported by the past 20 years of behavior analytic research rather than anecdotal testimonials, and they are answered in a style that assuredly will be comforting to parents. Each chapter begins with a true family story about a specific challenge faced, as well as the successes, failures, excitements, and disappointments experienced along the way. Each chapter also ends with a set of brief parent comments and stories called “Parents Speak” that will likely have parents sighing in relief that other parents have experienced similar trials and felt similar emotions.

Chapter 1 introduces readers to EIBI and describes how this type of treatment is based on a solid foundation of ABA principles and procedures. This is an especially critical addition to the second edition due to the fact that autism and autism treatment interventions have become so well known and publicized in the popular media. Parents are bombarded with an incredible amount of information about which autism treatments are effective and what they need to ask of their school district and of other providers. This chapter helps to clarify misinformation by highlighting the difference between the term “early intervention,” which refers to generic services for infants and toddlers with all kinds of disabilities, as compared to EIBI, which involves a comprehensive program of instructional techniques and protocols for children with autism supported by research and based on the science of behavior. A useful description of what one can expect to see with EIBI is given at the outset of the chapter to provide a snapshot of the different types of teaching scenarios. Additionally, the authors briefly describe several ABA instructional methods used during EIBI, such as discrete trial instruction/training (DTI/DTT), incidental teaching (Hart & Risley, 1975), natural language paradigm (Koegel, O'Dell, & Koegel, 1987), pivotal response training (PRT; Koegel & Koegel, 2005), and natural environment training (NET; Sundberg & Partington, 1998). More importantly, the authors use the first chapter to dispel some of the longest lasting myths of ABA treatment by describing how these various forms of instruction are derived from behavior analytic principles. The first chapter ends with a brief run-down on the legalese behind early intervention and EIBI to educate parents about their rights to receive such services.

Chapter 2 verifies the claims in the first chapter by documenting the empirical evidence in support of EIBI. Instead of presenting case studies or stories, the authors summarize the research findings on EIBI and core ABA principles for teaching children with autism. It is important to emphasize that the scientific evidence supporting behavior analytic treatment is only skimmed in this chapter. However, parents reading this book can begin to understand that ABA methodology is a critical component of successful early intervention programs. From the perspective of a professional in the field of behavior analysis, it is refreshing to know that readers of this book will be exposed to the science behind the procedures. Our field is well recognized for the use of rigorous methods to empirically test intervention procedures. Parents reading this chapter will get exposure to the scientific roots underlying ABA instructional procedures. As a result, they may begin to look more closely for the research behind other therapies that are heralded by internet sites and endorsed via parent success stories.

The second part of Chapter 2 breaches a topic not often covered by other texts, which is how parents can evaluate current research and how it relates to their children. A list of essential research terms is given to help parents demystify the language used in scientific studies. In addition, nine questions are posed that parents should ask about research to evaluate not only the scientific rigor of the study, but also how to use the research toward making better intervention decisions for their children. In this section, the authors describe the value of group designs for determining treatment effects, and they list a variety of outcome measures that are commonly used to evaluate progress. Although group design studies are essential for validating the large-scale effectiveness of EIBI services, the authors failed to introduce parents to the value of single-subject experimental designs. In my experience, parents and other educators often find it difficult to read and interpret the direct observation data from single-subject graphs. Given the emphasis placed by behavior analysts on individual behavior change, it is important for parents to be educated about the power of single-subject experimental designs, as well as the typical methods used for collecting objective data to verify behavior change. At the conclusion of Chapter 2, the authors provide helpful information about how to evaluate the pros and cons of taking part in research projects and how to avoid the pitfalls of being involved in less than ethical or professional research attempts.

Chapters 3 and 4 confront two other large decision hurdles for parents: What school and what type of program are right for my child? Chapter 3 gives examples of various school options that are typically available to young children with autism, including public schools, private schools, university-based schools, university-based programs, and home-based services. To illustrate the different educational environments and services available, Harris and Weiss choose a sample program to exemplify each category, which allows parents to determine what makes the most sense for their children. Chapter 4 elaborates on three common options: home-based therapy, center-based therapy, and school-based therapy programs. As a supplement to the information provided in the previous chapter, the authors describe each program option in terms of what it looks like, what the programming will entail, how much it will cost, and what types of services will be provided. The authors acknowledge that there is no research or data to support the effectiveness of one program type over another. However, they provide information about what programs are available for young children with autism, what goes into each level of support, and how parents can get assistance in identifying what help is necessary and feasible for their children.

Chapter 5 begins what could be called “phase two” of the book, as it provides more in-depth information about curriculum development, as well as the “ABA way” of organization and management. The Assessment of Basic Language and Learning Skills (ABLLS; Partington & Sundberg, 1998) is introduced as a foundation for assessment and programming. In their discussion of curriculum development, the authors make a simple but valuable point about the importance of teaching foundational skills. Parents are sometimes confused by the emphasis placed on the seemingly simple task of adapting the child to the learning environment and instructor-led teaching. Furthermore, parents are initially discouraged that ABA therapy does not begin by targeting complex social and communication skills that their children desperately need. This chapter offers expert advice on which skills are practical to address during the initial stages of EIBI, including rapport building and establishing interest in instruction. The authors also give a bit of history about ABA therapy, which should help prepare parents for the systematic nature with which programs are implemented and the importance of shaping the first steps towards success.

The latter section of Chapter 5 takes the reader through a sample EIBI curriculum with target behaviors and programming procedures. The authors address the potential effects of challenging behaviors and other factors on progress during intensive teaching, and they explain how curriculum changes and development can minimize these barriers to success. Finally, the essential curriculum elements are described in relation to all-important Individual Education Plans and Individual Family Service Plan goals, which may assist parents in incorporating ABA principles into the everyday lives of their children. Overall, the detail in this section makes for one of the more informative chapters in the second edition. That being said, a bit more careful and thoughtful read may be required to glean all of the valuable information contained within Chapter 5. Another noteworthy aspect of this chapter is the authors' description of the evolution of ABA therapy from an emphasis on “continuing with demands despite a child's protests” (p. 97) to the focus on “reinforcement in building compliance” (p. 97).

The final chapter succinctly brings together the information from previous chapters to help parents choose which program is best and most appropriate for their children. Contained in this chapter are recommendations for areas to consider when making a selection, including who the program is designed to serve, the functioning level(s) of children in the program, number of hours of instruction per week, method(s) for evaluating progress, staff ratios, and extent of teacher supervision and accountability. With this information in hand, parents can go into a program fully informed of the many factors that contribute to success. The authors also review several teaching strategies that exemplify “high quality ABA instruction” (p. 140), including task interspersal, errorless teaching procedures, and naturalistic instructional techniques (e.g., incidental teaching, NET, PRT). Although it is important to cover intricate topics related to ABA teaching methods, some of the information could derail those new to ABA (e.g., discussion of verbal operants). Furthermore, it would have been helpful to acknowledge the basic level at which the topics are covered and provide suggestions for additional reading or recommend that parents consult with a Board Certified Behavior Analyst (BCBA).

In the final section of Chapter 6, the authors address behavior management and how today's interventions for challenging behavior are much more refined than those used previously. In the early days of ABA, “the focus was simply on reducing behavior that interfered with learning or was otherwise disruptive or dangerous” (p. 156). However, the current direction with regard to challenging behavior is on “understanding behavior and preventing its occurrence” (p. 156). In their discussion of behavior management, the authors briefly touch upon functional assessments, antecedent intervention strategies, and replacement behaviors. Two helpful tables also list common function-based antecedent strategies (Table 6–6, p. 160) and common function-based replacement behaviors (Table 6–7, p. 161). Nevertheless, not enough consideration is given to the areas of behavior management, functional assessment, and interventions specifically designed to address challenging behavior in children with autism. After reading this book, parents certainly will be equipped with the knowledge of what skills to teach, but they may not be prepared to teach those skills in the face of interfering behaviors.

Concluding Comments

By the end of this book, readers will be impressed by the comprehensive nature of EIBI and its basis in the science of behavior. Most of the ABA myths as they relate to autism interventions are clarified, a substantial number of essential topics are covered, and examples of more complex issues are summarized. However, a primer on ABA treatment for children with autism would be more complete by addressing some of the other popular autism therapies with insufficient empirical support, such as the Developmental, Individual Difference, Relationship-based (DIR^®)/Floortime^™ model. Highly publicized unproven therapies continue to gain momentum and support through word-of-mouth and internet searches, which impede or distract many parents who are looking for an effective intervention for their children. A parent at a recent annual conference for the Association of Behavior Analysis International^® stated that, as a parent of a child with autism, he wished he could hear behavior analysts commenting about unproven therapies directly, without tongue-in-cheek or sarcasm. The addition of a section outlining the merits of other autism interventions would fit in very well among the other chapters in this text and could better highlight the relative benefits of ABA.

In conclusion, Right From the Start: Behavioral Intervention for Young Children with Autism serves as a very informative, succinct, and easily readable guide for determining the features of successful ABA-based autism interventions. The second edition is a great resource for parents, educators, and new behavior analysts who are interested in learning about the predictable hurdles and turns in the road that they will face on their initial journey with a recently diagnosed child. Not only does the book outline warning signs for parents, but it also arms them with the tools they will need to avoid common mistakes and setbacks. Harris and Weiss stay committed to ABA and its scientific foundations throughout the text while still maintaining a parent-friendly style; this format ensures that parents keep the big forest in sight while focusing on the many specific, but often distracting, trees.