Teaching Developmentally Disabled Children: The Me Book by Ivar O. Lovaas


Here is an instructional program for teachers, nurses, and parents that clearly and concisely shows how to help children who are developmentally disabled function more normally at home, in school, and in the community. The 250-page Teaching Developmentally Disabled Children is designed for use with children age 3 and older who suffer from mental retardation, brain damage, autism, severe aphasia, emotional disorder, or childhood schizophrenia.

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PREFACE

This book contains a set of programs that were started many years ago in an attempt to provide help for parents and teachers in dealing with their developmentally disabled children. One of the parents called these programs the "Me Book," for this is really a book for the child. As a result of following the programs presented in this book, the child does become more of a person, an individual, more of a "me." So, we adopted the subtitle The Me Book.
The book evolved and developed out of our experiences in working with developmentally disabled children. A description of these experiences will clarify our approach, for they formed the basis of our teaching philosophy. We hope that this explanation of our teaching philosophy will help clarify our position, so that it will seem less arbitrary and perhaps be less objectionable to those persons holding different views. Let us begin by relating the mistakes we made, because sometimes one can learn a great deal from mistakes.

In 1964, we institutionalized a group of children with severe developmental disabilities and began to formulate teaching programs designed to help them overcome atavistic and tantrum behaviors, to help them develop language, to improve their play and social interactions, and to build the other kinds of behavioral skills that these children needed in order to function better in less restrictive environments. This book contains revisions of many of the teaching programs which were initiated at that time.

A more complete summary of our early treatment successes and failures have been presented elsewhere (Lovaas, O. I., Koegel, R. L., Simmons, J. Q., and Long, J. S. Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 1973, 6, 131-165). The main findings and implications are summarized below.

Certain positive aspects of our teaching programs became apparent quite soon. For example, we could help the children quickly overcome many of their undesirable and interfering behaviors, such as their tantrums, their bizarre ritualistic behaviors, and their self-injurious behaviors. We were also able to teach them some very complex behaviors, such as language, which many had thought would prove too difficult for these children to grasp. The procedures were very time-consuming, but they were effective, for all the children did learn, although some learned more than others.

The first serious mistake we made in this program was to treat the children within an institutional (hospital or clinic) environment. The changes we created in the child's behaviors did not generalize, or transfer, to the rest of the child's environment, such as his home or school. However, we were successful when we made special efforts to bring about generalization. These special efforts involved working out the treatment and educational programming in these other environments, which brought us to question the necessity or desirability of using a hospital as a teaching and learning environment. Our goal was to help these children to live and function in the real world, and not in an artificial setting, such as an institution.

We had hospitalized the children in the first place because we still held the old view we had been taught that children like those with whom we worked were "ill" due to either psychological or organic reasons. That is, it was thought that they had experienced either inadequate parenting or had suffered from some organic brain damage. It seemed to follow, then, that since they were "ill" they needed "treatment," ideally in a "hospital." Given our background, it made sense at the time; it was an easy mistake to make. We decided, then, to change the place of treatment from the institution to the child's natural environment; that is, we began to treat him in his home and school.

The second major mistake we made was to isolate the parents from their child's treatment. We thought it quite appropriate that professional persons such as ourselves should play the major role in the treatment program, with a smaller role being assigned to the parents and the child's teachers. The children's problems were very complex, we felt, and only the most educated persons could help. The children needed professional intervention. There were several major problems associated with this decision. First, the children needed a great deal of treatment time in order to show improvement and there were so many such children that there were simply not enough professional persons available to meet the treatment needs. Second, if the parents didn't know exactly what their child's treatment program consisted of, what we were doing, why we were doing it, and what the final goals were, then they wouldn't be able to help their child maintain the gains made in therapy, and the child would regress. We realized our errors, and changed our approach to teaching the child's parents and teachers exactly how we had taught the children. The child's treatment was placed in the hands of the adults in his natural, everyday community. The parents and teachers became the child's primary therapists, and we became their consultants.

In retrospect, this new development made good sense. If a child's behavior is influenced by the environment in which he lives and learns, and since a child's environment is composed of several different settings (such as school, home, and neighborhood) then it follows that the child's total environment should be arranged to become therapeutic and educational, if the child is to make maximal gains in treatment.

A third major mistake was to expect a "breakthrough." We were expecting a sudden step forward, that possibly somehow we would hit upon some central cognitive, emotional, or social event inside the child's mind that would help him make a sudden and major leap ahead. Traditional conceptions are filled with such promises. Such a leap would have been so gratifying, and it would have made our work so much easier, it never happened. Instead, progress followed a slow, step-by-step upward progression, with only a few and minor spurts ahead. We learned to settle down for hard work. Persons who work with developmentally disabled children may take some comforts in Charles Darwin's basic hypothesis: Natura non facit saltum (Nature does not make leaps) (Actually, anyone who has been a parent also may become impressed with how slow normal children develop: it takes 9 months to be born, a whole year to learn how to walk, and a full 2 years before even minimal speech is occurring. And the infant is practicing literally 12 to 14 hours a day, 7 days a week, and takes no vacation!)

There were several other developments that emerged as we moved away from the traditional disease model of service delivery. We broke down the large hypothetical constructs of "autism," "aphasia," "retardation," etc. into more manageable components or behaviors. We didn't offer treatment for autism or schizophrenia; instead we were teaching the children specific behaviors such as language, play, and affection. These teaching programs were "interchangeable" across diagnostic categories in the sense that what we had learned about teaching language to retarded children could just as easily be applied to teaching language to aphasic or autistic children. The whole diagnostic enterprise became increasingly irrelevant.

One of the most gratifying aspects of our project centered around the development of specific intervention techniques. For years, many professionals had felt extremely uncomfortable when confronted with questions from parents or teachers concerning how to deal with specific behavioral problems: How do you toilet train? How do you help the mute child speak9 How do you help an aggressive child become more friendly? At last, we had found some concrete answers to those questions. Perhaps the former lack of answers to these questions was the reason for postulating internal problems as the cause for the child's problems in the first place. If the problems were internal and hidden, then no one, except trained professionals, could work on them. Perhaps such isolation helped prolong our ignorance.

Rather than viewing the child as ill or diseased, we came to view him as "different"—different in the sense that the average or common environment, which does so well for the average child, does not fit the needs nor provide the structure necessary to be a good teaching/learning environment for these exceptional children. Our task was, then, to construct a special environment, one in which the disabled child could learn. We chose to deviate from the average environment only as much as was absolutely necessary to make it a suitable learning environment for our children. We did this for two reasons: first, it would make it easier to return the child to his community later on, and second, the common environment has been developing over thousands of years, and it does possess some educational wisdom, even though this is not always apparent. We chose, therefore, to teach the children, whenever possible, as normal parents teach their normal children.

To summarize and state some implications:
1. The place of intervention was changed from the institution to the child's natural, everyday community.
2. The locus of intervention was changed from treatment to teaching.
3. Teaching was placed in the hands of the child's teachers and parents.
4. Autism, retardation, brain damage, and other diagnostic categories were broken down into smaller and more manageable units of behavior such as language, play, and self-help skills. These behaviors cut across diagnostic categories.
5. Diagnostic testing became de-emphasized.

These were the main developments. There were several others, and many of these occurred in other parts of the country, sometimes independent of theoretical orientation. For example, institutionalization became de-emphasized by almost all professionals. Gestaltists and existentialists also rejected the disease model and associated diagnosis. Some developments were quite independent of theoretical orientations—for example, the more new knowledge we gained, the more democratic the process became. That is, the consumers, or the parents, had a greater part in determining the kinds of services to be delivered. It would be interesting to speculate on all that has happened, but space does not permit.

The most important steps in behavioral teaching centered on breaking down the large and rather general problem of "disability" into more manageable and separate behavioral units, and to relate these behaviors to more manipulable environmental variables. Such analysis and systematic manipulation appears to have greatly facilitated scientific inquiry, which is a key to progress in education and psychology. We can see the beginning of cumulative knowledge. Since such an analysis is still in its beginning stages, this manual can best serve to establish both a helping and a working relationship between students and persons with developmental disabilities, where much more has to be investigated and learned in order for us to become truly successful teachers. When we do find out how to successfully teach, we will then have the tools and skills necessary to help developmentally disabled persons become functioning members of society; there will be no more retarded persons.

This short history may seem rather arbitrary and unfair to those who are trying to understand and help developmentally' disabled persons from the point of view of dealing with internal dysfunction or damage, the related diagnosis, and the subsequent treatment. Perhaps the issue of "Who is right?" can be clarified4f we examine two different strategies for gathering information. One can characterize research efforts as being largely deductive or largely inductive. Some investigators make generalizations (inferences about underlying dysfunction) after examining relatively few data, while others prefer to accumulate much more information or data before they feel they can justify a general theoretical statement. A former teacher of mine (Professor Ben McKeever at the University of Washington) divided researchers into two groups, shaft sinkers and pyramid builders. A shaft sinker works in relative isolation, he moves from one area to another, sinking shafts and hoping that he will strike a well of knowledge. When he does, a great number of problems will be solved at the same time. On the other hand, a pyramid builder feels that knowledge can best be gained by several persons working together, where each piece of information is sought to compliment or strengthen other pieces of information, where higher levels are built after lower levels are secured, and so on. He may not know exactly how the pyramid will look when it is finished, but he may have some general idea when he starts. Personality theorists, psychopathologists, and the like would be shaft sinkers, behaviorists would be pyramid builders. So far, the shaft sinkers haven't struck oil yet. The behaviorists have more going for them; the foundation of a pyramid under construction is more substantial and more reassuring than a dry well. In the future, perhaps, there will be a successful shaft sinker. The definition of a genius is one who finds the well with relatively little prior knowledge. And many a pyramid builder may just be a pebble piler in disguise. In any case, there is no a priori right or wrong way of making hypotheses about nature. My apology to all potential shaft sinkers.

Let us express our gratitude to the large number of students who have helped develop the programs presented in this book. These were students at UCLA who were enrolled in Psychology 170 A "Introduction to Behavior Modification," and Psychology 170 B "Behavior Modification Laboratory." They were dedicated to helping the less fortunate, they were flexible and open-minded, intelligent and creative, and, in general, all the good things one associates with the kinds of persons we all would like to work with. Many thanks to our colleagues in the Department of Psychology at UCLA, for their willingness to overlook some problems and reinforce the main efforts. We also want to thank the Staff at Camarillo State Hospital in Camarillo, California, for their help in facilitating the research which underlies many of the teaching programs in this book. Thanks also to Drs. Barbara Andersen and Crighton Newsom for their editorial comments. Very special thanks for the support of the National Institute of Mental Health (Grants MH 32803 and MH 1140) and particularly to Dr. Morris Parloff for his kind guidance. Finally, we want to thank Kristen Hannum for guiding and organizing the preparation of this manuscript, a very difficult job at times.