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Speech Pathology and Applied Behavior Analysis:
Opportunities for Collaboration

David Celiberti, Ph.D., BCBA
An interview with
Barbara E. Esch, CCC-SLP, BCBA
Chairperson of the Speech Pathology and
Applied Behavior Analysis SIG

 

I appreciate the opportunity to dialogue with you about your interest in ABA and the development of the SIG. I would like to start off with some more personal questions. How did you initially become interested in using applied behavior analysis as an individual speech pathologist?

My initial interest was probably the result of having an undergraduate minor in Psychology from Western Michigan University . The Psychology Department at WMU is behavioral so I was already oriented to the benefits of behavior analysis when I started working as a speech pathologist. Sometime later, the positive impact of well applied behavior analysis was evident to me in observing the clinical work of my behavior analyst husband, Dr. John Esch. His influence provided the impetus for me to obtain the credential as a certified behavior analyst and eventually to pursue a Ph.D. in behavior analysis. I’ve also been extremely fortunate to learn from noted behavior analysts such as my doctoral advisors Jim Carr and Jack Michael, as well as Mark Sundberg, Dave Palmer, and others who have been strong exemplars for how to integrate behavior analytic concepts and principles with actual teaching.

I understand that you are also a certified behavior analyst. How has this set of competencies enhanced your work as a speech pathologist?

The behavioral training and experience represented by the BCBA are highly valuable for enhancing the delivery of speech pathology services. Overall, these competencies allow us to identify and assess various environmental events (i.e., antecedents and consequences) that may influence many clinical problems. Through careful identification of these environmental factors, it’s possible to chart a data-driven clinical course of action to help individuals acquire stronger repertoires as efficiently and effectively as possible.  

What is your perspective on dual certification as a speech pathologist and a behavior analyst?

At present, there’s somewhat of a mismatch between the competencies represented by the BCBA credential and the marketability of the credential itself. We see that many professionals are taking it upon themselves to become certified in the absence of specific requirements (in many states) to do so. Unfortunately, many agencies do not reimburse for the services of behavior analysts. This probably means the value of these services is not yet well recognized, or perhaps this value has not been clearly articulated to policy makers. As has already happened with the nationally-recognized speech pathology credential (CCC-SLP), the BCBA will undoubtedly become more valuable as third-party payors (i.e., insurers), program administrators, and legislative agencies across the country (not just particular states) recognize and require the competencies it represents for individuals providing professional services to consumers. I think the Board [Behavior Analyst Certification Board] is working hard to accomplish this.

What led up to the development of your SIG?  

It really grew from a desire to promote collaboration between behavior analysts and speech pathologists, particularly in conducting and disseminating research. The field of behavior analysis provides important areas of overlapping interest with speech pathology. A major goal of applied behavior analysis is to help individuals learn socially important behaviors (perhaps one of the most important of these behaviors is communication). Treatments are positively focused and are based on the application of behavioral principles derived from scientific inquiry. A cornerstone of applied behavior analytic treatment is identifying possible environmental factors (e.g., motivation, instructions and other contextual cues, prompts, consequences) to determine why certain behaviors occur and then adjusting those factors in order to help individuals make positive behavior change.

Like speech pathologists, behavior analysts work with diverse problems of individuals across a wide variety of settings including educational (schools/universities), medical (clinics/hospitals), business and industry, institutions and group homes, and private practice venues. With over 100,000 practicing speech pathologists in the US alone, there are nearly unlimited opportunities for collaborative research that could ultimately benefit consumers of our collective services.

The collaboration of speech pathologists and applied behavior analysts is critical to the treatment of autism. What other areas or clinical applications do you believe can be positively impacted by such an alliance?

The new SPABA SIG provides an important opportunity to expand the potentially fruitful interaction between speech pathology and applied behavior analysis. Such an alliance could inform the delivery of services related to a number of important issues including speech/language acquisition and assessment, program outcomes, swallowing and feeding disorders, voice disorders, issues related to hearing impairment, prosthetic adjustment (e.g., hearing aids, laryngeal prostheses, communication devices), accent and dialect modification, speech/language rehabilitation related to neurological problems, rehabilitation of oral-motor problems related to oro-facial anomalies, issues related to aging in normal and disabled (e.g., Alzheimer’s) populations, public speaking (e.g., theater, business), fluency (e.g., stuttering), conservation (e.g., noise reduction), college teaching, and business management applications (e.g., practicum supervision, systems analysis in speech/language departments in clinics, hospitals, and schools).

In many school districts and agencies the relationship between behavior analysts and speech pathologists is less than optimal, and in some instances actually adversarial. What misconceptions do many behavior analysts have for speech pathologists and vice versa?

If, by misconceptions, you mean lack of information, I would say we may not fully appreciate what each brings to the therapeutic setting.  Hopefully, professionals in these two fields are knowledgeable about, and respectful of, one another’s training and they value the unique skills that each brings to the clinical or research setting. Both groups have a mutual goal of trying to help individuals change behavior in some way and this professional team certainly has the composite skills to identify and treat the complex behaviors that fall within their shared scope of practice.   Whether we work with our clients as a team, or parallel to other professionals, it is useful to focus on a therapeutic plan that maximizes the strengths of each person providing services. Behavior analysts approach problem solving by dealing with the effects of environmental stimuli on behavior; this is what they’re trained to observe, identify, measure, and modify. Thus, they tend to propose (and value) interventions that are based on an analysis of such events.

Treatments based on other interpretations of a behavior’s cause or function (such as “mental way-stations”) would be less of a priority simply because those “causes” might not as easily lend themselves to scientific manipulation. One example might be the preference by behavior analysts for language treatments arranged according to a behavioral taxonomy of function where controlling antecedents and consequences are identified and adjusted as necessary in contrast to particular remedial or habilitative approaches in which hypothesized causal variables for language skills may be less “testable” and, thus, skill improvement may be more difficult to achieve.  Speech pathologists, like behavior analysts, are well trained to identify behaviors. Moreover, some of these behaviors may be highly idiosyncratic (for example, articulation, voice quality, chewing/swallowing actions). The speech pathologist’s expertise in identifying components of a wide array of speech, communication, and swallowing behaviors makes it much easier to plan effective treatments according to the most efficient hierarchy of tasks (i.e., responses to be trained).  Further, because of their clinical training and experience, speech pathologists often find it quite easy to identify subtle changes that can be made in specific treatments to make interventions more effective.

This ability to “tweak” treatments at a very detailed level reflects the speech pathologist’s specialized knowledge in important areas related to behavior such as anatomy, physiology, and the impact of certain processes (e.g., disease, trauma) on brain function.  As a team, it seems to me that behavior analysts and speech pathologists are well prepared to provide state of the art treatments of choice for individuals within their care. Their ability to do so depends upon mutual recognition of the unique skills each can offer.

As you know, the theme of this issue is early intervention. What are some overarching suggestions or considerations that you would have for behavior analysts working with children with autism under the age of 3?

The first thing I would recommend is that professionals (behavior analysts or any thers) learn to listen to parents and other caregivers and to respond effectively, within the scope of professional practice, to their concerns. Parents of recently diagnosed young children are dealing with an overwhelming number of stressors. They’re working against the clock, trying desperately to find affordable, reliable educational services for their children and working hard to determine which of these treatments may be most effective. At the same time, they may be dealing with grief, anger, sleep-deprivation, or other significant challenges such as parenting other children, being a spouse, and holding a job. Their concerns need to be recognized by care – and service-providers. I’m not suggesting we work outside our scope of practice. On the contrary, we need to adhere to guidelines for ethical practice. But, within these parameters, we must listen carefully to identify our clients’ needs and priorities, then we must work hard to effectively address those concerns according to our particular expertise. Any professionals who have not had clinical training (and some behavior analysts have not) may need to add these important skills to their repertoires.  Related to this, we must recognize that young children with a diagnosis of autism (or any other disability) are, first and foremost, children. Their learning should be normalized as much as possible. One of the most important ways we can do this is by teaching them how to play.  For little ones, play is their “work.” Typically developing children learn an enormous number of foundational skills (e.g., early language, imitation, problem-solving) while playing, both alone and with others. For children with disabilities, we need to know how to design educational programs that maximize skill acquisition in normalized environments and one of the most important of these environments is the play setting.

Thank you, now what about for speech pathologists working with children with autism under the age of 3?

Because young children with autism often have severely restricted behavioral    repertoires (e.g., language, social skills, following instructions), they may engage in challenging and inappropriate behaviors (e.g., hitting, crying) that can interfere with therapy programs. These behaviors often function to produce important reinforcers (e.g., attention, escape from task demands, tangible items) but, typically, speech  pathologists are not trained to identify how antecedents and/or consequences can be analyzed and adjusted in order to teach replacement behaviors that will provide the same reinforcers in more socially acceptable ways (e.g., asking). Speech pathologists who have acquired these skills may find it easier to deliver their therapy programs by first training functionally equivalent behaviors that fall within the spectrum of speech/ language skills.

Can you direct us to a few journals in the area of speech pathology that may be of interest to behavior analysts working with individuals with autism?

As you know, there’s a lot of research at present in the area of autism and it seems to span not only specific issues of interest to speech pathologists and behavior analysts (e.g., speech, language, social communication, eating) but it also extends across a variety of professional journals. I would refer readers to their particular topics of interest in peer-reviewed publications, particularly those reporting empirically based investigations.   Some examples might be Journal of Applied Behavior Analysis, Journal of Autism and Developmental Disorders, Journal of Speech, Language, and Hearing Research, International Journal of Eating Disorders, Pediatrics, Journal of Clinical Child Psychology, Lancet, and Research in Developmental Disabilities.  Behavior analysts and speech pathologists may be interested in an article by Goldstein (2002)1 reviewing treatment efficacy of speech and language interventions for children with autism.

I understand that you launched your SIG this past May.  How did your meeting go? 

Our organizational meeting in Chicago (ABA 2005) was a great success with an initial membership of 18 SLPs and behavior analysts from the United States , Canada , and Australia – not bad for an 8 a.m. meeting on Sunday morning! It was clear that attendees welcomed the formation of this unique SIG, providing a long-awaited opportunity to expand the potentially fruitful interaction between these two related professions. As speech pathologists, we salute ABA for providing us this important venue for collaboration. As behavior analysts, we welcome this group of dedicated, knowledgeable professionals who share our interest in applying behavioral analyses to speech and language problems.

Who comprises your SIG?

The SIG is comprised of speech pathologists, behavior analysts, and students in these two fields who advocate a behavioral approach to address speech/language problems both clinically and through empirical research.

What is the mission and short-term objectives of the SIG?

SPABA’s mission is to promote communication and collaboration between speech pathologists and behavior analysts in the dissemination of behaviorally oriented speech and language research and in the application of evidence-based practices.   Our top priorities for current action are to announce the formation of the SIG in speech pathology media (e.g., national magazines, newspapers, state/regional organization publications), develop a SIG brochure, and increase student membership.

What SIG related activities do you have planned for upcoming years?

Much of our effort this year will be directed toward publishing articles of interest on our website and in mainstream professional outlets accessed by speech pathologists, behavior analysts, or both. We will also work to organize regional SLP-ABA groups.

Does ABA offer CEU credits for speech pathologists? If not, that may be another endeavor of your SIG to increase the SLP presence at ABA .

At present, ABA does not offer CEU credits for speech pathologists.  As more speech pathologists attend ABA , this may become a possibility.

As you know, there is an abundance of non-empirically validated treatments used by occupational therapists in the treatment of autism. Do you think your SIG can serve as an example to occupational therapists who are concerned about the wide gap between what is known empirically and what is actually being practiced?

One of the great advantages of training in behavior analysis is learning to separate empirically validated treatments from those that may make “common sense” but that may not provide clinical benefit efficiently or effectively. We hope all professionals who offer clinical services will strive to critically evaluate the utility of any new treatments that may be proposed, or reported in the press, or popularized through other media (the internet is a prime example). Pseudo-treatments can have disastrous effects. They can exhaust a family’s financial and emotional resources, waste valuable learning time, and lessen the impact of more useful treatments. We all have a professional responsibility to educate ourselves, and to help educate others, about which treatments are most effective and to offer those treatments to consumers of our services.

Can you please give me more information about your discussion group? What are some topics that get discussed? Who can join and how do they go about doing that?

The discussion group is a forum for speech pathologists with an interest in ABA and ABA professionals with an interest in speech and language to discuss issues of clinical or conceptual interest. Membership is open to clinically certified speech pathologists, behavior analysts, or students of either field. To join the discussion group, email mareilekoenig@comcast.net.

Thank you for taking the time to discuss the SPABA SIG and I wish you all the best! How can interested parties obtain more information or join your SIG?

We invite interested individuals to learn more about the SPABA Group SIG at www.behavioralspeech.com or contact the SIG Chair: Barb Esch: barbesch@gate.net

1Goldstein, H. (2002). Communication intervention for children with autism: A review of treatment efficacy. Journal of Autism and Developmental Disorders, 32, 373-396.

Reprinted from the Special Interest Group Newsletter Autism And Related Developmental Disabilities of ABA & ABCT – Volume 22 Issue 1 Winter 2006 available in the original format at:  http://gsappweb.rutgers.edu/dddc/winter_2005-2006_newsletter.pdf

 

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