Lesson 2: How to Conduct a Discrete Trial

The war on Steven's autism began in earnest in a small downstairs bedroom.  On this first day that I would work with Steven alone, I felt a twinge of anxiety run through me.  Would I be able to wrestle the target behaviors from the small boy who sat with his back to me, rocking his body to a rhythm only he could discern?  As I reviewed the program binder, which listed 25 teaching protocols individualized to Steven's needs, I felt daunted.  We were starting at a level I had not even recognized existed.  

Examples from Steven's Program List:

1. 2-D Identical Matching

2.  1-Step Gross Motor Imitation

3.  1-Step Non-Verbal Imitation with Objects 

4.  Come Here 

Following the discrete trial protocol we had been trained in, I prompted Steven to the table and ran through each program, taking care to log my data in the program binder so that the next therapist on the schedule would know where I had left off.  I also took detailed notes on Steven's general demeanor, degree of attention, and self-stimulatory behavior.  

Example of Discrete Trial Protocol:

1.  Give clear, concise instruction

2.  Allow 2-3 seconds for child's response (correct, incorrect, non-response). 

3.  Provide feedback as described below:  

a.  If correct, provide praise paired with primary reinforcement (e.g., Skittle)

b.  If incorrect, provide informational "no" and follow with prompted trial

c.  If non-response, follow procedure for incorrect trial.  

The discrete trial protocol originates from behavioral learning theory which proposes that all behaviors are learned, observable, and are the result of interactions that occur in the environment.  From this theory, behavior change is evidence of learning.  Learning theorists often refer to the A-B-C model (Antecedent, Behavior, Consequence) to describe how learning occurs.  Internalizing this framework for how to interpret behavior became the basis for my ability to facilitate learning in both public and private settings.  Parents, educators, even wives (!) can learn to use this method by reviewing the example above.  

The discrete trial technique became the underlying strategy that we would utilize.  It allowed us to infiltrate Steven's autism and reach him beyond layers of camouflage and barriers.  Each time we created the association between Steven's behavior and reinforcement, we were defeating his autism, one battle at a time.  As Steven's skill set increased, something amazing began to happen...he began to engage the enemy himself.  

Declaring War

Following that initial two-day crash course in discrete trial training, Steven's mother Jane created a master schedule.  Steven would receive three hours of programming in the morning and another three hours in the afternoon, provided by an eager staff of young women the family had hired.  In addition to these one on one sessions, Steven would also attend speech and language therapy for two hours per week, and occupational therapy for one hour a week.  

At first, I inwardly protested the rigor of such a program.  I soon realized however that, unlike a typically developing child, Steven did not spend each waking hour learning.  Instead, he interacted on a different plane, a hemisphere of glinting colors, textures, and sensations.  Inside Steven's brain, he did not naturally make connections between cause and effect, develop relationships with his family, or engage in communication.  He was so distracted by the manner in which his brain interpreted information that he missed the majority of learning opportunities that we take for granted when considering the development of typical children.

This dimension that existed inside Steven's head was so compelling that our attempts to pull him out into the world we walked in appeared to be aversive to him.  At times he would scream, cry, or bang his head on the table.  We were instructed to consider these behaviors incorrect responses to our instructions.  We were trained to signal Steven that these responses would not be reinforced by giving him feedback in the form of a flat, informational "no!"  In order to escape our demands, and earn his reward, Steven had to perform the target behavior.  

We started with a list of 10 programs designed to build foundational skills, skills that most typical children learn through incidental experiences.  Steven did not imitate, a hallmark feature of autism.  As humans learn through observational modeling, this trait was considered to be at the core of Steven's inability to learn functional skills.  How often had Steven's parents wondered why he displayed no interest in what they were doing?  He did not enter the kitchen to watch mommy cook, or place his hand on the vacuum to help daddy clean, as his brother Jeffrey did.  Instead, Steven would jump up and down, flapping his hands excitedly, watching the same Thomas the Train movie over and over, oblivious to the events that occurred around him.  

Our mission was to pull Steven from the clutches of the beast inside his head that restricted his development.  We created allies out of the very things Steven found so reinforcing.  Armed with an arsenal of  Skittles, and Thomas the Train toys, we prepared for each cognitive competition as we jockeyed for control of Steven.  In order to re-program Steven's brain, and facilitate his learning, we went to war with his autism.  

Lesson 1: Get the Child's Attention

"Steven will be sitting on command by the end of the first session," the ABA trainer stated confidently.  I was stunned.  From the incredulous looks on his parents' faces, I could tell that they too were skeptical.  Steven did not appear to be aware that we were present.  He moved about the small living room purposelessly.  From time to time he would pick up an item and give it a cursory lick, as if to explore the texture of a wooden toy train, a rubber-soled shoe, the edge of a hardcover book.  His mother called his name and he did not respond.  Instead, he pressed his face to the window and licked the glass.  

What happened next was pivotal to my understanding of autism and facilitating learning among young children diagnosed with autism and related disabilities.  Identifying this very important place to start became so ingrained in my technique that it has become so subtle as to be nearly undetectable... reminiscent of sleight of hand and of magic.  The very first step of initiating any learning task is to get the child's attention.  I refer to this step as "Lesson One."  

One at a time, each of us called out, "Steven!" to no avail.  I recall thinking, "no wonder parents often believe their child is deaf...he appears to hear nothing!"  This notion however, was altogether untrue.  Steven did hear things.  He responded to very specific auditory input, especially input that signaled something he enjoyed was imminent.  His parents commented that whenever they pressed the button on the VCR, Steven approached, waiting for his favorite Thomas the Train movie to be inserted.  What was our first auditory attention-getting cue?  It wasn't calling out Steven's name.  Nay, a more reinforcing sound:  the sound of tearing open the wrapper to a bag of Skittles.  

In a flash, Steven was by the trainer's side.  He grabbed her hand and pushed it up toward the Skittles bag she held in her other hand.  He made a high-pitched sound, "Eee!"  The trainer responded, "Come here!"  She gently prompted Steven to sit in a small chair and immediately popped a Skittle into his mouth saying enthusiastically, "Good Sitting!"

And so the first trials began.  We started with two small chairs facing each other, about six inches apart.  The aide sat in one chair.  The second chair was for Steven.  He circled like a shark stalking its prey; the Skittles bag was so reinforcing that it kept him in close proximity to the teaching area.  Trial after trial, we learned how to give a concise instruction, to gently prompt Steven to sit in his chair, and to provide immediate reinforcement contingent upon his sitting.  By the end of that first session, Steven sat independently in response to the instruction, "Come here!"  He made fleeting eye contact with me as I presented his Skittle.  I felt that I had glimpsed a whole new world...the world that existed inside Steven's head.  And I wanted to take a closer look.   

  

Discovering Autism

Looking back, I suppose the first day I discovered autism was the day I met Steven,* a two year old bundle of energy with straight, white-blond hair that hung low over his face because it was impossible to cut it.  "He hates having his hair cut," his mother informed me, with a somewhat forced smile pasted across her face.  Steven's eyes were a bright piercing blue, reminiscent of the ocean he lived so close to.  Although the color of his eyes was remarkable, none commented on the hue, rather they worried that Steven never made eye contact, not with anyone, not at all. His eyes seemed to stare into nothing, transfixed by something his parents and relatives could not fathom.  

But it was Steven's eyes, as they stared out from that flyer his parents had posted at my university, that hooked my attention and reeled me in.  Answering the ad seeking behavioral aides landed me in Steven's living room along with four other young women, Steven's parents, his grandparents, and a highly-qualified trainer from the top behavioral agency in the world.  I had no idea that this decision to help Steven would catapult me into a world of hardship, denial, tears, joy, triumph, and eventual acceptance.  This decision would also serve as a catalyst for the rest of my career.  The training I received from the agency became the foundation for the successes I would experience in my own early childhood special education classroom.  

Hence, although I had studied autism, and had aced my undergraduate classes in applied behavioral analysis taught by the notable Dr Ivar Lovaas, in a sense, I first discovered autism when I met Steven.  My story begins with him.  

*All names and identifying information have been changed to protect privacy and preserve confidentiality.  Any similarities to known individuals is purely coincidental.