Tuesday, May 1, 2012

Book Review: The PRT Pocket Guide

Brookes Publishing sent me a book I was not expecting. I received a copy of Robert L Koegel and Lynn Kern Koegel's latest book, "The PRT Pocket Guide", at no charge to me, to review.

Those of you who follow my blog know that behavioral intervention made my child worse, and I am not a fan of behaviorists who are pure, who view everything via a lens of behavior while throwing anything and everything else (sensory, development, reflex integration, diet, biomed) away.

Right off the bat, I have an issue with it.  The Koegels imply that dietary intervention is "snake oil" on page 9 of the introduction. They call it the "casein-free diet", which, for starters, is flat out wrong. (There is no such thing as a "casein-free diet" for autism.) My child is one of the responders to diet, we have medical evidence to back it up, and the behaviorists who were working with us at the time of the implementation of the diet and who saw what I'd describe as "infraction behavior" (that is followed by eczema) would back me up when I say my child needs to be on a special diet and so do other children.  Any professional, no matter how beloved or famous, who discourages a trial of dietary intervention plummets on my list of people to trust.

Absence of proof is not absolute proof.  While I discourage parents from relying on internet anecdotes from other parents when choosing intervention, and while I strongly encourage parents to do lots and lots of research, I, from experience, have seen intervention and therapies helping families years ahead of the scientific studies to show the progress children make in those therapies.

Our experience with all things behavioral got us everything 'they' promised would not happen.  Robotic. Prompt dependent.  A one-sided word machine.  Our child was considered a success. We checked off lots of things on the ABLLS.  None of it translated into the togetherness I wanted, none of it translated into reciprocity or conversation, none of it translated into the ability to be mainstreamed at school.

When our behavioral program fell apart and we had a developmental opportunity fall into our laps simultaneously, we learned that our child had zero non-verbal foundations of communication to support the word-machine.  No wonder she wasn't interactive.

We set about going back for the non-verbal pieces we missed under the direction of our behaviorist - and it has made all the difference.

We set about making ourselves "possible" (a Dr James D MacDonald term) for our child to interact with successfully - at non-verbal levels - and conversation and the verbal interaction pieces began falling into place without working on them directly.

"The PRT Pocket Guide" focuses on question asking, on verbal skills.  It spend a lot of time discussing motivation and reinforcers and natural environments and data collection from a behavioral perspective.

When we made ourselves socially "possible",  from a developmental perspective, my daughter's motivation came from her own success with us. No need to target teaching her question asking.  It emerged on its own.

The examples in the book bother me.
Page 168: "Rose is a 2-year-old girl who is nonverbal....Roses's goal: Increase the number and variety of expressive verbal one word utterances or communicative attempts in response to a verbal model."
I want to know - how is her non-verbal interaction. Is it rich with reciprocity?  We don't know. The Koegels are fixated on words and talk.

 On page 169,
"Julian's goals: Increase spent time engaged with peers at recess and the number of questions he asks during social conversations with his peers."
My kids in that age range do not spend a lot of time asking questions of one another. How do I know? I pay attention. They spend a great deal of time relating experiences or retelling fun experiences they had together, or planning an experience they want to have in the future.

We saw "success" with behavioral programming. My child learned everything we targeted.  But it didn't translate into two-way communication, interaction, reciprocity.  Your behavioral programming is only as good as the goals and objectives, and my experience has taught me to work from a developmental list, not a behavioral one.  I suppose my definition of "pivotal" starts with non-verbal foundations of communication, and I can't tell by reading this book that the Koegels agree with that. A parent who uses this book risks skipping important developmental foundations and going straight to teaching a child to ask questions when there is little to no interaction and reciprocity at non-verbal levels.  My guess is that fans of behavioral intervention will adore this book.

1 comment:

bookworm said...

**The Koegels imply that dietary intervention is "snake oil" on page 9 of the introduction.**

That seriously ticks me off. Pamela "lost" math skills for three days whenever she violated the gf/cf diet, not to mention the rash, irritability, and lost bladder control. Why would anyone go through so much trouble to stay gf/cf if there were no benefits. Arg!

**Absence of proof is not absolute proof.**

All you really need is a research study of sample size one. If you take your kid off gluten/casein for awhile and problems occur with every violation, that is powerful evidence that there might be a link for your kid. My family witnessed it too. Pamela ate half a biscuit at a family reunion. We were all staying in cabins. I told them nothing will happen today, but tomorrow she will wake up irritable, she will have a rash, and she will lose bladder control. All three happened the very next day. From that day on, they believed me.

**None of it translated into the togetherness I wanted, none of it translated into reciprocity or conversation, none of it translated into the ability to be mainstreamed at school.**

You should see the togetherness when Pamela was narrating A Wrinkle in Time for exam week. I blogged it last night. We are finally equally yoked! :-)

**The Koegels are fixated on words and talk.**

They have a problem with hyperfocus. Tee, hee, hee.

**A parent who uses this book risks skipping important developmental foundations and going straight to teaching a child to ask questions when there is little to no interaction and reciprocity at non-verbal levels.**

Amen! This knee-jerk reaction is prevalent today. Recently, someone asked about kids not asking questions. Almost every answer focused on mechanics. But, there are deeper things that must happen first. Here's what I wrote, "RDI helped with intent. It really is a developmental thing driving this. Go back to theory of mind. If a child doesn't realize that you cannot know what they think and they cannot know what you think, why ask questions? So, if the child doensn't know something, why should they ask you since you only know what they know. If they don't get that you have a separate mind, why ask questions about likes and dislikes. If they don't understand theory of mind, people are an anathema and things are more interesting. This shift of intent for Pamela started with RDI. I don't have to tell her to ask questions. She wants to know things now and asks other people questions.
* What's your name?
* Where're you from?
* Is it Will? (Someone she already knows).
* Play with babies when 50 years old? (She wants to know if she can keep playing with dolls).
* What's ______? (wants to know what a word means)
* Did you have fun with woman? (We had to meet with someone today).
* Is it _______? (wants to know who is on the phone)
* What are you typing about?"

While I was typing, here is our conversation:

Pamela: "What are you typing about?"
Me: "Questions"
Pamela: "What are questions about?"
Me: "Helping children with autism ask questions."

NO JOKE!

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