By Dr. Nancy Shamow

A Unique Program

A Word From Our Executive Director

Ann Landers once wrote that life is what happens to you when you are busy planning everything else. As I sit in my office in ASCENT's new State of the Art facility which opened on September 9, 2002 in Deer Park, NY, I can't help but recall 1998. I was approached by an attorney representing a small group of parents who were desperate to find appropriate education for their children diagnosed with autism. Meeting with the group, I came across familiar faces--attendees of an Outreach Program I provided as Principal of the Nassau Suffolk Services for Autism's Martin C. Barell School, a program I designed and helped start in 1993. My voluntary efforts at the Outreach Program stemmed from a responsibility to promote ABA (Applied Behavioral Analysis), a methodology I strongly believe is the only research validated treatment for autism. I was now sitting across from ASCENT's families who were frustrated by their children's failure, and disappointed with the absence of available openings in schools that provide effective treatment. They were parents, like so many others, who once dreamed of a bright and happy future for their children and who now watched in anguish as their children retreated into a world of silence. Some mortgaged their homes or sold their engagement rings to start a school that would replicate NSSA'a program. I decided to accept the challenge of starting a new school.

ASCENT's program began for a small group of preschoolers and one school age child in May of 1998 as a cooperative in the home of a parent. A small corner of the basement served as my office, where I developed IEPs, curriculum, and progress reports and continued my work in support of our application to the State Education Department to start ASCENT's school. While we convinced the Nassau County Department of Mental Health, Mental Retardation and Developmental Disabilities to approve and fund home based services for the preschoolers, no funding was available for school age children. These home schooled children excelled while the school age children who remained in their existing programs saw little or no gains. Facing an unresponsive State Education Department, ASCENT reached out to volunteers with respected expertise in their fields to develop a professional Board of Trustees. Never before touched by autism, these respected Board members continue to provide esteemed governance. With community support and under the direction of the Board of Trustees, ASCENT obtained a Charter from the New York State Board of Regents in 1999. Slowly allowing for more children to join ASCENT, we hired teachers, and filled the house while parents spent considerable time searching for an empty facility. ASCENT moved to its Glen Head location in July, 1999. 

The program was independently evaluated during the 2000-2001 school year by Dr. Jan Handleman, Director of the Douglass Developmental Disabilities Center of Rutgers University. His report described ASCENT as a "model program for the education of children with autism" which provides a "…nurturing environment where sensitivity is given for the delicate relationship between the Board, the staff, the children, the families and the community." Soon after Dr. Handleman's evaluation, ASCENT learned that we would have to vacate our Glen Head premises. As compelling as the founding story is, the intricacies involved and inspirations derived from designing our new facility in Deer Park has expanded our vision.

It is my dream and passion and that of ASCENT's parents, its governing Board and its staff and volunteers that drives us to become a model program for children with autism. ASCENT's highly structured, skill-oriented, instructional program is based upon the research proven principles of applied behavioral analysis. ASCENT provides children with a positive learning environment where the responsibility for effective learning rests with the teacher and not the child. The focus of education is on teaching new skills by providing individualized systematic instruction and predictable routines, objectively measuring outcomes and evaluating progress. The 1:1 instructor to student ratio at ASCENT services the severe learning deficits of children with autism. Discrete trial teaching is only one of several teaching formats used at ASCENT. Compared to traditional classroom instruction, discrete trial teaching provides students with multiple opportunities to practice skills. Skills taught in these learning environments are then generalized to a variety of more natural settings. Incidental teaching is used to expand and foster spontaneous language. Language promoted in this context is more likely to be reinforced and maintained.

While autism is characterized by learning deficits in many areas, speech and language deficits are often the most salient. Teaching speech requires the development of prerequisite motor imitation skills. At ASCENT, children learn to imitate gross and fine motor movements as well as oral motor movements of the lips, mouth, jaw and tongue. More advanced verbal imitation skills (e.g., sounds, blends, words, phrases and sentences) and language (naming and describing objects, labeling actions, giving directions, asking and answering questions, and using full contextually appropriate sentences) is then taught. Practice in controlling breathing may be given to increase volume, elongate sounds and facilitate blending of consonants and vowels to form words. 

While speech and language development is a major focus of ASCENT's education program, participation in family life is also emphasized. Engagement in productive and socially meaningful behavior is promoted by teaching skills that include the child in family activities (e.g., table setting, snack preparation and trips to the grocery store). Teaching independent skills to children allows opportunities to practice and maintain more appropriate repertoires of behavior without adult supervision. Independent engagement in self-care, work and leisure activities are taught using picture or written activity schedules. Conversational language (e.g., requesting objects, commenting and protesting) is integrated into the context of a child's day using time delay procedures, modeling, verbal prompts or written scripts and video modeling. Parent education is an essential component of ASCENT's program. Teaching sessions are provided at home and at school, where parents can observe and work with their children up to five days per week for 1.5 hours daily. Parent education allows parents to teach new skills and generalize gains made in school to the natural environment. Empowering parents with these skills fosters greater independence for their children. 

Children who are ready to begin a transition process attend a transition classroom setting during the portion of time they can be successful. Staff trained in direct observation, data collection and treatment implementation accompany these students to assess their skills in performing independently in this setting. Data are collected during structured academic/preacademic activities during classroom activities and include on-task, appropriate language, deviant behavior and positive interactions with peers. They return to ASCENT's mock Kindergarten classroom for the remainder of the day to acquire skills that allow them to attend the transition setting for progressively longer periods. 

As professionals servicing children with disabilities it is important for teachers to design learning environments that support the growth of more appropriate repertoires. The loss of time and reinforcement opportunities spent engaging in nondirected activities for which there is no empirical validity is an extravagance children with autism can ill afford. At ASCENT, parents and teachers address the urgency of children's needs and provide learning environments and opportunities that enhance the development of new skills. 


What is Applied Behavior Analysis

The New York State Health Department, in its Clinical Practice Guidelines, states: “It is recommended that principles of applied behavior analysis and behavior intervention strategies be included as an important element of any intervention program for young children with autism.” Applied Behavior Analysis, or ABA, is an array of teaching procedures based on the science of human behavior, that are derived from almost 100 years of laboratory research on the factors that control learning. Scientific evidence has established that high quality ABA administered to individuals with autism at a high intensity and duration produces comprehensive and lasting gains in many important areas of skill. ABA has been successfully employed in educating persons with autism at all ages, but studies show that early, intensive intervention employing the principles of Applied Behavior Analysis produce the best results. The earlier treatment is begun, the better the prospects for successful integration into a regular school setting.

What is the ABA Methodology

The applied behavior analysis methodology is comprised of research-based, demonstrably effective procedures that are tailored to meet the unique and individualized needs of each child. In the classroom, targeted skills to be learned are broken down into small elements and systematically taught using positive reinforcement. In the beginning stages of instruction, priority is given to the acquisition of new, constructive behaviors and the elimination of inappropriate self stimulatory behaviors like rocking, hand flapping, perseverative manipulation of objects or self-injurious behaviors. Each goal is taught in carefully planned steps that allow the child to be successful. Approximations to the final performance are systematically built as the child’s growing inventory of skills increase. In all cases, the objective is an increase in each child’s functional repertoire. Fundamental behaviors such as eye-contact, simple motor imitation and direction following, are taught before complexity is added. As the child and his or her needs progress, changes in goals and adjustments in teaching strategy are driven by data collected continuously as the child is learning. This allows the teaching to adjust to the child’s progress. Teaching is initially one to one, and is intensive. Each child works on a schedule of goals throughout the day, with teachers changing periodically with changes in goals. There is no “down time,” and what would otherwise be seen as recreational is incorporated into the teaching. Teaching is “outcome-driven,” such that responsibility for learning lies with the teacher. A child’s failure to progress is an indication that a procedural change is required. As the child’s skills improve, the one to one student/teacher ratio may be increased, with the rate of change governed by the resulting data. More is taught than academics, and teaching also addresses such areas as communication, eating, self-help, and social skills, among others. The intent is to accelerate children past the massive deficits and excesses that characterize autism, toward accumulation of an inventory of functional skills and classroom-acceptable behaviors sufficient to allow him or her to profit from the educational and social environment in a conventional school.

The child’s successes fuel the process, and a science-based methodology does not produce cold and aloof interactions. The prevailing atmosphere is warm and engaging. Children who may have previously experienced failure in other learning environments; are being taught to make choices, play, engage other people, communicate, and gain access to the same reinforcers that maintain all of us in life. Data collection, rigorous adherence to only research-proven teaching techniques and attention to detail do not remove the humanity from the process.

ABA Discrete Trial

Discrete Trial Teaching (DTT) is one of the instructional methodologies of an ABA-based educational program. Learning is broken down into small steps which are built toward more complex behaviors and skills. Learning opportunities are presented in a “trial” format, consisting of four major components: The teacher presents an instruction or question (stimulus). The instruction is followed by a prompt, if needed, to elicit the correct response. The child responds (correctly or incorrectly). The teacher provides an appropriate consequence or feedback, which could be a reward or a correction. Data are recorded for each trial. The instruction is given in very clear language that the child can understand, and, as the child becomes able to handle more complex language, it moves toward a more natural language base. The teacher may begin with a direct stimulus "look at me" then move to a more natural stimulus such as just saying the child’s name to get his or her attention. Prompts are not always needed, however are used to facilitate the desired response. Prompts can be visual such as a gesture or taking the child’s hand and moving it through the desired motions (a physical prompt). The aim is to reach a point where the child can perform the desired task with no prompt at all. The response should be evident within about 5 seconds. If there is no response, or an incorrect response, the trial is considered to be over and a new one begins. Feedback on each trial is immediately provided to the child. The more information that is provided to a child, the faster the learning can take place. It is important not to praise every response because some will be terrific, some barely adequate, some not quite accurate and some simply unacceptable. It is important that the feedback is an indication of where the response falls.

What are available Autism Resources?

1. Autism Society Of America

2. The Association of Behavior Analysis

3. The Doug Flutie Foundation

4. Autism Speaks

5. Autism - PDD Resource Network

6. Medline Plus Health Information

7. ASAT - Association for Science in Autism Treatment

8. FEAT - Families for Early Autism Treatment