Was a Major Autism Therapy Prompted by the Need For Glasses? Part 2


We set the stage for the origin of the Lovaas/ABA method for behavioral interventions in autism in Part 1.  The application of operant conditioning principles to the behavioral problems of an autistic child stemmed from the need to enable or entice the child to wear his aphakic eyewear after cataract surgery.  Without success, Dicky would continue to throw his glasses and be left with deep and potentially irreversible visual impairment.

Autism - Donvan & Zucker

As reported by the correspondent and journalist team of Donvan and Zucker, the “Dicky Study” represented the first indisputably life-changing use of ABA to instill beneficial behaviors in a child with autism while eliminating behaviors that were disruptive to learning and physically harmful.  By throwing his aphakic glasses across the room, Dicky was inflicting a form of  self-depriving behavior in maiming his vision that was every bit as injurious as tearing at his flesh.

Wolf, Risley, and Mees followed the basic shaping procedures pioneered by Skinner.  On the theory that the full prescription in the aphakic glasses might be too drastic of a change on visual stimuli, the investigators decided to begin with empty ophthalmic frames that had no lenses.  Dicky would be rewarded for putting the frames on over his ears instead of under them, and for looking through the center of the frame.  Eventually a bar was added to the frame, equivalent to orthodontic head gear, that would help Dicky position the frame properly on his face.  He was still very averse to anyone else touching his head.  In addition to using food rewards and walks as positive reinforcers, negative reinforcers described as “time-out” were used when Dicky threw his glasses, and he would have to go to his room and deprived of pleasurable activities.  The concept of “time-out” pioneered in this study is still very much in use thy parents today to shape behavior.

Time_Out_Photo

Wolf, Risley, and Mees originally intended to titrate Dicky’s Rx up in three stages, perhaps giving him low plus power at the outset, then increasing it to a moderate amount, and then to the full power.  This turned out not to be necessary in his case, but that is an excellent principle that we still make use of in our practice.  When negotiating the complex issue of sensory sensitivities of a frame on a child’s face, and the visual sensory overload that may be experienced by Rxing too high of a lens or prism value, we often begin with lightweight frames and low power Rxs.

Following the successful behavioral modification for wearing his glasses, and verbal training the followed the same positive and negative shaping procedures, Wolf, Risley, and Mees related the following:  “According to a report from the mother six months after the child’s return home, Dicky continues to wear his glasses, does not have any tantrums, has no sleeping problems, is becoming increasingly verbal, and is a new source of joy to the members of his family.”

Thus ABA was born.

6 thoughts on “Was a Major Autism Therapy Prompted by the Need For Glasses? Part 2

  1. Not quite following you on this one, Michael. It isn’t clear to me that the Skinnerian approaches that Wolf, Risley, and Mees — and subsequently Lovaas implemented as ABA were advances initiated by Optometry. While we have no shortage of instances in which frank optometric principles were conscripted by others without proper attribution, this doesn’t appear to be the case here.

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