SIFTING SOUND PRACTICE FROM SNAKE OIL CHAPTER 2 SIFTING SOUND PRACTICE FROM SNAKE OIL JUDITH E. FAVELL Presented By: Elizabeth G. Callahan Caldwell College

INTRODUCTION The human services arena has a history of dubious interventions and pseudo treatments. No particular arena has been immune to unsubstantiated claims or controversial fads, however the field of developmental disabilities has been particularly vulnerable. Although substantial and well substantiated progress has been demonstrated across decades, teaching adaptive skills, treating maladaptive behavior and improving the overall quality of life for individuals with developmental delays, this progress is often overshadowed by “breakthroughs”, “cures” or “revolutionary strategies”. Often promoted by comparing the new technique’s “astounding” effects to the poorer outcome of the traditional approach and the denunciation of this treatment. Institutions  Community Movement in Developmental Disabilities New models will continue to arise and this is fundamentally healthy and essential for the continuous innovation of the field of developmental disabilities. The issue is whether and how the veracity of claims about these new methods are assessed.

THE RULES & REWARDS OF SCIENCE Favell states the chapter and the book are: “predicated on the premise that science is virtually the only means by which the field of developmental disabilities can test the effects of any proposed ‘innovation’, and either establish or disconfirm its value as a beneficial part of services and supports”

THE RULES & REWARDS OF SCIENCE The Scientific Method : Quantitative, direct measurement of observable events to empirically verify effects Uses analytic means to determine if the intervention functionally caused effects Replication to establish that results are not confined to one individual , practitioner or other set of unique, non-repeatable set of circumstances. The Scientific Method separates substance from superstition, treatment from tricks and sound practice from snake oil.

THE RULES & REWARDS OF SCIENCE The scientific process has yielded an entire body of knowledge and technology which has been applied to bettering the outcomes for individuals with developmental disabilities. Functional means of teaching people to use the bathroom, feed themselves, read, work, communicate and engage in leisure activities. Effective means of treating incapacitating behavior problems, such as SIB and aggression were discovered. Such problems were found to conform to lawful principles and responded positively to comprehensive treatment which reduced their frequency and severity. This gradual accumulation of empirically valid and reliable methods of education, training and treatment in turn enabled the social revolution that emphasized the potential for growth in people with developmental disabilities. Oriented supports to facilitate their development, enables greater independence and enjoyment of life. Integrated living in community , work, less of a reliance on drugs, and treatment for maladaptive and socially stigmatizing behavior. ALL of these outcomes were possible through the process of basic and applied scientific research!

THE DISTRUST & DISDAIN OF SCIENCE Despite the essential contribution of science to the understanding of and amelioration of barriers and problems associated with developmental disabilities, science has remained distrusted and disdained by large contingents within both the field of the developmental disabilities as well as society at large (Danfoth, 1997).

THE DISTRUST & DISDAIN OF SCIENCE The process of science appears arduous and slow. Requires a seemingly inordinate period to conduct investigations, arrive at conclusions and disseminate its results. The methods and analyses of science appear to defy logic and do not conform to conventional wisdom and common sense. The scientific process appears arcane, complex & confusing to the developmental disabilities community, general public and professionals who have not received training to value the logic or methods of science. Science is a tool to advance knowledge and for social change but it is not often taught even on a graduate level in many disciplines, such that even highly trained individuals when presented with a new method, may not have the scientific knowledge to evaluate their legitimacy. Preoccupation with methodology which can appear to eclipse an interest in the meaningfulness of the results. Science can appear self-serving, detached from the real issues confronting those with developmental disabilities.

THE DISTRUST & DISDAIN OF SCIENCE Science’s hallmark as “value-neutral” risks results/outcomes that do not conform with prevailing beliefs, wisdom, treatment or instructional philosophy. Perhaps worst of all the scientific process may yield an unexpected, unwanted answers that don’t conform with prevailing beliefs. One must be prepared for this: that a promising approach disconfirmed. This possibility of that happening may be too painful to a family engaged in a desperate search for help or those professionals whose positions, livelihoods and even identities are tied to a specific belief/approach. Issues related to dissemination. Dissemination often occurs in scientific journals or at professional conferences. Communicating to the consumers occurs, but often deals with the outcome of the research and not with the role, methods and benefits of science. Consumers therefor are not exposed to knowledge which would provide them with a basic means of discriminating between claims made with or without sound empirical evidence. Families and professionals who are not part of the scientific community are left vulnerable to fads and unsubstantiated promises.

The care & feeding of fads Science is viewed as a slow, arcane and insensitive enterprise while the fads of the developmental disabilities community often have compelling features which are easy to promote and popularize. When functioning outside of the labor intensive realm of science the process of developing and disseminating a new idea or practice is not only easier but can occur at a much more rapid pace.

The care & feeding of fads Idea: derived from a hunch/observation/anecdote/case study Organize: theory and associate it with some terms and principles Meet the Press! (book, speaking circuit, radio, internet!) : Always in search of hype! Families in Desperate Search for Answers = Receptive Audience In this rapid trajectory from concept to audience, critical scrutiny may emerge only much later in the process, sometimes after the fad has been adopted widely and at great cost in terms of resources and emotional investment (Jacobson, Mulick, & Schwartz).

The care & feeding of fads Phenomena in developmental disabilities lend themselves to faulty observations and conclusions. For example variability of problem behavior and skill acquisition. Observations and accidentals correlations invite incorrect attributions of cause and effect relationships which spawn superstitious practices, in the area of problem behaviors and other domains. Due to the uneven course of development seen in this population, everyday observation is insufficient to determine what accounts for progress or regression. Faced with this variability in behavior and skills it is not surprising that families and even some professionals, in search of answers, seize faulty correlations. This process, though understandable, can and has created practices and movements that are nonfunctional or harmful.

The care & feeding of fads Just as in all other fields, the field of developmental disabilities, is populated with humans, whose needs for positive regard, attention, and making a contribution, as well as their own advancement and income, cannot be ignored. Science is still the essential tool to discriminate those “snake oil” salesmen and honest purveyors - to see whether they are promoting scientifically validated treatments. Individuals whose ideas are ultimately proven misguided or wrong should be forgiven. Individuals who reject efforts to test their claims or those who continue claims despite evidence against them – should be treated less charitably.

The care & feeding of fads Philosophical and/or political currents exert pressure on the field. Positive events: Benefits of early intervention in autism (McEachin, Smith, & Lovaas, 1993). More often, shifts in policy and practice appear to derive from negative events, particularly when an individual with a developmental disability is harmed in someway (Johnston & Shook, 1987, Weiss, 1998). Therapeutic restraint in light of press reports of injury (Weiss, 1998). Thoughtful analysis of risks/benefits as part of a comprehensive program for an individual with severe behaviors is quickly disregarded by those calling for categorical prohibition (Favell, 1990). Statements made in interviews, testimony and in press are often unchallenged and taken in by a public looking for palatable answers, rather than experts discussing evidence based analysis. Climate and contingencies foster extreme and unsubstantiated opinions that may give rise to dubious and improbable approaches that promise relief, especially to more challenging problems.

Applied behavior analysis: an example of the fruits of science & the foundation of fads Behavior analysis has played a vital role in revolutionizing treatment and training in developmental disabilities, moving services from custodial care to community based supports, freeing individuals from many behavioral and adaptive barriers that kept them dependent and often devalued. (Konarski, Favell & Favell, 1992). These advances are based on decades of solid research that has yielded a technology of treatment and training never seen before (Konarski, Favell & Favell, 1992). Despite the strong body of research and contributions to the field of developmental disabilities, behavior analysis continues to be the subject of major criticism from both parents and professionals (Hobbs, Cornwell, & Chiesa, 2000, Lovett, 1966).

Applied behavior analysis: an example of the fruits of science & the foundation of fads Lack of respect or acceptance is often manifested by the fact that new fads are referenced against behavior-analytic principles/methods. Positive Behavioral Supports (PBS): Depicted as an “alternative” to behavior analysis, rather than what it is, a derivative of behavior analysis. This implies that it is wholly different from the behavior analytic techniques from which it came Often comparisons include outmoded behavioral practices, which are now evolved into more effective practices utilized by behavior analysts as well as those practicing PBS. Person Centered Planning: focuses on individual and builds a support plan based on strengths, preferences and personal desires. Compared with behavior analysis, when in fact the very foundation of behavior analysis is its focus on the individual, emphasis on their unique preferences, reinforcers, strengths and needs. Strength-based planning is helpful orientation to design supports, however delivering supports must come from well researched behavioral principles such as shaping (Osborne, 199).

Applied behavior analysis: an example of the fruits of science & the foundation of fads The processes by which behavior analysis works are slow, methodical, difficult and expensive and empirical rather than values based. Behavior analysis is not as dramatic or fun as a machine or a dolphin! Behavior analysis does not claim instant breakthroughs, miracles or cures – which are part of what makes a “fad” so palatable. Behavior analytic methods do not necessarily conform to common sense and popular culture (ex. use positive reinforcement) Behavioral analysis “proved” itself when the medical and psychiatric communities “allowed” us in to work with those diagnosed with developmental disabilities. Continue to prove ourselves, as behavior analysts, in the face of fads, that often use us as a comparison point.

Essential steps toward sound practices In order to maximize vital innovation by promoting worthwhile strategies of demonstrable benefit in the field of developmental disabilities the author, Favell, suggests the following steps: Recognize that new fads and movements are neither inherently good nor bad. Encourage new ideas, not suppress them – ABA was once one of those radical ideas. Concentrate less on the origin and nature of the methods proposed, emphasizing instead that the approach be systematically evaluated and analyzed. Behavior analysts should remain open to new ideas outside of the field and lend their analytic and measurements tools to the process of evaluating it empirically. Distrust proponents of a movement who will not submit to such evaluations and prompt consumers to do the same. Whether the proposed approach rests on a well established body of literature or has not been explored thoroughly, experimental evaluation, using single subject design, is the surest way to answer questions about its effectiveness and is essential to accumulating a body of information on a new approach. Individual cases when necessary can be used when necessary (Ex. Secretin) These experimental outcomes, positive, negative may help to remove some of the philosophical, emotional arguments that would otherwise occur.

Essential steps toward sound practices 4. Qualitative and quantitative processes should be used to measure factors such as practicality, cost and social acceptability, and to yield the most comprehensive evaluation of a method. Can design questions to measure how often someone is on-task during meal- prep in their apartment, but the essential next step involves a decision regarding whether the processes and outcomes are good, harmful …value based decisions. Data can be useful but the next step involves decisions regarding whether the process and outcomes are good, harmful or beneficial. These are value based decisions which ultimately determine whether a a strategy, method, approach is in the best interest of an individual. Particularly challenging for individuals who cannot decide for themselves, must consider the role of the family.

SUMMARY The fundamental challenge is to differentiate which of these ideas are sound and actually help people and which are without substance. The scientific method is the only real means of “sifting sound practice from snake oil” and yet its principles and process are not readily embraced. Difficulty accepting science as a source of information and vehicle for change is contrasted by the ease with which fads blossom and flourish promising easy and quick results. Devaluation of scientific approaches and promotion of new methods by denigrating approaches that preceded them, which often in fact, inform them – typically behavior analysis. Must accept new ideas in the field of applied behavior analysis, rhetoric about their effects must be replaced by empirical tests and the use of direct measurements must be used.

REFERENCES Jacobson, J.W., Foxx R.M., & Mulick, J.A. (Eds.). (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. Hillsdale, NJ: Erlbaum, ISBN: 0-8058-4192-X