The Reading & Writing Program — An Alternative Form of Communication

Nina Watthen-Lovaas interviewed by Joi Bay, ABAforum.dk

The development and training of vocal language is one of the cornerstones in the classical Applied Behavior Analysis (ABA) of children with autism. But some children with autism have great difficulties with learning verbal imitation and as a consequence of these learning barriers the Lovaas Institute for Early Intervention (LIFE) has developed an alternative form of communication: The Reading and Writing Program. Nina W-Lovaas has been one of the leading persons in developing this program. In this interview she outlines the background and the history of the program as well as the results achieved through this program.

What is the history behind the Reading & Writing Program?

We noticed that some of the children who did not profit from the traditional ABA-program were visually very strong – for example they could put puzzles together – puzzles that were at a level higher than their developmental age would suggest. They would also remember the route to grandmother’s house or the route to Mac Donald’s – they remembered every detail of it, so when mom and dad took another route, they would be very upset. Their visual memory seemed to be advanced. So we thought if they are visually so strong maybe it would help to use a visual form of teaching because this way the instruction would not disappear as it does when you say to a child, “Give me the pencil!” When you have said it, the instruction is gone. If it was a written instruction the child could look at it and it would still be there, so we figured that writings could be helpful for the child in a different way. That is why we started with matching of words and letters and we found that for most of these children it was enforcing in itself to match letters. What we thought would be difficult for these children they themselves did not find difficult. For example, we thought matching an object to a written word would be very difficult. The children could do this with for example with 12 word cards on the table. After a short period of training we would present a different object and they would match this with the correct words without much problem at all. In a way, they learned to “read” on a very, very simple level. This is not real reading but the child showed us that it had the potential.

Then we switched it around and we matched a word to an object, which – again on a very simple level – would be the equivalent to writing. But often these children have fine motor problems so it wasn’t easy to teach them to handwrite. Instead we decided to teach them to type. We performed different experiments and started using one finger and I thought: this looks pretty good – maybe they are able to use both fingers? I was surprised once more, because typing came much easier to quite a large number of these children – much easier than we have thought it would. We then, gradually put together a typing program where we would start with just one single letter and advancing it to a word. The children should only copy in the beginning – they were not supposed to label anything. During the next step the child should copy or imitate a word by looking at a printed word and typing that word onto the keyboard and we showed them for example a cup, a car, a duck, a ball, whatever, and they learned to label by looking at the object and typing the name of that object.

Is the Reading & Writing Program an original contribution to the development of ABA treatments or has it been tried earlier in the history of behavioral treatments?

We built our program on similar activities that had been done for other children, but we found very few studies including children with autism. Everything we found was based on imitation. The biggest difference between what we do and what others have done before us was to use matching as a basis for developing a pretty advanced program over time. It was Svein Eikeseth and I who started the reading and writing program, but Erik Lovaas, the son of Ivar O. Lovaas, and I have written the manual in cooperation and he is also working with children with autism.

What are the main differences between the earlier attempts to teach children with developmental delays to read and write and the way you do it?

The research I have read about earlier attempts to teach children with autism to read and write, has not really taken it to the point where we have taken it. We have gone much further. This is the major difference as far as I can see. Previous research has stopped at just labeling – for example, a child should address its immediate need with one word. Our aim was to find an alternative way of communicating with people that would help a child to communicate at a higher level than just with one word sentences. The first Reading & Writing manual stops at a certain point in language development and therefore we are now working on a second manual that will address advanced language. It will have more complicated grammatical concepts and will start with how you teach a visual child prepositions and pronouns, and how to build sentences where you combine all these things. This way we hope that a reading and writing child can communicate more like a verbal child.

How would you describe the Reading & Writing Program compared to PECS?

They are different. In don’t really know enough about PECS at an advanced level. But at a more basic level, PECS is based on matching so you don’t really get to the concept of discrimination learning in PECS – at least not on the basic level that I am most familiar with. This way the children end up using PECS for merely asking for things that they need and want, which is a reinforcer – for example to go to Mac Donald’s, to go swimming, to get a favorite food. In the Reading and Writing Program we hope that it will go further than that. We want it to be a forum of much broader communication. When we use PECS with some of the children, we start with a PECS-symbol and then gradually we teach the child the written word. Then we combine the written word with the picture and finally we gradually fade the picture out so that the word will be the only thing they need. We hope that the Reading and Writing Program in some ways will be more practical than PECS because with PECS you always need to carry this big book with you with all the symbols in it. In the Reading & Writing Program the only thing you need is a portable computer in order to communicate by typing.

Is the Reading & Writing Program an alternative communication system or it is a way of enhancing the academic qualifications of the students?

We don’t have data on these questions yet, but it is obvious that some of the children who have learned through the Reading & Writing Program did not initially understand spoken language and they did not speak a verbal language. At the moment we have at least two children at the LIFE-institute who are learning to speak and in my mind – without the R & W program as a base – this would never have happened. The written words have helped these children to understand spoken words and also the combination of the written and the verbal words have gradually taught them the sounds of the words to such a degree that they slowly start to express them. One child in our program, who has been participating for six years – she is 8 years and started before she was three – can actually speak sentences. For example she says: ‘My name is Sara. I live here. I like to visit McDonald’s. I want to go to my grandmother’. To her mother this is a miracle even though it has happened very gradually over six years. I doubt that she would have been able to advance this far using PECS.

What are the indications for starting the Reading & Writing Program?

The indications are that a child does not learn receptive instructions after you have tried everything possible through ABA. And further, that this child cannot discriminate – no matter what you do or how many methods you try to make this child see or learn the difference between “book” and “pencil” it is impossible – you cannot teach the child. You train verbal imitation and the child cannot learn to produce sounds or to combine the sounds into words. So you don’t get anywhere after even 4 months of intensive 40 hours training per week with the best of the teachers that we have – that child is not moving forward. Then we say to the parents: let us try to add the reading and writing program to the traditional program – we never leave the traditional program, especially after we have seen that some of these children actually start to speak after a while. We will never leave the verbal imitation and we test this as we move forward to see if we can continue with verbal imitation as well. In Sara’s case we have stopped the reading and writing program and now we only use the traditional ABA program because she understands instructions and she also speaks.

Could the Reading & Writing Program be a shortcut to academic qualifications in the same way as regular reading and writing are for neuro-typicals?

Yes, it can. For children who learn very quickly and who are auditory learners we teach them to read and write by using phonics. We say for example “This is the letter “T” and what is the sound of the “T” – and they say “T” as in “cat”. They use the phonics to learn to read and they learn to spell the word. This is different in the Reading and Writing program where we use the whole word.

In Denmark some non-handicapped children also learn to read by recognizing whole words --the picture of the word – instead of spelling the word.

This is a discussion that has been going on for quite a few years. I am sure that the Reading & Writing Program could be used to teach auditory strong learners with autism to read and write but we have not been using it in that way. We have been using it for children who are in a middle group: children who learn to understand verbal instructions and to learn to speak to a certain degree but have problems in becoming fluent in vocal language. And for them it seems as if seeing the word, reading the sentence is easier than to produce the sentence without having the written instruction in front of you. So we use this method until these children can read the sentence fluently and then we fade out the written sentence and go on with just the verbal. It does help although we don’t have any data on this either. But for two of our children – Douglas and Brian – who had quite a bit of verbal language, it has made a big difference in their fluency.

How come you don’t have any data on the effectiveness of the Reading & Writing Program that was started in 1994 – ten years ago?

The problem is time. I am a practitioner and I like to work with the kids. But we have so much to do that we never get the time to take the data and transcribe it into an article and get it to be peer reviewed for publishing. It takes so much time even if you have data. We do have data on quite a number of children. We have more than 50 because we have sites in several locations in America who has used the R & W Program quite a while. It took me years just to write the Reading & Writing manual. For two years I have been promising that the next volume would come and it is still not there. So we need time and more people and it costs money and we never have money. We did have funds when Kennedy was the president of the USA – that’s when Ivar really had money to use for research. But our economy has not been that good since, it has been harder to get funding for research projects. If you want to do research you have to do it on your own time, which very few people can afford.

If you had the data, would it be possible to see any side effects of the Reading & Writing Program – in IQ tests?

Yes, I think so!

In some way, it is a new way of helping children who would not be helped very much from the traditional ABA-program.

Yes, that is the whole plot behind the program, that we can help more children. From the 1987-study we had 47% who were doing very, very well, and then we had 53% who did not do so well although the variation of that group was quite large. Some kids in this group would be quite good but there were also kids who did not do as well. Those kids became more and more interesting to us because – as Ivar says – in a way we have milked ABA dry. What else can we do? We have to find other ways to use what we know and see if we can reach these children. I think that the Reading and Writing Program was a result of that kind of thinking. We saw children who teachers tried to teach sign language and how difficult it was partly because some of these children have fine motor problems. When you make a sign, you have to listen and you have to look at the same time at the teacher’s hands – what is the teacher doing with his hands? And what is the teacher saying? It is a sort of a double type of discrimination that the child has to do when the sign language instructions disappear and you have a sign that consists of more than one motion. If you have the sign for a book for example: you start like this and you do like this and then you see the result of the sign that you might not remember. Your nervous system might not let you remember how that sign started with the hands together and then opening them up. With the written word the instruction will always be there for the children to check with and help them remember. I think there is a difference in that regard. Now, some of these kids working with the Reading & Writing Program, who learn quite a bit, find it takes a long time to type. For example the teacher writes: “Do you want potato salad for snack today?”. The teacher has to type that out and then the child reads it and answers, “No, I want potato chips”. That takes a while. But if you use sign language instead it could speed things up. So a mother of one of the students that we had learned sign language and started to teach her son to use sign language. He used very simple signs for asking for a thing – when he wanted an apple, he would go and make the sign for apple and did not have to type “I want apple, mummy”. Now he could go and just sign “apple” and he would get an apple. So he uses a mixture of the reading and writing and sign language.

It would be very easy to design a computer program that could teach these children how to match and discriminate letters and words. Is this something you see as a future possibility?

Exactly, but this method is very time consuming. You need a lot of reinforcement, so having a computerized version would be a great help, but it is a question of time, too. And finding the right people help us develop a computerized program. But I think it would be an advantage because then you could alternate between doing it on the board and on the keyboard and also use the computer which maybe would be more reinforcing for the child. The drawback is that you lose the one-to-one personal aspect when you use the computer. But I am sure that would be a very good addition to the program.

I haven’t read any criticism on the Reading & Writing Program yet, but I can guess what the criticism would be. Some professionals would say that it is a very slow way of learning to communicate. That PECS would be much faster to learn, for example.

That depends on the child. For children with heavy problems PECS might be the only alternative. We have children who could never learn to match a word to word and never will understand the connection between an object and a written word. For them the symbols would be the only alternative to learn some kind of communication. So we will always consider using PECS either as the only communication method or as an addition to the reading and writing program.

You don’t consider this program a very long way to go just to be able to ask for potato chips?

If you have a very long way to go you would always use PECS first for the real quick getting what you want, and then look into the future. Where will this child go with PECS and where can it possibly go through the Reading &Writing Program? This is also a very individual question for every particular child. After you have tried the Reading &Writing Program for six months you might say: This is it! This child is really taking off with this program although he is a very low functioning child in many ways, but the Reading and Writing Program has helped him tremendously. With another child the program does not work well after six months and it is even an idea to drop it and just concentrate on PECS.

Another criticism could be that this communication system does not facilitate spontaneous communications, since the adult initiates the communication.

Not necessarily. We have children who always have a portable computer that is very light. It’s an AlphaSmart 2000 and it weighs nothing and it is very easy to carry with you. It has a very small display. We have children who carry this with them all the time. One child is always spontaneously requesting with his AlphaSmart, so he can go to his mom and write “Can we go to the zoo today?” Or “I want hamburger now, mom, please”, he writes. And he can write: “I don’t want to work any more, mom! – I want a break now, mom!” So you can actually be requesting spontaneously as easily as you can with PECS, and you might just as well carry an AlphaSmart as a PECS communication book. So I don’t see any problem there. A number of the children have an advanced version of the AlphaSmart – it’s called Link – and this version verbalizes the sentence that the child types. After the sentence is typed the computer verbalizes the sentence. If I typed a sentence to you, the machine would say it so I wouldn’t have to show the display to the communication partner. This possibility saves time in the communication process.

I think a big problem for the children who really get into the Reading and Writing Program is that it is very difficult to get social communication with other children with this system, but I think it is even harder with PECS. You don’t get any social communication from child to child with PECS either. And if you have two children using PECS they would never communicate with each other because they would be too autistic to do that.

How far is it possible for a visual learner to go with the Reading & Writing Program? Will these children ever be able to read a children’s book?

Yes, they will!  No doubt in my mind. We have children who read books – Barney Books and Sesame Street Books and they can answer questions from the teacher about what they have been reading. So there is no doubt that they understand what they read.  

So at one point the “reading” becomes reading in the normal sense of the word.

Yes, but what we don’t know is how many of the children who we regard as visual learners will reach that level – that we don’t know.

Notes

Watthen-Lovaas, Nina and Lovaas, Erik Ernst (1999) The Reading & Writing Program. An Alternative Form of Communication. Los Angeles, CA: Lovaas Institute for Early Intervention .

PECS (Picture Exchange Communication System) is an alternative visual communication system.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

http://www2.alphasmart.com/

 


Joi Bay / 03.10.2004