MODIFIED DISCRETE 

TRIAL TRAINING (DTT)

Within Stepping Stones’ treatment program, emphasis is placed on acquiring new and appropriate behaviors. When children have a repertoire of constructive behaviors, problem behaviors often occur less frequently. Therapists are trained to ignore undesired or disruptive behavior but to promote compliance and other positive behaviors through the use of reinforcers. Reinforcers are chosen to be whatever the child desires most that is appropriate for use in such contexts as modified DTT.

 

The purpose of our program is to teach these children how to learn through acquiring academic, language, social, and appropriate behavioral skills. Behavioral methods enhance learning not only by teaching the child but also by replacing challenging behaviors with more appropriate ones. The child’s success is closely monitored by detailed data collection.

Stepping Stones’ treatment program involves a range of different skills that are taught to each child, using a range of locations in which to conduct the treatment sessions, which allows for generalization, and particular strategies to cope with challenging behaviors where necessary. As the child masters these skills, it becomes important to deliberately increase variability in order to facilitate generalization to all persons and settings in the child’s natural environment. Changes in instruction are made if the collected performance data indicates that modification is needed for the child to achieve successful mastery of the skills.

Intensity of Intervention:

Teaching is a process that will change over time. In determining the intensity or number of treatment hours, the child’s daily schedule should be considered in order to determine an appropriate balance between periods of intensive teaching and less intensive. In determining the intensity or number of treatment hours, the child’s daily schedule should be considered in order to determine an appropriate balance between periods of intensive teaching and less intensive, as well as allowing for the child’s need to have periods of free time.  Research shows that many children will do best with 30 or more hours per week of direct instruction. The duration of the treatment sessions are adjusted to provide maximum benefit. Although not confirmed by research, it is believed that the most appropriate age to begin intensive ABA treatment is between 24-36 months (before 3 ½ years of age). Every child’s program is individualized in order to meet his or her particular needs.

TREATMENT

FORMAT

A positive and systematic approach to teaching functional skills and reducing problem behavior as well as creativity and flexibility, capitalizing on the resources available for each individual child, is strongly emphasized in each child’s individualized program. Each child’s program is developed to include skills such as imitation and play (see following table). However, the emphasis of the program shifts during the course of treatment, dependent on treatment progress and behavior, though the treatment’s general structure remains the same.

DEVELOPMENT

PROGRAM

GOALS FOR A

DEVELOPMENTAL-BASED PROGRAM

Children Under 5 Yrs

  • Attending to environment

  • Attending to people

  • Verbal and motor imitation of others

  • Receptive language comprehension

  • Appropriate use of toys in play

  • Peer interaction

  • Making choices

  • Following routines

Children Over 5 Yrs With Language

  • Same as “Children Under 5″

  • Adaptive skills

  • Pre-academic skills

  • Academic skills

  • Self-help skills

  • Abstract language

  • Social skills

  • School readiness skills

  • Practical knowledge

  • Expressive language skills

Children Over 5 Yrs Without Language

  • Same as “Children Under 5″

  • Adaptive skills

  • Pre-academic skills

  • Academic skills

  • Self-help skills

  • Social skills

  • School readiness skills

  • Practical knowledge

​We believe that it is important to build on a child’s successes and expand the utilization of existing skills as well as encourage the development of new ones. Therefore, utilizing the child’s areas of strength and building upon them as rapidly as possible, while simultaneously attempting to offset the areas of weakness, is of great importance in our program. These teaching methods are based upon the application of a learning theory where the approach is very pragmatic. Therefore, thoughtful planning results in greater consistency across team members and leads to more successful outcomes for the child.

EVALUATION METHODS

Our program stresses direct measurement of the child’s performance. Direct evaluation is crucial because it allows the treatment team to determine the child’s progress as it guides objective and clinical decision-making. The assessment and documentation of a child’s pre-intervention or baseline behavioral performance is essential for treatment planning, decision-making, and evaluating the effectiveness of the intervention.In turn, this information assists in the development of realistic objectives, establishing performance criteria, and developing task and step analyses. In addition, baseline data provides the “before” picture with which to compare treatment results (the “after” picture).Therefore, an ongoing assessment of progress towards outcomes, as measured by individualized data collection systems, continues to be a major part of the program in order to guide the intervention process.

 

Data collected per treatment session reflects information that is specific to both teaching target skills and observations of behavior. In addition, regular clinic team meetings take place for each individual child. These clinic meetings often take place monthly. They serve as forums for discussions concerning the child’s treatment program and provide continued training for the treatment team. These meetings focus on demonstration of teaching sessions with the child so that the team can observe the various interventions that take place (which allows for more consistency with therapists’ performance), reviewing the effectiveness of the treatment program and making program modifications, as needed. Therefore, collaboration between the family members and service providers as well as flexibility in adjusting strategies in a timely manner is key in this evaluation process. All of these aspects of communication and planning are facilitated by clear and consistent treatment documentation.