Committed to creating an inclusive educational climate, the Faculty of Nursing and Health Sciences (FNHS), in collaboration with the Faculty of Humanities (FH) and the Smart Kids with Individual Learning Differences Center (SKILD) at Notre Dame University-Louaize (NDU), as well as the Association for Behavior Analysis Lebanon (ABAL), organized a symposium at the Pierre Abou Khater Auditorium titled, “Science-Based Instructional Practices Using ABA for Autism and Other Developmental and Behavioral Challenges.” Featuring a roster of expert speakers, the event covered the best practices, approaches, and considerations in the implementation of behavior analysis. In attendance were the NDU Vice President for Academic Affairs, Dr. Michel El Hayek, Vice President for University Advancement, Dr. Antoine Farhat, Dean of the FNHS, Dr. Jessy El Hayek, Dean of the FH, Dr. Maria Bou Zeid, Director of the Office of International Relations, Dr. Jessica El Khoury, ABAL President, Ms. Sousan Razzouk, and a wide range of faculty members, staff, students, and guests.
The ABAL, an affiliated chapter of the Association of Behavior Analysis International (ABAI), is an advocate of increasing awareness of science-based behavior analysis applications in various fields in Lebanon, most notably the education sector. The ABAI defines behavior analysis, specifically Applied Behavior Analysis (ABA), as the study of the interplay between biological, pharmacological, and experiential variables, their impact on human behavior, and the subsequent teaching of adaptive behaviors in a number of capacities, including those on the autism spectrum or with developmental challenges.
FNHS Dean El Hayek welcomed the speakers and attendees, thanking them for their presence at the symposium, the purpose of which was “to build a bridge between practice and compassion,” as well as “celebrating the achievements of persons with autism and other challenges.” In her own address, ABAL President Razzouk echoed these sentiments and emphasized the dedication of the Association to upholding the ethics of ABA practices, protecting the rights and dignity of those they serve, and championing inclusivity for the sake of a more just world. Razzouk additionally stated: “I hope that this collaborative endeavor today marks the start of a long-lasting relationship with NDU.”
The first presentation, by Ms. Jenny Chebli, NDU Alumna and ABAL Treasurer, introduced the basic principles of ABA to the audience, providing a comprehensive overview of how behavior analysis’ central ideas translate in different fields, namely education, psychotherapy, and organizational behavior management. Per Chebli, ABA’s goals are to increase the quality of life, adaptive behaviors, and individual independence.
Common behavior functions found in those with autism spectrum disorder (ASD) and other disabilities include escape/avoidance, attention-seeking, access to tangible items, and self-stimulating reinforcement. The assessment process therein would look at the ABCs of the situation: Antecedents, Behavior, and Consequences. Once a cause, observable behavior, and outcome are determined, ABA techniques can then be applied. Chebli noted that any improvement made in the clinic must also translate to life at home, as it tends to be the least structured. Generalizability is the ultimate goal of ABA, i.e., ensuring that adaptive behaviors apply to the majority of situations.
Next, ABAL Advisory Board Member, Dr. Lina Slim, gave a talk outlining the best practices in verbal development in persons with ASD. Given that autism is typically correlated with speech and language delays, Slim’s presentation discussed how the concurrent adoption of behavior analysis and speech-language pathology facilitates language acquisition and production, particularly in early interventions.
Speech pathologies can usually be placed into two categories: motor difficulty and initiation difficulty, the former referring to issues with the muscles used in speech, and the latter to independently generating speech. She underlined the necessity of evidence-based practices, which must be informed by extensive, clinical research in peer-conducted studies and incorporate the child’s familial and cultural values. Slim concluded with a caution against misinformed, pseudo-scientific, and potentially harmful treatments, and instead encouraged collaboration with certified speech-language pathologists so as not to jeopardize the child’s wellbeing.
Ms. Tamara Kasper, founder of Kasper Enterprises in Wisconsin, USA, then took to the podium, drawing from her extensive experience as a pediatric speech-language pathologist in treating toddlers, children, and young adults on the spectrum. Kasper introduced the concept of Naturalistic Developmental Behavioral Interventions (NDBI), which constitute face-to-face interactions, positive affect, responding, communicative prompts, pace and frequency, among other elements.
Kasper explained that NDBI focuses on child-led behavior analysis, studying children’s responses in order for the therapist to intuit their needs and implement the appropriate intervention accordingly. To illustrate the various techniques, Kasper showed the audience several videos of children responding to NDBI, pointing out the different cues that signal whether or not a child is comfortable, interested, or generating speech during the activity.
Offering a supplement to ABA, Dr. Lilith Reuter-Yuill from the Comprehensive Speech and Therapy Center, Michigan, USA, spoke next of Augmentative and Alternative Communication (AAC) in her talk, “Supporting Emergent Communications with Autism Using Augmentative and Alternative Communication.” AAC is an area of research and clinical practice that addresses the needs of individuals for whom vocal-verbal repertoires alone are inadequate to meet communication needs. The idea behind AAC, according Reuter-Yuill, is that even if individuals have “a disability that prevents them from developing functional speech, this does not mean that they are not communicating.” Popular examples of non-verbal communication include formal sign language systems, such as American Sign Language, or gestures developed at home.
AAC is a tool that not only applies to persons on the spectrum, but also those with Down syndrome, cerebral palsy, neurogenic disorders such as traumatic brain injury, as well as other disorders. Including a variety of communicative forms and verbal behavior topographies, AAC can be aided or unaided, i.e., using tools and equipment or relying on physical cues alone. Similar to ABA, Reuter-Yuill underlined the issues of administering treatments that have insufficient evidence, including but not limited to: a shortage of peer-reviewed articles, non-representative demographics, definition variation, and validity and reliability of clinical studies.
Dr. Christine Sabieh, Professor of Education at NDU, gave the final presentation, titled “Simply Three: Educator Profile, Accountability, and Technology.” Sabieh provided an overview of the elements required in education, particularly special education, to have a working and successful pedagogical framework. The first element, educator profile, involves consistent assessment of educators on a regular basis and their efficiency in consistently challenge students to reach their full potential.
The second requirement, accountability, is, for Sabieh, a key issue. This applies to the macro and micro levels of education, from the Ministry of Education and Higher Education to individual teachers. Accountability is not only a measure of educational quality, but also a question of progress: if progress is obfuscated, all variables must be reexamined, from a lack of funding to strategies that only work on paper. Sabieh summarized accountability with the 3 Cs: character, courage, and commitment. She said, “For anyone who goes to into this profession, accountability starts with you, and you should force the school to take that into consideration.”
Moreover, Sabieh advocated for the use of technology, asserting that it “needs to be incorporated in the classroom because it enriches the environment.” Accessibility and professional training are the cornerstones of ensuring that high-tech classrooms and teaching strategies are effective and meet learning outcomes. To conclude, Sabieh gave a rundown of the FH’s MA in Education, which includes an emphasis on Special Ed and is equipped with all the tools needed to cultivate capable and proactive teachers, school administrators, and the like.
The last segment of the symposium comprised an introduction to the IDEAL Program, a collaborative effort between NDU and SKILD. Lama Badaoui, Director of the Ideal Program, explained that it “was created to encourage those with special needs to have a fulfilling university experience even if they can’t pursue a typical undergraduate degree.” The two-year certificate program fosters a variety of skillsets in individuals with special needs, highlighting career development, communication in the workplace, life and social skills, and internship opportunities. A video was then played, chronicling the graduation of the first IDEAL cohort this past Commencement Ceremony of 2023, all of whom have acquired jobs in the months following graduation.
To illustrate the Program’s efficacy, Dr. Adriana Azar, doctor in translational and behavioral neuroscience, the sister of G., an IDEAL student set to graduate in 2024, gave her testimony on how IDEAL has dramatically improved his life, particularly after a long journey to find the appropriate path for his education and treatment. Azar shared their family’s experience in educational and medical spheres: between schoolteachers neither being able nor willing to understand G.’s behavior, to them suggesting he get pulled out of school and pursue a trade, they sought medical and psychotherapeutic advice both in Lebanon and the US. Both here and abroad, they continued to face the same obstacles: not reaching a definite diagnosis, and, as a result, failing to create a treatment plan that would facilitate G. into integrating with his peers at school.
Azar said of her brother: “G. is not on the autism spectrum, he does not have ADHD, and he has no difficulty reading. The lack of a diagnosis was partially why professionals were not equipped to help him.” Instead, Azar explained that what ultimately helped in this situation was the IDEAL Program, which—other than its curriculum—ultimately provides the one thing necessary: community. “The first noticeable difference we saw in IDEAL was that its students were not isolated from university life,” Azar said. “G. has always been at his best when he feels like he’s an integral part of the community; he doesn’t need to be taken care of—he hates it, actually—he just likes being part of a group.” The sense of belonging and genuine interpersonal connections that IDEAL students form at NDU are positive predictors of their enjoyment of life at NDU, where they are able to fully experience what the University has to offer alongside their friends from all walks of life.
The symposium was thus a diverse and enlightening event, tackling an array of topics with nuance and demonstrating evidence-based practices across various contexts. The conversation surrounding ASD, speech disorders, and other challenges underlined a need for board-certified professionals, properly trained, and who lead with compassion and integrity for the sake of others.