It’s human nature: we want our children to grow and learn in healthy ways and at healthy rates. If a child isn’t growing, we worry. If a child doesn’t appear to be learning at expected rates, we worry even more.
When children struggle with social communication or speech-language skills, it’s important to identify their needs early and provide skilled intervention. Problems arise, however, when a child begins a therapeutic intervention related to social learning or speech-language therapy and progress isn’t observed as quickly as everyone would like. While it is possible that the child isn’t learning or responding to the program, it is important to avoid dismissing an intervention before giving it a chance to work.
In statistics this type of mistake is called a “Type II error” and is commonly known as a false negative. In medicine, this happens regularly—for example, when a blood test yields a negative result for a disease that the patient actually has. It can also happen in speech-language therapy or social learning interventions because often the target skills are complex and require consistent practice to master. Judging that an intervention is ineffective before it’s had enough time to work can limit a child’s chances of a positive outcome. There are three main reasons why parents might decide that an intervention isn’t working when it actually is:
- Insufficient time
- Insufficient practice
- Insufficient data
First, learning complex information or systems takes time. Children with social learning needs or speech-language issues must simultaneously learn new strategies to address their weaknesses while “unlearning” the behaviors or ways of communicating that brought them to a specialist in the first place. For example, initiating conversation is difficult for some children on the autism spectrum. Teaching this skill requires a labyrinth of interpersonal skills that must be isolated, identified, defined, modeled and practiced before the child can be expected to demonstrate even a modicum of skill outside of the therapeutic setting. While some skills can be learned quickly (within 2-4 weeks perhaps), skills in areas related to language acquisition or social communication require several months and may develop gradually over the course of a year or more.
Second, learning new cognitive or communication skills is a bit like learning to play a musical instrument or a sport. You can’t just show up for a weekly piano lesson or soccer practice and expect improvement. The frequency, duration and effectiveness of practice play a big role in the success or failure of any intervention. You need to make time during the week to practice; otherwise you can’t expect a skill to improve. Of course we all have busy lives, and things fall by the wayside, but it’s important to recognize that a failure to practice isn’t the same as a failure of the treatment or intervention.
Third, it’s important to be able to measure small changes that occur during treatment of a child’s social behavior or language. When setting goals for treatment, it’s important that the therapist work with the parents and the child to establish how progress will be measured. Measuring even small changes is important because true learning—learning that “sticks”—tends to be gradual and difficult to see at times. A child with social interaction difficulties will not become a skilled social communicator without carefully scaffolded mini-goals and plenty of opportunities to practice. To measure small gains, there must be enough small data points. Gauging success or failure without measurable, “granular,” and achievable outcomes would be like assessing a struggling reader’s progress by asking, “Did you finish the book?” Neither a yes nor a no answer is particularly helpful or informative because we have asked the wrong question.
It’s human nature: we make mistakes. Sometimes we think an intervention is working when it’s not, and sometimes the opposite is true—we think an intervention is not working when it is. This “false negative” type of error can set a child back for three reasons. First, the child is withdrawn from an intervention that is actually working. Second, the intervention is then wrongly labeled ineffective. Third, the child often reverts to a previous state of dysfunction.
When parents of children with social learning or speech-language needs combine their good intuition with adequate time, sufficient practice, and high-quality data collection during intervention from a skilled therapist, their children’s learning outcomes will improve.
