Autism

Autism and neurodiversity

Autism

What is Autism?

Autism Spectrum Disorder (ASD) or “Autism” is a general term used to describe a set of symptoms with a developmental basis that affect how people communicate and relate to others and experience the world. There is a range of symptoms on the “spectrum” which vary in intensity and presentation from person to person with regards to how much their day-to-day living is impacted.

Back in 1943, Dr. Leo Kanner first described the characteristics of autism and it has since been learned that Autism is a developmental, or lifelong, disorder that affects about 1 in 54 children, with boys being 4 times more likely to be diagnosed than girls (Centers for Disease Control and Prevention). Although there is no known cure for autism, evidence based therapies in use by those practicing ABA have been leading the way in improving lives for those with Autism and their families. 

 What does it look like?

Autism looks different for every individual but there are some common symptoms involved, including:

Difficulty with, or lack of, communication skills

Difficulty with social interactions

Sensitivity  or numbness to sensory input

Reduced or unusual eye contact

Inability to identify emotions in others

Difficulty with transitions

Those who are diagnosed with Autism Spectrum Disorder are unique in their own abilities, talents, interests and potential just like everyone else. As a community, it is our job to ensure these individuals can realize their full potential.

Neurodiversity

The term neurodiversity refers to the fact that all humans, not just those with disorders, develop unique brain structures and response patterns over the course of their lives. You’ve probably noticed that the more you get to know someone, the more unique and distinct they become.

Practitioners in the field of ABA spend a great deal of time in direct treatment, with part of that time dedicated to carefully observing and learning about others in an effort to understand the motivations behind their behaviours. Many practitioners in the field cease to think about those they serve in terms of their diagnosis and think instead about those they serve in terms of their specific behaviours and motivations

The message about neurodiversity that we at Cayman ABA want to spread is that embracing the things that make each of us different and unique is what allows us to support each other effectively and learn to succeed in the world. This is true for our clients, their families, and all of us!

Prompting

Prompting: What is it?

In ABA, we always want our clients to succeed in everything they do. We want clients to feel empowered, supported, and know that they have the ability to do anything they set their mind to. A very common aspect of ABA includes something called prompting. Prompting is simply encouraging or assisting an individual to do something. In the case of ABA, we are assisting the client to respond appropriately. Essentially, we are adding or modifying a stimulus to evoke a correct response or behaviour. There are several different types of prompts, so let’s break it down with descriptions and examples of each.

  • Partial Verbal: Saying the beginning of the correct response, so the learner can say the rest 

Ex: Asking the learner, “What is your name?” and providing part of the correct answer, “My name is … “ 

  • Full Verbal: Telling the learner what to do, or saying the correct response 

Ex: Asking the learner, “What is your name” and also providing the complete answer, “my name is Bobby”

  • Visual: Providing pictures or textual cue to evoke the correct response 

Ex: Asking, “What is your name?”, and providing a card that says “Bobby” on it

  • Gestural: Gesturing or pointing to the correct response 

Ex: Asking for the toy cow, and then pointing to toy cow 

  • Modeling: Showing the learner what to do before they do it

Ex: Showing the learner how to put toys into a box for clean up, and the learner follows by putting toys into the box 

  • Proximity: Increasing the closeness of the correct response

Ex: Asking for the picture of the pig, and pushing the picture of the pig closer to the learner 

  • Partial Physical: A small and quick physical touch to direct the learner in the right direction

Ex: Gently tapping or guiding the client’s arm in the right direction to grab the correct item you asked for

  • Full Physical: Also known as ‘hand over hand’, we provide full physical guidance for the learner 

Ex: Using ‘hand over hand’ guidance to learn how to hold a pencil

These are all examples of how we use prompts in ABA. The ultimate goal of prompting is to encourage the learner to respond correctly, and praising them for that response.

The 4 Functions of Behavior series: Escape

The other function of a behavior is escape. Escape refers to negative socially mediated reinforcement. This involves escaping from an aversive experience, involving another person, in the outside environment (e.g., noisy classroom, difficult task, etc.).

Most children with Autism often resort to challenging behaviors to get out of work. They may display various types of behaviors, for instance, throwing into tantrums, self-injurious behaviors, property destructions, and at times self-stimulatory behaviors (e.g., hand flapping, body rocking, etc.) to escape a difficult task.

 These inappropriate behaviors can last for a long time because they are effective. They work. When a child cries, and tears the paper at school when presented with a math worksheet activity, and is brought outside for time out – the child stops doing the work. This is exactly what the child wants; to escape from the task. Teachers may think that they are teaching the child a lesson and hoping that the child would learn to comply next time. But no, they are just teaching the child to continue engaging in those types of behaviors to escape from the task. They are just reinforcing the escape behavior of the child.

 Parents encounter these types of situations as well at home. They also struggle on how to have their children comply with simple instructions without the child resorting into challenging behaviors (e.g., brushing teeth, wearing clothes, putting away their toys, etc.) The main key is to figure out some ways to stop these behaviors and have the child comply to have the task done.

 There are some effective strategies like enriching the environment, using high probability sequence (e.g., easy task, difficult task, then easy task), giving the child choices of activities, setting up schedules, being creative in presenting the activities, using a token economy system, FCT (Functional Communication Training), using the Premack principle – First and then, and more other techniques for the child to be more motivated in completing a certain task and not resort to escape it.

 In addition to those strategies, don’t forget to use highly preferred items/activities as reinforcers. You can easily see which items or activities are reinforcing to the child as those are the items they choose to play with or activities they engage in most if not all the time at home. Simple tips. After finding out those reinforcements, try to keep them and just have the child access to them after completing a certain task or demand. In presenting the task, make it enticing and fun for the child. You can do this by knowing what your child enjoys doing (e.g., flying him like a superman or like an airplane or moving like his preferred animal - hop like a bunny to go to a room in your house where you planned on doing the activity, etc). 

 Let’s go back to the strategies. As you can see, there are lots of different strategies to motivate the child to complete a task. But keep in mind that one child is different from another. We can actually just use one strategy or combine some strategies, whichever fits the child’s needs. For now, let’s learn how to use three strategies together like using FCT (Functional Communication Training), giving the child choices of preferred activities, and the use of the Premack principle that parents can use easily and effectively at home to teach their children to comply, stay on task and use more appropriate behaviors in escaping a demand. 

 

Functional Communication Training (FCT)

 We have already learned how to teach the child to communicate to gain attention and to access a preferred item/activity. This time, teach the child a replacement behavior for escape. Teach the child to ask for a break, go or I want to go. Why do we need to teach the child to ask for a break or ask to go? Because we much rather have the child verbally imitate us to say ‘Break or I need a break, I want to go, or get handed a ‘break or go ’ card than a child slap you on the face, or throw into tantrums for an extended period of time. So let’s replace it with an appropriate behavior because if we don’t teach them a replacement behavior to get what they want, they will continue to engage in those inappropriate behaviors to escape.

 We have to remember that the child can be escaping a social situation, a specific environment or a person, and not just from a task or demand. There are different techniques to teach the child how to request appropriately to escape from a demand. The strategies can be tailored to their language skill level and the severity level of their behaviors. You can use break/go cards, verbal prompts, visual cues, social stories, scripts and more. You just need to be creative and make sure to match it to your child’s needs and abilities.

 

Giving Choices

Knowing the child is the key here. You can start with simple preferred activities that you think are easy for the child to do it to completion. Present two preferred activities (e.g., inset puzzles, sorting colored toys, matching colored cars, or any activities that you see the child engage in most of the time). In this technique, the child will have a higher probability of complying and completing the task.  So for instance, ask the child ‘Which one do you want? The puzzle or the cars?’ as you present the two preferred items in front of the child. The child can either respond verbally or use gestures (e.g., pointing or touching the chosen item).

 

Premack Principle – First and Then

 The Premack principle is a principle of reinforcement, which states that an opportunity to engage in more probable behaviors (or activities) will reinforce less probable behaviors (or activities). For example, if a child enjoys playing games or listening and watching nursery songs on the iPad (more probable) and avoids putting away toys (less probable), we might allow the child to play with the iPad after (contingent upon) finishing putting away the toys. 

 This principle is often referred to as “grandma’s rule” because grandmothers (or any caregivers) often apply this principle: “First, you clean your room (less probable) then you can play with your computer (more probable).” This strategy is effective in teaching children with autism as it gives them a clear view of all the expectations.

 

 Contriving teaching situations at home

Now, let’s learn how to combine these three strategies in teaching your child to comply and learn to escape from a task more appropriately. During your free time, set at least 10-15 minutes to contrive situations in teaching your child. Let's say that you’ve already chosen two preferred activities (e.g., 3 piece inset puzzle and matching superheroes card game) for the child to choose from. Present the two activities and ask the child “Which do you want? The puzzle of the Superheroes card? Let’s say the child chose the puzzle. Then, present the instruction ‘First do the puzzle then you can play with your iPad (highly preferred item). For starters, just ask the child to fit in one piece of the puzzle. Provide a physical prompt if needed to complete the task then gradually fade the prompt as the child learns to do it more independently. Upon completing the task, immediately prompt the child to say ‘break, I want a break, go or I want to go’ or physically prompt the child to hand you a break / go card. Then reinforce heavily for using his words. Give the child 5 minutes to play and repeat the process. So, one instruction, then break. This process may vary depending on the skill and severity level of the child. I was just setting an example.

 You are maybe wondering why you just ask a child to fit in one piece of the puzzle and he/she gets a break for five minutes. One technique to avoid any challenging behaviors in presenting a task is to start from a quick, easy, and simple activity that ensures success. In this example, we are just teaching the child to learn how to complete a simple task and use his/her words ‘Break or I want a break or I want to go.’ to escape from a task rather than a child punching you in the face.

 You can build up the difficulty level of certain demands at home from simple putting away toys, dressing up, or brushing then give the child time to play. Let’s say, for example, you presented two pictures (e.g., brushing teeth and putting away toys in the box), then ask “Which do you want to do? After choosing one of the activities, then present the instruction ‘First brush your teeth then iPad.’ You can have the child play for a certain period of time (e.g., five minutes) after teaching him/her to ask for a break / or to go appropriately and then present another demand. You can only present more difficult tasks once the child learns to escape more appropriately. 

 

During the occurrence of challenging behaviors

 When the behavior occurs upon presenting a demand, don’t let the child escape from the demand. Let’s go back to our example. When giving an instruction to fit in the one piece of the puzzle but the child starts crying, kicking, and throwing; physically prompt the child to fit in the puzzle if you still can and verbally prompt him to say ‘Break or go.’ Even if the child didn’t imitate you for a break, let the child go. You have already successfully had him fit in the puzzle even if it was with a physical prompt.

But if you can’t physically prompt him anymore because it was too late and the child is already in a full-blown tantrum, then disengage with the child.  Do not continue giving the child a demand. Let the child calm down and keep him safe from hurting himself. Make sure not to attend to the child (e.g., don’t talk to the child and try to calm him down) and clear the room by removing all the toys or other things that could probably harm you and the child. Once the child calms down, allow a few minutes (e.g., 5 minutes) before you give the same demand. 

We may or may not present another demand after the tantrums. It would depend on the situation. It is essential to present again the same demand after the tantrum so that the child would learn to complete a task calmly and ask for a break more appropriately. We don’t want the child to learn the pattern of throwing into tantrums, get prompted for a break then he can go and play. Children with autism can easily pick up a pattern of behaviors. We want to avoid having them learn a pattern of engaging in inappropriate behavior first and then end with a prompted response.

 

 These are just some of the strategies in dealing with escape behaviors. Parents must learn just simple ways of addressing problem behaviors at home that are doable and easy to implement. Learning simple techniques at a time. Again, just remember to be consistent in dealing with the behavior.