Autism Behavior Modification: Techniques and Programs

Introduction to Autism and Its Management

Health professionals view autism as a disorder involving communication, social interactions, and repetitive behaviors (MedlinePlus 2009). It is usually identified first in early childhood. A person with autism has problems talking with others, may not make eye contact, and engages in unusual or repetitive behaviors. He may line up pencils in a conspicuous way, repeat the same sentence, flap his arms to express joy, or hurt himself to express sorrow. Some autistic persons never learn to talk. Health professionals describe it as a spectrum disorder because those afflicted exhibit different features and symptoms. Asperger syndrome is a milder form. The cause is still unknown and no cure has been found; therefore, the disorder may last a lifetime. Current approaches to its management include behavior and communication therapies and medicines to control symptoms (MedlinePlus).

Behavioral Therapy Techniques and Programs

The most distinctive feature of autism is the person's inability to relate to others (Kanner 1943, as quoted in Cautilli et al. 2002). The condition involves a disruption in language development or a complete failure to develop language, the need to maintain an unchanging environment, monotonous repetitions of behavioral sequences, strong abilities in very limited intellectual areas, and little spontaneity in play (Cautilli et al.).

Behavioral therapy techniques take the form of operant conditioning and modeling, through which autistic children can be taught many skills (Cautilli et al. 2002). These skills include displaying appropriate affective responses, talking, eliminating echolalic speech, playing with other children, playing symbolically, imitating others, and self-management (Cautilli et al.).

The creators of this program believed that language was the pivotal behavior (Cautilli et al. 2002). The program therefore focused on increasing expressive, receptive, conversational, and complex language skills, with the expectation that all other skills — such as toy play, peer play, and socialization — would follow. The training was enhanced with haloperidol. An experiment used three groups of children for the training. Those in the active treatment group were reinforced to be less aggressive, more pliable, and more socially responsive. Findings showed that treatment worked better when common home objects were used and when those objects remained present after treatment ended. The children's average IQ was 83. Early use of this program could help save states an estimated $2,460,402 by the time a child reaches age 55 (Cautilli et al.).

Behavioral therapists divide the behavioral excesses of autistic people into four functions: escape, attention, tangible reinforcement, and sensory automatic reinforcement (Cautilli et al. 2002). Behavior is generally considered communicative. A replacement verbal skill can be reinforced in place of an inappropriate one. Functional language training, when combined with this replacement approach, can reduce disruptive and inappropriate behavior (Cautilli et al.).

The effective strategies used in this model include incidental teaching, mand-modeling, time-delay technique, child-cued modeling, and contingent imitation (Cautilli et al. 2002). Incidental teaching, the primary strategy, structures the context in a way that maximizes the production of a desired response, which is then reinforced by natural means. The objective is to increase spontaneous speech. Language is learned expressively and in a natural context, which facilitates generalization (Cautilli et al.).

Parent training teaches parents how to give instructions, use prompts, and provide reinforcements for desired responses (Cautilli et al. 2002). It is also cost-effective. The most common form teaches parents the discrete trial format (Cautilli et al.).

This technique teaches action and object utterances (Cautilli et al. 2002). It is of special benefit to those with severe cognitive delays. This was demonstrated in a study conducted on developmentally delayed preschoolers, who were able to generalize 48 receptive and 48 expressive responses from only four to six direct teaching sessions (Cautilli et al.).

Equivalence relations represent a broader category of subjective relational responses in persons with autism (Cautilli et al. 2002). Further research is needed to determine how to incorporate these procedures effectively into the curriculum (Cautilli et al.).

This technique is designed to increase the variability of conversation (Cautilli et al. 2002). Experiments showed that introducing scripts with the fewest prompts possible would induce greater generalization, increase recombinative elements, and promote generative language. This, in turn, enhances fluency and the person's inclination to interact with others (Cautilli et al.).

Tools and Structured Interventions for Daily Life

It is not easy for parents to bring an autistic child outside the home, yet contact with the broader environment is essential for development (Krumins 2006). The child therefore needs tools to support this endeavor. These include a regular visual schedule, a "game plan" before leaving the house, clear explanations of expectations, sensory objects packed for each day's tasks, and informing specific individuals about what to expect from the autistic child (Krumins).

Programs that focus on joint attention can change attention states and improve social functioning and long-term prognosis (Mahoney 2006). This was the conclusion reached by Dr. Tanya Paparella of the Early Childhood Partial Hospitalization Program at the University of California, Los Angeles. Joint attention is a child's inclination to draw the attention of others through eye contact, referential eye gaze, and pointing. It is an important component of normal development that typically emerges between 9 and 15 months. Studies indicate that joint attention behaviors form the basis for developing skills such as complex expressive language and symbolic play (Mahoney).

The program is conducted over 12 weeks with 12 children with autism aged 2 to 7, for six hours a day, five days a week (Mahoney 2006). It provides direct intervention in speech therapy, occupational therapy, and recreational therapy. Children are also seen as a group or individually to promote language use, socialization, and appropriate interaction. The Mullen Scales of Early Learning are used to evaluate their progress (Mahoney).

Changing an autistic person's attention states through behavioral intervention can significantly contribute to the development of more complex social behaviors and communication skills (Mahoney 2006). Dr. Paparella further explained that simply reducing time spent in passive states can have profound effects on how an autistic person experiences the world (Mahoney).

Autistic children are generally understood to prefer an unchanged environment. Teachers therefore typically reduce the number of changes to which these children are exposed throughout the day (Jewell et al. 2007). To test this assumption, a study was conducted on 81 autistic children who were given a rotating classroom schedule for six months. They were evaluated before and after the rotation. The study found that approximately half of the children did not experience crisis or significant difficulty either before or after the classroom rotation (Jewell et al.).

This result challenges the currently accepted perception that autistic children prefer a completely static environment (Jewell et al. 2007). Because half of all respondents did not experience distress due to the changed classroom schedule, the findings suggest that autistic children do not universally feel uneasy with changing environments (Jewell et al.).

Applied Behavior Analysis (ABA) has proved to be an effective and superior teaching method for children with Autism Spectrum Disorders (ASD) (Handleman & Harris 2005). The Douglass Developmental Disabilities Center has been using ABA for more than 30 years to teach children, adolescents, and adults with ASD, combining research and clinical applications of the method (Handleman & Harris).

A follow-up study on 27 children at the DDDC showed that, of the 13 who started the program at 48 months or younger, only three were not placed in regular education classes afterward (Handleman & Harris 2005). Among the 14 who entered at 50 months or older, only one was not placed in special education classes. Those admitted with higher IQ levels were most likely to be placed in regular education classes upon completing the program. Even those with lower IQ levels who were placed in special education classes showed meaningful gains in IQ scores (Handleman & Harris).