Fri | Aug 18, 2017

Addressing problem behaviours in autistic children

Published:Wednesday | November 4, 2015 | 11:21 AMTrudie Williams

Autism is a neurological disorder which presents different symptoms on a spectrum of varying combinations and intensity. The signs of autism usually appear by the age of three years. Some researchers point to its signs appearing from as early as 12 months old.

While each person is affected differently, impairments in communication, social interaction and behavioural challenges may occur. Communication deficits may be manifested by difficulty conversing with other persons, limited eye contact, social deficits and behavioural challenges, which may be evidenced by non-response, crying, running from adults, hitting, biting or self-injurious behaviours (SIB).

Children affected by autism may be marginalised by peers and even adults. Such negative responses can create some stressors for families affected by autism, to include lack of acceptance in social settings such as church, school, stores, travelling via air or other limited spaces and events which they would otherwise have freely participated.

BOYS MORE THAN GIRLS

In the year 2000, the United States Centre for Disease Control (CDC) reported the diagnosed cases of autism to be one in 150 children in that country. By 2010, the ratio increased to one in 68, with boys being five times more likely to be affected than girls (one in 42 versus one in 189, respectively).

There are a number of reasons advanced for the seeming increase in persons diagnosed with the condition, to include greater accuracy in diagnosing along with reclassification of other earlier diagnoses.

Debates ensue re possible causes and risk factors, with varying levels of consensus. With growing awareness, there is an accompanying growth in support structures, environments and professionals. While the challenges faced by children and families affected by autism may be different, there are evidence-based therapies and best practices for treatment.

ABA AS A BEST PRACTICE TREATMENT

Applied Behaviour Analysis (ABA) is a best practice treatment, recommended by the Surgeon General of the United States and recognised by American Academy of Pediatrics. ABA is an early intervention approach that aims at improving positive behaviors while decreasing negative ones that can affect skill acquisition.

ABA treats all observable actions as behaviour with the commonly used description that everything we do is a behaviour, or anything a dead person is incapable of doing. The treatment approach usually consists of doing a functional behaviour assessment, which is aimed at identifying the child’s skill sets and deficits.

Appropriate interventions and treatment approaches are determined and administered. Further, there is continuous observation and recording of data for all treatment sessions to determine the effectiveness of the intervention approach.

Mark Sundberg is a practitioner and key contributor to the practice of ABA, in developing assessment tools and treatment approaches aimed at improving skills gaps in persons affected by Behaviour challenges. He points to the importance of Behavioural Psychology in understanding and changing Problem Behaviors.

Behavioural Psychology takes into account the Antecedent (A), which are events or environmental factors  that can be observed prior to the behaviour occurring, the Behaviour itself (B), and what happened after the behaviour, the consequence (C). This is the Three Term Contingency or ABC Analysis in Applied Behaviour Analysis.

Improving specific behaviours per individual is the focus of ABA interventions, however, there are some skills practitioners such as Dr. Mary Lynch Barbers consider as being most important for a child affected by autism, to enable greater interaction in general settings, irrespective of his/her functional level.

These are:

* Decreasing/eliminating problem behaviours

* Having the ability to request wants and needs from an unfamiliar/adult or person

* Independent toileting

I will first focus on decreasing or eliminating Problem Behaviours in the discussion. According to Dr. Mary Lynch, there may be a number of reasons for problem behaviours, which a Behaviour Intervention practitioner will try to identify.

1. Problem behaviors may occur if demands are too high and rewards (reinforcers) are too low. 

In an ABA therapy session, this disparity leading to problem behaviours may be more easily recognised than in other settings. In any setting, the child is quite likely try to escape the demands and in so doing, exhibits negative behaviours.
For teachers/parents, understanding how to balance both demands and rewards is important, and I will share some tips espoused by Dr Lynch. For structured events such as teaching or therapy, there are ways to avoid behaviour when demands are too high. It is important first to learn to have fun with the child/student and provide rewards or reinforcers that the child likes – for example, stickers, tickles, preferred book/toy/item.

At first, the reinforcer can be provided at even when there are no demands for the child to perform a specific behaviour. As the teacher/ therapist, parent, you should be seen as the one with the “goodies” and should not be freely available otherwise.

Once the child comes to you to access the goodies, you have paired with the child and now have the opportunity to introduce demands, starting relatively low and incrementally increasing the demands. For example, for a child who is learning to count, have him count to a small number where there is a high probability that he /she will be able to do successfully. Upon successfully completing the task demanded, immediately reward with the reinforcer and provide praise.

Future demands may require several successful attempts or counting to a higher number before providing the reinforcer, with a gradual, not a sudden increase in demands. For a child that you are teaching to label items and/or request items, once he/shows an interest in the item, this is an opportunity to have him request the item by name. Communication skills will differ for each child, some children may use signs, words or pictures.

2. Problem behaviours may get attention.

From the work of Dr. Sunberg, these are suggestions on how to respond dependent on the severity of the behaviour.  For minor behaviours like loud voices, whining, taking away someone else’s stuff, or knocking over things, these may likely be for attention, whether in the form of reprimands, looking at the child, laughing, or other.

If the behaviour continues to occur, there is some reaction that is reinforcing the behaviour, causing it to continue or increase. For such situations that the problem behaviour may be attention-seeking, it is recommended that the behaviour be ignored. Ignoring means not responding in any way that the child can establish a link to his/her behaviour, especially if there was some visible response in the past. When the child behaves appropriately, as the teacher/practitioner/teacher, be sure to consistently deliver praise or another form of reinforcement.

Where you are able to identify events, settings that lead to the problem behaviour (Antecedent), make an effort to avoid if possible or plan an activity for the child which will make it difficult for the problem behaviour to occur.

- Trudie Williams is an autism mom, advocate and an Applied Behaviour Analysis Intern: Email: yourhealth@gleanerjm.com