Autism and Behavior Change

Let’s face it, coping with a child who has a disability can be very difficult; especially when they display challenging behaviors. It becomes even more difficult if your child is non-verbal, minimally verbal, or experiences other communication challenges. Challenging behavior can involve anything from physical aggression and property destruction to pica (putting inedible items in the mouth) and self stimulatory or repetitive behaviors and anything in between. If the behavior has a negative impact on your child or your family, I think we would all classify it as a challenging or interfering behavior. It’s important to keep in mind that while our children with communication deficits exhibit challenging behaviors, these behaviors do have a function, and there could be a number of reasons why they occur. Information processing difficulties, unstructured time, oversensitivity (hyper) or undersensitivity (hypo) of some environmental or internal event, changes in routines, and feeling unwell, tired or hungry are just a few examples of why challenging behaviors may occur.

When thinking about challenging behaviors, it’s helpful to think about human behavior in general. Behavior can be biologically driven (we put on a sweater when we’re cold) or reflexively driven (we close our eyes if a light is too bright). So, behaviors generally occur because they serve an important function or produce a specific outcome. When challenging behaviors occur, we have to keep in mind that it’s a form of communication. The critical part of addressing such behaviors lies in trying to understand the purpose or function of the behavior. Our behavior is shaped by our environment, specifically what happens directly prior to (antecedent conditions) the behavior and directly after (consequent conditions) the behavior.

As a result of these behaviors being “learned” behaviors, we often see dramatic improvements in behavior by changing the situations and environment surrounding the behavior, or as stated above, the events that come before and after the problem behavior occurs. Gathering this information will assist us in starting to understand why the challenging behavior is occurring. This is part of what is called a functional behavior assessment, and there are many ways to go about collecting such information. This is always the first step in determining how to teach replacement skills that are functional for the child experiencing challenges.

For more detailed information on functional behavior assessments, the National Professional Development Center on Autism Spectrum Disorders offers the following links:

Steps of a Functional Assessment

Functional Assessment Checklist

Challenging behaviors in children (and adults) with autism typically serve one of the following functions; To obtain a tangible desired object or outcome; To escape a difficult or unpleasant task or situation; To gain the attention of others (either positive or negative attention); To try to regulate or calm oneself through self-stimulatory behaviors; And in an attempt to respond to pain or illness. Once the functional behavioral assessment has been completed, the information gained will point us in the right direction regarding the development of a behavior intervention plan (BIP). The BIP is a concrete plan of action regarding what exactly will be implemented to manage the challenging behavior.

Such a plan will typically consist of the following components: A description/definition of the challenging behavior being targeted, information regarding the function of the target behavior from the functional behavior assessment, a list of interventions previously tried (and how well they worked or did not work in modifying the behavior), a description of the “new” behavior that will be taught to the student that serves the same purpose (replacement behavior), proactive strategies that will be put into place to prevent the target behavior from occurring, other specific interventions that will currently be utilized (including people responsible for implementation), what will take place if the target behavior occurs (reactive strategies), how data will be collected to track behavior change, and information on how often the plan will be reviewed to determine effectiveness.

For more detailed information on behavior intervention plans, check out this link to a great PowerPoint presentation on BIPs created by Sonja R. de Boer, Ph.D., BCBA and shared by Autism Speaks:

Behavior Intervention Plans

I’d like to conclude this post by sharing a quote by Temple Grandin, Ph.D., an adult with autism, “Special educators [and parents] need to look at what a child can do instead of what he/she cannot do. There needs to be more emphasis on building up and expanding the skills a child is good at. Too often people get locked into a label such as dyslexia, ADHD, or autism, and they cannot see beyond the label. Kids that get a label often have uneven skills. They may be talented in one area and have a real deficiency in another. It is important to work on areas where a child is weak, but an emphasis on deficits should not get to the point where building the area of strength gets neglected.”

My next post will focus on the use of positive reinforcement and positive behavior supports to decrease challenging behaviors and increase functional communicative behaviors!

By letstalkautism

Debunking the Myths (part 3; empathy)

I spent the last few hours attempting to write a post to debunk the myth that individuals with autism spectrum disorders do not feel empathy. We all know that empathy is the ability to read the emotions of another individual and be able to feel those emotions along with another individual. Individuals with a diagnosis of autism may not outwardly show signs of feeling empathy, as they may respond to others in ways that are quite atypical. The question has been raised time and time again, “Do people with autism really lack empathy?”

I came across this post earlier today as I was researching this topic further, and it is so well written that I am choosing to share it with my blog followers. I think it’s far more pertinent as it comes from a parent of a child with autism in conjunction with other reputable sources. I hope you take away as much from this post as I did.

As with absolutely everything related to people with autism spectrum disorders, the answer is “sometimes,” or “it depends.” Sometimes empathy is obvious, but often people with autism have a hard time gauging others’ feelings or showing empathy. When this is the case, it may be the result of a lack of skills rather than a lack of feeling. That’s because many of the skills required to understand and respond to others’ emotions are precisely the skills that are most likely to be compromised in autism.

•To empathize with another person, one must recognize the other person’s feelings. People with autism have difficulties with “reading” others’ faces and body language, and may not fully understand their spoken words.

•To empathize with another person, one must share the other person’s hopes, dreams and/or expectations. People with autism may not, for example, share an intense desire for romantic involvement, ambition to rise up in an organization, or fear of embarrassment.

•To empathize with another person, one must have the cognitive and emotional experience to relate personally to another’s feelings. People with autism may have cognitive challenges – or they may simply lack the experience necessary to empathize – even if they are quite capable of sympathizing.

•To empathize with another person, one must not only feel with that person but also have the tools to show or tell about one’s empathic feelings. People with autism may not show or tell about their feelings in ways that are clearly understood by others.

•To empathize with another person, one must share a cultural understanding that displays of empathy are expected and desired. People with autism may not pick up on cultural cues, and thus may not express empathic feelings even when they are felt.

Quite a bit of research has gone into the question of whether people with autism truly empathize with others; what would stand in the way of empathy; whether empathy can be taught; and whether apparent lack of empathy really reflects a lack emotional connectedness.

The skill of “mind reading” – understanding anothers’ thoughts through careful observation of body language, vocal tone, facial expression, etc. – is key to empathy. People with autism often have a very difficult time with “mind reading,” though it’s clear that the skills can be taught.

While Simon Baron-Cohen chalks up lack of mind reading skills to an “extreme male” brain which focuses on systems rather than on relationships, Dr. Uta Frith notes that “failure of bonding or attachment does not appear to be a distinguishing characteristic of autism in early childhood.” A related study by Jones et al which compares psychopathic to autistic children finds “the affective/ information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people’s distress, whereas ASD is characterized by difficulties in knowing what other people think.”

While Frith, Jones and others suggest that apparent lack of empathy in people with autism is the result of difficulties in verbal and non-verbal communication, though, other studies suggest physical differences in the brain might account for lack of empathy. In addition, says one recent study, “Subjects with ASD may use an atypical cognitive strategy to gain access to their own emotional state in response to other people’s emotions.”

The Bottom line, While many people with autism may appear to lack empathy, the reasons may relate more to social communications deficits than to lack of underlying emotional response. On the other hand, there may in fact be physical differences that make it harder for people with autism to empathize – and show empathy – in a typical manner.

Sources:
Simon Baron-Cohen.Sex differences in the brain: implications for explaining autism.” Science. 2005 Nov 4;310(5749):819-23.
Uta Frith. “Review: Mind Blindness and the Brain in Autism.” Neuron, Vol. 32, 969–979, December 20, 2001, Copyright 2001 by Cell Press.
AP Jones, et al. “Feeling, caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder.” J Child Psychol Psychiatry. 2010 Nov;51(11):1188-97.
JA Schrandt et al.Teaching empathy skills to children with autism”. J Appl Behav Anal. 2009 Spring;42(1):17-32.
M. Schulte-Rüther et al. “Dysfunctions in brain networks supporting empathy: an fMRI study

By letstalkautism

Halloween: Plan Ahead for a Stress Free Halloween for your Family

Halloween is approaching quickly, and families of children with Autism understand that this can often be a challenging holiday for the family. Halloween can be a very exciting and fun holiday for many children with autism, but for others, it may be a very “scary” one. Here are some tips that may help minimize the stress and anxiety that may be associated with Halloween.

1. Check your local community resources for Halloween events. Many communities will offer Halloween festivities for children with special needs. This may be a great option for your child with autism, as such agencies and service providers will be aware of the unique needs of children with autism spectrum disorders. If your child has special dietary needs, remember to bring special treats for your son or daughter.

2. Consider planning your own party. Contact families from your child’s school or service agency and plan your own party with other families with children with autism. Prepare and have other families bring healthy yet delicious Halloween themed treats.

3. Plan your child’s costume well. Many children with autism have sensory issues surrounding clothing articles. If this applies to your child, try creating a costume out of articles of clothing your child is comfortable in. If you decide to purchase a costume for your child, have him or her try it on to see if the costume will be well tolerated. You may want to avoid masks, as many children with autism will have a hard time tolerating them. Once you and your child have chosen the perfect Halloween costume, have your child wear the costume, walk around in the costume, etc. prior to Halloween Day.

4. Start practicing trick or treating early. Practice may not make perfect as they say, but it certainly can help minimize your child’s anxiety on the actual trick or treating day. Plan out the route you will take, and if you have neighbors that are willing to assist, role play the procedure beforehand until your child is more comfortable with the routine. You may also want to consider purchasing or downloading videos to help prepare your child. If your child enjoys books, start reading books about Halloween with your child.

5. Schedule and Plan your Trick or Treating. Make a detailed plan that you are fairly certain you can follow. Your plan should include the time you’re leaving your home, the trick or treating path you will take, and when you will arrive home. You should also include rules about eating the treats your child receives. Will your son or daughter be permitted to eat a treat during trick or treating, or does he or she need to wait until you get home. Again, if your child is on a special diet, plan ahead and make sure you have treats with you that can be substituted. Remember to be flexible; however, if for some reason your child does not want to wear the chosen costume or becomes tired or agitated before the end of the route, it’s OK! It’s your child’s day, and follow his or her lead.
Click the following link for a variety of gluten free treats you can make for
Halloween: http://glutenfreecooking.about.com/od/glutenfreekids/tp/glutenfreehalloweenrecipes.htm (About.com).

6. Create a Social Story. Social stories can be a valuable tool for some children with autism. A Social Story can consist of a written or visual guide that describes the social interactions, behaviors, skills or concepts related to a specific social situation. Click on the following link for a great trick or treating social story http://www.autism-community.com/wp-content/uploads/2011/10/Going-Trick-or-Treating.pdf (Copyright © 2005 by Autism Inspiration).

7. Have your child be the “official” giver of candy. If trick or treating is too stressful for your child, or the risk of wandering is too great, put your child in charge of handing out the treats to those visiting your house.

8. Spread Autism Awareness. Consider creating note cards with information about autism and handing them out in return for the treat your child receives at each home. The note cards can contain facts about autism and assist in raising awareness, which is always a good thing!

9. Have FUN. The more at ease you are, the more your child will enjoy Halloween. Make sure you note what your child enjoyed and what was stressful or unpleasant so next year’s Halloween can be even more special!

10. Skip Halloween. If you’re certain that your child is not ready to participate in Halloween this year, even after attempting to practice, try again next year. After all, Halloween isn’t the most important holiday, and if it causes your child more anxiety than pleasure, it might be a good idea to skip it altogether.

Happy Halloween!

By letstalkautism

Debunking The Myths… (part 2; emotions)

Autism manifests itself in many different ways, that’s why it’s described as a “spectrum disorder”. No one can make broad generalizations about any facet of autism because every individual with autism is a unique and special individual and will possess unique characteristics belonging to only him or her.

I have had many parents talk to me over the years about their desire to have their children understand emotions. This is a grave concern, especially if the child is nonverbal. I don’t know of any parent that does not desire their child to have the ability to express when they are experiencing an earache, a tummyache, etc. Even more potent, what parent does not crave to hear those three words, “I love you”, from their child?

I often explain to the families I work with that these are important skills for our children to learn, however, there are several prerequisite skills that our kids need to have in their repertoire prior to being able to express such inner thoughts. Our kids FEEL these thoughts but often are not equipped with the tools to communicate them effectively. We do know that before a child can label private thoughts to others, they need to have the ability to label things outside their own bodies. It does not matter if the child is verbal or communicates in some other manner (alternative augmentative system), if a child can’t look at a cup and say “that’s a cup”, they will not be able to say, “I hurt” or “I love you”.

I have worked with young children, adolescents, and adults and each has expressed emotions in very different ways. Verbal individuals might be able to express emotions such as “I’m angry” or “I’m bored” or “I’m sad”. When our verbal individuals express such thoughts it is important to know their cognitive level to be able to determine whether the statements match the situation. It’s the only way we’ll be able to assist in formulating an intervention or plan for them to deal with the emotion at hand and communicate their feeling effectively to others.

I have also worked with a multitude of nonverbal individuals with autism, and as we all are aware, the emotional expressions are not always an accurate assessment of what the individual with autism might actually be feeling and experiencing. I worked with a young man who often laughed excessively when he was in pain or otherwise uncomfortable.

Yes, individuals with autism DO feel the same emotions as typically developing individuals, that’s not a point of controversy. What makes these individuals unique is the inability to express such emotions in ways others can understand them, both verbally and nonverbally. So, we as educators and parents need to make sure that we teach these skills to our children in a very structured manner to ensure that they acquire the ability to communicate emotions effectively. There are many great teaching tools out there to assist in this end goal, most under the broad spectrum behavioral approach or applied behavior analysis (ABA).

This has been long enough! The next “debunking” post will talk a bit about the other side of emotions, empathy.

By letstalkautism

Environment, Vaccines, and Autism – What Do We Really Know?

The ongoing debate about the causes of autism will long continue, and “Q” raises two very important yet controversial issues regarding the etiology of autism (see comment).  I’ll address each factor separately, but with the understanding that even though we don’t have all the answers regarding the impact of environmental factors and vaccinations as possible causes of autism, much research has been done and continues to be done.

Environmental factors continue to be looked at by researchers in the field, with the most recent studies focusing on factors that may be present when the child is in utero.  The first looked at prenatal exposure to certain antidepressants as well as certain viral illnesses.  Each variable increased the risk of having a child with autism, especially when they occurred within the first three months of pregnancy.  Other studies have looked at other environmental influences such as vitamin deficiencies, obstetric complications, environmental toxins and immune challenges.  Each study has associated these environmental influences with an increase in autism, so these factors have been linked to the development of autism but have not been determined to be the sole causal factor.

Regarding vaccinations as a link to autism, there have been several reliable and valid studies, the first published in 1999 conducted in the UK by the Department of Health, and the second conducted by a panel of 15 experts from the Institute of Medicine.  Each of these initial studies found that there was no connection between the MMR (Measles, Mumps and Rubella) vaccination and autism.  Additionally, a paper published in 2004, which consisted of a comprehensive review by the Institute of Medicine also found no causal relationship between vaccines and autism.  Even with these well designed studies, the idea that there is a link between vaccines and autism will surely persist even in the face of scientific evidence.

I’d also like to bring up the genetic factors that are most definitely part of the equation.  The facts that boys are four times more likely to develop autism than girls, second children born to parents who already have a child with autism are more likely to develop autism, and the multiple twin studies that have been done indicate a fiercely strong link between genetics and autism.

The bottom line is, we don’t know what we don’t know.  Our best educated guesses based on the research that has been conducted and published point to the fact that we do have to look more closely at possible environmental influences as a cause of autism, and how these factors may come together with the genetic component in the etiology of autism.

As a professional in the field, the one thing that is certain is that once early warning signs of autism are identified, a diagnosis and subsequent intervention is vital in the improvement of individuals with autism throughout their lifespan.

By letstalkautism

We are participating in Walk Now for Autism Speaks

Please join us in our fight to make a difference in the lives of the more than 1 million Americans living with autism today.

St. Vincent’s Special Needs Autism Services will be participating in Walk Now for Autism Speaks to help find the missing pieces of autism. Autism is the second most common developmental disorder in the United States affecting one in every 88 children born today. More children will be diagnosed with autism this year than with AIDS, diabetes & cancer combined. Research is crucial. Despite some promising discoveries, the cause of autism is unknown and a cure does not exist. Our goal is to change the future for all who struggle with autism spectrum disorders, and soon.

Walk Now for Autism Speaks is our chance to make a difference in the fight against autism by raising money for autism research and heightening public awareness. Please join us in our fight as we raise money to help fund essential research. You can donate to Walk Now for Autism Speaks and/or join our team online using the links at the bottom of this page. Donations can also be mailed to Autism Speaks using the donation form located on my page or send me a check made out to Autism Speaks.

For the direct link to our walk page go to http://www.walknowforautismspeaks.org/faf/login/teamPage.asp?ievent=1062199&lis=0&kntae1062199=F14B9F24B1DC4244A738839F66CA8BF4&page=view

Thank you for taking an important step in the fight against autism.

By letstalkautism

Debunking the Myths (part 1; parenting)

O.K., so let’s set the record straight regarding Autism. Few people in the field of Autism would dispute that there are countless myths and misconceptions floating around about this confusing diagnosis. It’s really not surprising, though, as what the experts in the field know today is far different from what experts in the field (even as recent as 5 years ago) thought they knew about Autism. There’s a reason behind these myths and misconceptions that seem to have persisted over time. Research in Autism today is progressing at a lightning quick pace, and researchers are discovering new facts about Autism every day. Autism, like most things, isn’t necessarily how it is depicted on television or in the movies. Know the facts about autism, and let’s debunk the myths.

Each week I’ll address one common myth regarding autism. I welcome any and all comments and look forward to meaningful discussions regarding the myth of the week.

Autism is Caused by Poor Parenting.
Sadly, there is a cloud of guilt that hangs over many families of children with autism. Families were previously told by professionals that the reason their child had autism was because he/she did not receive warm and loving interactions with the parents, particularly the mother. We now understand this is not true — autism is not caused by a failure to properly bond to a parent.

By letstalkautism