Pattern of Success

Kay told The Healthcare News that the essence of ABA is determining why an individual behaves in a certain way or develops a particular pattern, and then using repetition and positive reinforcement to achieve change. Determining why isn’t always easy when it comes to individuals with autism, but there are some common threads, she explained.
Children with autism will behave a certain way — often an undesirable or violent way — to gain attention, get what they want, or avoid doing something they don’t want to do, she explained. All children behave in such ways, she noted quickly, but those with autism take it to extremes, and very often their behavior is an expression of frustration related to an inability to communicate.

“If you had masking tape over your mouth and weren’t able to talk for a year, you’d probably want to hit people, too,” she said. “If you can’t tell people how you’re feeling, what’s bothering you, or simply what’s on your mind, it can get very frustrating.”

It is for this reason that teachers at the May Center focus on developing communication skills, said Kay, adding that with progress in this vital area, it is often much easier to then address other behavioral patterns and “rituals,” as she called them.

And children with autism have many such behaviors. Kay said obsessive/compulsive behaviors are common, and that one student at the school would become upset if language cards were not arranged neatly or if the books on a shelf were not perfectly straight. Another child would put inedible objects in her mouth — at the rate of 50 times an hour — while another would arrange potato chips in concentric circles before eating them.

Altering such behavior can often be a painstakingly slow process, she said, because doing so takes the child out of a comfort zone. The goal, then, is to create a new, wider comfort zone — and this is where reinforcement and rewards, often in the form of rides in the shopping cart, come in.

Using some of Joe’s behavioral patterns, or rituals, as examples, Kay said teachers at the school will isolate a particular pattern of behavior and dissect it. They begin, again, by analyzing why such behavior prevails, and then set about creating a strategy for mitigating it. Often, the primary tactic is imitation — a teacher will exhibit a desired behavior, encourage the student to do likewise, and then recognize and reward the student when he or she behaves properly.

This is much harder than it sounds because children with autism do not actually know how to imitate, so they have to be taught that skill. In Joe’s case, for example, a staff member would repeat a simple task roughly 400 or 500 times before he could successfully imitate it. Some students require 2,000 to 3,000 repetitions before they pick something up.

With Joe, the staff at May has had a lot of work to do on the broad subject of food. He would become anxious if any type of food was put in front of him except saltines. Meanwhile, he would avoid any saltine that was broken or even slightly chipped. In fact, if he came upon a broken cracker, he would promptly discard the entire sleeve.

At the public elementary school he attended before coming to May, he would often go through four or five boxes of saltines looking for a sleeve with no broken crackers. Joe was also averse to eating with anyone else because these individuals would have food other than saltines and he simply didn’t want to see anything else in front of him.

Kay told The Healthcare News that there has been progress in all areas. Joe has actually taken a bite of chicken, and he can now tolerate being in the presence of a broken saltine, and has actually put a non-perfect cracker to his lips. And because of this, he can now eat with other people.
“None of this may sound like much to many people, but we’re thrilled with how far he’s come,” said Kay. “He’ll actually sit at a table with other foods, which is huge.”

This progress has been achieved through imitation and positive reinforcement of desired behavior, she said, adding that when Joe would sit in the company of a broken cracker for a determined length of time without getting agitated, he would be rewarded with a token; 10 tokens can buy a ride in the grocery cart.

This same approach was used to address Joe’s habit of biting or kicking his classmates, said Kay. His teacher would start by rewarding him for going a certain period without an aggressive action toward another. The initial threshold was several seconds, she said, and was consistently lengthened. Now, Joe isn’t rewarded unless he goes a full seven minutes without an aggressive act. The broad goal is to reinforce good behavior while simultaneously discouraging aggression.

“We make sure that he never gets what he’s looking for after he’s been aggressive,” said Kay. “We get the message across that nothing good happens when he’s aggressive.”

Joe’s story is similar to that of others at the center, said Kay, noting that there are degrees of autism and each child’s case — and learning pace — is different.
The key, she stressed, is for parents to get help for their children with developmental disorders as soon as possible.
Assessing Joe’s future, Kay said that while there will certainly be limits on what he can accomplish, she is confident that he can someday hold a job and live a somewhat normal life.

He should eventually expand his diet well beyond saltines, and, if all goes well, he will not pick up new rituals to replace the ones he has discarded.
But with autism, it is very hard to predict the future, she said, noting that the present tense is challenging enough. For students and staff alike, progress comes in small bites — literally and figuratively.