Using Language in a Clear Way for Children with Autism

If you’ve ever heard behavioral therapists speaking with children with autism, you may have noticed that they speak with very clear and minimalistic language. Some people may even think it’s too robotic. So, why do they do it?

A language impairment is one of the main criteria to receive a diagnosis of autism. Many children may have difficulties not only expressing themselves but also understanding what other people say. Adults may think that the child is just ignoring them but in reality, the child may not understand what the adult is saying. Imagine going to a foreign country with people speaking a language that you do not understand and having no means of figuring out what the people are saying. If someone says, “Hey you, come here” in their language, would you respond?  If you don’t understand what they are saying you probably would not respond. This is how your child might be feeling.

The next time you try to give instructions to your child, think about this, and try some of the techniques we’ve outlined below.

First, use clear and minimalistic language. Say, “come here” instead of “hey Johnny, will you please come here now?!”

Second, to increase the likelihood that your child will pay attention to you and hear what you are saying, try the following strategies:

  • Give your instruction while you are physically near your child (i.e., next to them).
  • Crouch down close to your child so your voice and face are closer to him, increasing the chance of him looking at you.
  • Physically touch your child to bring his attention to you.
  • Talk to him about what he is engaged in before giving your instruction. For example, if your child is playing with Legos, you can first make a comment about the activity such as, “I really like what you built!”
  • If needed, interrupt his play if he is engaged in a highly preferred toy or activity before giving your instruction.

When these strategies are combined, they may help increase the likelihood that your child will understand you and follow through with what you instructed them to do.

Teaching alternative behaviors to decrease or stop inappropriate challenging behaviors

Implementing a behavior intervention plan to decrease or stop a challenging behavior is one thing.  Teaching an alternative to the challenging behavior is another.  Imagine this: your child climbs on the kitchen counter to reach for a jar of cookies way up in a cabinet.  Can you implement a plan to decrease or eliminate the behavior of climbing on the counter?  Yes, but there is also a chance that your child will just learn another challenging behavior to get him the same result.  In practice, it is always best to teach and alternative behavior.  Teaching the alternative behavior, in a way, can make the “unlearning” of the challenging behavior much faster.

There are four reasons why children may engage in challenging behaviors: either to get something she or he wants (access), to get out of doing something they don’t want (escape), to get attention, or because the behavior itself feels good or pleases them (self-stimulatory/automatic).  The general theme that you will see throughout this article is that the alternative behavior that you should teach your child should still lead to your child getting what they want (i.e., one of the four reasons).

Let’s say your child screams and throws objects when they are done with their dinner.  Your child is trying to get out of something—the dinner table.  What might you teach your child to do instead of throwing and screaming?  You can possibly teach your child to “properly” communicate when they are done whether it be signing “all done” with their hands, saying “all done,” giving an “all done” laminated picture to an adult at the table, or some other mode of communication based on your child’s repertoire of skills.  At first, assist your child when you begin to see the signs of them being all done by guiding them through the physical movements of communicating (i.e., exchanging a picture or signing), or modeling the words they should use.  Gradually fade this assistance until they are doing it on their own, without engaging in the challenging behaviors.

The same strategies should be utilized for the other “functions” of behaviors, or when your child engages in challenging behaviors for other reasons.  When they want a cookie that is out of reach in the kitchen, teach your child to ask for the cookies using whatever mode of communication is appropriate for your child to replace the climbing on the counters.  It is important to give your child cookies every time they ask when they are first learning as this will be the key to decreasing the challenging behavior of climbing on the counter.  As your child gets used to this process, you can start giving him what he wants once in a while—this is a way to guarantee that the new behavior becomes stronger over time.

For attention-based challenging behaviors, one way to tackle this is to figure out what you think your child should be doing instead of the inappropriate behavior.  Of course, considering your child’s repertoire of skills first is important when figuring out what replacement behavior to teach.  Let’s say your child somehow finds the time you spend with him getting a “lecture” from you reinforcing, maybe one thing that you can do is stop or at least minimize the amount of time that you spend lecturing him and spend more time with him when he is behaving appropriately.  While doing that, also you can also do your best to spend more time with your child when he or she is behaving well (e.g., spending some time to play a favorite game, watching a favorite tv show, about talking about school/anything).

Lastly, when your child engages in challenging behaviors because it feels good, a little more thought has to be put into the alternative behavior.  It should be something that is not harmful and something, preferably, that you can control.  For example, if your child engages in repeating words/phrases or just vocalizing sounds that are not socially appropriate, allowing your child to engage in these behaviors in a particular environment (e.g., their bedroom) and teaching them to ask for “talking in my room” or something similar may help to gain control of where they may engage in this behavior.  When your child engages in this behavior anywhere else, he should be required to use the communication phrase and then go to the specified location.  Self-stimulatory behaviors can be very difficult to address on your own—more so if the behavior is also self-injurious in nature.

It will help you as a parent to practice on these concepts; however, should you continue having difficulties as to how to address you child’s most challenging behaviors, it is a good idea to reach out to a trained professional such as a BCBA as soon as possible.

What approach should caregivers take with challenging behaviors?

Managing challenging behaviors can be quite stressful.  Most of the time, parents just do what they can to get through the situation with as little fuss and fighting as possible.  Unfortunately, this often times involves strategies that may be counterproductive, increasing the chance of these behaviors occurring in the future.  If the goal is to decrease these behaviors in the long run, there are specific strategies to use based on why the behavior is occurring.  Not all behaviors should be treated the same.  These strategies that we will discuss below and in future posts may not always be the first strategy a parent would think of, we do recommend consultation with a behavior analyst who can provide a treatment plan and provide support for you and your family along the way.

In general, it is important to plan for a) alternative behaviors to teach your child to engage in instead of the behaviors they currently engage in during specific situations, as well as b) how to handle behaviors in the moment when they are occurring.  When planning for these strategies, it is crucial to always think about why your child is exhibiting the particular challenging behavior.  There are four reasons that people engage in maladaptive behaviors, to get something they want, to get attention from someone, to get out of a situation, and to get sensory feedback from the behavior itself.  We will briefly review these four reasons in this post.

Children often engage in maladaptive behaviors to get something they want.  For example, a child may want a cookie out of reach in the kitchen, so he screams in the kitchen, hitting his head until someone comes in the kitchen and offers what they can until he or she gets what they want.  The child learned that screaming and hitting his head is an effective way to get a cookie.

Children also engage in maladaptive behaviors to get attention from others.  Have you ever been talking with your partner and your child starts screaming or engaging in other bad behaviors?  This may be because he or she wants your attention, for you to pay attention.

A very common reason why children engage in challenging behaviors is to get out of things.  Imagine a child eating dinner and he starts throwing his food and hitting their caregiver.  The caregiver says, “okay, okay, all done,” and allows the child to leave.  The child learned that throwing and hitting is an effective way to get out of eating.

Lastly, children diagnosed with autism engage in challenging behaviors sometimes because they like how the challenging behavior feels.  Screaming, pinching their bodies, pulling their hair, banging their heads on hard surfaces are all behaviors that may serve some sensory need.  It is important to distinguish this from any of the other reasons previously discussed before determining how to react and what to teach instead.

Take some time to think about your child’s challenging behaviors and why he or she may be engaging in them.  Stay posted for future posts outlining strategies for how to react to these behaviors and what to teach your child instead, based on why they are engaging in the behavior.

What have been your specific challenges?

Using Visual Schedules to Support Students with Autism

Visual schedules can be used to support students with ASD in classrooms. They are a very common support that we’re sure that many teachers have already used or may being using in their classrooms currently. Visual schedules can be an extremely important element to provide students with an overview of the day’s activities and events, by identifying specific tasks that will occur at specific times. Visuals can present an abstract concept such as time in a more concrete and manageable form. The use of visual schedules for students with autism and Asperger Syndrome has many benefits. For example, visual schedules allow students to anticipate upcoming events and activities.

Visual schedules can help develop an understanding of time and they can really help facilitate the ability to predict change. Additionally, visual schedules can be used to stimulate communication exchanges by discussing past, present, and future events, as well as to teach new skills such as health care and grooming. Finally, visual schedules have been used to successfully increase on-task behavior, as well as enhancing the student’s ability to be independent and to make transitions from one activity to another. Visual schedules are effective because they capitalize on the visual strength exhibited by many students with ASD.

When creating visual schedules, consideration of each student’s level of understanding, that is if a student can read, of course we want the schedule to be handwritten, and if a student is at a pre-primer level, or just learning to read, the use of pictures, icons, or actual photographs, can be created. It’s important to make decisions based on the strengths of each of these students; Construct visual schedules to correspond to a student’s ability to understand visual representation. For students who require concrete visual schedules to understand upcoming events, an object schedule that uses the actual materials for each of the activities can be used. For example, if the student is expected to brush his or her teeth after lunch, put a toothbrush on the schedule to indicate that it’s time for the student to brush his teeth. Photographs of students actually completing the target activity can also be used with the visual schedules for students who require concrete representation.

The important thing to keep in mind here is to determine the appropriate level of visual representation. If a student is functioning at a photographic level, a color drawing can be paired with the photograph to induce the higher-level concept. Similarly, if a student is functioning at the black-and-white drawing or icon level, written words can and should be paired with that icon; clock faces can be added to the visual schedules to begin to introduce the concept of time. Schedules can be arranged either a left right or top to bottom format. Schedules can be constructed in a variety of formats, and so when you are developing the schedule, consider the length of time the schedule will be used, how durable the materials must be to meet the demands of the student, and whether the schedule is going to be permanent or if it needs to be mobile.

Additionally, student participation in creating visual schedules can allow a student to feel more comfortable when they’re allowed to participate in preparing their visual schedules. The participation can occur first thing in the morning, as the student enters the room, during morning routines; students can assist in assembling the schedules, copying it, or even adding their own personal patch in some manner. This interaction can be used to review the daily routine, discuss changes, and reinforce the rules. Be creative; have fun developing the visual schedules! And again, these schedules promote independence by identifying student expectations.

Why Is Following Through Important When Giving Instructions

One of the biggest concerns that parents have when raising children living with autism is that “their children just don’t listen.” Besides making instructions very clear and giving instructions only when the child is paying attention, the biggest most important thing a parent must do is follow through when the child does not respond.  Not following through when your child does not respond only teaches your child that there is no need to follow your instructions in the future.  This pattern, if not addressed, can be very frustrating and stressful.

Following through; however, can be difficult because many times parents are multitasking on a daily basis: cooking dinner, cleaning up the house, talking on the phone, and telling their kids to clean up in the other room et cetera.  Think about this before giving instructions: make sure you have your child’s full attention before giving your instruction and once you give your instruction, make sure you can immediately assist your child with completing the instruction you just gave.

Imagine this situation.  Mom gives Sally her clothes in the morning and tells her to get dressed.  Mom then leaves the room and tries to get lunches and other kids ready as well.  She comes back and Sally is still in her jammies playing with her dolls.  Mom tells Sally again that she really needs her to get dressed, this time making sure Sally is looking at her while she gives her instruction, points to the clothes, and then leaves again to finish getting things ready for school.  When she comes back five minutes later, Sally is still in her jammies playing with her dolls.  When Sally’s mom tells her to put her jammies on in the future, do you think Sally will comply?  Probably not.

Try this instead.  Mom tells Sally she has three more minutes to play with her dolls then it’s time to get dressed.  She sets a timer so the beep becomes a signal to transition to another activity (dressing).  When the timer goes off, mom is right there to take the dolls and give Sally her clothes.  She tells her “get dressed.”  Instead of leaving the room, mom stays to make sure Sally starts getting dressed.  If Sally just sits there, within about 10 seconds mom tells Sally again to get dressed but this time mom helps Sally start taking off her jammies, gradually backing away as Sally does more and more of the task herself.  Mom does not leave the room and does not repeatedly tell Sally “get dressed” without helping and making sure Sally does get dressed.  Once Sally is done getting dressed, Sally’s mom gives her the dolls back for 5 more minutes of play before school as a reward for getting dressed.  Here, Sally will learn, over repeated times of Sally’s mom following through, that when her mom tells her to get dressed, she cannot continue playing with her toys unless she does what her mom says.

Again, one of the most important factors when increasing your child’s compliance is follow through! How easy is this for you to do?

When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

The following are things that you should expect as a parent when you begin treatment for your child with Autism.

You and your child have a right to a therapeutic environment.  This means that the teaching environment set up to help your child is one in which socially significant learning occurs.  As a client, your child also has the right to services from an agency in which their number one goal is the personal welfare of your child (e.g., safety, treatment efficacy, advocacy). This means that all energy put into the program is to help your child become more independent and lead a better life.

It is also your child’s right to have a treatment program supervised by a competent behavior analyst. Unfortunately, as the rates of autism have increased, so have the number of treatment programs allegedly providing assistance to children with autism.  Furthermore, in many locations, the demand presently outweighs the supply for trained, experienced behavior analysts. It is imperative that the credentials and qualifications of your service provider be credible.

Your child has a right to be provided with a program that teaches functional skills. Functional skills are skills that a child can use in their everyday life and that furthers their independence (tying shoes, initiating conversation, engaging in cooperative play, etc.). There is little benefit in taking the time and dedication to teach a child something that cannot be incorporated or used in their everyday life.

Assessment and ongoing evaluation are crucial components of any ABA program, and should be expected.  This includes setting up a program based on the individual needs of a child and continuing a program based on the ongoing needs of a child. These needs will continually change, therefore ongoing assessments and modifications are imperative, necessary, and a right.

Parent and caregiver trainings should be included in the ABA program. These typically include meetings between parents or caregivers and their service provider in which valuable ABA strategies are discussed, demonstrated, and implemented. The focus of these meetings is to educate parents about various but individualized ABA based techniques they can implement with their child to address challenging behaviors, reinforce desirable behaviors, and promote generalization of progress.

Lastly, and perhaps most importantly, a child with autism has the right to the most effective treatment procedures available. In this case – scientifically validated treatment programs which today have only been shown to be based on ABA principles and techniques.

Motivating Children With Autism

Motivating Individuals Living with Autism: Intrinsic and Extrinsic Motivation

Motivation can be challenging issue for most of us. Take for example the fact that a lot of us struggle to exercise or to get on a diet even though these lifestyle changes could likely make a huge difference in our health and consequently, our quality of live.  In Behavior Analysis we sometimes discuss motivation by categorizing it in two ways—intrinsic and extrinsic. Looking at motivation in this way gives rise to an interesting conceptual discussion which points back to the work behavior analysts do with children with autism. Intrinsic motivation refers to motivation that would be described as coming from within a person. That is, you do something because you like it. For example, the prima ballerina that rehearses 8 hours a day because she wants to be able to perform exceptionally. Extrinsic motivation on the other hand refers to motivation that comes from others or our environment.  For example, some employees in a manufacturing company may show up to work on time to avoid getting in trouble with the boss (a quick footnote is that our behavior is under many influences and thus there are many sources of motivation on behavior at any given moment. These are rudimentary examples to help facilitate the point of motivation).

The same intrinsic and extrinsic motivational mechanisms apply with children living with autism. Many children with ASD are not interested in doing all of the things that we would like them to do or other tasks or skills that other typically developing children do.  Some of our children on the spectrum may choose to engage in repetitive play or ignore others. It is not uncommon for children with autism to attend to things that only they find interesting. And when this free time is interrupted or when they are asked to attend to something or someone else, they may appear unmotivated to learn or disinterested. In some cases, other challenging behaviors may be occasioned if we follow-through with our demands.

Without motivation, the learning process may be significantly slowed down if not impossible; therefore, at every stage of an ABA program, every effort is made to increase a child’s motivation to learn. Ample time is spent finding out what things a child likes (e.g., reinforcer surveying or reinforcer sampling) and what things will motivate them to attend long enough to learn.

Motivation in an intensive Applied Behavior Analysis program may initially take the form of something external (extrinsic), such as being rewarded with their favorite foods, candies, or activities. Often times, verbal praise and high-fives or anything that a child may find enjoyable is used. However, it is hoped that over time, this motivation will transition from extrinsic to intrinsic such that a child will engage in learning for personal joy and accomplishment (e.g., building a block house and being happy with the completed structure) and for that reason, rewards like candy or other foods can be systematically reduced while more natural rewards take their place.

Using extrinsic rewards is a common concern that others may have when their use is considered in an early ABA program. However, as long as individuals managing ABA programs plan ahead and strive to transition from extrinsic into more intrinsic forms of reinforcers over time, the use of extrinsic forms ought to be considered in their child’s program in order to facilitate learning early-on in the service.

Parenting Survival Skills

Do you ever feel like your child or children take all of your energy and you therefore have no energy to give to your spouse, partner, or friends?  This is very normal although so important to pay attention to, be mindful of, and work at.  Humans are social beings and we need that support network to function in our daily lives.  Without it, we will get worn down and we will eventually see turmoil in our relationships, work, and ways of parenting.  Below are some relationship recommendations that are so important when raising children, more importantly, children with autism.

First, ensure that you have a close adult companion who you can confide in.  If you have a spouse or partner, it will most likely be them.  If you do not have a spouse or a partner, identify a close friend who you can have real, open conversations with and who can call on when in times of need.  It’s important to let someone know what you are going through and how you feel.  Someone who just listens can be a great source of strength.

Second, have high levels of communication with your partner about your parenting strategies, away from your child.  It is so important to have consistent parenting styles and strategies.  Disagreeing during an episode with your child will only increase the stress and make matters worse.  The communication needs to happen when you are alone with each other and you can come to resolutions.  This will help in times when one parent needs a break and the other parent can step right in and be consistent with the strategies that the first parent was just using.  Just as a marriage builds a relationship, a child builds a team.

Ask for help, especially at first. Don’t hesitate to use whatever support is available for you. Your family and friends are there to help, but may not know how.  Maybe you can just have someone take the kids out for an afternoon? Or cook dinner for your family one night.

If you can, allow yourself to take a break, take some time away.  It can be as simple as taking a walk or even going to see a movie, going shopping or visiting a friend can make a world of a difference. Schedule fun adult time on a regular basis, away from your child, with your partner or close friends.  This is so important!  Parenting is difficult and brings many challenges to relationships.  It is important to spend time together, focusing on the two of you and not worrying about your child in the next room.

Lastly, don’t forget to rest.  If you are getting regular sleep, you will be better prepared to make good decisions, be more patient with your child and deal with the stress in your life.

Remember that if you want to take the best possible care of your child, you must first take the best possible care of yourself. Relax, have fun, and focus on you!

Did this help you?

How To Make Long Car Rides More Manageable With Children With Autism

Taking a long car ride anytime soon?  It’s time to start planning how to keep your child busy and how to make the long drive as enjoyable as it can be.  Some children with autism may do really well on car rides as it provides them with time for them to do enjoyable things such as looking out the window and watching the trees and other cars go by.  Some may enjoy listening to the music in the car, or even sleeping throughout the trip!  Other children may not do so well and parents may run into troubles such as crying, screaming, kicking seats, and even trying to get out of seat belts.  Regardless of how easy or how difficult your car rides are, some of the below strategies may assist with make the ride a bit more enjoyable.

First, remember to switch on the child lock so that the rear door cannot be opened from the inside. If your child is someone who tries to get out of the seat belt, then you may consider getting covers or locks for the buckles in the backseat. Also, make sure that the child’s car seat is installed correctly.  You can also make the car seat more comfortable for the long car ride by adding more padding under the seat cover.

Providing visuals can be another great strategy in making long road trips more manageable.  Use schedules, maps and even photo albums to help understand where you are going and whom you will see. Any type of visual support will reduce anxiety and increase interest.

Your child may need to take some regular breaks and be able to get out of the car to stretch or run around.  Look for signs that your child may be anxious, such body language, and take pit stops as needed.

Planning out the mileage of the trip and divide that mileage up into small chunks can be very helpful. If you are driving 300 miles, break this up into 10 chunks of 30 miles (or even 20 chunks of 5 miles, depending on how often your child may need positive rewards for good behavior).  Every 30 miles that your child behaves well (define this for your child such as sitting nicely, no screaming, and no kicking) he or she is allowed to pull a prize out of a prize bag that you have prepared ahead of time with treats, small toys, and special items that your child will enjoy.  Children with autism often dislike uncertainty and that uncertainty often creates overwhelm and behavior problems.  To avoid this, draw out squares on a piece of paper so he knows how many squares are left until you arrive at your destination.  Possibly make the half way point a very large prize, if he or she earns it.

Prepare a snack bag as well as a toy bag ahead of time so you have food when your child is hungry and toys when your child is bored.  Toys such as drawing boards, electronics (iPad or similar device) on which the child can play games or watch movies, travel games such as perfection, and books may work well to keep your child occupied.

The theme is to plan ahead so you and your family can be prepared for the long trek ahead.

Have fun and Bon Voyage!

What Kinds Of Behavior Are Behavior Analysts Interested In

Behavior analysts are interested in behaviors which are observable and measurable. Voluntary behavior, or what is known as Operant Behavior, is of particular interest to behavior analysts. This is the kind of behavior that we are primarily concerned with when it comes to helping children with autism as it is the type of behavior that can be influenced or learned as a consequence of environmental events. We can manipulate a person’s learning of operant or voluntary behaviors by manipulating environmental events. For example, parents often reward their children for cleaning up their room (an attempt to reinforce the behavior). Cleaning a room is a voluntary behavior and by rewarding such voluntary behavior, the parent has set up the environment to increase the likelihood that their child will clean up the room again to get rewarded again. For the purposes of this post, we will use the terms reward and reinforce interchangeably, though reinforce is the correct term.

The second type of behavior is involuntary behavior, or a reflex. Technically, it is referred to as a Respondent Behavior (as opposed to an operant behavior). Reflexes are automatic behaviors that are physiological and not usually influenced by consequences. You as a person have little or no control in the behavior occurring. This includes behaviors such as a sneeze, becoming startled when something jumps out at you, or blinking. Since reflexive behavior is automatic and cannot be changed by environmental events or consequences, this type of behavior is rarely the focus of an ABA program.

In general, behavior analyst have an interest in reducing maladaptive, undesirable, challenging behaviors while increasing desirable replacement behaviors. Replacement behaviors are alternative behaviors we would like to teach individuals to take the place of the challenging behaviors. These behaviors should serve the same purpose (function) of the challenging behavior, be socially appropriate, and easier to engage in than the challenging behavior.