- Psychological Issues
Ideally, children with autism and other neuropsychological disorders need to be under the care of a pediatrician experienced in the treatment of neuropsychological disorders and also need to be evaluated and followed by a pediatric neurologist. Additional evaluations and treatment by occupational therapists, physical therapists, and speech language pathologists, and psychologists are usually necessary as well. (Many kids with autism and other neuropsychological disorders do not make eye contact or follow directions.) Parents often wonder if there is something wrong with their child’s hearing. Usually, this is not the case, but children with autism do need a hearing evaluation just to make sure.
Applied Behavioral Analysis (ABA) and a handful of drugs are the most effective ways to manage behavior problems in children with autism and other neuropsychological disorders. Parents can contact an ABA therapist in their area for help. (Visit the Association for Advancement of Behavior Therapy website to locate ABA therapists.)
Applied Behavioral Analysis (ABA) programs begin with a behavioral assessment. This insures the right match between the behavioral intervention and the specific behavioral problems. In the behavioral assessment we want to accomplish four things:
Defining the behavioral problem in behavioral terms simply means that we are going to find a way to count the frequency or time the occurrence of the behavioral problem whenever we observe it. For example, if a parent says a child is aggressive, this is not a behavioral term. We cannot see or measure the aggression. However, if a parent says a child hits a sibling, then this is a behavioral term. We can see the child hit a sibling and count the frequency that the child hits a sibling.
A baseline is a representative sample of the behavioral problem over a short period of time-for example, the number of tantrums the child has each day or how long the child stays on task. Once we have a baseline we will begin our behavioral intervention and continue to monitor the frequency with which the behavioral problem occurs. After a reasonable period of time, we can then compare changes in the frequency of the behavioral problem to the baseline to see if our behavioral intervention is working. Obviously, if the behavioral intervention is not working for some reason, then we will try something else.
Noting the antecedents of the behavioral problem: Keep a diary of what happens immediately before the behavioral problem occurs. For example, if a child tantrums after a parent says “no,” then the parent saying “no” is an antecedent condition.
Noting the consequences of the behavioral problem: Include in your diary what happens to the child as a result of the behavioral problem. In the above example, if the child tantrums, after being told “no” and the parent gives in, then the parent giving in is the consequence. (Now what do you think the child will do the next time the parent says “no”?)
The next step in an aba program is to set up a behavioral intervention. When we think about behavioral problems, we tend to think of behavioral excesses, such as aggressive behavior or temper tantrums. Not so obvious are behavioral deficits, which are appropriate behaviors that do not occur or occur at a very low frequency. Examples of behavioral deficits are: attention deficits; not following directions; elective mutes; lacking age-appropriate skills, such as being toilet trained; lacking appropriate dressing and feeding behaviors, etc.; failure to imitate; motivation problems; shyness; cooperative play; depression; hypoactivity; and withdrawal.
Some other examples of behavioral excesses are: excessive crying; hyperactivity; stereotypical repetitive movements or ritualistic behaviors, such as rocking; self-injurious behaviors, such as head banging; tics, phobias, lying, and stealing.
Generally speaking, if we have a behavioral excess, then we want to choose a behavioral intervention to decrease it. And if we have a behavioral deficit, we want to choose a behavioral intervention to increase it. So if a child is cries to get what he or she wants we might set up an aba program to only give the child what he or she wants when appropriate language is used. Or if we have an appropriate behavior occurring at a low rate we might reinforcement the behavior so it will increase in frequency. Either way, appropriate behavior will be learned.
The last step in an aba program is maintenance and generalization of behavioral changes. Once we have intervened and changed behavior successfully then we want to make sure the behavioral change is permanent and generalizes to other situations. And we have used any tangible reinforcers, such as candy or other treats we will want to fade them out and let the natural reinforcers in the environment take over.