Better Lives for People with Autism: Behavioral Treatment Helps People with Autism Achieve Independence and Control
The public has been much focused on autism of late as more media stories, movies and books represent people with this disorder. That's all to the good, but we are concerned by the argument -- sometimes made by people with autism themselves -- that this is not a condition, but merely a form of individual expression.
"Don't try to stop us from acting autistic," the argument goes. "Don't try to change our non-verbal behavior, our hand-flapping, crying, screaming and other 'tics' - because that's who we are."
It's a flawed argument that we believe poorly serves everyone, and especially individuals with autism.
What we call autism is a name for a wide range of behaviors. Its definition and diagnosis vary from state to state and often from specialist to specialist. Treatments are often the same as those for people with behavior disorders or mental retardation. We may simply be observing a group of behaviors, giving them a name, and then -- because changing those behaviors can be extremely arduous -- asserting that they are an inherent part of such a condition.
Arduous, yes, but treatment with the method known as applied behavior analysis (ABA) often achieves great success. The end result -- far from killing individual identity -- is to expand children's repertoire of behaviors and enable them to lead more independent lives.
ABA dispenses with labels, instead viewing autism as a group of deficits in speech and other forms of communication and social skills. Typically, treatment begins with an assessment of what pre-school age children can and cannot do. Teaching then focuses entirely on their deficits, with the goal of bringing them to ever higher levels of behavior.
What does this look like?
Working with one or two students, the teacher provides an antecedent, or command -- "Give me your book" -- and waits five seconds for a response. If the child hands over the book, the teacher says "Good job," writes down a plus for that behavior and moves on to a new one.
If not, the teacher helps the child give the book, writes a minus, and repeats the request. Each successfully completed sequence is called a "learn unit," and research shows that the more learn units a child completes, the more he or she will progress. In our classrooms, some children with autism typically complete between 800 and 1,000 learn units in a day.
This is slow and painstaking work. We've seen children who took two years to respond to a request to stand up. Some critics argue that success, when it comes, is illusory -- that using candy or toys to prompt a response doesn't constitute genuine learning, and that ABA produces robotic, programmed responses.
So it appears initially. But we find that by teaching enough examples of behaviors -- tying a simple pair of shoes, then more of reinforcers given to the child -- eventually we produce behavior that is "generative." The child no longer needs to be prompted at each step, but instead makes the inductive leap of responding without receiving something in return.
In a very real way, this process mirrors how children without communication disorders learn new behaviors. Typically-developing children learn to obtain what they want or need with very little instruction -- almost incidentally. "I don't know how he picked that up," a parent often says. Children with autism and other communication disorders don't learn these skills incidentally -- but through a variety of strategies and reinforcers, ABA teaches them to do so.
Looked at this way, the stereotypic behaviors of children with autism -- hand-flapping and other repetitive movements -- emerge not as attempts to communicate, as some proclaim, but instead as an effort to obtain reinforcement when alternative reinforcers are lacking.
We all do this in some form -- tapping our legs or clicking the end of a retractable pen in a boring meeting. But because we have incidentally acquired other interests and skills during our lives, we have other options open to us -- for example, drawing figures or patterns, or even finding ways to tune in and extract what is ultimately of interest from the discussion.
We think that children with autism who incessantly flap their hands lack other skills and interests -- not because they can't learn, but because learning is not rapid and incidental for them. ABA seeks to fill this gap.
What can ABA achieve?
If the goal is complete normalcy, parents will often be disappointed. Not everyone will see the results achieved by Catherine Maurice, a California mother whose child with autism went on receive a regular education. But greater independence and social interaction can, in some measure, almost always be achieved. We have been present many, many times when children who have never spoken before -- or have only spoken infrequently and randomly -- utter their first true words. It is a blessed, amazing moment, and evidence increasingly shows that many children who formerly simply would not have spoken can be taught to achieve complex, meaningful communication.
This is neither "curing" a disease nor eradicating natural identity. We are not making robots of children or preventing them from becoming unique, creative individuals. We are simply enabling them to live richer, fuller lives. Why would anyone speak out against that kind of treatment?
This editorial appeared on AScribe Newswire on June 3, 2005.
Published Monday, Jun. 13, 2005