General Behavioural / Educatonal Suggestions for Autistic Children

Keep expectations high. The child should be expected to complete all tasks which are within his or her ability. He/she should be expected to put away all the toys or materials that he/she plays with. That is, task completion should always be an expectation. In some circumstances (e.g., if the child becomes distressed) it may be necessary to reduce the length or size of a task. However, this should be done in a subtle manner such that the child does not notice (e.g., removing several beads to string from the box of beads). It is critical that people deal with the child in a consistent fashion and follow through on their requests to him/her. This is because consistency will help the child to generalize the skills he/she learns to all of his/her environments. Therefore, it is recommended that coordinated programming be implemented in all his/her usual environments (e.g., home, school, respite). "Ground rules" should be decided upon and adhered to by all working with the child. Regular meetings and a communication notebook that the child carries may facilitate the communication process. Children with autism vary with respect to their amount of connection with the world around them. The less "connected" a child is, the less able he/she is to benefit from the experiences which would help a normally developing child to learn and grow. In direct proportion to their lack of "connectedness", the child with autism requires adult intrusion in their play/activities in order to have experiences which promote learning. Moreover, there is no benefit to a child who engages in non-productive behaviors (e.g., stereotypical, repetitive play) for long periods of time. These behaviors only become more of a habit and hence more resistant to change. The amount of intrusion that a child can accept varies from child to child. Many children react with some upset when an adult intrudes into their non-productive activity. This only natural. The amount and form of the intrusion will be dependent upon many factors (such as, the emotional constitution of the child, the activity being intruded upon, the level of habit of the activity). Eventually the child will need less intrusion as he/she becomes more responsive to the environment and responsive to standard teaching methods. In order to increase the frequency and complexity of the child's appropriate behaviors (e.g., appropriate attention seeking, attempts to communicate, independent play skills, compliance to requests), it is recommended that such behaviors be praised or otherwise rewarded when they occur (e.g., with a natural consequence like following through on the child's request). It is hoped that by increasing the frequency of the positive behaviors less desirable behaviors (e.g., tantrums, stereotypical behaviors) will gradually come to be replaced by more appropriate ones. It is critical that caregivers use their attention in a selective fashion. That is, caregivers should attempt to provide attention to the child when he/she is engaged in positive rather than negative behaviors. Whenever attempting to eliminate or reduce the frequency of a problematic behavior, it is important to determine what function the behavior serves for the child. Once determined, it is important to teach the child a more appropriate behavior which serves the same purpose as the problematic one. For instance, if the child whines in order to gain attention, it is necessary to teach the child more appropriate ways of gaining attention and which work better than whining to gain attention. Never target the reduction or elimination of a behavior without targeting the increase in a socially or developmentally appropriate behavior which serves the same or similar purpose for the child. N.B. Frequently stereotypical/self-stimulatory behaviors don't need to be specifically targeted for reduction, since increasing the child's ability to purposefully effect his/her environment (e.g., how to manipulate/use more toys) results in their reduction or elimination. If a child has temper tantrums, it is important that these tantrums be dealt with in a consistent fashion. The child will soon learn that tantrums are not an appropriate method of getting one's needs met if all of the people he/she encounters respond to them in a similar fashion. (Remember, things generally get worse before they get better. Children sometimes act up more often when parents first begin a behavior change program. Be patient and be persistent). Whenever possible, tantrums should be ignored. That is, when the child is in no danger of harming him/herself or others, caregivers should withhold their attention from/ignore the behavior(s) the child is displaying (e.g., throwing objects, screaming). It is important to remember to ignore the behavior but not the child. This is especially true if the behavior appears to be task avoidant in nature. Thus, you should continue to do what you were doing with the child before he/she started to engage in the negative behavior. For example, if the child was working on a puzzle so that he/she learns that engaging in negative behaviors does not enable him/her to avoid tasks. If the child is engaging in a behavior which is more difficult to ignore (e.g., kicking the caregiver), caregivers should withdraw their attention from the child, as well as, physically move away from him/her (but remaining close enough so that the child's behavior can be readily monitored). Periodically caregivers can neutrally issue a verbal instruction, e.g., "(child's name ), calm down". (Remember that if the tantrum was related to a request, the child should be expected to comply with the request once he/she has calmed down). It is very important that you never "give in" to a temper tantrum. For example, if the child is very upset (e.g., screaming/crying) because he/she wants a chocolate bar, do not give the child the chocolate bar so that he/she will stop tantrumming. This only proves to the child that eventually crying and screaming (or whatever negative behavior that the child is displaying) will get him/her what he/she wants. It only takes one time, among many opportunities, of giving in to keep the behavior(s) occurring at high frequency. The faster that the child learns that his behavior is not appropriate and that it won't get him/her what he/she wants, the sooner the tantrum behaviors will cease being displayed. Sometimes children with autism have a tendency to insist that certain routines and rituals be followed and become distressed when they are not permitted to complete such routines. In order to avoid inadvertently reinforcing such "insistence on sameness", the child's day and the activities in which the child is involved should be varied to avoid unnecessary routine (i.e., don't allow him/her to engage in the same activities in the same order every day). Additionally, he/she should be exposed to new situations and activities on a regular basis, even if initially for only short periods of time or small samples of the activity. Always avoid getting into any kind of physical struggle with a child. As he/she grows older and stronger, physical struggles will become much more difficult to win, and it is important that the child not get the message that physical domination is an appropriate way to achieve a goal. As appropriate, encourage the child to complete tasks or portions of tasks independently. Always provide the child with sufficient time to attempt tasks on their own. When assistance is necessary, provide only the minimal amount of prompting necessary for the child to experience success. Prompting should be reduced over time (i.e., always try to provide less assistance/prompting on each occasion than you did on the previous occasion). A good rule of thumb is to give the child the benefit of the doubt when you are unsure of whether he/she is capable of doing something. That is, assume he/she has the ability and allow ample time for him/her to attempt the task on their own. Remember the least intrusive prompt is to wait five to ten seconds after an instruction or before any prompt is delivered, unless the child begins to perform an action which is clearly off task. In that event, deliver the next most intrusive prompt in the hierarchy of prompts (i.e., from least to most intrusive: waiting five to ten seconds, verbal prompt, model prompt, gestural prompt, partial physical prompt (e.g., a brief light touch), and hand over hand manual guidance). N.B. This hierarchy can be extended, that is, within each prompt category there are many levels of intrusiveness depending on the amount or degree of information provided. Some children with autism may develop a "learned helplessness" (including low self-esteem) and/or prompt reliance when given too many or too intrusive prompts to complete activities/tasks (i.e., over prompting). Learned helplessness refers to the idea that the child believes that he/she is not capable of doing something because someone else is always doing it for him/her. When too much prompting is provided, the child doesn't get the opportunity to try more independently and may never learn to do the task independently. Sometimes, after having something done for them for a long period, the child may absolutely refuse to attempt the task because he/she either believes that they are incapable of doing it or believe that they should not have to do it because someone else can/will. Prompt reliance refers to the fact that a child may tend to wait for prompting to occur even though he/she may have the ability to complete the task without prompting. For example, a child may not put his/her coat on unless specifically told "Put your coat on", even though he/she may have been told that it was time to go outside and may observe peers putting on their coats. Or, a child may not flush the toilet until specifically told to do so (i.e., they may stand in front of the toilet, knowing what to do and being perfectly capable of doing the task, but will not do it until given a prompt). Similarly, some children who are learning to sign will automatically present their hands to the adult when told to "sign" (i.e., they are used to being "put through the motions" of the sign). Therefore, it is imperative that caregivers fade prompting as quickly as possible (i.e., provide less assistance today than you did yesterday) because children with autism develop "habits" very quickly. It is important to continually search for and identify activities, objects, and food items that the child really enjoys, as these items or activities can be used to motivate and reward the child when he/she displays appropriate behaviors. Also, frequently varying rewards will help to ensure that the child does not become bored with a particular item or activity (i.e., no longer finding it to be motivating or rewarding). Consistently expecting the child to complete a task before he/she is rewarded will help him/her to establish an understanding of the concept of "if-then" contingencies. Over time the child should be expected to complete more tasks or to work for longer periods of time before reinforcement is provided. The goal here should be to have the child work for the same length of time as his/her peers and/or to do the same amount of work before being rewarded. An important technique to use when teaching autistic children new skills is called "fading". Fading, with respect to reinforcement, concerns fading the number of times a reinforcement is given within a task and also fading the type of reinforcement so that eventually the only reinforcement used is intrinsic in the task itself (e.g., pride in a completed craft project). For example, a child may initially require reinforcement for simply coming to the table and sitting down. The reinforcement could be a desired activity or small edible, paired with lots of verbal praise and hand clapping. While remaining at the table, the child would be intermittently reinforced for not crying and, similarly, when he/she had completed a task requested of him/her. Such reinforcement should be quickly faded to being only for doing the complete task, then several similar tasks, etc. That is, it should be a natural expectation for the child to come to the table and sit quietly without needing to be reinforced every time for doing this. Not only is the number of times that the child is reinforced faded but so is the form of the reinforcement faded. Eventually, the edibles/objects initially used as rewards will be replaced with more social and intrinsic rewards. Also, the extent of the verbal praise and attention will decrease. Eventually the only reinforcement that the child receives will be the occasional (i.e., intermittent) pat on the back or toned down verbal praise (e.g., "good job") and the satisfaction/increased self esteem for having completed the task to the best of his/her ability. The "trick" to effectively fading reinforcement is to provide only the amount of reinforcer necessary to ensure that the behavior keeps occurring. If the behavior stops occurring or does not occur at the frequency desired, bump up the amount and/or frequency of reinforcement given, so as to re-establish the behavior. Once the behavior is fully established, reinforcement fading should be attempted again. Whenever possible, use a fast-paced task variation approach during one-to-one teaching sessions (i.e., providing a variety of tasks in sequence, some of which are easy, some of which are relatively difficult, some of which are fun, some of which are familiar, etc.) to help maintain the child's attention and motivation and to ensure that he/she experience success frequently. Properly employed, a task variation approach will help provide the child with experiences that show him/her that learning can be fun and that not all tasks requested of him/her are hard or ones that he/she does not like. Initially, the amount of time the child spends engaged in preferred activities should not be significantly longer than the time he/she spends doing non-preferred activities. As the child experiences success, he/she will become a more enthusiastic participant during teaching sessions and be in a better frame of mind to attempt new and/or more difficult tasks which he/she might otherwise refuse to attempt. As the child succeeds at more difficult tasks he/she will be empowered and experience heightened self-esteem. Exploit the child's interests (e.g., maps, television programs, cars, whatever). Children with autism are more likely to be attentive and motivated if they are interested in an activity. Within the child's area(s) of interest, a wide range of basic concepts and cognitive skills can be taught, limited only by the creativity of the teacher. In order to better empower the child and give him/her a sense of control over his/her environment, it is important to provide him/her with choices whenever possible. Such a procedure will also improve the child's nonverbal and verbal indicating skills. Being able to make decisions concerning activities often instills a child with a sense of control and makes them more willing and enthusiastic participants. Forced choice questions (e.g., "What do you want to do first?") are often useful in this regard. It is important that one be careful with how one words choices presented to the child. When the child does have a real choice, it is important to make this obvious to him/her. If he/she does not have a real choice and instead you are telling the child that he/she has to do something, do not word your statement as if he/she has a choice (for example, do not say "Do you want to paint?" or "We are going to do a puzzle now, okay?"). Always follow through with the child's choices as situationally appropriate. Incorporate the child's choices into the task variation process. Allow the child to pick the "preferred activities" while you pick the other activities to do during a session. This will also help the child learn that if he/she does something you want him/her to do, then he/she can do something that he/she wants to do (i.e., learning about "if-then" contingencies). When the child completes a significant portion of a relatively longer or more difficult task, it is important to provide intermittent verbal reinforcement. Positive feedback regarding a child's attempts at a task is important for him/her to maintain and enhance his/her self-esteem. Also, it will make the child more likely to participate in future activities that are relatively difficult for him/her. However, as his/her abilities grow, it is important to tone down your enthusiasm and use more age appropriate reinforcements (e.g., "Good job" or "Good try" and high fives). As the child's confidence in his/her abilities increases, the natural reinforcement involved in a task well done should be emphasized and will thereby gradually become a stronger motivator for the child. For example, he/she will show pride in the finished product of a craft activity. Some children with autism respond positively when activities are presented in a novel and enthusiastic manner. For example, one could play with a toy in an inviting manner, rather than simply directing the child to play with it. Similarly, some children react negatively when tasks are presented in a "task-like" or directive manner. Always try to enhance the attractiveness of a task/activity through your enthusiasm about doing it. Initially focus on teaching a small number of activities or skills (e.g., 6 to 8) so that each can be presented to the child on a daily basis. It is believed that the child's ability to learn new skills will be enhanced by frequently providing him/her with opportunities to perform them. Always use naturally occurring exemplars when the opportunity arises. It is also important that new skills/activities be taught and practiced in naturally occurring situations where the reinforcer is inherent in the activity. For example, if teaching the child how to point, purposely put the desired item(s) out of his/her reach so that he/she must indicate what is wanted and have you give it to him/her as the reward for having so communicated. Children tend to learn a great deal from other children, especially social skills. As such, children with autism tend to benefit greatly from structured exposure to normally developing peers. Thus, it is recommended that the child with autism spend a significant portion of their day fully integrated with typically developing peers (i.e., half the school day). Most commonly, integration is recommended for the child once any specific behavioral concerns (e.g., aggression, self abuse) have become manageable and the child's attention is such that he/she is likely to benefit from the peer exposure (e.g., sufficiently long attention span, able to have attention directed toward the teacher, capable of imitating the behavior of peers with prompting). Goals and objectives which might be difficult to teach in a group setting (e.g., teaching specific component skills, like how to kick a ball before teaching how to play soccer) can be worked on with the child by their aide during one-on-one time away from the integrated classroom setting. However, in the integrated environment the child with autism should have the same expectations and "rules" for behavior and performance as do the rest of the children in the class. Modifications to the classroom routine to facilitate the environment of the child with autism are easy to incorporate and should have an enhancing effect on the learning environment for all the children. The most common modification involves adding visual stimuli; for example, having picture representations of song choices during circle time, so a non verbal child could choose the next action song for the group. Other modifications are only limited by the creativity of the teacher and aide. Prepared by staff of society for treatment of autism, May, 1998