Thoughts on Accommodating Autism with the Application of ABA therapy
Disclaimer: I’m not a licensed ABA (Applied Behavior Analysis) therapist. I have a BS in psychology and have taken classes on behavior modification, of which ABA is one form. I have not worked much with autistic children, but I spend a lot of time communicating with autistic adults. I do work closely with a child who receives ABA therapy, but his disabilities are very different from classic autism.
[EDIT: I should also add that ABA is far from the only behaviorism-based intervention therapy. Many different practices have been developed based on the simple principles of behaviorism first laid out long ago by Pavlov and Skinner, designed to do everything from teaching sports to helping people quit smoking… and some of the suggestions I make below may work much better with one of them. The best teachers and parents use behavioral principles instinctively – rewarding good behavior and associating positive acts with positive results. Most, unfortunately, get it wrong and wind up training their kids into bad habits like tantruming and whining. I wish every parent in the world would take a basic class in behaviorism.]
As I’m sure most people in autism circles know, there is a lot of tension out there between the Autistic Self-Advocacy community, many of whom have been bullied, abused, and otherwise treated horribly for who they are, and the community of parents of autistic children, who are often overwhelmed, bewildered, scared for their children’s safety and futures, and frustrated that, in addition to all the stress of being parents, they have to be parents to children who are nothing like what the parents expected.
I come down, on the whole, firmly on the side of the self-advocates; I think it is critical to listen carefully to what any marginalized community says about their own experiences. At the same time, I think they sometimes forget that many parents do not have the tools or the ability to build a fully autism-friendly life for their children, and that some compromises simply have to be made (as much as I hate them) at this point, in order for an autistic child to be integrated into our terribly narrow-minded society.
All of which brings me to the point of this post: based on what I know… when would I use or not use ABA [or rather, any behavioral intervention therapy, of which ABA is currently the most common and popular] with an autistic child?
I would NOT use it to:
- Stop them from stimming
- Try to teach them to look or act “normal” (neurotypical)
- Make them use eye contact, hand shaking, and other neurotypical social behaviors that may be incredibly stressful for them
- Teach them language (?). This one I’m not sure about. Some communication skills, I think, can be taught via behavioral therapy, though something like PRT (pivotal response training) works much better for this than discrete trial training, which is the method used by most ABA therapists.
I WOULD consider using ABA to:
- Stop children from continuing behaviors that are dangerous to themselves or others. Note: much self-injurious behavior (hand-biting, head-slapping) is not actually dangerous, and should not be interfered with– it may serve as a very important coping skill, and taking it away could cause your child psychological harm.
- Train motor skills like shoe-tying or hand-writing (to be honest, I’d have to look into this one a little more, too. There are some aspects of typical ABA that may need to be modified or avoided. For instance, often an ABA therapist will guide a child’s hand with their own during a new task, which would be harmful to a child with sensory sensitivities that make them averse to being touched)
- Introduce new things into the life of a child who is easily upset by change. One of the good things about ABA is that it is very routine-based. If used correctly, this consistency could actually work well with an autistic child’s preference for the predictable.
I would also be very cautious about using ABA with children older than kindergarten-age, because at that point they have enough self-awareness to figure out that someone is trying to change (or worse, “fix”) them, and this can be very emotionally damaging. It is also critical to find a therapist who is willing to question norms, to believe in letting children “be themselves” as much as possible, and look at the real root of behaviors that are labeled “problematic.”
Hypothetical Situation #1:
Your child insists on eating exactly the same thing every day, and has a very limited range of foods zie [gender-neutral pronoun replacing he/she, pronounced “zee”] is willing to eat, to the point where you are concerned about zir health.
Use ABA to train the child to eat a given quantity in order to get a reward, or before zie is allowed to leave the table. It may work, but will be a traumatic process for both you and your child, and increases the risk that zie will develop an eating disorder later.
1: Make sure your problem is actually a problem. Talk to a nutritionist. A limited diet isn’t necessarily an unhealthy one, and if zie is getting all of zir food groups, there’s honestly nothing wrong with zir eating the exact same thing every day. Yes, it may be stressful when eating out and you may have to stand up for your child and yourself when others criticize, but that alone is not enough reason to make your child miserable at mealtimes. Your child’s health must come first, and that includes not having zie traumatized by having to force zirself to eat foods that make zir feel ill.
2: If your child is not getting everything zie needs, try supplementing with vitamins or fortified foods.
3: Consider the reasons behind your child’s pickiness. An insistence on sameness can be a sign that zie is stressed and cannot cope with any additional uncertainty. See if you can do things to make mealtimes calmer, or let your child take zir plate into a quiet room to eat alone once zie is old enough to feed zirself. Another issue might be sensitivity to certain flavors, textures, or combinations of textures. Let your child try plain, unmixed foods. Look for things with similar textures to foods zie already likes.
4: ABA might be helpful in teaching your child to try new foods. It can even become part of your child’s routine– a single bite of something new at the beginning of every dinner. I would start getting the child used to this by first having zir try “new” foods that aren’t really new– a favorite food colored with food coloring or cut into a new shape, and reward zir for eating it. Then, once your child has gotten used to eating zir “new bite” every night, introduce variations. Once the idea of tasting something is not, itself, a struggle, it will be easier for you to tell what foods zie genuinely cannot tolerate. Do not force your child to continue eating anything that makes zir retch, gag, cringe or spit.
Hypothetical Situation #2:
Your child has an opportunity to so something that zie would really like or that would be helpful for zir– joining a mainstream classroom, attending concerts or museums– except that zie has a stim/habit that isn’t compatible with that situation, like making loud noises during classical concerts or being unable to stay in zir seat at school.
Sadly, the “standard” solution here is to use forceful ABA to train your child that zir behavior is bad and must be stopped/controlled. Just don’t; you’ll end up with a traumatized child. (Read one person’s experience here: http://juststimming.wordpress.com/2011/10/05/quiet-hands/)
Ideally, the world would be more tolerant of your child’s differences. But you can’t always find places and people who comply. Can you find a balance? Yes.
1: Seek out options that work for your child first– can your arrange with zir teacher for zie to be given regular breaks at school to run around, or sit on a modified chair that is more comfortable for zir? (Often, children are restless because they need sensory feedback. Sitting on a chair that bounces, or wearing a weighted vest, can make it easier for them to sit still.) Can you attend concerts that are child-friendly and used to interrupting noises? Do your child’s noise outbursts indicate that something is distressing zir that needs to be addressed?
2: Consider behavior modification only after looking for other solutions. Also ask yourself if the benefits of behavior modification will be worth the struggle– to your child. If zie adores classical music, it may well be worth zir while to learn to sit quietly for an hour. If zie just hates being at concerts, it’s possible that no amount of intervention is going to stop zir from fussing.
3: Talk to a therapist about using ABA to reward the behavior you want rather than get rid of the behavior you don’t want. A therapist can, for instance, help train your child to sit still/quietly for increasingly long periods of time– starting with just a minute or two, if needed. It should be made clear to your child that there are only certain times when zie is expected to be quiet/still, of specified duration, after which zie will be allowed to relax and behave naturally.
4: Remember that, just like tying laces or learning math, staying quiet is hard work for your child. Understand, too, that like math skills, not all children have the same inherent ability to do this work, and getting angry at them for their failures will not help them do better. Instead, encourage and reward any improvement in their behavior, no matter how small, so they can learn one step at a time. An ABA therapist can help you learn the most effective methods of doing this.
Problem-solving is a complex process of having everyone’s needs met as much as possible. To work well, it has to involve patience, compassion, and thinking outside the box. When caring for a child on the spectrum, neurotypical adults will have to step out of their comfort zones, empathize with experiences that are completely unfamiliar to them, and accept that their most basic “common sense” assumptions don’t always apply. I would encourage parents of autistic children not to rely entirely on professionals, but instead to also consult adults on the spectrum to help them understand their children’s behavior and the reasons behind it.