Dr. Kawthar Hameed Abdullah
Ed.D Educational Psychology & Special Education
There are many unique therapies that parents can choose to support their child with autism spectrum disorder. Here are a few that parents may want to consider that can assist with behavior modification. Remember therapies work better if its being done in a positive, non-threating way; check with the therapist on what types of techniques they may use.
Positive Behavior Support (PBS)
Positive Behavior support is an approach which aims to increase a person’s quality of life, and meet their individual needs. It includes teaching new skills, decreasing challenging behaviors and increasing social inclusion, autonomy and independence.
Challenging behavior is frequently a n indication that a child’s needs are not being met. The goal is to understand why they are behaving as they are, and understand what needs are not being met. You can then respond effectively before behavior spirals out of control and implement strategies to address their needs.
Foremost prevention is emphasized in PBS. This means figuring out unmet needs and putting supports and strategies in place to meet them, identifying situations where skills may be lacking and teaching the skills and minimizing environmental stressors. Strategies may include: making changes to the individual’s environment, improving communication options, building relationships and increasing active engagement in pleasurable activities. Information is gathered and analyzed to increase understanding on what is happening for people and plans are put into place to decrease challenging situations and behaviors and increase quality of life.
Social skills training
Social skills training aims to improve the child’s reading and understanding of nonverbal communication, such as eye contact, body language, tone of voice and facial expression.
It may also focus on perspective-taking (seeing things from another perspective) problem solving and understanding social rules. It aims to teach the child how to assess and understand situations, and the most appropriate responses.
Social skills training can occur one-on-one with a therapist, or in a small group. Sometimes it will include outings where skills learned in sessions can be practiced in real-life scenarios; for example going to a supermarket and purchasing things.
Social skills training may also be a specific program to target a particular skill deficit, or as a part of a larger social skills unit, and may be incorporated into an ABA program or similar.
Cognitive-Behavioral Therapy (CBT)
CBT is an emerging therapy for autism and is a combination of cognitive (thinking) and
behavioral (doing). It focuses on being aware of thoughts and emotions, and changing harmful behavioral or thinking patterns. It may also involve or include mindfulness, meditation and learning new coping skills.
CBT has been very effective in treating many mental health issues, and research is looking at
how CBT may be useful for people with autism, as it has been proven effective to treat co-occurring anxiety and depression in individuals with autism, as well as social and communication skills.
Good practice guidelines mention that CBT may need to be adapted to suit people with autism, for example the therapist needs knowledge in autism, be able to provide information on
autism, as well as change the way the therapy is conducted in terms of information and tasks
presented and structure.
Applied Behavior Analysis (ABA)
ABA may be one of the most popular therapies of autism spectrum disorder, but also one of the most controversial therapies around. There are many people against the use of ABA including adults that have gone through the therapy as children.
Many call ABA “compliance training” and say it forces children to ignore their instincts and boundaries, which can impact future judgment and relationships and make them more vulnerable to abuse. Children also may not be taught the importance of consent, and may suffer lasting trauma as a result of ABA.
A study published in 2018 in the Journal Advances in Autism found that nearly half of children and adults exposed to ABA had post-traumatic stress disorder (PTSD) and were 86 percent more likely to experience it than their unexposed peers. According to the study, trauma sets in soon after treatment begins. For example, a three-year-old child receiving 20 hours of ABA a week would experience PTSD within five months of treatment.
Children who undergo intensive ABA, which can involve up to 40 hours of therapy a week , are also denied a normal childhood, many of the adults with autism that went through ABA have commented. Most of them claimed they felt segregated from their friends.
However, it is worth noting that ABA has changed over the years. ABA in the past was highly structured and adult-directed, and often happened in a clinical setting. Today, therapy is more child-led and takes place in natural contexts, such as the family home, the park and the grocery store. Physically painful or demeaning punishments, such as slapping, yelling at the child or even administering electric shocks, were also used in the earlier versions of the therapy, back in the 1970s, but are considered unethical today.
In the end, its up to the parents to decide if they think ABA will benefit their child. I can give the information, but the parents must reach their own conclusions.
ABA techniques can be used to teach new skills, change problematic behavior and encourage an occasional behavior to occur more often. It is used with children with autism to increase or teach communication and language skills, social skills, play skills, and self-help skills, and to reduce aggression, self-injury or harmful self-stimulatory behaviors.
ABA therapy takes behavioral techniques and applies them in a more structured way with a specific goal in mind. The first step is an assessment of strengths, needs, likes and goals.
Strengths are needed so the specialist knows what level the child is currently at in terms of ability. Needs are assessed to determine what skills would be beneficial for the child to learn; such as, a better way to communicate what they would like instead of having a meltdown.
What the child likes and doesn’t like are important as the therapist needs to be aware of what may be an appropriate reinforcer. Goals are important as they benefit the child and improve their quality of life.
The program should address a wide range of questions such as:
• What behavior needs to change?
• How will this change benefit the child?
• What is the baseline of that behavior? E.g. how often is that behavior occurring?
• What new skill will be taught ?
• What prerequisite skills does the child have?
• What steps will we need to take?
• How will it be measured?
Once goals have been recognized, the intervention can be designed and then implemented. Information is monitored, and changes to the programs are made accordingly.
It is crucial when looking at ABA to establish the reasons why behavior is being addressed.
It is key that it is in line with the child and family goals or serves a practical purpose and
NOT just to make someone “fit in” or appear “normal”.
Parents should understand the needs of their child and the goals they have for them, in order to choose the best therapies that will render the best results .
Dr. Kawthar Hameed Abdullah is an educational psychologist and a special educational specialist. She holds an Ed.D in both educational psychology and special education. She has over 25 years experience working with children with different educational, intellectual and emotional challenges.
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