A Survey of Autistic Behavior Modification Techniques

A survey of professionals who treat children with autism revealed the techniques most effective in modifying certain autistic behaviors. An open-ended, preliminary questionnaire was sent to professionals working in schools in Illinois. Treatment techniques for immediate echolalia, delayed echolalia, ritualistic behavior, self-initiated isolation, failure to accept change in routine, hypersensitive to touch, manipulation of digits, hand flapping, head banging, and biting were investigated. An expanded questionnaire was developed using the respondents' answers from the preliminary questionnaire. An analysis of data revealed those techniques most commonly employed to modify specific behaviors. Modification Techniques 3 A Survey of Autistic Behavior Modification Techniques Leo Kanner opened up a new world to therapists, doctors, teachers, and parents when he introduced his definition of autism in 1943. Originally, he described children as autistic if they exhibited certain characteristics such as preferring to be left alone and not relating to others (Simpson, Smith-Myles, Sasso, & Kamps, 1991, p. 1). Over the years, dozens more characteristics have become associated with autism. For instance, disturbances in response to sensory stimuli, insistence on sameness, impaired verbal and nonverbal communication, and self-stimulation, are all now considered to be common characteristics of autism (Matson, 1994, p. 14). As more characteristics of autism are being identified, the diagnosis of autism is increasing significantly. Recent figures show that autism affects 15 in 10,000 people, and all of the autism spectrum disorders affect over 400,000 people in the United States (London & Etzel, 2000, p. 401). Autism has lifelong effects; early intervention to modify the most problematic behaviors would give an individual a greater chance for a more normalized life. There are many questions concerning autism that have not been answered suitably for all professionals. Is there Modification Techniques 4 a way to prevent autism? What exactly causes autism? Who should be classified as autistic? There are several books, journals, and websites containing hundreds of different answers to these questions. Until professionals and researchers can solve those issues, it seems more pertinent to focus on answering the following question: How can professionals most effectively modify certain autistic behaviors? The answer to this question will positively impact the life of a person with autism. The modification of behaviors characteristic of autism is one of the most challenging tasks performed by professionals for their clients. Our knowledge of autism grows and changes with each passing year. The best techniques used to alter a behavior one year are often disregarded a few years later. Pedagogy that may be widely accepted one year may be found to be prohibiting rather than producing a desired effect the next year. Because there are so many autistic behaviors that forbid normal socialization, expression, and interaction, it is essential that professionals discover techniques through science, observation, and collaboration, to help these children cope despite their handicaps. There are several behaviors characteristic of autism that can be problematic for professionals when treating Modification Techniques 5 their clients. Although these behaviors can range in their severity and frequency, each behavior must be uniquely modified. In my research, I will examine the techniques used to modify four basic treatment areas: self-stimulation (echolalia, ritualistic behavior, manipulation of digits/hand flapping), hypersensitivity to touch, aggression (biting, head banging), and social skills (self­ initiated isolation, resistance to change). When professionals know how to modify these behaviors, they can certainly aid a child with autism immensely. Self-stimulatory behaviors are some of the most common behaviors found in children with autism. Self-stimulation can be differentiated into two groups, verbal and physical (Fouse & Wheeler, 1997, p. 270). Verbal self-stimulation is exhibited primarily through echolalia. Echolalia is the delayed or immediate, whole or partial vocal imitation of another speaker. The purpose of echolalia is not known to an absolute certainty. Echolalia might be the product of confusion in a highly challenging environment, or it may serve as a communication function (Quill, 1995, p. 119). Some researchers believe it is a social function, an attempt to make contact with other people. Most professionals attempt to decrease the occurrences of echolalia in order for the child to become more socially Modification Techniques 6 acceptable. Self-stimulatory behaviors manifested through physical means may most need remediation. Hand and arm flapping, manipulation of digits, and ordering objects, are just some of the physical self-stimulatory behaviors that are considered to be compulsive in nature. Children with autism engage in self-stimulatory behaviors in order to achieve calmness and relief from stress or overstimulation. Some claim that self-stimulation also increases in times of boredom. Grofer-Klinger and Renner report that repetitive motor movements such as hand flapping occur in younger and lower functioning autistic children (2000, p. 480). Recent studies have focused on using a child's obsessive behaviors as reinforces to decrease their inappropriate behaviors. Debra Rose, Assistant Director for Communication Services at Wabash and Ohio Valley Special Education District, stresses that the key to remedying these behaviors is, "to replace them with a more socially appropriate one" (personal communication, June 15, 2001). Hypersensitivity to touch is another prominent characteristic of autism. The tactile and vestibular systems allow human beings to understand the world around them. (Trott, Laurel, & Windeck, 1993, p. 1). When an individual is hypersensitive to touch, the filtering or Modification Techniques 7 processing of sensation is atypical. Even the lightest touch might cause a serious reaction. Thus, the child might display aggression, confusion, or anxiety when he/she is touched uncomfortably or unexpectedly. This causes extensive social problems for the child in a variety of settings. At horne, parents often do not understand why their child does not like receiving hugs from them. For this reason, professionals must work diligently to treat their clients with hypersensitivity. Helping children reduce their hypersensitivity will impact other aspects of their disorder, including a probable decrease in aggression and increase in appropriate social behavior. Aggression in children with autism takes many forms. It is not uncommon to see a child with autism become aggressive due to overstimulation, boredom, or confusion. Simpson and Smith-Myles (1998, p. 149) believe, "The social deficits associated with the disability often create frustrations and difficulties which result in aggressive behavior. " This aggression may be expressed through self­ injurious behavior or injurious behavior to others. In particular, head banging can be a self-injurious behavior done voluntarily and emotionless in order to reduce stress (Ernst, 2000, p. 449). Combating injurious behavior is essential to the mental and physical health of the child Modification Techniques 8 and their classmates, and it will determine the successfulness of their future. Individuals with autism may also have considerable deficits in social skills. Love, acceptance, and independence all depend upon a child's ability to interact and adapt to the world around him/her (Fouse & Wheeler, 1997, p. 89). Friendships and social relationships are fundamental parts of human life. Some hypothesize that inappropriate social behavior results from a failure of underlying cognitive modules or from a failure to understand internal states of others (Loveland, Pearson, Tunali-Kotoski, Ortegon, & Gibbs, 2001, p. 367). Because many children with autism cannot interpret facial expressions, body language, and intonation, social interactions may be quite intimidating and frightening to them. A deficit in social skills may result in later severe mental problems, life in residential or psychiatric institutions, or an inability to obtain employment (Strain & Schwartz, 2001, p. 120.) Having adequate social skills would entail having the ability to adapt to the environment and avoid interpersonal conflicts (Matson, 1994, p. 241). It is of the utmost importance that social skills are taught to children with autism because as adults they will most likely continue to struggle with isolation and Modification Techniques 9 awkwardness. It is clear that many of these behaviors characteristic of autism impact each other. If a child is aggressive or engages in physical self-stimulation, then the child will have problems developing social relationships with his/her peers. Modifying behaviors in one area will affect the way a child with autism behaves in another. When professionals can look at a child with autism as not having a multitude of isolated problems but as having a chain of interconnected behaviors, they can begin selecting a therapy program based upon the unique characteristics of that child. As the preceding discussion has shown, working with a child with autism can be both challenging and exciting. Dealing with emotional outbursts and physical aggression can be quite difficult for professionals. The most arduous part of a professional's job is determining which technique to employ when modifying inappropriate social behaviors, self-stimulatory behaviors, or aggressive behaviors. Some techniques work wonders with a number of children with autism but do not show any results for others. It is, therefore, essential that professionals have multiple techniques readily available to them so they can discover what works best for each of their clients. Discussions with Modification Techniques 10 other col