Breaking down behaviors for children on autism spectrum

When a child is diagnosed with autism, parents often feel like they are racing against time. This developmental disorder affects language, social skills and IQ. The earlier steps are taken, the better the results for the child. One popular intervention – called Applied Behavioral Analysis – has earned the seal of approval from powerful advocacy organizations.

When a child is diagnosed with autism, parents often feel like they are racing against time. This developmental disorder affects language, social skills and IQ. The earlier steps are taken, the better the results for the child. One popular intervention – called Applied Behavioral Analysis – has earned the seal of approval from powerful advocacy organizations.
(Photo: Malcolm El plays with toy trains at Potential Inc.) [audio:100405msaba.mp3]

At Potential Inc. in Newtown, Pennsylvania, 3 year old Malcolm El is sitting at a small table with lots of toys. When he started therapy here in January, he just grabbed the toys, without saying anything – as a toddler would. Executive director Kristine Quinby is teaching him how to do more:

Quinby: So if he’s reaching and grabbing for something, not only do we teach him how to say that he wants that item by labeling that item, but we also teach him to keep his hands down and look at us, and say clearly what he wants, and then he can get that item

Based in part on BF Skinner’s work on positive reinforcements, Applied Behavioral Analysis breaks behaviors down into small steps, and therapists work with children on each step, often with endless repetitions. The right response is rewarded with high fives and cheers. Improving communication skills is the key to changing other behaviors that trouble children with autism, says Quinby:

Quinby: If we can improve communication then we can improve behavior, in terms of how he responds to directions, how he behaves in the classroom setting and how you know if he is able to communicate his wants and needs he won’t have a need to engage in problem behaviors

For example, Malcolm has had fewer temper tantrums since he started coming here. His mother Camille El says he follows instructions better, and talking to her son has become more interactive:

El: before- we would just be walking around and every time we saw something we would label it, and Malcolm repeated us all the time, and we repeated Malcolm, we were just a family of repeaters, instead of having a conversation, but at least now, I can ask Malcolm a question, he can respond to me appropriately, and then we can move forward.

Ideally, ABA is intensive, at least 20 hours a week. Kids who receive therapy on this level, and start between the ages of two and three, often show dramatic improvement says Tristram Smith, associate professor of pediatrics at the University of Rochester Medical Center.

Smith: They make large gains in IQ and social development and communication skills, and often are able to be included in general education settings and keep up with their peers

20-plus hours a week is a lot. That points to a problem with Applied Behavioral Analysis. Many insurance plans don’t cover this benefit, and paying for sessions becomes a big problem for families. Another issue is finding providers, says Dr. Geraldine Dawson, chief science officer for the advocacy organization Autism Speaks.

Dawson: We feel there really has to be a bigger emphasis on training professionals on using these interventions so that people can have access to them if they have the resources.

Malcolm’s ABA sessions are covered by insurance, but Camille El made about 20 calls before finding a spot for him – and has to drive an hour each way to get to his sessions.

Another issue: ABA does not work for all children. Tristram Smith at Rochester University Medical Center:

Smith: Some kids do very well in ABA – other kids make slower progress, so it would be important to be able to think about what are some other options for those kids

Smith says research suggests that kids who do better with ABA tend to start off with better verbal and problem-solving skills. He’s doing research to compare ABA to other interventions, in hopes that treatments can be tailored to individual children.