Applied Behavior Analysis with Autism Spectrum Disorder Patients

Applied Behavior Analysis with Autism Spectrum Disorder Patients

The number of children being diagnosed with autism has been growing exponentially over the past 20 years and is at an all-time high of 1 in 68 children and 1 in 42 boys.  With this extreme growth rate comes the very high probability of treating a patient with autism spectrum disorder (ASD). ASD is a neurological disorder that often causes qualitative impairments in social interaction and communication as well as restricted repetitive and stereotyped patterns of behavior, interests, and activities.  A low threshold for frustration tolerance combined with difficulty communicating effectively can also lead to aggression towards self and others.  Individuals with autism are also at high risk of experiencing severe anxiety with everyday activities, as well as events that are less frequent such as going to the doctor and being examined.  When caring for an individual with autism in the medical setting, knowing and utilizing the basics of ABA can lead to a better overall experience for both the medical team and family.
Applied Behavior Analysis (ABA) is a scientific approach to understanding behavior and how it is affected by the environment.  At this time, ABA is the only research-based methodology proven effective for children with Autism and is endorsed by the U.S. Surgeon General.  ABA can be used effectively for all individuals and in any setting, whether one-on-one or in a group setting.  ABA focuses on first building a positive association between the individual with autism and the caregiver and therapeutic setting.  The main components of ABA include using assistive communication methods, applying consistent consequential strategies/reinforcement, and modifying the environment for the benefit of the individual with autism.
Pairing is the process of establishing yourself or other aspects of the environment as a positive reinforcer by associating or “pairing’ it with already established reinforcers.  This process can lead to compliance as well as a more pleasant experience for both you and your patient.  A simple tip to applying this tactic is to engage in a fun interaction with your patient, preferably with an item/activity that he/she only has access to when you are with them, prior to beginning any exam or testing.
Using consistent consequences is the main way that individuals with autism learn.  ABA heavily relies on positive reinforcement and only uses punishment as a last resort.  Some examples of reinforcement systems include sticker charts, token systems, and contracts.  Knowing when they will be able to access their favorite toy or activity helps alleviate some anxiety and rigidity that is commonly felt by individuals with autism.  By asking about and using their familiar system of reinforcement for use during an examination or during a series of tests, you can help the appointment move more comfortably for everyone involved.
Modifying the Environment
Sometimes there are specific things that trigger anxiety or unexpected behaviors in individuals with autism. Knowing these triggers in advance will allow you to modify the environment prior to your patient’s appointment. Some common triggers are loud noises and extreme temperatures.

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Being an RBT for me was extremely fun because where were you going to find a place where you can be completely silly without having to worry what people thought about you? This was the only job that made me feel like I could make a dramatic difference while being myself.

I also liked to be surrounded by people that had the same goals of wanting to help kids and the teamwork made the job much easier and more enjoyable.

Change and progress was the ultimate goal for our kiddos. The early intervention program was seriously only a miracle because I saw changes in the kiddos that from day one, you wouldn’t even recognize who they were.

Changes from being able to utter 3-4 words where they can only make a syllable from when they started, the behavior decreases in which kiddo that used to engage in 30-40 0 self-harm to only half, learning how to wait during games, table work where they use to swipe and drop to the floor if they had to.

My favorite was when the parents would tell us what amazing progress they were making at home. I used to tear up and felt for these parents so much because it was already difficult for them and now, they can trust and rely on ABA and the therapists knowing their goal was ours.

By Emma Rogers, BA, RBT

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