Wednesday, February 27, 2008

Problem Behavior = Missing Skills

Problem behaviors are evidence of missing skills. We need to figure out what the missing skills are and take the time to teach the skills. We often need to figure out how to substitute a more acceptable behavior that works equally well from the child's point of view. This is the paradigm shift that you need to make as you think about discipline for young children with autism

teach what you do want the child to do
rather than punish what you don't want the child to do.

This is not an easy change of thinking. But here is why it makes sense and works. The child with autism will tend to repeat, exactly, whatever he did last time regardless of the consequences. This means that we can't use the typical punishment paradigm to help children diminish problem behaviors. The young child with autism typically cannot, on his own, think of an alternative behavior for the problem behavior , so he repeats whatever he did last time. It makes no difference if the behavior was punished last time because the child can't imagine another behavior.

Here is an example from today at my clinic. Tony, throws almost every toy that he picks up. His dad says sternly, TONY! DON'T THROW! Tony looks gleefully at dad and picks up the next toy and launches it! The stern words do not diminish the frequency of Tony's throwing--just the opposite!

I tell the dad to try ignoring the behavior unless Tony is about the launch something dangerous. This is what happens. Tony throws the next car he picks up. His dad looks away. Tony, who had been silent until this point, says Tony, don't throw and moves closer to dad with the same car in hand. This time, looking right at dad, Tony throws it, as though prompting his dad to play the other side of the don't throw game, he says TONY! DON'T THROW! and then of course throws it right at his dad!

Tony's dad reported that time-outs don't work, yelling does not work and even a smack on his behind does not work--Tony only does things more often when he is punished. We know that a child can learn from a time-out or any kind of punishment if, and only if, the behavior diminishes after the punishment. If the behavior increases after a punishm
ent--not an uncommon outcome for children with autism, then we know that whatever we are calling a punishment is working like a reward from the child's perspective. Tony's dad could just as well have said YEAH! TONY, THROW THAT CAR AGAIN AND AGAIN AND AGAIN BECAUSE I LOVE WHEN YOU THROW THINGS! By providing Tony with an absolutely predictable verbal response every time, his dad was rewarding Tony and by the time I witnessed this behavior--Tony was throwing dozens of times in a 45 minute session. It was a hard behavior to change because it had been rewarded thousands of times.

We needed to teach Tony to 1) directly seek out attention from his dad and 2) to play with his toys. Those were the missing skills.

It will be a long time before we convince Tony that playing with toys is as rewarding as throwing toys. From his perspective, every single time he throws a toy, he gets his dad's attention and his dad says the same thing. Throwing is very powerful while at the same time being very easy to do. This is why, in the ideal world, we would start to teach Tony how to drive a car immediately after seeing him throw it for the first or second time. We would not say a word about his throwing unless it was to get a soft ball and hand it to him saying Throw the ball! Particularly we would know we needed to teach a new skill if we saw that Tony was intentionally throwing to get Dad's attention. We might teach Tony to go to dad and say Dad, play with me! because this is a much more acceptable way for Tony to get dad's attention. Motor planning difficulty makes it hard for Tony to drive cars, hug bears, stack blocks, stir pots in his pretend kitchen. So, each skill needs to be taught--hand over hand if need be. Many demonstrations and much praise will allow Tony to learn the missing skills.


Beth Up North said...

My son is in an autism classroom. He is hitting other kids to greet them and get their attention. I wanted to teach high fives as a replacement behavior but his teachers would rather use a "keep your hands to yourself" approach. Any ideas how to make that approach work? We continue to work on greetings in general and he always uses verbal greetings at home. He gets immediate feedback for this at home but not so much at school. Help! It is exciting that he so wants to interact with the kids at school but we can't seem to get past this problem behavior.

Tahirih said...

You can ask that an official Functional Behavioral Assessment be done where there will be a systematic count of how many times a problem behavior occurs. When an FBA is done, some ideas related to how the behavior is "functioning" are discussed and after determining that the behavior functions, say, as a way to interact with other children, then a substitute behavior which functions equally well would be taught. "keep your hands down" does not meet this test because it does not function equally well as a social interaction strategy and now, of course, it may be highly reinforced by the predictable teacher response. Something a little less official might also be done if you have a good working relationship with teachers. One way or another, ask the teachers to do a count to see if the behavior is diminishing. Literally, at several set times in the day, count to see how often the behavior is occurring. Then count again in one week to see if the numbers are going down. If the numbers are going down, then the current strategy is working. If not, then it is not working. The numbers don't lie. I will try to do a post on how to help kids learn self-regulation as this more general topic is related.