Abstract
Applied Behavior Analysis has proven to be an excellent method of changing and shaping maladaptive behaviors and developing more appropriate behaviors in children with Autism Spectrum Disorder. Asperger’s Syndrome is considered part of the Autism Spectrum Disorder as described in the DSM V. However, children with Asperger’s Syndrome exhibit higher cognitive levels of functioning and awareness of social situations than many other children with more severe Autism. Is Applied Behavior Analysis and appropriate intervention in introducing social and other behavior skills appropriate for children with Asperger’s Syndrome?
Introduction
Autism Spectrum Disorder (ASD) is a disorder that affects approximately 1 in 65 children. The number of children being diagnosed as such has greatly increased in the last two decades. The causes for Autism and its related disorders are unknown but research is beginning to find genetic reasons for the disorder. There is also no cure for Autism Spectrum Disorder and its related disorders. Intensive therapies and early interventions such as Applied Behavior Analysis and speech and language therapy seen to help considerably.
Autism and Asperger’s Syndrome
The American Psychiatric Association recently updated and modified the Diagnostic and Statistical Manual in 2013 and reflected a minor adjustment in the definition and diagnosis of Autism Spectrum Disorder. Asperger’s Syndrome and other Pervasive Developmental Disabilities. The following criteria are measured in levels of severity in addition to be present. The level severity is crucial in appropriately treating a child appropriately and early. The definition and symptoms according to the DSM-V (Centers for Disease Control 2015) are:
Persistent deficits in social interaction and social communication and across contexts.
-deficits in reciprocity
-reduced sharing of interests
-inability to imitate
-deficits in using and reading body language appropriately
-difficulty or inability to engage in appropriate personal relationships
B. Restricted, repetitive patterns of behavior, interests or activities.
- repetitive motor movements and unusual use of objects (hand flapping or lining up toys)
- regular schedules and routines that must be maintained, inflexibility and sameness
- fixated interests or preoccupation
- hyper- or hypo-activity to sensory input from the environment
These symptoms may or may not appear in conjunction with intellectual disabilities as well. Generally, children with Asperger’s Syndrome do not have intellectual deficits, instead their symptoms are the social and communication aspects of the syndrome as well as behavioral deficits. Children with Asperger’s Syndrome are typically enrolled in general education classes with accommodations for learning and testing. Speech and language therapy is often implemented to improve these deficit areas. Applied Behavior Analysis has also become a popular therapy to help discourage maladaptive behaviors and encourage more positive behaviors.
Applied Behavior Analysis
According to Axelrod, McElrath and Wine (2012), applied behavior analysis is the direct application of behaviorism to humans. B.F. Skinner is considered the father of behaviorism. The main principle behind ABA is changing behaviors through consequences. By applying positive reinforcement a behavior is strengthened. Negative reinforcement can also strengthen behavior. Consequences that have maintained a behavior can be removed in order to extinguish an unwanted behavior. Punishment has also been proven to weaken behaviors. ABA generally uses positive reinforcements to produce new behaviors that are desired. An example would be that every time a child completes their homework, they are given a cookie. Negative reinforcement is the removal of a stimuli that is not wanted; the child finishes his homework so mom stops nagging. Extinction is withholding a stimulus that encourages a behavior. If a child tantrums in order to gain attention, withholding attention and ignoring the child will ultimately result in the child no longer having temper tantrums. Punishment is withholding a favored activity, such as playing a game for inappropriate behavior. Time out is an excellent example of punishment (Axelrod, McElrath and Wine 2012).
ABA has had excellent success in children with many types of disabilities, but its success with children with ASD is extremely popular and has been proven to be effective as a therapy.
One issue with ABA is that is must be consistent across settings in order to be fully effective. Parents, siblings, teachers and other caregivers need to follow the same behavior plan. Axelrod, McElrath and Wine (2012) state the ABA has helped children with autism to eliminate self-injurious behaviors, violent behaviors directed at others and increased learning and social skills. The authors cite studies that have shown that children who receive 40+ hours a week of intensive behavioral therapy have exhibited significant gains in learning and adaptive skills.
Criticisms of Applied Behavior Analysis
There are many criticisms of the ABA model for therapy. Critics cite that it lacks a human quality, it ignores consciousness and emotions. Behavior learned in this way could be construed as being puppet like creating children that act like robots. Critics also cite, that the therapy grew out of experiments on animals such as rats and pigeons (Axelrod, McElrath and Wine 2012). ABA to be effective, as mentioned needs to be implemented across settings and by all of the people the child comes into contact with to be fully effective and for the newly acquired behaviors to be generalized in these settings. For example, if a teacher successfully teaches the child to greet the cafeteria worker every day but the child will not greet the cashier at the grocery store, the behavior of greeting people appropriately is severely limited (Bolte and Hallmayer 2011). Carefully crafted behavior plans can become very complex and difficult to implement if the therapist or family tries to approach too many behaviors at once. Depending upon the child, ABA can take a long time to make a small difference (Bolte and Hallmayer 2011).
Dillenburger and Keenan (2009) offer excellent insight into the relationship between ABA and Autism. Behaviorism defines everything that a human does as a behavior. Unfortunately, in the case of children with Autism, the behavior in invariably attributed to the Autism. Autism is a descriptive label that describes a disorder and the symptoms associated with it. The cause for these symptoms is unknown. Dillenburger and Keenan (2009) warn that although ABA has its successes in treating children with Autism it is not the only approach for working with this population.
Asperger’s Syndrome
Children with Asperger’s exhibit social and behavioral issues, thus the diagnosis. However, they possess normal to above normal intelligence. These children are included in general education classes in school and recognize appropriate and inappropriate behaviors. ABA can be effective in treating the behaviors that children with Asperger’s but it is not always appropriate. Several other therapies have proven to be very effective with this population due to their understanding of their behaviors and the consequences that follow.
Borden (2011) cautions that Autism Spectrum Disorder, and especially children with Asperger’s are each very unique in their presentation of communication and social skills as well as repetitive behaviors or preoccupations. He advises that therapies introduced to the child should be carefully considered and appropriately applied. Borden does give a positive response to ABA but suggests that parents also remain open and seek out other therapies that could be equally if not more effective that ABA.
Social Stories
The use of social stories is a popular method of exposing children with Asperger’s and teaching them appropriate responses in social situations. The lessons are often tailored to a particular situation the child is encountering, this makes the social story meaningful. Using a social story to teach a child what to expect when going to the airport when there are no plans to go the airport, is not appropriate. A social story that teaches a child how to deal with being picked on by a classmate is much more effective and appropriate (Bolte and Hallmayer 2011).
Social stories involve an actual written story or book, although computer generated stories are also being used that give a narrative of a social situation. It alerts a child with Asperger’s what cues to look for in the person they are engaging with and what behaviors will be expected of him. Role playing the scenario after reading the story several times also helps to solidify the behaviors and interchanges expected in the situation. Social stories are excellent for preparing a child to transition from one grade to the next or to a new school. These stories introduce the new environment and talking about how to ease the anxiety a child with Asperger’s will experience when a major change like these occur (Bolte and Hallmayer 2011).
Cognitive Behavioral Therapy
Cognitive behavioral Therapy utilizes an approach that examines the relationship between thoughts, emotions and behaviors. By examining thoughts that result in negative feeling and then negative behaviors, patients with the guidance of a therapists attempt to become conscious of their thoughts and change them in order to change their emotional reaction to the thought and ultimately their behaviors. The therapy is usually successful after a couple of months of treatment and has proven to have long term effects in those who participate.
Cognitive Behavioral Therapy is proving to be extremely successful with people who suffer from depression and anxiety. Children with Asperger’s are often extremely anxious because they are very aware of their environment, changes and challenges in their environment. CBT has been applied to children with Asperger’s and success has been very positive.
Storch et al. (2013), performed a study that looked at the effects of CBT on the anxiety level of children with Asperger’s and compared the results to a group of children with Asperger’s who did not receive the treatment. They found that 75% of the children who received eighteen weeks of CBT had a significant reduction in anxiety. The children who received their usual therapies (ABA, medication) remained at the same levels of anxiety. This study is very promising. Because children with Asperger’s are more aware and able to express themselves, CBT is an appropriate alternative.
A child with Asperger’s who becomes very anxious in changing their schedule to incorporate a new activity could benefit greatly. For example, the child would like to begin taking piano lessons after school one day a week. This greatly upsets her schedule and it is only once a week, not every day which is even more upsetting. CBT would help her think of her thoughts and recognize the emotions it evokes (anxiety and worry) and identify the physical reaction or body’s behavior, she begins to rock and flap her hands. Once the child recognizes and accepts the thought, the anxiety is eliminated and so is the behavior.
Medication
Using medication to help children cope with the anxiety, obsessive and repetitive behaviors they experience as well as depression or others symptoms they experience has become very popular. The last two decades have seen an explosion of medications on the market that help people deal with all kinds of psychiatric issues from mild depression and anxiety to schizophrenia. The CDC (2015) does not advise in the use of medication in the treatment of ASD and Asperger’s. They advise parents and caregivers to listen to their doctor and to be proactive and observant of their child if medication therapy is decided as a course of action (Centers for Disease Control and Prevention 2015).
While there is no medication that treats ASD as a whole, there are medications that can treat individual symptoms. Risperdone is a common medication for hyperactivity and inability to focus. Doctors may prescribe an anti-depressant or anti-anxiety medication is a child is exhibiting these symptoms. Epilepsy occurs with Autism in a much higher prevalence that the general population and medication will be prescribed for this condition. Like any child on any medication, parents need to be observant and vigilant to see what effects the medication has on their child. Parents also need to weight the side effects with the perceived benefits of medication.
Animal Therapies
Foden (2011) explores the various animal therapies that are also showing promise in helping children with ASD and Asperger’s. Equine therapy involves horse riding on a regular basis. Many studies have shown that horse riding is a very effective physical therapy for children, especially with cerebral palsy but the effect on children with Asperger’s has been related to social and interactive skills. Therapy dogs have also been very successful in helping children with Asperger’s learn how to interact appropriately and gently in a give and take situation. Dolphin therapy at several seaquarims throughout the country is also helping children with ASD and Asperger’s emerge from the closed shell for a little while at least. Studies on these therapies have shown that children are more open and willing to engage with other humans after interaction with animals (Foden 2011).
Conclusion
Autism Spectrum Disorder, which includes Asperger’s Syndrome, is a disorder that affects a child’s social interactions, communication (verbal and non-verbal) and is coupled with unusual and repetitive behaviors as well as sensitivity to sensory input. The incidence of children diagnosed with ASD has exploded in the last twenty years and professionals are scrambling to help these children and their families appropriately.
Applied Behavior Analysis, has proven to be very effective in changing and developing new behaviors. Behaviors a person exhibits are always followed by a consequence. The consequence can assure that the behavior will continue to occur or can stop a behavior from occurring. Therapists in this field work closely with family members, teachers and other caregivers to develop detailed plans and schedules in order to produce wanted behaviors or eliminate unwanted behaviors. Despite the success of ABA, there are drawbacks such as the implementation on a consistent basis throughout the course of the day. Some critics also cite that ABA does not take into consideration the emotions and other human qualities of a child.
Other therapies such as Cognitive Behavioral Therapy, animal therapy, social stories and medication have had success as well. Currently, CBT holds great promise in the treatment of children with Asperger’s.
References
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