Long Island Behavior Analysis Conference

Addressing Skill Deficits in Students with High Functioning Autism as a Proactive Approach to Prevent Behavioral Challenges

Students with high functioning autism (HFA) typically display cognitive abilities in the average to above average range, and some superior range; therefore often participate in general education classes. While these students have many strengths, specific educational approaches are often needed to address the core deficits of an autism spectrum disorder. Failing to address the specific needs of students with HFA may in turn lead to these students displaying challenging behaviors (Myles, 2005).

A proactive and multi-dimensional approach using antecedent interventions can be effective in addressing the core deficits associated with ASDs and the individual needs of students with HFA. Specifically, interventions addressing deficits in social communication, behaviors associated with having a restricted range of interests, or stereotyped patterns of behavior should be part of a student’s educational program. Further, individuals with HFA often struggle with adaptive functioning; meaning they may need support to complete certain daily activities in school. Also, it is important to note that 70% of individuals with an ASD may have one additional diagnosis, and 40% may have two additional diagnoses. Common comorbid conditions are ADHD, developmental coordination disorder, anxiety disorders and depressive disorders (American Psychiatric Association, 2013). Therefore, when educating students with ASDs, it may be necessary to consider these additional skill deficits. If core deficits are not addressed, then students are likely to experience more significant challenging behaviors. Due to the variety of components involved in educating children with HFA, a multi-leveled intervention package is often necessary. Merely addressing challenging behavior that is occurring without addressing skill deficits that exist will not teach students replacement adaptive skills that they need in order to be successful. Adaptive functioning is important because adaptive skill is closely related to functional independence and quality of life (Scahill & Lord, 2004).

Students with ASDs experience delays related to social communication, therefore specific teaching to target these deficits can help to improve school performance. Lack in skill-set may appear as lack of motivation in a student with HFA. Additionally, difficulties with cognitive flexibility are common; meaning students with HFA often have difficulty in “going with the flow.” Accepting changes or creating an alternative plan when a student’s idea does not work out the way they anticipated can lead to behavioral challenges. A modified cognitive behavioral therapy (CBT) approach is effective in helping students to restructure thoughts that lead them to becoming “stuck.” CBT approaches have been shown to significantly reduce mood disorders in children with ASDs (Bauminger, 2002). Educational staff can modify traditional CBT in order to accommodate the needs of students with HFA. Providing visual supports, scripts to outline the presenting problem, and coming up with reasonable solutions to the problem can be effective tools to use when students face scenarios that seem dire and hopeless to them. For instance, presenting a visual diagram of the problem helps students think about how they may adjust and modify their behavior.

When students expend their energy on small problems, they often get drained and become unavailable for learning. Oftentimes, these small problems can lead students to feeling overwhelmed. Frequently, students with HFA will need guidance in developing solutions to these problems to prevent an extreme emotional reaction. For example, not receiving a perfect score on a test could be experienced as a traumatic event for a student with a rigid thought process. Frequent practice is often required to prepare students for the fact that they will be presented with problems on an ongoing basis and that these problems will vary in magnitude depending on the issue. Forgetting to bring in your homework or losing a game is a less severe problem than getting into a fight on the playground. Learning to recognize the size of the problem and the reaction that matches that problem is an important skill that students must learn. Cognitive restructuring to address distorted thoughts and literal interpretations of events can be done using cartoon thought bubbles of specific scenarios. Using this type of visual modality can be an effective tool in teaching students how to modify how they think, feel and behave in a social context (Wellman, Baron-Cohen, Caswell, Gomez, Swettenham, Toye, & Lagattuta, 2002). Additional school-based interventions such as modeling, reinforcement, and social stories can further improve skill development in natural settings (Gray, 2000; Matson, 2007). For example, the goal of a social story is to provide correct social information leading the student to more appropriate responses.

In school, many students with HFA often experience anxiety; which affects their ability to focus, participate in social activities with peers, and in instruction. Difficulties with communication and problem solving skills may lead to increased anxiety and behavioral challenges in school. Many students may appear to be noncompliant or oppositional, when in fact the behaviors they are demonstrating are more related to skill deficits. Many students with HFA experience anxiety related to specific fears which appear to be a result of conditioned learning (Koegel, Openden, & Koegel, 2004). These phobias may be successfully addressed using systematic desensitization interventions. Systematic desensitization can be done by gradually teaching students to tolerate stimuli that present as aversive to them.

Many students with HFA experience difficulties with emotional recognition and regulation. Teaching correct recognition of emotions can be done using visual supports or through video modeling. Video modeling for individuals with ASDs has shown to be effective in addressing social-communication skills, functional skills, and behavioral functioning. Additionally, those skills learned through video modeling can be maintained over time and generalized to other settings (Bellini & Akullian, 2007). Behavior mapping is another tool that teaches students to conceptualize what behaviors are expected in different situational contexts, and can increase a student’s overall social competence (Winner, 2007).

Individuals with HFA frequently show deficits in executive functions (EF), hence often display problems with inhibition, planning and organizing, shifting topics, and self-monitoring behavior (Semrud-Clikeman, Walkowiak, Wilkinson, & Butcher, 2010). Arranging the instructional setting to address these EF deficits can further assist in preventing behavioral challenges. Environmental modifications can provide students with ASD the structure, visual supports, and predictability they may need in order to learn new skills (Henry & Myles, 2007). A distraction free environment consists of materials being well organized and shelves labeled. Color-coding students’ materials (i.e. books, folders) specific to each subject is helpful. This provides critical information that assists in finding and putting away materials without additional support from the teaching staff. Visual cueing systems, such as models for writing assignments, and behavioral expectations should be displayed throughout the classroom and on the students’ individual desks.

Behavioral interventions are most effective for students with autism (Horner, Carr, Halle, McGee, Odom, & Wolery, 2005). The behavioral principle of positive reinforcement can be used to increase the performance of desired skills. Positive reinforcement can occur as part of a class-wide or individual positive behavioral support system. Regardless of the reinforcement approach used, it is important to develop goals or targets for reinforcement collaboratively with the student. This will maximize the student’s willingness to participate. When collaborating with the student, it is essential to clearly define and provide direct explanation of behavioral targets. A token economy is one method to deliver positive reinforcement for meeting behavioral objectives.

Many students with HFA lack appropriate coping skills. These skills are necessary to self-regulate, and often require specific instruction. Effective coping techniques such as: deep breathing using a visual counting chart, progressive muscle relaxation (systematically tensing and releasing major muscle groups), or “going” to a calm place (using guided imagery or visual supports) can help students calm themselves. Additionally, these supports assist students with self-regulation, and can interrupt the behavioral challenge while redirecting the student to a calm place. When presented with an intense behavioral situation (i.e., the student is completely unable to emotionally regulate), the removal of the stressor may be required. Very often students will tell you exactly what has caused them to become angry or frustrated, so it is important to listen to what they have to say. The use of Atwood’s emotional thermometer (2004), to allow the student to self-rate the level of intensity of their emotions in the moment can be helpful. What is considered to be challenging behavior can take many forms and may require different reactive approaches. Whichever approach is used, it is important to remain calm while helping the student to de-escalate. When the student is calm, this serves as an opportunity to debrief and discuss possible alternative solutions to the challenging behavior that was exhibited, and to develop a plan should the student encounter this problem again.

Edel McCarville, PsyD, is a School Psychologist and Colleen Menard, MSEd, is a Special Education Teacher for Levittown Public Schools. For more information, please contact Edel at emccarville@levittownschools.com.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Attwood, T. (2004b). Exploring feelings: Cognitive behavior therapy to manage anger. Arlington, Texas: Future Horizons.

Bauminger, N. (2002). The facilitation of social-emotional understanding and social interaction in high functioning children with autism: Intervention outcomes. Journal of Autism and Developmental Disorders, 32, 283-298.

Bauminger, N. (2007). Brief report: Individual social-multi-modal-intervention for HFASD. Journal of Autism and Developmental Disorders, 37(8), 1593-1604.

Bellini, S., Akullian, J., & Andrea, H. (2007). Increasing social engagement in young children with autism spectrum disorders using video-self modeling. School Psychology Review, 36(1), 80-90.

Gray, C. (2000). The new social story book. Arlington: Future Horizons.

Henry, S. & Myles, B.S. (2007). The comprehensive autism planning system (CAPS) for individuals with Asperger syndrome, autism, and related disabilities: Integrating best practices throughout the student’s day. Shawnee Missions, KS: Autism Asperger Publishing Company.

Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single subject research to identify evidence-based practice in special education. Exceptional Children, 71, 165-179.

Koegel, R.L., Openden, D., & Koegel, L. K. (2004). A systematic desensitization paradigm to treat hypersensitivity to auditory stimuli in children with autism in family contexts. Research and Practice for Persons with Severe Disabilities, 29(2), 122-134.

Matson, J. L., Matson, M. L., & Rivet, T. T. (2007). Social-skills treatment for children with autism spectrum disorders: An overview. Behavior Modification, 31(5), 682-707.

Myles, B. S. (2005). Children and youth with Asperger syndrome: strategies for success in inclusive settings. Thousand Oaks, CA: Corwin Press.

Scahill, L., & Lord, C. (2004). Subject selection and characterization in clinical trials in children with autism. CNS Spectrums 9, 22-32.

Semrud-Clikeman, M., Walkowiak, J., Wilkinson, A., & Butcher, B. (2010). Executive functioning in children with asperger syndrome, ADHD-combined type, ADHD-predominately inattentive type, and controls. Journal of Autism and Developmental Disorders, 40(8), 1017-1027.

Wellman, H. M., Baron-Cohen, S., Caswell, R., Gomez, J. C., Swettenham, J., Toye, E., & Lagattuta, K. (2002). Thought-bubbles help children with autism acquire an alternative theory of mind. Autism-The International Journal of Research and Practice, 6(4), 343-363.

Winner, M.G. (2007). Social behavior mapping: connecting behavior, and emotions across the day. San Jose, CA: Think Social Publishing.

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