Hillside Family of Agencies, a provider of care for youth and families in Central and Western New York, has been utilizing aspects of the Applied Behavior Analysis (ABA) method for many years. Recently, the organization has more widely practiced this therapeutic approach to help children with autism spectrum disorders lead more independent and socially active lives.
Using ABA, Hillside has been able to both support challenging behaviors that have long been exhibited and improve the quality of life for youth with autism spectrum disorders (ASD). The stories of two youth, Adrienne and Sarah, demonstrate how ABA intervention has led to increased independence and improved social functioning for youth with ASD in a variety of environments.
Adrienne enrolled in Hillside services when she was eight years old, presenting with ASD and obsessive-compulsive disorder (OCD). At that time, Adrienne had very limited communication skills and was only able to express herself using just a few words. Adrienne also would not allow anyone to touch or hold her. This was especially distressing to Adrienne’s father who longed to give his daughter a hug and physically express to her signs of his affection.
Adrienne also had oral and physical sensory challenges. Adrienne’s mother provided Hillside with a limited list of only eight different foods that Adrienne would eat separately and never together. Adrienne also had extreme preferences related to her clothing. She only liked to wear pink and white clothes and would daily wear only one specific pair of sneakers by stepping on the back of the heels, but not tie the laces. Another concern of Adrienne’s parents was her frequency of illness, which was exacerbated by the fact that she would never wear a winter jacket, hat, or gloves during cold weather.
Implementing ABA in Adrienne’s treatment, Hillside was able to address these limiting behaviors that had existed for most of Adrienne’s eight years to improve her quality of her life and independence.
First, Adrienne’s therapists began to use repetition to teach her to wear a jacket, hat, and gloves during the winter months. Instead of trying to teach Adrienne an entire complex behavior in one session, her therapists broke out the behavior into a series of simple tasks. As Adrienne mastered each task, another sequential step was introduced. Adrienne was asked to begin wearing the jacket unzipped for just a few seconds and with each trial was encouraged to keep her jacket on for a longer duration. Adrienne was provided with rewards that were meaningful to her every time she wore her coat. Through this repetitive process, Adrienne eventually wore her jacket for one minute. Now Adrienne puts her jacket on all by herself and often follows that behavior with a self-initiated search for her hat and gloves. According to her therapists, Adrienne has expressed a sense of accomplishment and increased independence in learning this new set of skills.
In the second phase of therapy, Adrienne’s therapists purchased for her a new pair of sneakers of the same type she currently owned and preferred. Breaking down this complex behavior into smaller simple steps, therapists were also able to get Adrienne to wear her sneakers with her feet completely in the shoes and teach her to tie her own laces.
In subsequent phases of therapy, Adrienne has been taught how to say her own name, verbally identify colors, and increase her conversational vocabulary. She also has been introduced to additional foods beyond the designated eight first provided to Hillside by her mother.
And perhaps of greatest impact to Adrienne in her relations with her family, she will now allow her father to hold her and demonstrate signs of his physical affection towards her. Adrienne will also initiate her own physical exchanges with her father and she has begun to communicate with him. Through ABA, Adrienne has been able to have the kind of deeper relationship with her father he thought he may never have with his young daughter.
Sarah enrolled in Hillside services through its early intervention program, which provides treatment to children from birth to three years old who have developmental delays. Most children who enter early intervention services, exhibit signs of developmental delays in at least one area: cognitive, physical (fine and gross motor, vision and hearing), speech and language, social/emotional and adaptive and are eligible for further evaluation, as was Sarah. It was through this further testing that Sarah was diagnosed with ASD.
Sarah first started working with Hillside therapists at three years old. At that time, she would often act out with sudden verbal outbursts, bite others, and pull out her own hair. She also had trouble sitting still for long periods of time, a behavior that greatly impacted her family’s tradition of having dinner together.
Using behavioral modification strategies, Sarah’s therapists developed a structured routine involving positive reinforcement and repetitive training to strengthen desirable behaviors. In addition, when Sarah would display undesirable behaviors or “act out,” her therapists would distract her with a toy. The objective of this practice was to remove behavioral triggers from Sarah’s environment and teach her a new behavior in response to the same trigger. Within a few weeks of utilizing this technique, Sarah was “taught” to grab a vibrating teething toy to satisfy her sensory need instead of biting herself or others or pulling her hair. Through repetition, therapists have helped Sarah to find new ways to cope and self-calm.
Using careful behavioral observation and positive reinforcement, Sarah’s therapists also taught her how to sit still for longer periods of time. One step at a time, therapists would encourage Sarah to increase the duration of time she sat at a table reinforcing the behavior through “play,” with puzzles or string beads that she enjoyed. Sarah can now sit at a table and eat meals with her family.
To further ensure Sarah’s treatment would be successful, her therapists worked closely with her school and family to organize therapeutic and home environments for consistency. The rewards and consequences for her behaviors both desirable and undesirable also needed to be delivered in the same manner across both environments.
At the time of enrollment, Sarah was in an integrated classroom with typically developing three-year-olds and children with developmental disabilities. By age five, Sarah had successfully transitioned into a regular education kindergarten classroom with typically developing children her own age and was supported by her therapists offering supplemental services. Now at age six, Sarah remains in a regular education program with typically developing children and has reduced the level of supplemental services needed for her successful functioning. She now requires only 10 hours of supplemental and home-based services, in comparison to the more than 40 hours of service she received during her early intervention program. This spring, her therapists will most likely reduce their level of support to 5 hours.
Adrienne and Sarah’s stories are just two of many at Hillside Family of Agencies. Using Applied Behavior Analysis, Hillside has been able to work with hundreds of children with ASD to increase their independence and improve social functioning. Applied Behavior Analysis has been proven as an effective treatment modality in Hillside’s service delivery and will increasingly be practiced by the organization to improve the quality of life for a broader population of youth, not just those with ASD, in years to come.
For more information on ABA or services for youth with autism spectrum disorders at Hillside Family of Agencies, contact Dan Lesinski by email at firstname.lastname@example.org.
Hillside Family of Agencies (www.hillside.com) is a family and children services organization that provides child welfare, mental health, youth development, juvenile justice, special education, and developmental disabilities services across central and western New York and in Prince George’s County, Maryland. Hillside Family of Agencies is comprised of affiliates Crestwood Children’s Center, Crestwood Children’s Foundation, Hillside Children’s Center, Hillside Children’s Foundation, Hillside Work-Scholarship Connection, and Snell Farm Children’s Center.