What Potential Does the Applied Behavior Analysis Approach Have for the Treatment of Children and Youth with Autism?

Article excerpt

The assertion that applied behavior analysis is the most powerful approach in the treatment of autistic behaviors warrants examination. Applied behavior analysis is characterized by discrete presentation of stimuli with responses followed by immediate feedback, an intense schedule of reinforcement, data collection, and systematic trials of instruction. This highly structured format seems to meet the needs of individuals with autism who typically respond to routine and directness. However, a critical analysis of the approach is necessary to determine the real potential of applied behavior analysis in the treatment of children and youth with autism.

***********

Autism is a spectrum disorder that encompasses many labeled disorders such as autism, pervasive developmental disorders, and Asperger syndrome (Jacobson, 2000). Symptoms of this psychological disorder typically include varying levels of impairment in interpersonal skills, emotional or affective behavior, and intellectual functioning. One of the most pervasive characteristics of the disability, however, is a delay or impairment in the ability to produce and respond to language (Secan, Egel, & Tilley, 1989). Many children with autism do not develop speech and other children with the disorder often exhibit unusual speech patterns such as echolalia or the repetition of what has been heard. Frequently, the tone of their speech is flat and unexpressive. Language difficulties are compounded by social impairments. Children with autism frequently are unresponsive to others, fail to make eye contact, and miss social cues such as a person's facial, verbal, postural, and gestural responses (Gena, Krantz, McClannahan, Poulson, 1996). In addition to these areas of difficulty, other common disturbances involve stereotypic behaviors, self-stimulatory behaviors, self-injurious behaviors, repetitious actions, preoccupation with select objects or topics, aggression, inflexibility in routines, and over-sensitivity to sensory stimuli.

Autism is a developmental disorder that is usually identified before 3 years of age. Strange behaviors appear early in the child' s life and diagnosis has been expedited by more public awareness of the disability (e.g., popular cinema such as Rain Man). This is certainly a positive outcome of such attention, but inaccurate portrayal of the disability can lead to public misunderstanding. For example, only a small percent of individuals with autism possess the splinter skills of "Raymond" in Rain Man (i.e., card counting ability).

Research has not been able to pinpoint any single causation of autism; consequently, interventions for the disability have varied greatly. Heflin and Simpson (1998) provide a very thorough overview of interventions for children and youth with autism that incorporate strategies from psychoanalytic, medical, educational, and behavioral perspectives. The sheer number of possible interventions for parents and/or guardians to consider is overwhelming and confusing. Researchers, themselves, debate about the potential of various treatment options (Lovaas, 1987). Some experts make optimistic claims to cure the disability (Lovaas, 1993), while other professionals focus on remediating a specific behavior or building a particular skill (Stromer, Mackay, & Remington, 1996). Caregivers and educators are faced with the problem of choosing the most promising treatments.

Treatments that concentrate on emotional disturbances related to autism stem from the psychoanalytic approach. Holding Therapy, for example, attempts to build a bond between the child with autism and the parent/guardian. The caregiver is advised to hold the infant very closely and tightly as s/ he speaks in a comforting tone, even when the child tries to escape the embrace. Another approach that emphasizes relationship building is the Son-Rise program (Kaufman & Kaufman, 1998). Parents are to repeat the actions of the child in an environment that is not distracting or stimulating. …