April 22, 2013 6:51 pm Published by QSAC
by Jeff Stimpson, QSAC Parent
I’m coming from the kitchen and just trying to balance a bowl of soup when I hear Ned’s shattering “Ow!” What’s happened now? “He bit Ned!” Jill says as I round the corner. Jill is my wife. Ned is my 12-year-old son, typically developing. “He” is Alex, my 14-year-old son with autism.
Ned’s head is in Jill’s lap, and I see the shaking shoulders that I have seen way too often. We all see it – except Alex, who charges his little brother. He plunges toward Ned with his forearm to his teeth. Then Alex sinks his teeth down on Ned’s arm. I grab Alex’s arm and waist and his neck and arms in what my brother Lee in his martial arts period used to call “a full nelson”. I have my older son who has autism in a full nelson.
“Alex stop this. Stop this or you could wind up in some place where they’re not this nice to you and you will have a problem!” Think I like saying this to my son? I manhandle Alex over by the door – what the hell else am I supposed to do? – and he collapses to the floor, screeching. He wraps his arm around my legs and bites my legs. It’s not right that Alex is biting me. “Alex, you have to calm down…” He deflates at my feet and wraps his arms around my leg and sinks his mouth toward my legs where I feel the what he’s always saved for his own forearm but on this night went into Ned and soon after into my leg. (“Did he break the skin?” Aunt Julie will ask the next day. “No, of course not.” Of course not.)
“Jill,” I say, “I need you to stay home tomorrow. I know Jill can’t: Her boss is tough and anyway I don’t mean it. What I mean, as I’ll assure her later, is that saying it meant something to me.
I get Alex to the couch; he plunges toward Ned again. We didn’t go through the last 14 years to wind up like this. “Alex, leave your brother alone. Get a grip on yourself-” I take his chin (look at the beard he refuses to shave!) and try to turn it toward my face. This always worked when he was a little boy, when all he did was bolt from our apartment and from restaurants. “Alex, get a grip on yourself or you’re going to have to go somewhere where they won’t be so nice to you.”
I don’t know what I mean by this; it seems to make Ned cry harder in Jill’s lap. This moment peters out as Alex starts asking, “What’s wrong? What’s wrong?’ He slaps his own face. “
“Alex looks like’s about to cry,” says Ned. (And Alex does, adding, “Sorry. Sorry.”) “I know what to do,” Ned announces. “Just let me go to my computer.” Ned plays Minecraft on his computer. “I’m building solar panels,” Ned says. “Just let me go do that.”
Jill and I sit at the dining room table and discuss eventualities. “Let’s get through this,” I tell her. I settle Alex down in his bed. Sometimes I listen to music on my iPod or play “Angry Birds” on his iPod while he goes to sleep. Not tonight. I stare at him as he falls asleep, then I come out to the table where Jill is sitting and staring at words of her own she’s written on her computer.
The rims of her eyes are red. I tell her we’ll get through this. “That’s not what I’m crying about,” she says.
Jeff Stimpson lives in New York with his wife Jill and two sons. He is the author of Alex: The Fathering of a Preemie and Alex the Boy: Episodes From a Family’s Life With Autism (both available on Amazon). He maintains a blog about his family at jeffslife.tripod.com/alextheboy, and is a frequent contributor to various sites and publications on special-needs parenting, such as Autism-Asperger’s Digest, Autism Spectrum News, the Lostandtired blog, The Autism Society news blog, and An Anthology of Disability Literature (available on Amazon). He can also be found on LinkedIn and on Twitter @Jeffslife.
April 12, 2013 4:30 pm Published by QSAC
It is known that many behavior problems in individuals with Autism and developmental disabilities are maintained by social reinforcement, positive and negative (provided by other people), however some behaviors persist in the absence of social contingencies and appear to be maintained by sensory stimulation that is directly produced by the person. Examples of such behavior include repetitive and rhythmic actions (such as rocking, flapping hands, twirling objects), certain destructive behaviors (such as tearing clothes) and some forms of self-injurious behavior, (such as hand mouthing or head banging). Usually these behavior responses are called ‘stereotypy,’ ‘self-stimulation,’ and ‘ritualistic behavior.’
Several interventions have been developed as treatment options for behavior maintained by automatic positive reinforcement.
One intervention frequently reported in the literature is sensory extinction (EXT). Sensory extinction involves elimination or attenuation of stimulation produced by a behavior, while still permitting responding to occur (for instance carpeting a table top in order to attenuate sound, effectively reduces an individual’s object twirling on the table, placing vibrators on the back of the person’s hands reduces finger and arm flapping, padding devices reduces some forms of SIB). EXT procedure actually includes manipulation of the physical environment and although it has been shown to be effective it does not directly establish alternative forms of appropriate behavior.
Another procedure for behavior maintained by automatic reinforcement is differential reinforcement, which is usually implemented in either differential reinforcement of other behavior (DRO) or differential reinforcement of alternative behavior (DRA)contingencies. For example, stereotypy can be reduced by delivering praise and food contingent on the completion of intervals during which inappropriate behavior did not occur (DRO), or by having a therapist provide social reinforcement contingent on object manipulation (DRA). One possible explanation for the limited effectiveness of DRO and DRA procedures with individuals who engage in stereotypic behavior is that stimulation produced by the behavior is continuously available and other reinforcers cannot compete with that, unless they are extremely potent or if little effort is required to obtain them.
One of the most effective interventions include noncontingent reinforcement (NCR) or often called environmental enrichment. Several research showed that the use of NCR decreases variety of stereotypic behavior problems when individuals were given free (noncontingent) access to leisure items or when object manipulation was provided within an alternative activities. In some studies it has also been shown that NCR is more potent than EXT. The main advantage of NCR over both EXT and differential reinforcement is that, when reinforcement is delivered in the form of noncontingent access to leisure (manipulable) materials, behavior is suppressed in the absence of a programmed contingency. Additionally, NCR generally does not produce extinction bursts, does not require the use of potentially restrictive devices, and eliminates deprivation that may occur when an individual fails to meet criterion for reinforcement in a differential reinforcement contingency. Also, in cases when the alternative activity requires some form of object manipulation, NCR may strengthen and maintain appropriate behavior.
Overall the success of this treatment is dependent on selecting stimuli that provide sensory stimulation that matches the reinforcing qualities of the automatically maintained behavior.
Nevena Savic, MA
April 5, 2013 8:42 pm Published by Alex Kenny
by Anya Kurtz Silver, QSAC Assistant Director of Adult Behavior Services
ASAT is a not-for-profit organization of parents and professionals committed to improving the education, treatment, and care of individuals with autism. Since autism spectrum disorders were first identified, there has been a long history of failed treatments and fads, imposed on vulnerable individuals as well as on their families. From the scandal of the “refrigerator mother” theory, to the ongoing parade of “miracle cures” and “magical breakthroughs,” history has been dominated by improbable theories about causation and treatments.
In March 2013, the CDC (Centers of Disease Control) reported that the prevalence of autism is 1 in 50 school age children. Unfortunately, countless families spend thousands of dollars on unproven or harmful treatments for their child with autism, wasting both valuable time and money that could otherwise be directed toward effective intervention.
ASAT’s core mission is to disseminate accurate information about autism treatments, to empower families to identify and choose the most effective, scientifically-validated intervention for their children. All families should have timely access to clear, accurate and science-based information about autism and treatments. This information will help these families distinguish between the fads and “miracle cures” that have plagued autism intervention for decades, and effective science-based intervention.
ASAT also works on educating the public about effective autism treatment through proactive contact with the media. There is a media watch committee whose sole responsibility is to respond to inaccurate information or proposed treatments described by the media and to support accurate media depictions of empirically–sound interventions for individuals with autism spectrum disorders.
ASAT has achieved some notable accomplishments this year, including the development of a formal externship program, an increase in the use of social media to reach the public, and a focus on an international presence for ASAT. Please check out the ASAT website to find out more. And be sure to sign up for the newsletter!
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