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Posts Tagged ‘Adults with Autism’

Raise your hand if you did NOT see the Dateline NBC special on adults with autism……..It’s been pretty popular this week and if you haven’t heard about it, perhaps you are living under a rock. We won’t judge you! You can still catch it here.

Rachel Kaplan Working on a Farm

Many parents reported online how sad the show made them feel or how depressed they were for their child’s future. I agree that it can be overwhelming to think about the cost of servicing so many adults with autism or even worse, to think of a loved one without adequate care. However, it is not all gloom and doom. Adults with autism can still learn! Don’t give up hope. To prove this fact, today’s research review describes the results of a study on 4 adults with autism. Lattimore, Parsons, and Reid conducted the study and published it in 2006.The Journal of Applied Behavior Analysis published the study in 2006.

Study Purpose

The authors set out to study and compare the outcomes for adults with autism who received job-site training. One group received training plus simulation while the other group received job-site training only. Researchers taught participants skills such as learning to prepare envelopes for mailing books, emptying trash cans, or preparing packing paper. The study authors taught these skills using principles of applied behavior analysis (ABA).

Study Design

The authors used a multiple probe design across participants to demonstrate experimental control and to analyze the effects of the intervention. This design allowed the authors to rule out extraneous explanations for the study results, and it especially controls for maturation (e.g., the participants getting better due to exposure to the task or simply getting older).

Study Results

Participants who received job-site training plus simulation training made more progress or had higher task performance than those who did not receive the additional simulation training. This was true even if the participant worked only 1 day per week!

So while the future may feel bleak given the limited resources available for adults, it is important to know that adults with autism may still learn. It is never too late to start ABA!

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Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Readers really gravitated to our story on Monday about adults with disabilities so we thought we would share a success story about one of the adults we have served. Alwan’s adult service provider reached out to us because they needed help with his Self Injurious Behavior (SIB). Alwan hit his head about 2,000 times per month. The SIB was so severe that Alwan was required to wear a helmet all day. Alwan was blind in one eye from the SIB and he was developing cataracts in the other eye. Alwan was 28 years old and carried several diagnoses including profound mental retardation and autism.

Record Review

Because we “inherited” Alwan, we first completed an extensive record review. From the record review we learned that Alwan was heavily medicated in an attempt to decrease the SIB. Alwan had no formal communication system. Alwan had serious feeding issues and was on a strict puree diet. Additionally, he had a protocol for drinking liquids to prevent aspiration. Finally, Alwan had 1:1 staffing all day and 2:1 staffing when out in the community. Additionally, he was “pre-sedated” before all appointments and the staffing ratio on appointments was 4:1.

The record review also referenced a set amount of top spinning time. From the review we learned that Alwan enjoyed spinning tops, lids, etc. We did not, however, understand why this time was limited to only 30 minutes per day.

Functional Behavioral Assessment

The next step was to complete a functional behavioral assessment. We have defined, described, and given examples of these before. To get started, we created an ABC chart for the staff to complete when they observed these behaviors.

We also completed direct observations of Alwan. The observations revealed that Alwan was physically tugged, pulled, and directed all day long. Staff literally dragged him from place to place. Moreover, he had no choice about what to eat, what to drink, or even how to spend his time. Because he lacked communication, staff determined everything for him. The only thing Alwan could control was dropping to the floor and hitting himself in the head.

The observations also provided clarity about the issue around top spinning. When Alwan spent time spinning tops, he became very “worked up” and excitable. All of those behaviors led to an immediate increase of SIB. Essentially, he rocked, flicked the tops, watched them spin, laughed, and then proceeded to hit himself. However, if top spinning did not occur, head hitting was kept to a minimum.

We conducted interviews with staff to find out additional information about Alwan and his behavior. Staff revealed that Alwan really enjoyed walking to the park and riding in the van. Alwan also enjoyed taking a bath.

Many times, SIB is associated with pain, so we asked a few questions to help determine if underlying pain existed. We learned that Alwan had gastrointestinal (GI) issues that needed medical attention so we referred Alwan for a GI workup. Honestly, one bowel movement every 5 days is enough to make us hit our heads a few times.

Finally, we noticed that whenever Alwan was denied something that he wanted, he engaged in head hitting as if to say he was mad about being told no.

Intervention Priority: Communication

Our first concern for Alwan related to his need for a method of communication. We encouraged the provider to hire a speech and language pathologist to help design an appropriate communication system for him. Seriously, who graduates from a program at age 21 without a form of communication? We feel strongly that his IEP team neglected their duty to teach him important skills such as effective communication.

Intervention Priority: Leisure Skills and Reinforcement

We recognized early on that top spinning was a problem. First, it is not an appropriate leisure skill. Second, top spinning was directly correlated with head hitting. Thus, we wanted Alwan to learn new leisure skills. We also wanted Alwan to have more time doing the things he enjoys such as taking baths, going for van rides, and taking walks in the park. It is important for Alwan to have a meaningful day filled with things that he enjoys (and is capable) of doing.

Intervention Priority: Response Interruption and Redirection (RIRD)

Finally

Intervention Priority: Staff Training

We scheduled time for the staff to learn about why challenging behavior occurs. We also reviewed the current BIP and discussed our suggestions regarding changes to the BIP. We taught them how to increase the amount of time that Alwan spent doing things that we liked. We taught them how to interact with him in a way that decreased the amount of time their hands were tugging on his body and increased the amount of time they had positive physical interactions with him. We also taught staff how to implement RIRD.

Outcome

The team is continuing to follow up on Alwan’s GI care. They are making sure that he has regular bowel movements. They are increasing his opportunity for choice in what he eats and what he drinks. They are increasing access to preferred activities such as van rides and trips to the park.

The speech and language pathologist continues to work with staff on developing and implementing a formal mode of communication for Alwan. He is beginning to point to indicate what he wants and needs.

Staff are learning to attend to positive behaviors and to interrupt negative behaviors. They are also learning to interact with and enjoy Alwan.

Most importantly, Alwan has reduced his head hitting to only a few episodes each month! Isn’t it amazing how effective an assessment and function-based approach can be?

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We just returned from the ARI conference in Las Vegas hosted by the Autism Research Institute. We were able to meet many people, parents and practitioners alike.

We feel that this conference is must for families who are learning to treat their child’s autism. If you could not make it to Las Vegas, consider attending the spring conference which will be held in Newark, NJ.

Attendees at the conference are able to attend a variety of lectures from experts in nutrition, medicine, and educational programming. In addition to lectures, participants may also drop in on demo room sessions where the experts show you how to do a particular technique. The demo room this year included, among others, tips from us on how to teach your child to swallow pills. Email us if you would like a copy of the brief handout that we provided.

Attendees are also able to visit the booths of many exhibitors including Talk About Curing Autism (TACA) and Kirkman Labs.

Lunch is provided on site allowing participants time to network, mingle, and speak intimately with presenters.

We were also very lucky to meet Alex Plank, Kirsten Lindsmith, and Jack Robison who were filming for Autism Talk TV. These young adults all have a formal diagnosis of autism spectrum disorders (ASD). They participate in the website Wrong Planet and they have proven that individuals with ASD can live a full and productive life.

We always feel renewed after such a great conference experience. We want to hear from you. Did you attend the conference? What was your favorite part?

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