An overview of topics covered in a seminar in Autism Week 2000

The starting point in understanding why difficult behaviour occurs must always begin with understanding the nature of Autism and its impact on the person’s ability to function in everyday situations. To do this, we must understand:

v The nature of communication impairment, even for the person who has fluent speech,

v The way the person with Autism processes information in its detail, rather than organising it to form “the whole picture”.

v The role of ritual and routine in making sense of an overly complex environment,

v Obsessive behaviour and factors which contribute to its escalation.

v Sensory sensitivity and its impact on behaviour.

There are some in the field of disability who believe it is possible to programme for behavioural change without understanding the nature of an individual’s disability eg if you respond harshly enough, the person will stop the unwanted behaviour. For many of you who have tried this approach you will know that it might work in the short term but very soon another, equally difficult, if not more difficult, behaviour will emerge.

Of course, you cannot programme for behavioural change without understanding the nature of Autism. If you want to fix something you need to know what is going wrong. Consequently, to bring about positive change you need to understand the nature of impairments in Autism and the difficulties these create for the person living and coping with this disability.

Only when we understand the nature of Autism can we conduct a functional analysis of why difficult behaviour is occurring ie an analysis of what function the behaviour is serving for the individual.

To begin with, the person with Autism has underlying problems with communication and information processing which often causes them to be seen as challenging, disruptive, non-compliant, withdrawn, lazy, unmotivated or even rude. It is only through understanding the impact of Autism on a wide range of skills, and the function their behaviour serves in attempting (unsuccessfully mostly) to communicate everyday needs and wants, that we can begin to understand how we can intervene to make positive change.

Frequently we find that specific behaviours arise because they are the only functional means the person has to:

v Make a request.

v Escape from a confusing or stressful situation.

v Gain somebody’s attention for assistance.

v Demonstrate boredom due to under-stimulation.

If the primary function of behaviour for the individual is to communicate a need, a want or a dislike, we need to teach the person an alternative, more appropriate means of having their needs understood and acted upon.

For the non-verbal/language-impaired person, an alternative communication system can include the use of objects, which the person is taught to associate with specific needs. Through these objects they can communicate to others Eg a set of car keys (for a drive in the car), a sun hat (for the park), a towel (for the beach), a cup (I’m thirsty), a plate (I’m hungry). All of these items, including a plastic cup and plate and small coloured towel, can be kept in a “Communication Basket” which is maintained in a convenient, accessible place. The person will need to be taught to associate these items with their needs and also how to make requests of others using these items.

For an individual who understands that a picture can represent an object, we can use photo or Compic Choice Boards. For the verbal person, we can provide them with written curs for when they are feeling angry or frustrated or prompt help-phrases.

Prevention is, of course, always better than intervention. Providing the person with suitable communication alternatives empowers the person to be more socially appropriate. Without an effective communication method, we should not be surprised when the person uses the only means at their disposal to communicate – through their behaviour. Other preventative strategies, based on an understanding of the nature of Autism include:

v Prepare the person in advance for change through use of transition-objects, sequenced photos depicting the sequence of activities in which the person will engage, Compic timetables or written timetables.

v Use concrete, precise speech.

v Incrementally build the person’s tolerance for over-arousing sensory environments. In the case of adults who are distressed by these environments, avoid them.

v Organise work in a way which takes account of the person’s difficulty with sequencing and seeing “the whole picture”.

v Allow controlled access to obsessions.

v Do not overestimate the person’s level of comprehension of language.

v Be aware that many people who are non-verbal/language-impaired will not process long sentences eg if you say to the person “after dinner, when your Dad gets home, we will go out in the car” he may only process the last words you said ie “out in the car”. Consequently, when you proceed to make the dinner, the person may become confused and distressed.

Where all of the above have been undertaken and specific unwanted behaviour is still occurring, a number of questions should be asked eg is the behaviour more likely to occur:

v At a particular time of day?

v With particular people?

v Around particular events?

v With particular tasks?

v In particular environments?

v Are there situations in which this behaviour never occurs?

v How do others react to this behaviour during and immediately after it occurs?

Answers to these questions may establish a pattern. Eg if a pattern emerges that the behaviour is more likely to occur, or occurs more frequently, with person “A” and not “B”, what is this telling me about “A” and “B’s” management style? If the behaviour only occurs when I take the child to the supermarket and not to the local shops, what might this tell me about the child’s sensory difficulties? If the behaviour occurs everyday within an hour of lunchtime, is there a connection between the behaviour and hunger? If the behaviour is more likely to occur at particular events, what is this telling me about the means the person has to make a choice? The answers to these questions will allow me to make a hypothesis as to why the behaviour is occurring, develop a programme to fix it and create a plan to carry it out.