| “a therapy of choice”, more studies are required, that compare different approaches but keep constant some elements that might affect the results. Elements such as parent involvement, and intensive early intervention in a highly structured setting that lasts for an extended period of time may be applied in different methodologies, since these might be the elements that have an impact on child’s learning achievements. Even more, looking for the one “therapy of choice” may not necessarily be a goal to pursue. Some studies show that not all the participants have equally responded to the behavioral or any other approach. Nonetheless, it is important to acknowledge Lovaas for his pioneering work, which has helped on changing our thinking about the potential people with ASDs have. The Behavior Modification by Reward is an approach in which the teacher, parent, or therapist's task is to find what the desires (reinforcers, or controlling stimuli) of the individual are, that will either cause a preferred behavior be increased or maintained, or a less preferred behavior to be replaced without the use of punishment. An example could be Mary, a 3 year old child, who tantrums badly each time she is put to bed at night. She cries for hours, exhausting herself and her family. This behavior interferes with her ability to wake up in the morning, and she is tired during the day at school. Under the assumption that the initial motivation of the tantrums is either anxiety or frustration due to her lack of ability to express her wants, the family decides to make a study, taking data on all the activities related to going to bed. They analyze several assumptions: Is she anxious when left alone? Is her bed uncomfortable? Is she scared of darkness? Is she having trouble to understand that sleeping is part of a routine, and after this a new day will arise? Is the home environment too noisy? Are the family members having “too much fun” and being too loudly after Mary is in bed? After analyzing the data, it may became evident that it is a combination of several of the assumptions that have created the original tantrums, and that these have been reinforced by their “positive” results (their outcome being the child sleeping in her parents bed). As an alternative to the tantrum, the child can be provided, while in bed, with opportunities to do things that she likes. A routine can be established in which these activities become the prelude announcing that it is time to sleep. However, when she selects the tantrum as her means of communication, this behavior (not the child) will be ignored. In addition, some of the aggravating elements, such as the darkness, can be corrected by keeping some light during the night. Typically, during the first week of the intervention the tantrums may increase, but alerted parents will be prepared to continue ignoring this behavior until it disappears. Behavioral interventions are often effective in helping people use more appropriate behaviors in a wide variety of situations, rapidly creating initial behavioral changes. It is therefore considered to be a therapy that requires less time resources. Because of the need to control the response to a particular behavior, settings that specialize in this approach tend to have clear rules and specified guidelines, such as how to apply time-out and when to ignore aggressive and self-injurious behaviors (after assuring that the environment is safe for the child or others). Recommendations for paying attention to a child's desired behavior may consist on offering immediate positive statements, praise, and hugs (if desired by the child). The use of reprimands and thigh slaps were included as consequences for challenging behaviors, such as aggression or noncompliance in Lovaas’ study. Although this study achieved better results compared to other ABA studies that avoided physically aversive reactions, one could not conclude, however, that aversive responses were the factor that |
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| Clinicians who work in the field often report that challenging behaviors tend to either disappear or be meaningfully reduced when the child learns to communicate his or her needs. By making use of pictures and symbols to develop functional communication, augmentative methods of communication profit from the fact that many individuals with autism are visual learners. |
| helped improve results. As a matter of fact, Catherine Maurice documented, in her book “Let Me Hear Your Voice”, behavioral approaches used with her two autistic children. Regardless that she refused to use aversive procedures, her children did very well, being able to eventually be included in regular education classrooms. Effective non-punitive intervention requires a good deal of concentration, patience, and coordination within the different environments that are in touch with the individual. It is, nevertheless, highly recommended, since it enables teachers, parents, and therapists to transfer effective solutions of a challenging behavior from one situation to another. Moreover, aversive procedures tend to be short-lived, do not teach new skills and may sometimes cause increases in acting-out. It is our responsibility to look for practices that are effective but respectful of the child’s human rights, capitalizing on his/her strengths and things that motivate him or her. |