Fall 2013

What does Autism look like?

It is often said that if you have met one person with autism, you have met one person with autism. Autism Spectrum Disorders (ASD) may seem incredibly different from one person to another based on the varying characteristics of what is called the “spectrum”. It is important to understand that not all people with a diagnosis of autism display all of the symptoms discussed in this article. Individuals vary widely in ability, behaviour, age, activity level, cognitive functioning, and personality. To acquire a diagnosis of autism the individual must meet the diagnostic criteria adapted from the DSM-V (see flow chart). The social challenges related to ASD do not necessarily involve withdrawing from social contact with others, but rather is a difficulty developing and sustaining relationships. Children with autism may prefer isolation and ignore other people, are often unresponsive, show no interest in playing with others, rarely initiate social interactions and have difficulty with reciprocal conversation. Often times many children with autism have deficits in non-verbal communication, such things as eye contact, facial expressions, gestures and joint attention of others. Individuals living with autism also have display impairments in understanding the feelings and thoughts of others, making true mutual friendships extremely difficult to achieve. Another area of difficulty is restrictive, repetitive and unusual behaviours and interests. People with autism may display obsessive routines, such as rearranging books on a shelf, or intense interest in one topic, such as a particular character from a movie or reciting facts about a certain radio station. Coping with changes in their environment can be a difficult task as they depend on specific routines. One of the most noticeable characteristics of autism may be the stereotypic behaviour, which are portrayed differently across each individual. Some of these repetitive behaviours may look like rocking, hand flapping, toe walking, spinning objects, and fixation on one part of a toy or objects.

Applied Behavioural Analysis (ABA)/ Intensive Behavioural Interventions (IBI)

“ABA is a scientific approach for discovering environmental variables that reliably influence socially significant behaviour and for developing a technology of behaviour change that takes practical advantage of those discoveries” (Cooper, Heron, & Heward, 2007, p. 3). Well, what does that mean? It means that ABA is based on the science of learning and behaviour. It is currently the only treatment proven that creates meaningful and lasting change in individuals with autism. ABA methods support individuals with autism in a variety of ways. To better understand what ABA does, lets break it down:

• Teaching skills to replace problem behaviours – so that the child learns what to do, not just what to stop doing
• Increasing positive behaviour and reducing interfering behaviour (for example, reinforcement increases on-task behaviour and reduces stereotypic behaviours)
• Developing and maintaining socially significant behaviour
• Determining the function of behaviour – why does it keep happening and what is maintaining it?
• Parent training to help change responses to your child’s behaviour (these responses could unintentionally be rewarding problem behaviour)
• Increase the child’s academic, social and self help skills
• Improve the ability to focus, comply, and increase motivation to perform tasks
• Generalize and transfer behaviour from one environment to another

Since each ABA program is unique and individualized it is difficult to define what a typical program will look like and the amount of therapy and level of parent involvement varies. Typically an ABA program is implemented at a lower intensity and would include 5-20 hours of therapy per week with a behaviour therapist. Intensive Behavioural Intervention (IBI) is based on the principles of ABA and is delivered at a more intensive rate usually with early learners and is typically 20-40 hours per week of therapy. Therapy hours are flexible and can be delivered at home or in the community and are designed to meet the needs of the family.

Components of our ABA programs:

• Assessments – Each learner will be assessed using the Assessment of Basic Language and Learning Skills (ABLLS-R) or the Verbal Behaviour Assessment and Placement Program (VB-MAP)
• Supervision – Each program is designed and monitored by a senior therapist, as well as supervised by a Psychologist
• Training – all team members are fully trained by supervisors who provide support, monitoring, and ongoing training for the duration of the programming

Clients often ask me these questions. Many individuals wonder whether their drinking or drug use is normal. Some wonder if they have an addictive personality or have inherited a defective gene because they have some alcohol or drug users in their family. Addiction sneaks up on people. It does not respect age, gender, color, ethnicity, culture, social background or intelligence. A waitress, chemist, physician, engineer, manager, factory worker, homemaker and stock broker are all equally susceptible. In all cases it is cunning and baffling for the addicted person and their families! Often a family member, friend or employer is the first to notice signs of addiction – abnormal behaviour such as missing work, loss of enthusiasm, fatigue, depression, overspending, staying out late, or verbal or physical fights. Along with the excuses – ” I only had one drink at the office party”; “I need the medication or the pain gets too bad”; “I need a drink to feel better”; “I’m under too much pressure a drink or toke soothes me, I can stop anytime”; “I use because you nag so much”…… Fill in your own blanks. Sean was concerned his drinking was getting out of hand and wanted to reduce his drinking. It was affecting his health, work, social and family life. He felt tired, lacked concentration and was becoming more isolated from friends and family. We agreed to start treatment with a harm reduction plan to reduce the drinking and within a few sessions he was successful in his goal of reducing his drinking. He then chose to attend bi-weekly maintenance counselling sessions until he was sure things were under control. Larry’s employer mandated, as a condition of continued employment that he seek help for his prescription drug dependency. He was anxious, irritable at work and lacking concentration. After the assessment it was obvious he was not yet ready to start treatment. I explained without him feeling ready and less ambivalent about his intention to change it was not advisable trying to engage in addiction treatment. Instead, he decided to continue with therapy as a way to gain a better understanding of what his areas of risk and triggers were. Linda came to counselling to deal with the relationship issues with her partner, which in her perception, were unrelated to her regular substance use. However, our assessment told her that her substance use was affecting her entire quality of life, including work and family relationships. She learned in therapy that she needed to resolve her substance use problem in order to resolve the issues that originally brought her to counselling. John came because his spouse insisted. While he didn’t think his drinking was a problem, his wife’s complaints and constant threats to leave him had frightened him. Through therapy he learned about what he needed to watch for in regard to areas of risk and treatment.