Behavioral Therapy and Early Intervention for Improved Outcomes

‘Autism’ or ‘Autism Spectrum Disorder’ is a neurological condition that makes social interaction hard, messes with communication, and causes repetitive or stereotypic patterns of interest or behavior. These patterns can really get in the way of a person’s normal functioning. Over the years, lots of different treatments have been tried, but behavior therapy has stuck around as a mainstay for kids and adults with Autism Spectrum Disorders. New behavioral treatments, especially when started in childhood, have shown great results in improving social behaviors. In the past, autism was seen as something you could manage with a lot of support and structure.

Medical and mental health pros can spot the signs of autism, rule out other possible causes, and refer kids to specialists in behavioral therapy, usually Applied Behavioral Analysis (ABA), which has the best track record. Behavioral interventions aim to cut down problem behaviors and teach better ones using basic behavior change principles. These methods are based on learning principles; they look at what triggers certain behaviors and what happens after, then tweak this chain to boost good behaviors and reduce bad ones. These interventions can range from one-on-one instruction to naturalistic approaches focusing on communication or replacing bad behaviors used for communication. Behavior modification techniques can be really effective in helping young kids improve their future life conditions.

CASE VIGNETTE

Ms. A, a 1 year and 8 months old girl, was brought to the clinic because she wasn’t speaking as much as expected for her age. She was also stubborn, had temper tantrums, ground her teeth, acted socially inappropriate, showed repetitive behaviors, and had trouble paying attention and with motor skills.

She’s the second child in a non-related parents’ marriage. Her dad, 35, is a farmer, and her mom, 28, is a homemaker. She has an older sibling who’s 12. The family lives on their own. There’s some unspecified history of mental illness in both her dad’s and mom’s families. Her birth was normal, and her mom was 26 when she was conceived. The baby was active, and her mom had regular check-ups. There was a severe abdominal pain episode in the third trimester that led to a hospital stay. She was born full-term via LSCS, cried right away, had normal color, and weighed 2.5 kg. She was breastfed and got her vaccines on schedule. Apart from a respiratory infection at 3 months old, she’s been healthy. Her motor development was normal until 7 months, but then delays showed up. She said her first word at 1 year but hasn’t made progress since. She recognizes her mom and responds to her name but doesn’t interact socially as expected for her age. She doesn’t make eye contact and seems uninterested in people and surroundings. She’s very attached to her mom and depends on her for everything. She likes playing alone and has a short attention span.

CLINICAL EVALUATION/ IMPRESSION

At 1 year and 8 months, clinical evaluation showed she was behind in development. Her Vineland Social Maturity Scale (VSMS) score gave her a Social Quotient of 60, meaning her social age was like that of a 1-year-old. This showed mild social and adaptive functioning retardation. The Developmental Screening Test (DST) gave her a Developmental Quotient of 65, corresponding to a developmental age of 1 year and 1 month, indicating a mild delay. The Childhood Autism Rating Scale (CARS) suggested a moderate level of autism. Based on her symptoms and preliminary assessment, she was provisionally diagnosed with features of Autism Spectrum Disorder.

CASE CONCEPTUALIZATION

Using behaviorism theory, the child’s stubbornness, tantrums, lack of attention, and repetitive behaviors were seen as key problems needing immediate attention. Reinforcement and associative learning principles were the main tools to address these behaviors. The child’s age and immediate goals guided the therapeutic approach.

INTERVENTION PLAN

Given her Autism Spectrum Disorder features, a modern behaviorist approach was used to manage her stubbornness, tantrums, repetitive behaviors, and other issues. Since she was under 2 years old, there were some limitations in the plan. Still, the treatment was based on behavior therapy principles, mainly using secondary reinforcement on a fixed ratio scale. ‘Prompting’ was the main method used. Secondary reinforcement means a stimulus reinforces a behavior after being associated with a primary reinforce. In this case, secondary reinforcements were given when she showed desirable behaviors, like being less stubborn or following simple instructions from the therapist or her mom. Prompts were used to teach certain behaviors. For example, she had to obey her mom to be carried. If she cried and banged her head, her mom wouldn’t pick her up. Another example is the therapist prompting her to place objects by size. If she didn’t do it, the therapist wouldn’t give her praise. The intensity and type of prompts and reinforcements were adjusted based on her behavior and responses. Immediate reinforcements were occasionally given for highly desirable behaviors.

“Ms. A has been showing remarkable progress,” says her therapist. “When she first came in, she was totally detached. Now, she’s started interacting with others. It’s really nice to see the small improvements after each session” (Personal Communication, 2017). The therapist noted that prompting and fixed ratio reinforcement helped a lot. The main challenges were her age and occasional physical issues. But her family, especially her mom, was very cooperative and followed all instructions at home. Despite taking a lot of time, steady progress was seen. The therapist believes this case shows how effective behavior modification techniques can be for young children with autism.

SUMMARY

Behavior modification techniques using secondary reinforcement and prompting can effectively manage young children with Autism Spectrum Disorder. However, individual differences and socio-cultural contexts can affect the results a lot. The therapeutic atmosphere, alliance, and family support are also crucial for the therapy’s effectiveness.