Susan Stevenson, Advisor
Pervasive Developmental Disorders: Effective Teaching Strategies
April 16, 2000
I researched maladaptive behavior as it manifests in those with pervasive developmental disorders to learn more about its effect on classroom learning. In researching this topic, I encountered many definitions and possible etiologies of autism spectrum disorder. Regardless of the cause(s) of autism spectrum disorder, its behavioral symptoms have many common components, which all interfere with effective learning, and can be an attempt to communicate discomfort or stress. Maladaptive behavior may also be an attempt to draw attention to themselves or something in the environment. Escaping a demand is a strong motivator for maladaptive behavior. Inappropriate response to others is another area of difficulty for the population with autistic spectrum disorder. Techniques reported in the various literatures provide methods of teaching alternative and appropriate communication to replace maladaptive behavior, and classroom applications of these techniques.
I. Types of Maladaptive Behavior
II. Maladaptive Behavior as a Communication Effort
A. Expression of discomfort
1. Types of stressors
B. Attention seeking
C. Escape from demands
D. Inappropriate response to others
III. Treatment Interventions and Classroom Adaptations: Communication-Based Strategies
Susan Stevenson, Advisor
Pervasive Developmental Disorders: Effective Teaching Strategies
April 16, 2000
LEARNING INTERRUPTED: MALADAPTIVE BEHAVIOR IN THE CLASSROOM
I researched maladaptive behavior as it manifests in those with pervasive developmental disorders to learn more about its effect on classroom learning. I also investigated various adaptations and treatment strategies used in classrooms to accommodate those with learning difficulties as a result of pervasive developmental disorders. I focused on communication--based strategies in my research.
In researching this topic, I encountered many definitions and possible etiologies of autism spectrum disorder. To better understand the maladaptive behavior interrupting learning in those with autistic spectrum disorder, I reviewed the literature regarding its biology, behavior, and manifestation of learning difficulties. Martin, in 1995, describes the biology of the cranium. There are 12 pair cranial nerves which control all input to the brain from the sensory organs, 10 pairs terminate in the brain stem. As such, the brain stem serves as a relay system for sensorimotor signals to and from the cerebrum, and is the initiator of many higher cortical functions. In autistic spectrum disorder, there is a malfunction of multiple cranial nerves, resulting in abnormal registration, modulation, and integration of sensory input. In addition, Wing (1996) presents evidence pointing to involvement of the limbic system, cerebellum, and frontal cortex. This difficulty manifests in a triad of impairments (Wing, 1996): impairment in social interaction, communication, and imagination, resulting in a narrow and repetitive repertoire of activities. Begley & Springen (1996) describe autism spectrum disorder as having four components: social phobia, compulsive behavior, communication difficulties, and savantism existing in different combinations in the array of conditions described as autistic spectrum disorder. Their research indicated involvement of brain chemicals, genetics, and viruses in causation of these conditions.
Regardless of the cause(s) of autism spectrum disorder, its behavioral symptoms have many common components, which all interfere with effective learning. Five main types of maladaptive behavior performed by those with autism spectrum disorder are stereotypical, ritualistic, self-injurious, tantrum, and aggressive behaviors. Stereotypical behavior, is defined as repetitive movement of the body or objects (Edelson, 1995), and can involve any of the sensory pathways. Examples of stereotypical behavior are hand flapping, tapping ears, scratching, rocking, mouthing, sniffing, and other such behaviors. Stereotypical behavior stimulates the senses while causing feelings of internal pleasure, due to a simultaneous release of beta-endorphins in the brain. It serves to calm the individual, but focuses his or her attention inwardly and away from attention to learning (Edelson, 1995).
Ritualistic behavior is
an attempt to regulate something concrete and controllable because the person cannot identify and control some real psychological problem...way of subduing ideas or feelings that seem too hideous to be accepted...symbolically removing something that is experienced as a dire threat. 1
Essentially, it is an "act of terror". 2 It interrupts life with compulsions to act in maladaptive ways, and creates feelings of helplessness and anxiety. Compulsions may be caused by a lack of serotonin in the brain. People engaging in ritualistic behavior show indifference to othersí needs, going to great lengths to perform rituals in a maladaptive attempt to control both their environment and the actions of others within it (Weinberg, 1993).
Self-injurious behavior is "any behavior that can cause tissue damage, such as bruises, redness, and open wounds",3 for example, head banging, self biting, or hand scratching or "any behavior that results in physical injury to a childís own body".4 Causational theories include the seeking of internal pleasure and release of beta-endorphins as also seen in stereotypical behavior, sub-clinical seizures, middle ear infections, or hypersensitivity to sound (Edelson, 1995).
Tantrum behavior is usually defined as a combination of two or more maladaptive behaviors, such as screaming, aggression, crying, dropping to the ground, and self-injurious behavior. Often, tantrums can be attributed to sensory overload, anxiety, anger, or frustration (Grandin, 1988). Tantrums are often crisis-level behaviors and can be dangerous for all involved.
Aggression is an act of violence to another person or object, including hitting, kicking, biting, slapping, pinching, grabbing, and pushing. Again, often this maladaptive behavior is triggered by painful sensory stimuli, anger, frustration, or anxiety (Grandin, 1988). Another factor may be extreme exhaustion. Aggression can also be a learned behavior expressed in a pattern. The key to improving classroom learning for those with autistic spectrum disorder is decoding the communicative message of maladaptive behavior, and then adapting the treatment and setting accordingly.
All the maladaptive behaviors described above can be an attempt to communicate discomfort or stress. Stressors may be internal, sensory, or external in nature. Internal stressors are stressors within the individualís body and mind, including ideas and memory as well as physiological difficulty or discomfort. For example, Wing (1996) reports evidence of internal differences in the use and structure of the limbic system, cerebellum, and frontal cortex in this population. These differences affect how the individual perceives and responds to the world, including what is pleasurable or painful to that person. Low levels or imbalances of brain chemicals like serotonin are another internal stressor. Low levels of serotonin can lead to compulsive behavior. An imbalance in the oxytocin chemical system can cause social phobia (Begley, et. al., 1996). Lack of beta-endorphins can contribute to or encourage self-injurious and stereotypical behavior. Rimland found evidence of metabolic problems involving digestion of casein and gluten. Seroussi (2000) elaborated on these findings, indicating the presence of compounds containing opiates in the urine of some children with autism. Other, everyday internal stressors like hunger, fatigue, illness, and feelings also affect those with autistic spectrum disorder as they also affect each and every one of us.
Sensory stressors are stimuli which, when processed by the different sensory system of the person with autism, cause pain, pleasure, or confusion. In autism, stress or sensory overload can cause incoming stimuli to be scrambled. Stereotypical behavior may be an attempt to shut out these overwhelming stimuli, or an expression of difficulty shifting attention away from the offending stimuli. Screaming, crying, tantrums, aggression all may be a way to say STOP, or I NEED HELP (Grandin, 1996). Families For Early Autism Treatment, Inc., indicated 26% of self-injurious behavior was a direct result of sensory stimulation problems. The communicative intent of these behaviors is clear, but the message is often hard to interpret when conveyed through maladaptive behavior, instead of a more socially acceptable and specific form of protest.
External stressors are demands placed on an individual by his or her environment. People with autism spectrum disorder have difficulty in understanding and manipulating their environment. Because of their communication differences, they often experience communication breakdowns, which they may not recognize or have the means to repair (Hodgdon, 1999). "Most children DO NOT lack communicative intent, but rather show limitations in the ability to use communicative signals for a full range of purposes, including social purposes." 5 Lacking the ability to use conventional signals and to consider what the listener needs to know to understand them, they instead use maladaptive behaviors, such as self-injurious behavior or echolalia to express themselves (Berkell, 1992). In addition, autism spectrum disorder can cause severe sensitivity to environmental disturbances that may seem minor to others, for example, the sound of a phone, a change in place or routine, or a change in temperature. Since they lack a more effective, reliable means of communication, those with autism may use maladaptive behavior to try to change their environment.
Maladaptive behavior may also be an attempt to draw attention to themselves or something in the environment. People with autistic spectrum disorder have difficulty using language for socialization purposes, such as social interactions, establishing joint attention, and establishing social connections Requesting an item, greeting a person, asking or answering questions, commenting, conversation, and expression of feelings all become difficult (Hodgdon, 1999). Families For Early Autism Treatment, Inc. found that 26% of self-injurious behavior was caused by misused positive social attention. For example, if a person found that head banging was a means of gaining social attention from a desirable person, he or she may bang his or her head every time he or she would like attention. Our challenge is to decode this communicative attempt and provide alternative, more effective, communicative means.
Escaping a demand is a strong motivator for maladaptive behavior. Families For Early Autism Treatment, Inc. found that 38% of self-injurious behavior was used as a way to escape demands. People with autism may not have an appropriate way to say NO, or request a break, so they obtain a break from demands any effective way available to them. Their difficulty lies in their inability to easily learn skills that give typical children a sense of control over their environment (Harris & Weiss, 1998).
Inappropriate response to others is another area of difficulty for the population with autistic spectrum disorder. The interactive styles of significant others can contribute to or help alleviate this problem. A facilitative interaction style is better to use when interacting with a person with autism. This technique allows lags of up to 30 seconds to compensate for processing difficulties, avoids using direct questions when possible, and gives opportunities for clarification of information (Berkell, 1992). Teaching appropriate interaction styles is another way to replace maladaptive behavior with an appropriate behavior that serves the same purpose.
Berkell (1992) indicates that when evaluating treatment strategies, one should consider the chronological age of the student, the social supports available to the family, the setting in which the program will occur, and one should concentrate on teaching functional skills. Functional skills are skills that are age-appropriate, used regularly, and that will continue to need to be performed by someone else if the student is unable to perform them for him or her self. A good beginning is to conduct a functional analysis of the maladaptive behavior exhibited by the person with autism. This technique allows the teacher to identify the reinforcing function of the behavior, thereby ensuring the treatment strategy will focus on teaching the student to access the same function more efficiently and to obtain the same negative reinforcement (escape) or positive reinforcement (attention, tangibles). (Families For Early Autism Treatment, Inc., 1996-2000). Berkell (1992) reports on four items to measure when assessing behavior. The first item to measure is to determine the function of the maladaptive communicative behavior: behavior regulation (request/protest), social interaction (greeting, calling, showing off, social game), or joint attention (comment, request information). The second item to evaluate is the degree of conventionality and social acceptability of the current behavior followed by measurement of the sophistication of the studentís gestural and social communication skills, and his or her ability to repair communication breakdowns. Measurement should be taken at both the verbal symbolic level, and the nonverbal symbolic level.
Berkell (1992) also presents intervention guidelines, stating that goals should be based on both developmental and functional criteria, focusing on functional use of communication. Goals should aim to foster balanced interactions between the person with autism and his or her environment, and also aim to improve the facilitative communication style of significant others. Management of behavior problems should be fully integrated into the studentís day, and coupled with teaching self-regulation of emotional arousal or stress level. This corresponds with Quillís (1995) statement of the goals of education for this population: increasing independence, understanding of the environment, and self-control.
Hodgdon (1999) points out learning differences in people with autistic spectrum disorder may affect their learning of skills to replace maladaptive behavior. For example, lack of generalization of learned skills, inability to discern what behavior to imitate and when behavior is appropriate, and learned chains of behavior that may be hard to change or interrupt mid-chain. Commonly, these students donít understand communication, have difficulty expressing themselves, and donít know what else to do instead of the maladaptive behavior. Quill (1995) lists five program features to teach alternative communication behavior. First, implement a predictable daily routine. Second, students with autism often have visual learning strengths. Using visual tools to "support and provide the structure that helps students participate effectively and avoid many behavior difficulties" 6 is often a beneficial way to teach alternative behaviors. Visual aids are
material supports which include concrete objects, photographs, pictographs, and printed materials that assist the childís ability to attend to relevant information, provide ongoing organization and structure, clarify expectations and information, and increase independence. 7
Third, development of communication skills, such as augmentative communication systems uses visual aids. Hodgdon (1999) also supports using visual tools to get the studentís attention, improve understanding, decrease fear and anxiety, support appropriate behavior and participation, improve expressive communication, teach self-regulation of behavior, teach self-management for independence, and increase the success of the student across settings. Quill (1995) continues with social activities based on the studentís interests, and lastly, practicing relaxation techniques. This program stresses consistency, use of simple language input, and redirection of maladaptive behavior.
Another strategy, proposed by Edelson (1995), is to ignore the maladaptive behavior if it is attention seeking in nature, to prevent reinforcing the behavior. If the maladaptive behavior is an attempt to escape or avoid a demand, Edelson (1995) suggests insisting the person complete the task despite the behavior. In contrast, Families for Early Autism Treatment, Inc. (1996-2000), report a study allowing the escape to occur while reminding the student of the rule "when you finish your work, we can play" once every two minutes, resuming instruction when the student returned to his or her seat. Once the student was compliant with the instruction, the session ended and the student was allowed access to reinforcers for 10 minutes. The number of demands placed on the student during each session was gradually increased over time, and this method succeeded in reducing escape behavior to nearly zero, simultaneously increasing compliance with instruction. Important factors in this technique were: student access to highly preferred items after compliance with instruction, deprivation of items when the student took too long to comply, gradual increase of demands, and the discontinued reinforcement for maladaptive behavior. Edelson (1995) also recommends relaxation therapy, adding the element of visual imagery, "a set of techniques that use various visual supports to teach social skills and self-control...to clearly explain social-behavioral rules and skills". 8
Families for Early Autism Treatment, Inc. (1996-2000) also cited a study done in 1992 by Koegel, Koegel, Hurley and Frea. This study looked at increasing social skills and decreasing maladaptive behavior through self-management. The specific focus was whether self-management could be used to increase social communication skills, and, if so, would this increase lead to a corresponding decrease in maladaptive behaviors when others interacted with the student. The baseline they established for their group was appropriate social responses less than 50% of the time. The method determined and monitored age-appropriate correct responses to questions, recorded the responses on a wrist counter given to the student, and granted a reinforcer to the student after 30-40 correct responses. The results were an increase to 75% correct responses, accompanied by a decrease in maladaptive behavior when the response was correct. In addition, the students showed a 50% increase in verbal initiations, a behavior not targeted.
Autism Society of America (1995) suggests such social skills programs as learning to recognize facial expressions and emotions of others and self, learning to communicate in social situations as above, and general social communication. McClannahan & Krantz (1999) suggest use of requesting, pointing, and reporting as beginning social interaction activities included in a daily schedule. Hodgdon (1999) lists social engagement, the basis for communication, as an important item to specifically teach students to perceive others as valuable communication partners. In return, Hodgdon (1999) recommends that communication partners of a student with autistic spectrum disorder take time to prepare him or her for what is about to be communicated. Communication partners should get on the studentís level, establish attention, use visual supports, and include time for the student to respond, guiding response if needed.
Part of preventing a communication breakdown between communication partners is coupling familiar schedules and routines with easily understood forms of communication (Hodgdon, 1999). Hodgdon (1999) states that maladaptive behavior is more likely to occur when students donít comprehend what is happening around them. Schedules and calendars are visual tools that provide structure and give students information about their lives. They prepare students for what will or will not happen, help students understand when something is finished, and support communication (Hodgdon, 1999).
Another communication tool to help students control their environment is the skill of making choices and requests (Hodgdon, 1999). Offering choices may reduce student resistance to learning and help students to transition to an alternate activity. One of the important concepts that accompany this lesson is that one gets what one chooses. Hodgdon (1999) recommends using visual choices, beginning by presenting the student with two choices. Encourage the student to indicate his or her choice, give the item chosen and remove the item not chosen. Another technique Hodgdon (1999) discusses is placing in front of the teacher a desired item and a picture of that item in front of the student. Using this picture exchange system (PECS), the student practices initiating a request and engaging a communication partner. The ability to make choices and requests is rewarding and reduces the instance of maladaptive behavior while increasing appropriate communication.
Teaching a student to protest or reject choices is equally important. Hodgdon (1999) states that people with autistic spectrum disorder may need direct instruction on how to understand the protest of others, and how to respond to othersí protests in addition to learning how to use protests to get their own needs met. Various instructional techniques may be used, such as role-playing, mirror practice, and other visual tools to demonstrate NO. Hodgdon (1999) recommends using a variety of terminology in instruction ("no", "all gone", "later"). Teachers should use visual support to give related information, for example, when is "later", or what other options are available to the student. When a student engages in maladaptive behavior as a protest, the opportunity arises to teach appropriate protest-- "If you donít want this, tell me NO"--and then one must respect the choice of the student, allowing him or her to exert control over the environment. This will reinforce the appropriate protest while ignoring the maladaptive behavior. Intervention should occur as early as possible in the behavioral chain, and students may be reminded periodically of ways to appropriately protest.
Hodgdon (1999) comments that the emergence of language can cause frustration for students and teachers. Language development is a learning process, and when language does not work for a student, he or she will revert to a maladaptive behavior that does. A question Hodgdon (1999) recommends asking oneself, as a teacher of language, is "if my student can only learn to communicate 10 things, what should they be?" 9 Teachers should choose words, signs, and pictures that most help students exert control over their environment to get their wants and needs met, and cause a strong social response in others. The goal is to help students participate in the world around them and to replace maladaptive behavior with appropriate communication. When interacting with a student, who has limited language, teachers should keep in mind that the word used may not be exactly what the student means, especially in an emotional situation for the student, and remain alert to both context and nonverbal communication.
In emotionally charged or especially stressful situations for the student, a teacher can form a hypothesis about what the emotion might be, and link the emotion with appropriate request or protest communication, providing the vocabulary for the student. Often, retelling the story of what happened after the fact, and rehearsing appropriate communication using visual strategies and relaxation techniques is helpful (Hodgdon, 1999). Hodgdon (1999) explains how narratives mimic the way the brain successfully orders and makes sense of information while describing what is encountered in life. The basal components for conveying meaning are a concept/thing coupled with an action or statement of condition. The character and plot of a narrative form just that structure, which is helpful to those with autism spectrum disorder, who may have difficulty with syntax.
New communication skills should be able to be carried out (generalized) to all environments the student encounters. Sign language and communication aids such as electronic devices, picture boards, or communication books should be available to the student and easily interpretable by the people in that environment. (Autism society of America, 1995). Environmental changes can also help the learner with autism. Eliminating fluorescent lights, lowering the sound of buzzers or bells, carpeting a room to muffle noise, and putting cut tennis balls on chair legs to muffle scraping are strategies for classroom use (Grandin, 1988). Availability of a break or quiet area for a student to regain control when over stimulated is critical, as is constant availability of visual support and communication aids. Schedules are easily velcroed to a desk or kept on a clipboard or in a binder. Communication books may be attached to a belt loop, key chain, or pocketsize.
At the Groden Center, we use all of the above methods in varying degrees based on the studentís individual needs. In my classroom, we have begun to use bathroom transition cards. A picture card of the bathroom will be on the studentís schedule or handed to the student by a teacher. The student then walks to the bathroom, where a matching picture is attached with Velcro to the door, with a Velcro spot next to it. The student attaches the picture he or she is carrying to the Velcro, matching it to the other picture, and then enters the bathroom. Transition to the bathroom was a problem time for many students in my classroom, but since beginning this method it has become an easier transition for them to make.
A specific student in my class has difficulty discriminating "yes" and "no" in response to a question. When asked a question, he always verbalized or signed "no". Even in the presence of a tangible item he wanted his tendency was to repeat the label for the item instead of saying "yes". I began using pictures representing "yes" and "no" with him, and noted an improvement in his ability to answer yes/no questions appropriately using the visual support. In one instance, he was able to qualify his "no" with an additional sign to indicate what he needed, a major communication breakthrough for this student. The same student, using sign, independently generated a sentence "break shoe" to indicate he wanted his shoes off. This new communication replaced a maladaptive behavior of kicking his shoes off with force. As a teacher, it is exciting to see a student learn to control his or her environment in a socially acceptable, appropriate manner, and without the communication training and visual supports that would not have happened. I highly recommend trying some or all of these techniques to educate and improve the quality of life for students with autistic spectrum disorders.
1 Weinberg, G. (1993). Invisible masters: Compulsions and the fear that drives them. New York: Grove Press, p.1.
3 Edelson, S. (1995). Center for the Study of Autism [On-line]. Salem, OR, pp1-2.
4 Families for Early Autism Treatment, Inc.1996-2000 [On-line] last updated 12/24/98 pp1-21.
5 Berkell, D.E. (1992). Autism: Identification, Education, and Treatment, pp.107-131.
6 Hodgdon, L. (1999). Solving behavior problems in autism. Troy, MI: Quirk Roberts Publishing, pp.59-64.
7 Quill K. (Ed.) (1995). Teaching children with autism: strategies to enhance communication and socialization. Albany: Delmar Publishers.
8 Edelson, S. (1995). Center for the study of autism [On-line], Salem, Oregon. Pp.1-2.
9 Hodgdon, L. (1999). Solving behavior problems in autism. Troy, MI: Quirk Roberts Publishing, pp.177-183
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© Lisa MacDonald 2000. The author can be contacted by e-mail at Dandelion71@cox.net
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