Strategies for habilitation in Autism

4. Managing Repetitive Behaviors
A variety of strategies have been shown over time to be useful in dealing with the interfering, perseverative behaviors seen in this group (Schopler, 1995). Counselors and teachers can choose to ignore, replace, divert or prevent such behaviors. They can let them run their course or they can skillfully manage them.

Activities that fully involve, absorb, occupy and satisfy each person work best for maintaining attention and reducing repetitive behaviors. Unstructured free time is the most difficult experience for these individuals to manage, it is then that perseverative and compulsive behaviors are likely to appear.

Ignoring repetitive behaviors is useful when these behaviors have no negative impact upon others or the environment. This worked well for one young man who frequently and repeatedly lunged forward, pointing his hand very close to others faces. With ignoring, over time, this behavior totally disappeared.

Replacing the undesirable behavior with a more acceptable activity with similar characteristics often works. A man who repeatedly told unacceptable jokes and made unpleasant comments to the staff, was taught more appropriate, clean jokes. Staff members would then ask him for his "joke of the week" and would react energetically with attention and laughter. Gradually the inappropriate jokes faded out.

To divert and redirect perseverative responses, staff try to incorporate similar motor movements into constructive and useful purposes (Schopler, 1995). For the young man who paces back and forth, pushing a lawn mower back and forth across the yard can be both satisfying and productive. For the woman who likes to pick at small imperfections in wallpaper or floor tiles, weeding flowerbeds is a practical option. For the person who randomly flails his arms, cleaning windows is an acceptable choice. A young woman who ritualistically makes lists while she is by herself, can be diverted to making lists that are useful to herself and the community, like grocery lists and lists of plants to be ordered from the horticulture catalog.

Response prevention is the goal when repetitive behaviors are damaging or costly to the community. One young woman compulsively wiped all bathroom surfaces dry then stuffed the toilets with paper until she could see no more water there. This proved costly with regard to paper products and plumbing. The only way to prevent this behavior was to have a staff member present in the bathroom. When somebody was with her she used the bathroom without engaging in her compulsions.

Some behaviors like pacing or rocking are hard to extinguish entirely. They can be managed however, by providing a structured time for their expression. For a young man who perseverated in pacing back and forth every few minutes during his work, a schedule was created wherein ten minutes of his on task behavior was followed by a break of five minutes of free time for him to do his pacing. Gradually, time on task was increased, and free time was diminished.

Sometimes it is just dangerous to interrupt ritualistic or self-stimulating behaviors once they have been initiated, because violent responses might be triggered. In these cases it may be best to let the behavior run its course, as long as it is not harmful, and when the individual has stopped on his own, to lead him back to the on-going activity.

The choice of the strategy used to address any perseverative behavior is dictated by a thorough understanding of each person and tempered by the nature and disruptiveness of the activity. The residentês sense of security and the safety of both resident and staff must always be major considerations.

5. Enhanced interaction
To overcome social isolation, typical of adults with autism, a range of interactive activities can be encouraged. Caregivers should select those options that best fit the cognitive, linguistic and interactive features of each resident. These can begin with nonverbal reciprocal activities which might include delivering notes from one person to another, retrieving the mail from the mail box and bringing it to the office, turn-taking in contexts of simple games, or distributing items to an assembled group, such as passing out napkins or drinks at snack time.

Meaningful physical and social interactions can be structured into tasks to enhance sharing and interdependence (Kay, 1991). Use of a two-person saw, carrying two ends of a heavy load, pushing and pulling a wheelbarrow are examples of structured reciprocity. These interactions between staff and workers and eventually between peers provide the experience of sharing.

In the peer model, as staff and adults with autism work together to complete assigned tasks, socialization is inherent in their joint efforts, however, verbal interaction is more difficult to achieve. Adults with autism are not likely to talk to each other, although they will respond when others speak to them. To encourage verbal exchanges, simple games are useful such as "Red Rover, Red Rover" where naming another person propels the game forward. Table games that require talking, like Uno and Bingo are available. For those who can read, scripts can be devised to cue verbal expression in specific social situations, from everyday greetings to encounters at stores and restaurants in the community. Once familiar with the scripts, individuals with autism may then remember what to say without the written cue.

Next Section