Behavioral Intervention for Children with Autism Spectrum Disorder and Other Developmental Disabilities: A Guide for Parents and Professionals

Author: Huang Weihé
Publisher:
Publish Date: 2005-01-01
Features: This book, aimed at parents, relatives, and professional treatment personnel of autistic patients, should meet four standards: credible, readable, practical, and focused on treatment. Through reading, readers can not only systematically understand autism and other severe developmental intellectual disabilities but also learn positive treatment methods. Dr. Huang Weihé is a behavioral psychologist with years of clinical experience. He has long been engaged in theoretical research and consultation work on autism and other severe developmental intellectual disabilities, frequently giving face-to-face lectures to parents, relatives, and professionals of autistic patients. "Behavioral Intervention for Children with Autism and Other Developmental Disorders" is the crystallization of his years of research and practice, fully meeting the four standards of credibility, readability, practicality, and a focus on treatment.
II. Language Application Deficits
Language ability and language application or communication ability are not entirely the same. Some children may have lower language abilities due to their young age. However, they can still communicate effectively using limited vocabulary, such as expressing what they want or do not want. In contrast, some autistic children already possess certain language abilities, but their ability to use language for communication is significantly impaired. Many studies have documented that in free play environments, autistic children speak less frequently and use fewer types of language compared to normally developing children. They seem to know how to initiate and sustain a topic. For example, when asked if they like something, their responses are often just "yes" or "no," followed by nothing more. Correspondingly, autistic children often have lower listening and comprehension abilities. In language communication, they sometimes talk to themselves, sometimes ask but do not answer, and do not understand turn-taking or politeness. Some autistic children may not speak frequently, but careful observation reveals that their speech is mostly composed of questions rather than answers. Their questions can sometimes be repetitive and incessant. The true purpose of these questions is often not to obtain answers or information but to attract others' attention. When asked questions, they may give simple answers, irrelevant responses, or rarely provide appropriate and sufficient answers or information. Some autistic children can talk endlessly about topics they are interested in, while otherwise remaining silent. In summary, in terms of language application or communication ability, autistic children can be both delayed and eccentric. The reasons for this are both a language disorder and related to their cognitive deficits.
III. Language Repetition
Language repetition, or the phenomenon of children repeating others' speech, may be one of the most characteristic symptoms of autism. Language repetition can be further divided into immediate language repetition and delayed language repetition. Immediate language repetition occurs when autistic children immediately repeat what others have said. For example, a mother asks her autistic son, "Xiaogang, are you hungry?" and he also says, "Xiaogang, are you hungry?" In contrast, delayed language repetition refers to autistic children repeating what others have said after a period of time. For instance, a mother once told her autistic son, "Don't lock the door." When putting him to bed that night, he might repeat, "Don't lock the door," though the actual meaning might be "no." This shows that language repetition can sometimes serve a specific purpose, though the expression is very strange. In the 1970s and 1980s, the academic community did not fully recognize this function of language repetition. Now, it is generally believed that immediate language repetition often occurs in autistic children when they do not understand others' questions or requests. Once they learn how to respond in such situations, this language repetition phenomenon decreases. From an evolutionary perspective, there is still no definitive answer to why autistic children exhibit language repetition. However, some empirical studies suggest that the social cognitive development of autistic children differs from that of normal children. For example, in normal children, joint attention ability typically develops before imitation ability. In autistic children, joint attention ability is a major deficit. In other words, they often develop imitation ability first and then gradually develop some joint attention ability; in some autistic children, they almost lack this joint attention ability. When autistic children rely solely on their imitation ability during language development without combining it with joint attention ability, their language often has a mechanical and repetitive characteristic. It should be noted that not all autistic children have language repetition issues, nor are all children who exhibit language repetition autistic. Many children, when first learning language, imitate adults' speech to some extent. However, in normal children, language imitation is often very limited, such as imitating words beyond their language ability. Moreover, this language imitation occurs at very specific times, such as when children are around 2 years old and starting to learn language. In autistic children, language repetition is often more pervasive and persistent, requiring specific treatment to gradually reduce.
### Section II: Autism and Fragile X Syndrome
As early as 1943, Martin and Bell discovered that 11 males and one female in a family were intellectually disabled through pedigree analysis. They further hypothesized that this special distribution of intellectual disability might be caused by genetic issues related to sex chromosomes. This report did not receive much attention at the time. By 1977, Australian scholar Grant Sutherland further discovered that the fragility and instability at the end of the human X chromosome might have led to this familial intellectual disability with different distributions between males and females. Due to the influence of this study and subsequent related research, a large number of reports on this special intellectual disability emerged in the late 1970s and 1980s. It was also during this period that this intellectual disability was officially named Fragile X Syndrome. Fragile X Syndrome is a type of intellectual disability. Its epidemiological characteristics are that the prevalence rate is higher in males than in females. That is, approximately 1 in 2,500 to 1 in 1,250 males are affected, while approximately 1 in 5,000 to 1 in 1,600 females are affected. This section will review the causes and manifestations of Fragile X Syndrome, the relationship between autism and Fragile X Syndrome, and some basic principles for intervening in patients with Fragile X Syndrome.
#### I. Causes and Manifestations of Fragile X Syndrome
Fragile X Syndrome is caused by mutations during the formation of the X chromosome in the human body. In a segment of the X chromosome's DNA, changes can occur due to inheritance. One type is complete change, and the other is DNA hypermethylation. If these changes are relatively minor, patients may show no special symptoms or only mild symptoms in clinical manifestations. Conversely, if these changes are more significant, the following symptoms of Fragile X Syndrome may appear.
First, in terms of physiology and body shape, patients with Fragile X Syndrome often have distinct physical features. For example, they generally have long faces, significantly oversized ears, prominent foreheads and chins, and large mouths with thick lips. After puberty, the testicles of male patients with Fragile X Syndrome are larger than those of normal individuals. Due to their severe cognitive and social deficits, they often have fewer sexual desires. Many patients with Fragile X Syndrome also have hypertension, which may be related to their relatively common anxious disposition. Additionally, approximately 20% of patients with Fragile X Syndrome also have a history of epilepsy.
In terms of cognition, patients with Fragile X Syndrome often exhibit symptoms of intellectual disability. For example, in males, 16% of patients have severe intellectual disability, 28% have moderate intellectual disability, 46% have mild intellectual disability, and 7% have borderline or normal IQ. In females, the proportion of patients with intellectual disability is lower: 8% have severe or moderate intellectual disability, and approximately 30% have mild intellectual disability. Most females with X chromosome mutations are in the borderline or normal IQ range.
In addition, patients with Fragile X Syndrome often have lower abilities to process abstract and complex information mediated by sound but stronger abilities to remember object images.
In terms of language, most patients with Fragile X Syndrome can speak, but they often repeatedly use the same words and topics, speak quickly and unclearly, making it difficult for others to understand them. They also often emit meaningless sounds. Due to the hyperactive tendency of many patients with Fragile X Syndrome, they often struggle to engage in conversations around a topic during actual language communication and may act impulsively and lack necessary restraint.
#### II. Training for Sitting
Training should start with the simplest behavioral actions, as this increases the likelihood of success for both the teacher and the child, laying a foundation for more complex training. Therefore, training for sitting is often the first step in intervention. Of course, this assumes that the child cannot sit properly without training, which hinders learning in other areas. Below are the basic steps for training sitting.
1. The teacher selects an appropriate small chair and places it behind the child. The teacher prepares some rewards the child loves, such as small candies or drinks.
2. The teacher gives the command "Sit down" while helping the child sit down with their hands.
3. Once the child sits on the small chair, the teacher immediately says, "Good sitting," and gives appropriate rewards (e.g., giving the child a small sip of orange juice or a hug).
4. Then, the teacher has the child stand up, providing assistance if necessary. After the child stands up, repeat the above steps.
5. Gradually reduce the teacher's assistance and rewards during this process while slowly increasing the distance between the child and the chair.
6. If the child tries to leave the chair, the teacher insists on putting the child back on the chair to make it clear that permission is needed to leave.
Once the child can complete the above steps in one environment and under the instruction of one teacher, the training should be moved to other environments and conducted by other teachers to make this a natural behavior.
#### II. Training for Eye Contact
Autistic children often avoid eye contact, which not only hinders their learning but also makes them appear different. Training for eye contact is therefore very important.
1. The teacher and child sit facing each other on small chairs. The teacher prepares some rewards the child loves.
2. In every five-second (or ten-second) unit, the teacher calls the child's name and says, "Look at me." As soon as the child looks at the teacher's eyes, the teacher immediately says, "Good looking," and gives appropriate rewards.
3. If the child does not respond to the instruction twice, the teacher pauses for five seconds, such as by turning their head to the side. Then, they give the instruction again.
4. If the child continues to fail to respond, the teacher provides assistance. The teacher can hold a small piece of candy while saying, "Look at me," and slowly move it to the middle between the teacher and the child's eyes. As soon as the child's gaze follows the candy and meets the teacher's eyes, the teacher gives a reward. If the child still does not look at the teacher at this time, the teacher can also gently lift the child's face to look at the teacher as assistance.
5. Once the child can follow the instruction to look at the teacher continuously for about ten times, the teacher gradually reduces assistance. For example, gradually hide the candy in the teacher's hand, delay the timing of assistance, or only reward eye contact without assistance.
6. To increase the duration of eye contact, gradually increase the time from when the child starts looking at the teacher to when the teacher gives a reward. The teacher can count to two, then three, then four in their mind before giving a reward.
7. The teacher can then gradually increase the distance between themselves and the child while performing the above training. The teacher can also apply this method to other situations, such as teaching the child to increase eye contact during play.