| INTERVENTION AREAS |
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Based on our Professional experience, below are presented some intervention areas that were found to be more frequently seeked. Nevertheless, ABA is not limited to these areas of intervention.
5. Obsessive Compulsive Disorder (OCD)
Autism is a neurodevelopmental disorder of which expression varies greatly from one individual to another. It is therefore treated as a spectrum, which means that symptoms vary in occurrence and severity across individuals. Whereas one individual may present a good verbal ability, another may not vocalize at all; whereas one individual may imitate well another person’s movements, another may find this skill very difficult. Therefore, each individual should be treated differently and treatment should take this into account. However, there are some central difficulties that are observed in most individuals diagnosed on the autistic spectrum. These include: Language and communication: these difficulties include verbal and non-verbal communication, such as eye contact, facial expression, body language, understanding spoken language, etc. Social behavior: individuals who are diagnosed on the autism spectrum generally find it difficult to understand and/or express emotions, such as showing empathy and conversing with others. They generally present difficulties engaging in social interaction and play activities. Behavior: individuals diagnosed on the autism spectrum generally engage in repetitive behaviors, they may insist on following routines and engage in rituals; rigid organization of objects, etc. Autism emerges in the first three years of life. Individuals affected by autism spectrum disorder manifest developmental delays in skills which are learnt between infancy to adulthood. Autism is a disorder that affects the individuals, their families, caregivers, educators and all those involved in their day to day life, specially when taken into consideration the complexity of behaviors, reactions and emotions these individuals present Although treatments, particularly early intensive intervention, may improve the individual’s skills, behavior, autonomy, communication and social interaction and general functioning, there is no “cure” for autism. Nevertheless, if no intervention is applied, the probabilities of the autistic child growing into a functional adult are drastically reduced. One of the most successful interventions, based on scientific findings, is IEBI (Intensive Early Behavioral Intervention). Based on Skinner’s operant conditioning, learning theory and research, IEBI relies on identified principles of behavior, such as reinforcement, fading, shaping, prompting, etc. Applied behavioral analysis refers to the application of those and other principles, and actually encompasses several different strategies for treatment. One of the first studies that applied behavioral learning principles to the population of autism spectrum individuals is Dr. Ivar Lovaas, in UCLA during the 60s. In this study, 47% of the children diagnosed on the autistic spectrum who received early intensive behavioral intervention were successfully integrated into the mainstream education system. A follow-up study eleven years later confirmed that benefits were maintained. Several decades of research demonstrate the effectiveness of ABA in the intervention with a variety of populations, teachers, parents, educators, therapists, caregivers, environments and behaviors.
ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder. As such, it is affected by organic, neurophysiological and environmental factors. ADHD is found to be comorbid with other conditions, such as ODD (Oppositional Defiant Disorder) and CD (Conduct Disorder). ADHD often requires the use of medication to control behavioral and cognitive symptoms. So far, the combination of stimulant (pharmaceutical) and behavioral therapy shows the greatest benefits. An effective treatment must consider the effects of medication on behavior, physical and parental conditions, which might influence application. Careful evaluation should precede treatment. Some of the important elements of treatment of ADHD include adherence to daily routine, educators and parental involvement, as well as autonomy and self regulation objectives. A successful intervention plan should consider cognitive needs, and address them through the application of behavioral strategies. It should increase socially appropriate behaviors and reduce antisocial and undesired or inadequate behaviors at home and at school. Examples of important elements that are included in a behavioral intervention for ADHD are:
Examples for antisocial behavior include lying, stealing, verbal abuse, rudeness, bullying, aggression, vandalism, destructiveness, etc. Aggression (verbal or physical) is one of the main concerns currently at school and home settings. Childhood aggression is found to be correlated with other problems in adolescent life, such as delinquency, poor academic achievement and substance abuse. Aggressive behavior seems to be increasing cross-culturally and not to be limited to a certain place or mentality.
Some nervous habits, such as nail biting, thumb and finger sucking are common behaviors in early childhood. However, when these behaviors become chronic, they may have physical and social consequences, such as tissue damage, dental deformities, reduced peer acceptance and negative peer evaluation, which are important contributors for social development. In these situations, other nervous habits such as hair pulling might also increase. Some theories suggest that nervous habits are evoked by stress and/or anxiety. The “environmental restriction” theory maintains that limited motor activity evokes nervous habits. On the other hand, the “arousal modulation theory” suggests that behaviors such as nail biting calm the individual in times of autonomic arousal (anxiety) and provide stimulation at times of inactivity (boredom). Currently, no one theory has gained more empirical support over another. Behaviors such as nail biting and thumb sucking might be a normal action if indulged in occasionally; a simple tension releasing mechanism (a form of addiction); or a sign of severe internal tension if severe and persistent. Nervous habits may be maintained by different variables across individuals, making it therefore necessary to determine the function of the target behavior on an individual basis.
5. Obsessive Compulsive Disorder (OCD) The American Academy of Child and Adolescent Psychiatry estimates about 1 in 200 children has the brain disorder known as OCD. The condition is characterized by obsessions (recurrent and persistent thoughts, impulses or images) and compulsions (repetitive behaviors and rituals, such as hand washing), that can turn the child’s life upside down. The causes of this disorder are still uncertain, although interplay between genetics and environment appears to be plausible. Children and adults who suffer from OCD often are diagnosed with comorbid conditions, such as depression, anxiety disorders, panic disorders, attention deficit disorder, learning disabilities and Tourette’s syndrome. Children who suffer from OCD are likely to be boys of average or high intelligence, with OCD or other related psychiatric conditions within their family. The age of onset for boys is typically between 5 to 8 years, whereas girls typically show onset during adolescence. The OCD child often suffers from fears, which seem irrational but yet torment him or her. It (erased) often becomes even more difficult, seeing as most teachers are not trained to deal with serious behavior problems. In the classroom setting, the OCD child might insist on drawing a map over and over again, continuously sharpening sharpened pencils, store papers or arrange his or her desk continuously. As the child grows older, obsessions might be paired with compulsions, taking more and more over the child’s life. The child might become isolated, later on might turn to alcohol and drugs and at times attempt suicide. Children with OCD are likely to drop out of school and to lead a life characterized by underachievement and missed opportunities. The following obsessions are the most frequent in children and adolescents who suffer from OCD:
Adolescents are amongst those most likely to be affected by anxiety as a result of exams pressure, extracurricular activities, dating and peer relations. Where it is normal to become somewhat anxious under those situations, some individuals feel overwhelmed. When anxiety is persistent, intense and prevents the individual from enjoying life and from functioning efficiently, it becomes a disorder. At this point, the individual may benefit from long and short term strategies that will help to control and overcome fears and anxiety caused from exposure to certain situations.
Nearly all children experience some degree of fear during their development. Although most fears vary in the degree of frequency, intensity, and duration, they tend to be mild, age specific and to pass after a certain period of time. Typical fears that children may experience include fear of strangers; of separation; of loud noises; of darkness; of imaginary creatures; and of certain animals (e.g. spiders, snakes, dogs). These fears appear to result from daily experiences and do not involve intense or persistent reactions; they are short lived and mostly adaptive. When fears and anxiety become persistent (last more than 6 months) and bring intense reactions, they start interfering with normal functioning. The development and maintenance of childhood phobias are thought to be influenced by genetic factors, temperamental predispositions, parental psychopathology, parenting practices and individual conditioning history. Researchers define phobias as:
Some children have difficulties attending school and may become extremely upset or even ill when forced to go to school. These children are neither delinquent nor antisocial. The problem might be further exacerbated by parental expectations for achievements. Berg and colleagues (1969) postulated the following criteria for school avoidance:
Sibling relationships are very unique, because they last over a lifetime and remain important through adulthood. The quality of sibling relationships changes across and within families. These individual differences in early childhood were found to relate to children’s ability of social adjustment and understanding. The shaping role of siblings on children’s aggressive behavior has been documented, and middle school children’s behavior is associated with the quality of sibling relationships in early childhood and preschool years. One of the primary tasks of young adults is the development of personal relationships. Older siblings are often seen as a socialization agent and significant attachment figures. In light of this, then, where conflicts are a normal occurrence amongst siblings of different ages, it becomes more and more important to encourage a cooperative family system, characterized by engagement in prosocial behavior, affection and cooperative play, cooperation, help, praise, comfort, reassurance and sharing.
Insomnia, nightmares, and an inability to fall or stay asleep are normal occurrences in children and adults. When these happen frequently, they begin to interfere with normal functioning. Currently, more and more children are diagnosed with sleep disorders, a fact that might be associated with the increase of ADHD diagnoses. Research suggests that elementary school age children who get enough sleep, which is defined at about 11 hours a night, do better in school, are more content, suffer fewer accidents, and are less likely to become obese than children who don't get the sleep they need. On the other hand, children that do not get enough sleep are more easily frustrated, intolerant, irritable, and oppositional. Research findings also indicate that lack of sleep is associated with reduced attention span and increased reaction times. Some children become more active when short of sleep. It is well known that the biological need for sleep increases during maturation. Therefore, the ability to interact and to learn may be diminished in sleep deprived children. Reduction in cognitive efficiency and an increase of behavioral problems is often observed in children and adolescents who do not sleep enough.
School violence is one of the most pressing issues, as its rate increases internationally. School violence does not only appear in its physical, most obvious form, such as bullying, insubordination and vandalism. It also appears in more subtle forms, such as classroom disruption, verbal threats and humiliation. This contributes to the creation of an unsafe and threatened learning environment (Putnam, Handler, Ramirez-Piatt & Luiselli, 2003). Researchers have distinguished between three types of aggression: direct aggression, which is physical aggression; direct verbal aggression, such as using swear words and threats; and indirect aggression, which includes hurting or offending an individual through others, such as telling tales, gossiping, and excluding from activities. Another dimension that contributes to the threat of the learning environment is disruptive behavior during the class. This takes several forms, the most frequent being non-compliance and refusal; aggression towards the teacher or adult; defiance of authority; and interruption to instruction. Research findings illustrate that peer support for antisocial behaviors occurs even before adolescence, lending support to peer attention as a reinforcing factor for antisocial behavior; and also to Adler and Adler’s (1995) hypothesis that aggression is used as means to gain high social status for the individual, and that the continuation of aggressive behavior facilitates the maintenance of the achieved status. However, some aggressive children had been observed to be socially excluded, and described as unpopular. These children, though, are frequently being bullied as well as bullies. Some scientists suggest that the age range of five to seven years is crucial for social and cognitive development, a time when children develop their perceptions and problem-solving skills. Therefore, aggression might be seen as a tool for achieving social status only at a later stage, when social cognition is more developed. It is clear that age and sex differences exist in the phenomenon of antisocial behavior. Also, personality seems to play a role (aggressiveness as a basic characteristic underlying friendship), as well as group social norms and parental factors. An intervention for prevention or extinction should take all these variables into account and therefore target several contexts and other elements. |
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Idea of the month
13. Aggressive Behavior Appropriate attitude towards aggressive behavior in the present may prevent future engagement in aggressive behavior. It is in our (adults) hands. |