Motivation
Procedures that increase motivation, as defined earlier, have now been reported
extensively in the literature. In particular, several antecedent variables
have been identified that increase children with autism's responsiveness
to social and academic stimuli, while simultaneously decreasing the amount
of disruptive behaviors exhibited during interactions (Kern & Dunlap,
1998; R. L. Koegel et al., 1998; Schreibman, Stahmer, & Pierce, 1996).
These variables include child choice, task variation and interspersal of maintenance
tasks, reinforcement of response attempts, and the use of natural and direct
reinforcers.
Child choice is defined as the incorporation of child-preferred or child-chosen
materials, activities, topics, and toys into learning opportunities. Although
the clinician follows the child's lead, the environment remains structured
such that desired target behaviors are incorporated into the activities, while
maintaining the child's attention, and decreasing the likelihood that the child
will avoid the interactions and engage in disruptive behaviors (cf. Dyer, Dunlap, & Winterling,
1990; Kern et al., 1998; R. L. Koegel et al., 1998; Moes, 1998; Sigafoos, 1998).
Motivation can also be improved by varying the task sequencing and interspersing
previously mastered tasks with new acquisition tasks during a learning activity
(Carr, Newsom, & Binkoff, 1980; Davis, Brady, Williams, & Hamilton,
1992; Dunlap, 1984; Winterling, Dunlap, & O'Neill, 1987). The child thus
experiences a higher rate of success, a greater likelihood of reinforcement,
and consequently, increased responsivity (R. L. Koegel, Carter, et al., 1998).
Broadening shaping criteria to reinforce the children's appropriate attempts
to make social and communicative responses, as compared to a stricter shaping
criterion wherein only responses that are as good or better than previous responses
are reinforced, has been shown to increase the children's acquisition of language
and academic tasks (R. L. Koegel, Carter, et al., 1998; R. L. Koegel & Egel,
1979; R. L. Koegel, O'Dell, & Dunlap, 1988). This may be especially important
for acquisition of first words in nonverbal children (R. L. Koegel et al, 1988),
particularly because related areas such as phonology, pragmatics, and semantics
may not yet be strongly established due to lack of practice of these complex
multiple components that comprise appropriate social interactions (cf. Camarata,
1996; Camarata & Leonard, 1986).
Research has shown that incorporating natural reinforcers that are directly
and inherently related to the child's response leads to increased motivation,
enhanced learning, and more rapid acquisition of the target behaviors (L. K.
Koegel & Koegel, 1995; R. L. Koegel, Carter, et al., 1998; McEvoy & Brady,
1988). Use of natural, direct reinforcers can teach the children that there
is a direct relation between their response and reinforcement (L. K. Koegel & Koegel,
1995) and may shorten the delay between a response and reinforcement, resulting
in the stimuli and reinforcer becoming more salient (Kazdin, 1977; Skinner,
1979).
Incorporating the motivational variables described earlier, as a group, into
an intervention approach can significantly improve language, academic, and
social functioning, while simultaneously decreasing disruptive behavior in
children with autism as well as other populations (Dunlap, Kern-Dunlap,
Clarke, & Robbins, 1991; Kern & Dunlap, 1998; L. K. Koegel, Koegel, & Carter,
1998; R. L. Koegel, Dyer, & Bell, 1987; R. L. Koegel, Koegel, & Schreibman,
1991; Moes, 1998; Schreibman et al., 1996).
Multiple Cues
Responsivity to multiple cues is another pivotal area that when changed appears
to produce widespread improvements in children with autism. Research
has indicated a lack of response to multiple cues, or stimulus overselectivity,
in children with autism (Allen & Fuqua, 1985; Bickel, Stella, & Etzel,
1984; Fein, Tinder, & Waterhouse, 1979; Frankel, Simmons, Fitcher, & Freeman,
1984; R. L. Koegel & Schreibman, 1977; Lovaas, Koegel, & Schreibman,
1979; Pierce, Glad, & Schreibman, 1997; Reynolds, Newsom, & Lovaas,
1974; Schreibman, Charlop, & Koegel, 1982; Schreibman, Kohlenberg, & Britten,
1986), which occurs when a child responds to an overlimited portion of cues
in the environment or responds on the basis of an irrelevant component of a
complex stimulus. Lack of responding to multiple cues can lead to negative
sequelae such as learning problems in the areas of language acquisition, social
behavior, observational learning, and generalization (Burke, 1991; Dunlap,
Koegel, & Burke, 1981; Lovaas et al., 1979; Schreibman et al., 1996). Intervention
that teaches children with autism to respond to multiple cues in the
environment has been shown to enhance attention to social cues and increase
learning and generalization (Burke & Cerniglia, 1990).
Self-Management
Another area that appears to be pivotal for widespread intervention gains
is self-management or self-regulation of behavior. Typically developing children
acquire increasing autonomy and self-regulation as they mature. In addition,
children without disabilities demonstrate widespread generalized use of newly
learned behaviors through self-management of responding. However, children
with autism often do not appear to develop the necessary self-regulatory
behaviors needed to be responsive to the environmental social cues that lead
to independence.
Individuals who are not showing widespread generalization of newly learned
skills or autonomy of responding can be taught to self-manage behavior. The
general procedure involves teaching individuals to discriminate between appropriate
and inappropriate behaviors, then to actively record correct responses, and
in some cases to administer self-rewards. This procedure can foster generalization
of appropriate behaviors across settings and interactions with others while
decreasing the need for constant and long-term vigilance by a clinician (Jones,
Nelson, & Kazdin, 1977; Kazdin, 1974; Kern, Marder, Boyajian, Elliot, & McElhatten,
1997; R. L. Koegel, Koegel, & Parks, 1995; Pieree & Schreibman, 1994;
Stahmer & Schreibman, 1992). Interventions using self-management have been
shown to result in increases in personal competence, problem solving, and independence
(L. K. Koegel & Koegel, 1995) and have been successful in targeting a variety
of behaviors such as stereotypy (R. L. Koegel & Koegel, 1990), social skills
(L. K. Koegel et al., 1992; R. L. Koegel & Frea, 1993; Reese, Sherman, & Sheldon,
1984), disruptive behavior (Newman, Tuntigian, Ryan, & Reinecke, 1997),
appropriate play (Stahmer & Schreibman, 1992), and academic skills (Harris,
1986). In addition, implementing a self-management program can promote a cycle
of increasing positive interactions, as the children leam to self-recruit reinforcement
for appropriate behaviors in the natural environment, thus increasing the likelihood
of obtaining reinforcement from individuals outside the intervention setting
(Baer, Fowler, & Carden-Smith, 1984; Todd, Horner, & Sugai, 1999).
Self-Initiations
Self-initiations are an additional pivotal area that when targeted tan lead
to improvements in social and pragmatic development. Although typically developing
children demonstrate a variety of initiations (such as asking questions) in
social and learning contexts, children with autism and similar communicative
disorders often do not use initiations that lead to such interactions (cf.
Hung, 1977; L. K. Koegel, 1995; Paul & Shiffer, 1991; Tagar-Flusherg, 1994;
Taylor & Harris, 1995; Wetherby & Prutting, 1984). Strategies that
teach children with autism to self-initiate social and teaching interactions
may promote learning in language, social skills, and pragmatics (L. K. Koegel,
Camarata, Valdez-Menchaea, & Koegel, 1998; L. K. Koegel, Koegel, Shoshan, & McNerney,
1999; Krantz & McClannahan, 1993; Yoder, Warren, & Hull, 1995) and
concomitantly lead to decreases in untreated disruptive behavior (Oke & Schreibman,
1990).
Summary of Conceptual Framework
In summary, we have hypothesized that a qualitative impairment in social communicative
interaction plays a major role in autism spectrum disorder (L. K.
Koegel, Valdez-Menchaca, Koegel, & Harrower, in press). Behaviors in
this category that may be evidenced early on, prior to the onset of intentional communication (10-18months),
include lack of eye contact, lack of anticipatory movements, lack of head
positioning, stereotypic movements, and unusual facial expressions. From
an intervention perspective, the disability may be long and well-established
when intervention commences. By this time, the aforementioned learned helplessness,
or lack of motivation to engage in complex social and academic tasks, may
permeate the child's behavior and exhibit itself as a marked lack of motivation.
Specifically, the children often do not respond at all to complex social
stimuli or exhibit extreme latencies in responding. When pushed, they may
engage in disruptive behavior including tantrums, aggression, and self-injury.
Addressing core behaviors during intervention is an emerging strategy in reducing
proxy behaviors or symptoms that show an indirect relation with core symptomatology
of children with autism. As can be noted in Figure 1, the major or
core area in this conceptual framework relates to increasing the child's motivation
to engage in social communicative interactions. This involves motivating the
child to initiate social interactions, to self-regulate behavior, and to respond
to complex interactions involving multiple cues. Thus, specific procedures
designed to increase motivation are incorporated into all teaching and learning
interactions. Research has shown that addressing this core area may result
in large improvements not only in the core areas of social communication,
initiations, and self-management but also in many proxy behaviors including
reductions in disruptive and stereotypic behavior and improvements in vocabulary
and language, speech intelligibility, and play interactions with peers.
Brief Review of Recent Outcome Studies
In addition to the large number of studies over the past 3 decades showing
that children with autism tan learn numerous individual target behaviors,
there now is a growing body of literature demonstrating concomitant changes
in untreated behaviors following intervention for certain core behaviors
as the focus of intervention. Matson, Benavidez, Compton, Paclawskyj, & Baglio
(1996) reviewed 251 studies from 1980 to 1996 that utilized behavioral interventions
for children with autism. These authors discussed the concept of
pivotal behaviors as a growing trend that may decrease the amount of time,
effort, and number of behaviors requiring direct intervention while simultaneously
increasing the effectiveness of intervention.
The following brief review of outcome studies is divided into (a) examples
of studies reporting data on collateral and generalized improvements in multiple
observable behavioral symptoms that are characteristic of children with autism
and (b) examples of global long-term outcome studies. - Koegel, Robert, Koegel, Lynn & Erin McNerney; Pivotal areas
in intervention for autism; Journal of Clinical Child Psychology; Fall
2001, Vol. 30, Issue 1.
Therapies for Children with Autism Spectrum Disorder:
Behavioral Interventions Update
- Vanderbilt Evidence-based Practice Center. (2014). Therapies for Children with Autism Spectrum Disorder: Behavioral Interventions Update. Agency for Healthcare Research and Quality.
Personal
Reflection Exercise #6
The preceding section contained information
about pivotal areas in intervention for autism. Write
three case study examples regarding how you might use the content of this section
in your practice.
Update
Validation of a Screening Tool
for Autism Spectrum Disorder
in Adults - A Study Protocol
- Parvaiz, R., Al-Sayegh, Z., Jacobsen, P. K., Danielsen, I. M., & Videbech, P. (2022). Validation of a screening tool for autism spectrum disorder in adults - a study protocol. Danish medical journal, 69(12), A02220118.
Peer-Reviewed Journal Article References:
Arnaud, S. (2020). A social–emotional salience account of emotion recognition in autism: Moving beyond theory of mind. Journal of Theoretical and Philosophical Psychology. Advance online publication.
Howes, A. E., Burns, M. E., & Surtees, A. D. R. (2021). Barriers, facilitators, and experiences of the autism assessment process: A systematic review of qualitative research with health professionals. Professional Psychology: Research and Practice. Advance online publication.
Whitehead, P. M., & Purvis, K. (2021). Humanizing autism research and treatment: Facilitating individuation through person-centered therapy. The Humanistic Psychologist. Advance online publication.
QUESTION
13 What is the rationale behind the use of natural, direct reinforcers? To select and enter your answer go to Test.