<p><img src="//relias.innocraft.cloud/piwik.php?idsite=2&amp;rec=1" style="border:0;" alt=""> Autism Therapy Techniques: How Much Choice Should an Individual Have?
By | October 15, 2013
For everyone who watched Peter Gerhardt’s webinar about individuals with ASD transitioning to adulthood, you heard about a must-read article: Balancing the right to habilitation with the right to personal liberties: the rights of people with developmental disabilities to eat too many doughnuts and take a nap. (Bannerman et al 1990).  And I would hope that if you work with teens or adults in any capacity you have read it as well.  It highlights the question that I have asked myself throughout my career and I would think most interventionists have—how can choice-making be integrated into the habilitation process and how much choice should an individual have?  (Now I know you are thinking, “From a behavior-analytic perspective, options in life are valued, but choice is anything but free” (Skinner, 1971).  But let’s just go back to your pre-Skinnerian days regarding choice for ease of discussion).

So, on the one hand, we can let our clients make all their own choices.  It is their personal liberty, which we are all afforded.  But obviously, we don’t want to just sit back and let them engage in stereotypy all day, or even hurt themselves.  Then on the other hand, we have the clinician or parent making all their choices for them, because they know what is in their “best” interest.  The obvious answer is some combination of the two autism therapy techniques.  But how do we do this?  What if our clients do choose to eat to many doughnuts and take a nap when we let them choose an activity?  Now ask yourself, if I said you could do anything you want today, what behavior would you engage in?  Might your answer be something that could be construed of as overindulgent or lazy?  So, we all have the personal liberty to behave this way sometime and some may even argue that we need these breaks from our regularly scheduled life of work, exercise, and communicating.  How do we balance this with our clients and get them to a point that they make choices that are not detrimental to their own habilitation and independence?

One of the very important points that Bannerman and colleagues brought up is that many individuals don’t know how to choose.  This needs to be incorporated into our educational curriculum  and autism therapy techniques for individuals with ASD early on.  Even simple discriminations of yes and no can be difficult for some.  Clients at every functioning level should be given opportunities to make choices in their residential and work settings, within and between scheduled activities. Some clients might only be able to make simple choices initially (e.g., what dessert to eat, when to go to bed).  Other clients might learn to make more complicated decisions (e.g., how to spend a workshop paycheck, how to handle a problem with another client).  Thus, choice making should be integrated into the habilitation process.  Staff members must be motivated to provide these opportunities for choice.  Supervisors can enhance staff motivation by setting up contingencies for these activities and autism therapy techniques (e.g., a program of observation, feedback, reward).  Also, activity schedules should be set up to allow time for choice (Bannerman et al 1990).

Just as you and I are allowed to make choices about our daily lives, our clients should be as well.  Unfortunately, few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD. As such, there is very little evidence available for specific treatment approaches in this population (Gerhardt, 2013), but that doesn’t mean we shouldn’t apply what has worked with other populations and examine their effects on adults.  Below are some often cited articles that incorporate the use of choice in an individual’s program (most often to see its effect on occurrence of problem behaviors).  I encourage everyone to examine the role choice is playing within the instructional curricula not only for adults, but for their younger clients as well.  If we can teach the skills early on we may not have to worry about them eating too many doughnuts or napping more than is acceptable, but really how many doughnuts is too many?

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Annie Collins-Castillo

Annie has been working with individuals affected by autism since 1999. Her passion is to improve the lives of these individuals and has driven her professional and academic endeavors utilizing Applied Behavior Analysis. Annie has worked directly with clients in Oklahoma, California, Hawaii, and Japan and supervised at a clinic in Hawaii leading a team of behavior therapists. She looks forward to impacting the largest number of individuals by working with Autism Training Solutions.

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