I’ve been working with children and a few adults with autism for almost 2 decades and I had a revelation several years ago soon after I published my book—The Verbal Behavior Approach.
The Big Three are:
1) Major problem behaviors at or near 0
2) The ability to request wants and needs
3) Independent (or at least scheduled) toileting
I know that there are always exceptions but in general I feel whether your child is 5, 15, or 50 years of age, I think without these three big skills, he or she will have less opportunity for inclusion at school or in the community. In addition, without these three skills, parents often cannot access babysitters, respite providers, or work opportunities for their children. They may also have a difficult time taking their children to pools, restaurants, and on planes.
I see a lot of times these 3 big skills are not being properly addressed in schools. For instance, you have a child who is 11 and either the parents, or the school, or a combination of the two, are so hyper-focused on academics and getting the child to a certain reading and math level, meanwhile, language, toileting and problem behavior reduction are taking a back seat.
One of my previous clients, I’ll call him Danny was in 5th grade and was talking in full sentences and fully independent with toileting. But I was called in when he started having more problem behaviors like pounding the desk, screaming and even knocking over a chair and table. Whenever I see issues with problem behaviors appear like in Danny’s case, I always think first: could it be a medical issue, especially if the behaviors happen abruptly and I talk about this in my recent blog on the importance and of ruling out medical issues.
But if problem behaviors are happening more chronically and getting worse over time, I usually find that the demands are too high and/or reinforcement is too low. The child needs a full assessment which I discuss my #1 mistake blog post. In Danny’s case, the demands were way too high and Danny never learned how to use language like “This is too hard, Can you help me or I need to take a break.” Basically, when things got too difficult, Danny screamed and turned over chairs to make the work stop.
Danny had toileting down pat but his major problem behaviors were not at or near zero, and even though he could talk in sentences, he was not able to request help or tell his teacher that the work was too hard.
I know from both personal and professional experience that if a child or adult does not have these 3 big skills: major problem behaviors at or near 0, the ability to communicate basic wants and needs and/or is not toilet trained, it is going to be very hard to have the child included in general education and sometimes a more restrictive school is needed. Danny’s teacher, for example, was recommending that he be transferred from public school with an ABA focus to a private autism school with children with much less language and worse problem behaviors. Luckily for Danny, I was able to assess him fully and put a plan in place to keep him successfully within his neighborhood school.
I encourage IEP teams to write IEP goals focusing on these 3 big skills if they are not in place. There is no point in focusing on reading or math, if the child cannot communicate in some way that they want a snack or if they are exhibiting severe problem behaviors.
Just to review, I think the goal for all kids with autism should include these 3 Big Skills by the time they are 5: 1) Major Problem Behaviors at or near zero, 2) The ability in some way to request wants and needs and 3) Independent or at least scheduled toileting.
If you are working on anything else, please think about these skills, assess or re-assess and meet to develop goals for these 3 critical areas.
See you next week!