It is important to be aware of the language you use. Ask the person or their caregivers how they wish to be identified and what they would like to be called. Your company might call individuals patients, clients, students, learners, etc., but it is important that when speaking to the person, you use their names and preferred pronouns. Simply put, treat others as you would like to be treated!
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a range of symptoms including social communication and social interaction deficits and the presence of restrictive, repetitive patterns of behavior, interests, or activities.
The DSM-5 Diagnostic Criteria Set for Autism Spectrum Disorder are
a. Social Communication AND Social Interaction deficits (all three from the list of symptoms)
b. Restrictive, repetitive patterns of behavior, interests, or activities (at least two from the list of symptoms)
c. Symptoms must present in early development period (may not fully manifest until social demands exceed limited capacities)
d. Symptoms together cause significant impairment in other areas of everyday functioning
e. Symptoms are not better described by another DSM-5 diagnosis
ASD or autism spectrum disorder is a developmental disability. Typically, symptoms appear by age three, though for some individuals, the symptoms may appear later as they get into school and are around more peers. Symptoms are typically characterized by deficits in social communication and also by restricted, or repetitive, or stereotypic behaviors or interests.
As I mentioned briefly before, one very important thing to remember is that each individual with autism is unique. So I'm going to give you some examples, but please remember that the individual that you care for may be a little bit different.
Let me explain what I just talked about in a little bit more detail. We'll start with social communication. Impairments in social communication are going to vary from individual to individual. It may be something as simple as a student not responding when his fellow classmate asks for help on homework.
It may be that an individual, rather than asking you for a snack, takes you by the hand and leads you to the pantry to show you what they want. Or it could be something like a grocery store bagger who sees a customer that he thinks is fat, and he tells her that. Social communication just means that they have deficits understanding social areas and also deficits within communication, and sometimes a combination of the two.
Let's talk now a little bit more about restrictive and repetitive behaviors and interests. Some examples of these may be a child who when putting his clothes away always has to put his underwear away first, and then he puts away his socks, and then he puts away his shirts. But if this order is changed in any way or if the pile is in a different stack, he may become agitated or refuse to put his clothes away.
Another example may be a child who plays with trains. But rather than playing with the trains on the track and putting the cars together and rolling them around, she only lays on the floor and spins the wheel on the train, so she's focused on that one specific part of the train.
Another example may be let's say a teenage girl who's in high school and knows all of the lines from every episode of her favorite TV show. Yet when you ask her to remember the dates for her history homework, she has a little bit of difficulty studying those. You see where the behaviors are-- perhaps repetitive, like spinning the alleles on the train, or very restricted, like the high school girl who only has one focus of interest.
Behavior analysis is the science of behavior based on principles of learning studied extensively by B.F. Skinner. ABA works by changing behavior. Individuals can learn new skills, behave in more effective ways, and replace problematic behaviors with ones that are more successful.
The core principles of ABA are that the consequences that follow a behavior control whether that behavior will increase or decrease. Desirable consequences will increase behavior, whereas undesirable consequences will decrease behavior. ABA is the application of these principles to real-life issues in order to change behaviors and improve lives.
The three-term contingency helps us see the behavior’s relationship to the environment. The three-term contingency helps us look at the following:
Early intensive behavior intervention (EIBI) is recommended for individuals with ASD. Research shows the application of the principles of behavior is effective in reducing inappropriate behaviors and teaching skills to address deficits. Research also shows that ABA-based treatment programs are the only proven effective treatment for individuals with ASD.
Introduce yourself and get to know the patient with whom you are working. It is important to establish a positive relationship and build rapport with your patient. In ABA, we call this “pairing,” as we are pairing ourselves with reinforcement as we build rapport with the patient.
Build rapport with patients and their families as well as coworkers, BCBAs, and staff. Make sure you show a positive attitude with patients and their families.
We do not support using aversive stimuli to decrease behavior excesses. If a patient finds some learning items or activities to be aversive, we look for ways to make them fun and exciting.
Dual relationships are any relationship other than a therapeutic one between a technician and a patient (and their family). They are forbidden by the ethics that govern our positions because they make it difficult to maintain boundaries and can impair judgment.
Because of the potential for dual relationships and crossing over from being friendly to being a patient’s or a caregiver’s friend, it is important to set boundaries. This helps protect the patient-technician relationship.
Remember the nine core ethical principles:
We might need to breach confidentiality if we know or suspect child abuse, neglect, suicidality, homicidality, or elder abuse. You must immediately report to the local abuse authority if abuse is suspected.
Remember, reporting to your BCBA is acceptable, and then the BCBA reports on your behalf. If you cannot contact a BCBA, then you need to report directly.
