Applied Behavior Analysis: Addressing Cognitive and Emotional Development in Children with Autism (page 2)
It has become well known in recent decades that behavioral intervention procedures can be effective for teaching simple skills in the areas of language, socialization, self-help and academics to individuals with autism spectrum disorders (ASDs). However, far less attention has been paid to behavioral approaches for addressing complex cognitive and emotional skills. In fact, some professionals outside the behavioral community contend that complex cognitive and emotional abilities cannot or should not be addressed from a behavioral perspective. In this article, we will explain how this perspective is incorrect and is largely based on a misunderstanding of what Applied Behavior Analysis (ABA) is. Further, we will discuss how and why ABA is a useful perspective from which to address complex skills in individuals with autism and describe how many of us in the field have been doing this for years.
The autism community generally accepts the distinction between social cognition and executive functions. There is significant overlap between these two areas of functioning, but we will describe the two areas and how we address each separately. Social cognition refers to one person’s ability to understand the mental states of others. Some refer to this ability as “Theory of Mind” or “mind reading” (Baron-Cohen, Leslie & Frith, 1985), while others use terms such as “perspective-taking.” Whatever you call it, the ability to understand what it is like to stand in another’s shoes is crucial for many areas of social and emotional functioning, including empathy, compassion, social problem solving and even just being a good friend or partner to someone.
A significant amount of research has demonstrated that many individuals with ASDs are impaired in their social cognition abilities. In the children and adolescents we treat, we often see difficulties in the following areas: 1) understanding others’ emotions (identifying how others feel, what caused them to feel that way and what one should do about it in various situations); 2) understanding others’ moment-to-moment desires (e.g., my friend and I have been talking about sports statistics for 20 minutes now and he is bored, so I should change the topic); 3) understanding others’ long-term preferences (e.g., my mom loves chocolate ice-cream and hates vanilla, so I should buy her chocolate ice-cream for her birthday, not vanilla); 4) understanding deception (e.g., distinguishing between telling “white lies” as a joke or prank versus intentionally deceiving someone in a malicious way); 5) being able to identify what others can sense versus what oneself can sense (e.g., Grandma can’t see the toy I’m holding up right now because she is on the other end of the phone, so I need to tell her what it is); 6) understanding what others know and that their knowledge is affected by what they are able to sense (e.g., Jimmy doesn’t know I got a new puppy yesterday because he wasn’t at the store with me, so I should tell him about it; Mom was there, so I don’t need to tell her about it); 7) understanding others’ beliefs and that beliefs are not the same thing as knowledge (e.g., the difference between false and true beliefs, why a person might have one versus the other and how this affects how I might interact with them); and 8) understanding others’ thought processes (what thinking is, how we talk about it, how it is different from doing and feeling, etc.). Any or all of the eight areas described above can be problematic for individuals with ASDs, depending on their unique histories and current circumstances.
Executive function refers to the brain’s control over goal-directed behavior. Areas of executive functioning that are commonly discussed include working memory, short-term memory, attention, inhibition, planning, self-awareness and problem solving (Ozonoff, Pennington & Rogers, 1991). The frontal lobe of the brain is often discussed as the location of these functions, and research has clearly demonstrated that damage to this area of the brain produces decrements in these functions. There is no doubt that healthy functioning of the frontal lobe of the brain is necessary for executive functions. However, the ABA approach to executive functions, like everything else that involves what people do, is to treat it as a skill. If at least some part of executive functioning is a skill that is teachable, then the principles of ABA may well inform how we understand and teach it. In fact, this is exactly what we have been doing for years.
Just as with social cognition, a significant amount of research has shown that many individuals with ASDs have impaired executive functions. Some of the deficits that we encounter are in the areas of: 1) attention (attending to what is relevant, maintaining attention over long periods of time, etc.); 2) short-term memory (e.g., remembering what occurred within the last 30 seconds or so); 3) working memory (keeping ongoing information online and being able to process it and do something with it a short time later, such as repeating a string of numbers back in reverse order); 4) inhibition (e.g., not attending to distracting and irrelevant stimuli, stopping oneself from doing something that will not produce a positive result, etc.); 5) flexibility (e.g., allowing oneself to perform a routine in a different sequence than normal); 6) self-awareness (e.g., monitoring and taking note of one’s own actions, regulating one’s own emotions, keeping oneself on task, etc.); 7) problem solving (e.g., what to do when your plan is not working, how to fix a toy, find something that is lost, etc.); and 8) planning (i.e., visualizing and stating an objective, vocalizing steps needed toward achieving it, taking those steps, monitoring one’s own progress toward a goal, correcting oneself when errors are made, achieving the goal, telling others when appropriate).
This all sounds very complex and probably does not resemble what you have heard about what has been done in ABA programs in the past. However, the ABA approach lends itself perfectly to addressing these complex skills because the approach is inherently practical. Below, we describe how we go about using ABA to teach cognitive and emotional skills.
Reprinted with the permission of the Autism Society.
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