Autism Successes: Billy and PDD

Autism Successes: Billy and P.D.D.

I was first introduced to Billy sometime ago in the Spring of the year. He was in kindergarten and  was  diagnosed with P.D.D. NOS  (not otherwise specified). He was a verbal, likeable six year old, who could be very charming and had a fine sense of humor. However he was getting to be a handful for his parents.

He was fairly non-compliant, and his parents had to ask again and again, till they were finally yelling, whenever they asked him to do anything, even something, as simple as coming to dinner. He was quick and intelligent and made good connections when his questions about a topic were answer- ed, but suffered from a very short attention span, especially when asked to perform a simple academic task. He was also mildly aggressive with his sister, and would slap or punch her when she grabbed one of his toys.

His parents wanted him to attend a local private school, but were apprehensive, since it did not provide any special education supports. They worried that he might run into trouble at the private school and not get the extra help he might need.

The first problem we decided to address was non-compliance. Often, a parent will find themselves spending 15 minutes arguing with a child to do a two minute task. This is very common among children diagnosed with PDD and also with Attention Deficit Disorder. But research has shown that this is due to the child’s impaired concept of time. The parent intuitively knows how short the task is, while the child has no such automatic concept. It’s as though he were being asked to stop his preferred activity, forever, and begin doing that small chore, not for a few minutes, but forever as well.

I suggested we try a two-pronged approach. One was to get Billy accustomed to the habit of compliance. We did this with a game I called Mr. Marc Says, and later, Mommy Says. Billy was offered a penny for each simple task he performed right away, simple tasks like count to five, touch you nose, touch your ears or clap twice. He was offered 50 and eventually100 pennies in a brief ten minute session. If he took longer than five seconds to begin to follow a direction, a penny was taken off the table. Billy enjoyed the game and greatly enjoyed earning extra money.

His mother too, enjoyed seeing Billy follow so many directions so quickly and enthusiastically. During the first few sessions, when she began using the intervention, she got a little carried away, and started asking him to perform harder and harder tasks, such as put your shoes away, and pick up your toys and put them away, so that Billy began to tire rapidly. I had to explain that the purpose of the exercise was not the content, but the process. While it would be thrilling to have him mop the kitchen or some other chore, right now we needed to get him used to compliance, by making the tasks quick, easy and numerous.

In ABA we call this technique behavioral momentum. Salesmen are accustomed to using it all the time. They make numerous innocuous requests of a client such as asking for a pen, then some paper, then some harmless information. When the prospect has gotten in the habit of agreeing, they finally ask him to sign on the dotted line.  More often than not he does. We weren’t trying to sell Billy anything. We were just trying to get him used to t compliancy that would help make him successful. Gradually his everyday compliance began to improve.

The one sticking point however was his almost addictive love of video games. Whether it was a Sesame Street game or a computerized version of Chutes and Ladders it was very difficult to tear him away from the computer to comply with a brief request.  However we decided to turn this behavioral lemon into valuable lemonade. His time on the computer was made valuable by limiting it to an hour a day. If he had to be asked more than once to do something he would be warned that he would loose five minutes of computer time, for each time he had to be asked. That simple warning and the use of a token economy did the trick. Billy seldom had to be asked more than once. A request, and a warning, would after a time, replaced dozens of scolds.

We also used computer time as a reward to increase his attention span and time on task. Initially, Billy was able to spend no more than four or five minutes on a simple academic task, like reading or doing some simple math problems. We offered Billy a minute of computer time for every two minutes he could remain on task, doing some reading or math, without more than a ten second break. Gradually over a period of four months, Billy learned to stay on task for more than thirty minutes of reading and thirty minutes of math. We praised Billy for his increased concentration, but never pushed him. We let the reward of computer time do the heavy lifting. He could choose the most appetitive reward and also choose how fast he improved.

Because we chose Engelmann’s classic Direct Instruction text, Teach Your Child To Read In 100 East Lessons, this intervention also had the effect of getting Billy to read at a 2.5 grade level as he was about to begin first grade. This made sure that school would not be difficult or aversive but something that was easy to cope with. Billy would not need to engage in misbehavior to escape aversive tasks. Needless to say Billy became one of the best readers in his class. During parent conferences, teachers reported that he was also one of the best all around students in his class.

Another behavior problem was Billy’s physical aggression towards his little brother. Every time he would grab one of his toys he would punch or slap him to get it back. Needless to say this was quite upsetting for Billy’s parents.

The function of the behavior was obvious, to regain his toys. This was an honorable intent. No one likes to have their things swiped away from them.  But this  form of the behavior was the problem. The first thing we did was to deny his aggression its reward, namely regaining his toy. If he hit his little brother to get back a toy, neither of them could play with it the rest of the day.

I then spent time training Billy to ask his mother, to intervene, by teaching him precisely what to say. We rewarded this training with some small favorite edibles till it was firm. “Mommy, Sam took my toy. Please make him give it back to me”.   I instructed Billy’s mother, that this new improved behavior had to be rewarded with a prompt positive response. The new behavior of asking needed to be as efficient as hitting to retrieve the toy, even if she was on the phone with a close friend. Improving Billy’s behavior had to take temporary precedence over any conversation. After a few days Billy’s behavior began to quickly turn around. After loosing a toy for hitting, and getting a toy back by asking, Billy started to ask and not hit, virtually all the time.

By the fall, Billy’s parents felt he had made sufficient progress that he no longer needed professional help. His parents felt successful and empowered with the new tools they had learned to use.