By Michael J. Cameron, PhD, BCBA-D, Pacific Child and Family Associates
The diagnosis of autism spectrum disorder (ASD) comes with a lot of changes for a family, but one of the biggest may not seem that important to begin with. When an autism treatment plan is developed, the structure and prescribed strategies can seem like a relief to parents who have been frustrated, confused and worried for so long. This includes common visual tools like a token board.
What Does Autism Treatment Look Like?
Over the past 40 years, token economies have been one of the most important technologies of behavior interventionists and behavior analysts (Matson and Boisjoli, 2009, pg. 240). Token economies are used to strengthen a behavior, or increase its frequency. A child diagnosed with ASD will be “payed” for completing tasks, and then these tokens are used to buy desired activities or items. (Miltenberger, 2008).
The aesthetic difference between treatment for ASD and typical behavior with a child struck me on a trip to Maine’s coast last year. I saw a boy and his father playing in the ocean surf together and collecting items from the seashore. They both seemed to be having fun. After a while, they ran up the beach to their things and I saw the father pull out a laminated token board. He told his child he did a good job, and handed him a big bright red poker chip.
At the beach, in the middle of what seemed like a vacation, the child was easily identified by bystanders as having “special needs.” A child that is not on the ASD spectrum wouldn’t have poker chips on the beach. He’d have something more appropriate for the setting, and something that would engage him. The dad in this example was doing all the right stuff from a behavior analytic perspective, and I put a seagull feather in his beach cap for being such a connected, caring, and involved dad. The point here is that behavior analytic treatment can “look” much different than it typically does and, as behavior analysts, we have an obligation to show families how conditioned reinforcers can be maximally serviceable with a little creativity.
Educational Reinforcement – Instead of Tokens
Working within a child’s inherent interests and educational goals should be the central focus of ASD treatment and reinforcements. These artificial tools put distance between a child and a parent, and call attention to a child’s treatment. They aren’t easily integrated in everyday life, and this is a problem.
In order to make a change, I recommend that we as a community of ASD specialists, caregivers and families start adopting an educational reinforcement approach. (A term B.F. Skinner used several times in his book Science and Human Behavior. Skinner appeared to be describing consequences that would, at once, accelerate desired behavior while possessing some educational utility). The reinforcer in an ASD treatment plan should both increase behavior and provide a learning opportunity. Poker chips don’t do that – but with a subtle change in approach, a token economy system can.
When reinforcement tools and systems are grounded in a theme or subject that interests the child, they instantly become transformed.
I recently consulted with a school that worked with high school students with autism spectrum disorder. While the science teacher wanted to develop a differential reinforcement and token economy system for the omission of undesirable behavior, I advised that we focus on something tied to the teacher’s academic curriculum (she was teaching human anatomy at the time of my consultation). Therefore, we developed a program that used construction paper representations of the 206 human bones to serve as conditioned reinforcers. Following an interval of time, in which a student refrained from challenging behavior, they were told to select a bone from their bundle of bones in their desk. For example, one student would be told to find the humerus bone while a second student was told to select the manubrium bone. The routine served as a way to reinforce each student for appropriate behavior and require a demonstration of his or her bone discrimination skills. As the students “earned” the bones of the body, they hung them on the classroom wall under their name. Moreover, as they progressed with their appropriate behaviors, they got to add to their skeleton. Finally, as defined sections of a student’s skeleton were completed (e.g., the arm and hand), they were allowed to exchange “bones for benefits” (e.g., time playing a preferred video game). Completing your skeleton became the goal for these students. In addition to reinforcing behavior, the bones also reinforced the academic lessons they were learning. Any classroom of students with any abilities would be doing something similar, which takes away the stigma.
The Importance of Surprise, Interest and Community
The best part of using educational reinforcement is the ability to remain surprising and unpredictable with the child diagnosed with ASD. Reinforcements can be playful – one child I’ve worked with loved pirates, so we used a Pop Up Pirate game to reinforce the girl’s socialization and play bids with other children. The tool was socially acceptable, fun, and provided a natural way to reinforce the child on a variable and unpredictable schedule (e.g., the spring-loaded pirate’s head on the top of a barrel was sprung by putting swords in the side of the cylinder; but the child never knew how many swords it would take to make the pirate’s head leap). Other children instantly gravitated to this little girl, so she didn’t feel stigmatized at all as a result of using her reinforcement system.
Educational reinforcement tools need to be connected to good science, but beyond that the field is wide open for tools. Start by identifying a child’s interests or sticking with a theme based on the child’s curriculum. You need to find something that will fit your behavioral goals and treatment goals, as well as your family’s home. Since the child and the family will be involved, it has to be engaging enough to be used regularly.
For some kids, Formula 1 racing might be their passion, so your tools have elements of racing, racecars and drivers involved. Others might find the space race period of history exciting, so for a period of time their tools reinforce what they are learning in science.
Be creative with the tools and use different modes of reinforcement – including visual, auditory (e.g., I’ve used data sonification, or sound graphs, for a blind child I developed a conditioned reinforcement system for) and tactile stimuli. By keeping it dynamic and changing based on interests and subjects in school, you can notice reactions and make additional changes for better results.
Instead of working with contrived tools that put distance between a child and their peers, families can use something that is engaging and less socially stigmatizing. For example, that boy on the seashore – well, he could have accumulated the starfish, snails, and sea urchins he was enthusiastically pointing-out to his father. In the community, individuals diagnosed on the ASD spectrum won’t feel like their reinforcements are on display. Rather, they can blend in and become socially united.
It’s a small shift in approach, but it’s one that matters.