Autism is complicated, but there are theories and methods of intervention that can be useful in its treatment. The most well-known and well-studied evidence-based intervention, Applied Behavior Analysis (ABA), demands constant re-evaluation in order to produce results. At the heart of this approach is “analysis.” It promotes the idea that if learning is not taking place, the analysis of the connections between the antecedent (the behavior trigger) and the unwanted behavior and the reward must be incorrect. It rightly places the burden of effective intervention on the therapist.
It takes careful analysis to determine which behaviors are functional and which should be modified. Sometimes it is obvious; for example, if a child has a tantrum when he does not get his way, we would like to give him another way to express himself – and we would reward the more functional behavior to increase its likelihood. But sometimes the functionality of a behavior cannot be determined; and, even more distressing – sometimes the functionality of a “non-typical” behavior needs to be accepted. Where do we draw the line between productive and unproductive behavior? This is a dilemma that confronts our family on a daily basis.
Sam has OCD tendencies, but we are still unsure whether his obsessions exist so that he can better understand the world he lives in, or whether they are useless exercises in perseveration. Now that he has mastered fine motor control, Sam loves to draw. For awhile he was only interested in drawing emojis; then it was the comparative layouts of two Barnes and Noble stores; presently, he wants to draw and compare the different restrooms he comes across (sometimes sneaking into the ladies room). He makes note (both verbally and mentally) of the essential attributes of his chosen subject matter and then he proceeds to draw them “perfectly.” He looks over the finished product, scanning for mistakes – which he invariably finds. Then he starts the drawing from scratch on a new paper in order to correct the errors. Should this be discouraged? Should he be made to accept his artistic mistakes without correcting them? Should we pemit corrections on the same paper only?
Our therapist says he should not be allowed to re-draw over and over to correct errors and that he needs to change up the subject matter more often. I understand the therapist’s view: rigidity and perseverative behaviors are hallmarks of ASD, and they are really difficult behaviors to extinguish. But are all these behaviors non-functional? Sam is a people pleaser and he often accepts limitations if given an advance warning, but I’m not sure that, especially in the case of art, we are doing the right thing by limiting him. Why should he not be able to correct a mistake? Why should he need to change the subject matter more often? What if he is gaining knowledge from his intense study of the environment he lives in? What if he is looking to determine his place in what he may perceive as a confusing world? What if drawing has a calming effect after a stressful day?
Recently his special education teacher denied Sam access to the sensory gym because she felt he was avoiding a writing task. His BCBA has always accommodated those requests without reservation. She believes his sensory needs are the motivation for his requests (as opposed to task avoidance). After the denial by his teacher, he completed his writing assignment but he was agitated the rest of the day. Of course, that behavior could have been a coincidence; but how do we know?
The fact is that we don’t know. Many times, as is true with ABA, it is just trial and error. But while we are trying to figure it all out, when it comes to interventions, what is the ratio of harmful to helpful? Research is lacking in this area, but Ron Suskind’s book, Life Animated, sheds light on one person’s experience. Ron’s son, Owen, was allowed to watch Disney movies ad nauseam, but that obsessive activity ultimately was deemed to have helped him understand and communicate with those around him. It eventually led to a positive life outcome.
Could it be that some of the perseverations of autism exist to counteract the difficulty these kids have in understanding the way the world works? If so, maybe future research can guide us because we really need to know when to just let it be.