Often children with autism spectrum disorder (ASD) are described as “in their own world” or “hard to reach” or even “without empathy.” But those special people who live and work with them realize that these characterizations are really not accurate (well, OK, many may be hard to reach, but not impossible to reach). A number of children with ASD demonstrate an interest in specific items or topics that can be intense. Others may appear to have little interest in things until the right topic or item comes along and it seems almost magical. Once these interests have been demonstrated, how do we as parents, caretakers, or therapists respond? It is this response that is the topic of this week’s post.
Let’s start out thinking about children without ASD (sometimes called neurotypical children). These children have topics and items that interest them and others in which they have little or no interest. Some children like Sesame Street, some like baseball, some like Disney movies. Some will be fascinated with cars or NASCAR racing, while others are glued to the Superbowl, the World Cup, or Wimbledon. We typically find these interests healthy, a part of normal development, and most parents and teachers will support them. Children receive model cars as gifts, are able to watch Sesame Street on TV and perhaps get an Elmo doll, watch the sports channels and maybe even attend athletic events. They may end up playing T-ball, or Little League, or recreational sports. Sometimes they even receive school credit for reading books or giving reports on their areas of interest.
Now let’s look at children who have been diagnosed with ASD. They also have topics and items that interest them and others in which they have little or no interest. All of the topics listed previously could also be listed for children with ASD. Often (not always) the expression of this interest for children with ASD is more intense than neurotypical children, sometimes to the near exclusion of everything else (this is what “restricted interests” means). Because their focus is so intense and all-encompassing, it’s not unusual for peers to be put off by constant talk about one topic and for parents, therapists, and teachers to want to “rein them in” to help them “better fit” in society.
ASD is classified as a neurodevelopmental disorder in the DSM-5, along with ADHD and a few other things. At the most basic level, neurodevelopmental disorders are issues of excesses and deficits. Restricted interests in ASD combines the excessive or intense interest a child has in a few topics and the deficit of interest in other topics. The intense interests children with ASD demonstrate are often not topics that have much interest for the majority of people, while a neurotypical child’s intense interest in our national pastime of baseball is not only acceptable but often encouraged and used by parents and teachers as an incentive. Children can write book reports on books about baseball and baseball players, or get baseball cards or go to a baseball game as a reward for good behavior or good grades. What if we started to look at the intense interests of a child with ASD as an opportunity to engage that child in learning, and the deficit of interest in other topics as a skill deficit that can be learned? I think this transforms the “problem” into an “opportunity.”
When we wish to change a child’s behavior, we basically have two methods – we can encourage the child to do more of what we want through rewards, or discourage the child from doing what we don’t want through punishment. Most behavioral research shows that encouragement and rewarding desired behaviors is more effective than punishment, and this is a foundation of Applied Behavioral Analysis (ABA). ABA identifies specific desired behaviors and teaches the child how to perform them, rewarding the use of those behaviors. At its most fundamental level, this is a “first – then” process: the child must first use the desired behavior, then he gets a reward. For a reward to be an incentive, it has to be something pleasurable or desired by the child. A reward may be an object like a desired food or toy, an action like a hug or tickle, or an opportunity to do something like play a video game. This is the basis of changing behavior, and can be used in many situations; we can teach a child to ask by “first ask, then I will give it to you;” we can expand a child’s diet by ”first try a bit of [some new food], then you can have a favorite food].” The opportunities are limitless.
With the “first – then” process, a child’s excessive focus on a single topic of conversation can be used to help the child learn to engage in more socially acceptable conversations. We want the child to learn that it’s important to talk about something of interest to the other person in a conversation. What if we started out by demonstrating that we can talk with them about their interest? We could set some parameters around this like “first you say “Hi. How are you?” and wait for me to answer, then you can say something about [child’s interest]. Over time, we can expand that first action – “first you ask the person what they want to talk about, and you talk for 1 minute about that, then you can talk for 1 minute about [child’s interest].” It isn’t a quick fix, but lasting change in anything is rarely accomplished quickly.
In summary, before we can help a child change his behavior or teach him something new we need to have his attention and have a relationship with him. Often the quickest way to do both is to engage with that child in something that interests him, and to use rewards for desired behaviors that relate to his area of interest. When we can see a child’s special interest as a tool rather than problem, we begin to explore more possibilities and provide the child with more opportunities for success. And perhaps most importantly, we can join the child in his world even if only for a short time.
Russell J. Bonanno, M.Ed.
TAP Program Manager