Diagnoses of Autism Spectrum Disorder (ASD) have been on a constant rise it is imperative that therapists and doctors are aware of approaches to improve and develop their patient’s lives and enhance their work life. The subject of this case study is a 9 year old boy, Mikey and has gone back and forth to clinicians and therapists for two years. He has trouble with sustaining communal communications and connecting with his sibling and school friends.
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His parents articulated that he has been having problems with his daily morning schedule, and that it is creating behavioral problems. If Mikey’s morning starts off bad, it affects his whole day. If it is a normal school day, he would not be able to concentrate on his work and have trouble corresponding with his class and school friends. His parents shared that Mikey shouts when he is awaken by the sound of his alarm clock, the cries of his baby sister and the blender; also, that he has trouble waking up in the morning, preparing for school, connecting with his peers and finishing his class work. Mikey also has difficulty staying asleep at night and always seems tired but cannot have a lie-down during the day. He also has difficulty with playing and sharing with his younger sister; if asked to share a toy with her, he ignores the request and continues playing as if he did not hear what was asked of him. When the caregiver sat down and watched him play, she noticed that he was in a world of his own repeatedly watching a single spinning toy. He seemed to show that he can be kept interested in a single toy or action for several minutes.
According to Benson (2016), there are three categories of characteristic of individuals who have ASD. First, they have issues communicating with others. It was observed that Mikey had trouble communicating with his sister and peers from school. In the case study, it was found that Mikey was at the developmental stage of a twelve month old. The Revised Knox Play Scale was used to test his capability to mingle with others optimistically and confidently while playing. Mikey was then scored as being at the level of a twenty four month old in imitation. His level of being able to imagine and pretend to be in another person or somewhere else was at the level of a thirty month old. Mikey’s result for his motor skills development was at the age of a thirty six month old on the other hand, he had the developmental skills of a forty eight month old in terms of using his whole body during play and social connections with others while playing. The final score was of his attention towards toys which was at the level of a sixty month old.
After weigh up all of Mikey’s ability levels, it is obvious that he has trouble with communication, relations with things and people, and bodily movements and behaviour. All these characteristics and what Benson (2016) highlighted that individuals with ASD have trouble with. He also acknowledged that children with ASD have trouble adapting to new customs and sounds, which seemed like Mikey had shown some difficulty with as well. It concluded that Mikey has Autism Spectrum Disorder. It was suggested to Mikey’s parents tha Mikey should undergo treatment from a professional therapist outside of his school to promote more productivity in his school work along with improving his involvement in daily routines and reducing his negative behaviour especially in the mornings as that seemed to affect his whole day.
With a child who has ASD it is not suitable to use negative reinforcements as they do not understand why an adult is taking their toy way. They have trouble with communicating and adding more negativity towards their upsetting situations could cause a terrible backlash. One way to eliminate the bad behavior is to change his reactions towards it by giving him a goal to look forward to. Mikey has trouble in communicating with his sister and classmates. The best way for the therapist, teachers and parents is to reinforce any positive interaction he has with rewards through positive reinforcement. According to Mcleod (2018), when an individual shows good behavior, to enforce that behavior and make the individual do it more often, a reward that the individual finds rewarding should be given. This in turn helps the individual believe that if they act in a certain way, good things will come to them and then it slowly becomes a good habit and eliminates the negative behavior of the individual. For example, Mikey did not want to share the toy with his sister and ignored both his parents when told to share. They can then tell Mikey, if he shares, he would get to watch television for an extra 10 minutes before bed time tonight but only if he shares. The goal of this treatment is to eliminate Mikey’s unnecessary behavior of not communicating and sharing socially and changing that behavior with a more positive and socially acceptable behavior.
With changing Mikey’s behavior, a schedule of reinforcement needs to be planned and followed through to help identify the how and when to reinforce the positive behavior and eliminate the negative behavior. Baustista (2018) stated that “a schedule of reinforcement” performs as a regulation affirming when a certain “behavior will be reinforced”. In order to carry out positive reinforcement, the therapist should begin the reinforcement and show parents how to contribute or conduct to the reinforcement. First, the therapist tells Mikey to share the toy with his sister. There are two ways this could go, because Mikey is not familiar with the therapist, he might feel intimidated and share his toys with his sister. If this happens, the therapist might need to spend more time around Mikey and his family but before so, when he hands the toy to his sister, he should immediately be rewarded by his therapist and parents. In this case, the therapist could pick up another toy that Mikey shows interest towards and play around with him and the toy, his parents should also give positive feedback like giving him verbal compliments about how good of a boy he is and he is such a wonderful and loving brother, to make him feel that he is not forgotten and good about himself.
However, if Mikey fails to follow the therapist’s first instruction, the therapist can give it a couple of minutes and ask again, if he still fails to do so ask one last time and then suggest to Mikey that he needs to share the toy with his sister or no one can play with it. Here a slight bit of negative reinforcement comes into play; however, it is shared between him and his sister. Often, children will give in and then a time limit can be set as to how long the sister can play with it and they can take turn to make it fair. This should be practiced every day during their play time. When Mikey begins to become more responsive, the responding time should slowly be decreased until he begins to share when his sister asks for it.
As Mikey shows very negative behavior towards sounds like the blender or his sister crying that wakes him up. It is important to conduct a functional behavioral assessment (FBA) to find out why Mikey reacts that way towards those specific sounds so the therapist can come up with an effective treatment plan. The first step is to speak to parents, teachers and even Mikey himself if he is able to describe how he acts. The unwanted behavior needs to be correctly defined so that an appropriate plan can be set into place of what behavior needs the most attention and change with. Furthermore, all information regarding the reasons behind Mikey’s negative behavior needs to be collected from everyone who spends time with Mikey quite often. It can be from parents, teachers, other therapists and even from Mikey himself. He is the only person who knows the reason behind his behaviors. Only Mikey himself can tell how he feels during the time of the stimulus that causes him to react in certain ways. Information can be gathered and examined by Morin’s “ABC chart tool”. The “A stands for Antecedent”; basically, the stimulus elicited right before Mikey reacts. The “B is for Behavior” which is how Mikey reacts towards the stimulus and finally “C is for Consequence” what occurs after. The following step is for the therapist to create a “hypothesis” for what is eliciting the behaviors based on the information that has been collected previously.
The final FBA step according to Morin is to create a plan to change the behavior. But before that, the therapist needs to work in a group to identify whether the hypothesis of the behavior is sound by changing the stimulus and see whether it modifies the behavior. The group of professionals will in turn form a Behavior Intervention Plan (BIP) to promote teach other suitable behaviors.
In conclusion, ASD is a very wide neurobehavioral condition that will impact a child’s existence. It is vital that counselors conduct a proper and thorough analysis of their client and previous researchers done on children with ASD and certain behavior modification techniques before they proceed to conduct the treatment. There are many researches and theories out there to help with considering which type of treatment is best for a specific child. Reinforcement is important and necessary to help children understand that there are certain ways they can behave and certain ways they cannot behave. As children with ASD can have trouble communicating and understanding depending on their individual condition, in most cases, positive reinforcement would most likely produce better results. However, nobody actually knows until a professional assess the child and develops a treatment plan for that child.
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