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Autism and Behavior Therapy: Taking the Next Step

ForwardBy Cathy Jameson

Ronan usually wakes up sluggish around 9am. He woke up bright and early at 4am on Monday last week. I had woken up just a few hours earlier because of a nightmare. I tossed and turned through the early morning hours, but ended up getting only 3 hours of sleep. I knew it was going to be a long day for both us. Thankfully, extra help was on the way. Ronan’s therapist would be here at 10am.

Ronan was in good spirits despite the o’dark-thirty wake up. He continued to be chipper and active when his therapist arrived later that morning. Explaining how the day had started, she was pleased to see that Ronan was so happy, but she knew he’d soon tire. With that in mind, we rearranged and shortened the day’s agenda. Even though we’d scaled back some of the activities, we kept with the plan to go out into the community.

For the last few weeks, after watching Ronan display an increase in negative behaviors when we were in town, we’ve been practicing going out. In the past, some outings with Ronan have ended terribly.  Not every one of our outings turns into a horrible, terrible, no good, very bad day, but toward the end of the summer, Ronan’s behaviors were consistently tanking. With each attempt I tried to get Ronan out the door, in the car, out of the car, to the store or to wherever it was we were going, he got more and more frustrated. He also started to become somewhat aggressive.

Ronan doesn’t like to be frustrated, and I don’t like to see him get to that point either. When the every-now-and-then negative behaviors began to occur more frequently, a friend of ours suggested that I look at Applied Behavior Analysis (ABA) therapy again. It’s worked for us before, and since I’d tapped out of my knowledge and ability to redirect Ronan to more appropriate choices and behaviors, I knew that it was time to ask someone else for help. I’m glad that I did.

When we head out with our therapists, Ronan works on going to the library appropriately, he learns how to walk into and out of stores safely, and he practices making small purchases, too. In just a few short weeks of starting ABA, Ronan’s gone from adamantly refusing to get into the car to independently sitting in his car seat. Since that happened quickly, we’re working on a new goal.

Our next goal is for Ronan to be able to go for a drive without having to have his music or his videos on replay. I don’t really mind his music or videos, but as soon as he requests a song, he changes his mind and signs that he wants to watch a movie instead. The constant requests and signs he’s trying to show me in the rearview mirror are a distraction to the driving I’m doing. So, we’re working on being content with the first choice as well as extending the listening/watching time before making a new request. While he works on that goal, Ronan’s also working on tolerating his siblings’ movie choices because they don’t always want to watch the same movie over and over and over again. One more goal for the car rides is tolerating Mommy’s music. I like to listen 80s music when we run errands. When Ronan accomplishes that goal maybe I’ll be able to jam to my own tunes in the car for more than the few minutes I do now.

In the past, getting Ronan into the car was the beginning of a long battle. That battle would continue once we arrived at a final destination. Sometimes it lasted until we returned home. With the few changes we have been able to make during recent therapy sessions, I’m observing positive responses, more eye contact, and an increase in vocalizations. I welcome these changes. Ronan’s gone from throwing himself on the floor of the library to following a routine. He can now walk to the area where the DVDs are. He can carefully scan the shelves. He can patiently wait in line behind other library patrons, and he can check out his own movies, too. With only a few successful visits under his belt, I wondered how long the streak would last. The latest visit was the best one yet.

While he was searching for a movie, I said, “You look for a movie, and I’ll look for one for the kids.” Ronan is not a fan of the Muppets, but he grabbed Muppets Most Wanted and handed it to me. Baffled, I said, “Ronan, is this for you?” He signed no. I looked at him and said, “Ronan, is this…is this for the kids?” He signed yes. I was floored. His siblings had checked out that movie two weeks ago. Recognizing it, he must have wanted them to see it again. After handing me the Muppets movie case, Ronan found one of his favorite films. Picking it up, he held onto Horton Hears a Who, indicated that he was done, and quietly walked toward the circulation desk to check it out.

Another area that we’re focusing on is going into stores. Ronan only likes to go into a few stores, but I need to get shopping done at other places, too. After reviewing what’s happened at the “worst offenders”, usually a Big Box store, our therapists have helped me come up with a strategy to not just get Ronan into the store - and to get all the of the items that I need to get - but to get Ronan to walk out of the store successfully as well.

We haven’t found complete success yet, but Ronan’s gone from crying his eyes out once we approach a Big Box store to being able to walk through the store with no meltdowns. He’s even able to stand in line at the register and has bought something. He was able to do that on Monday morning after his 4am wake up, so his therapist and I thought we’d go practice going shopping again on Tuesday. With the shopping trips we’re doing, Ronan has been navigating the busy aisles, has been making choices, and has been noticing other customers. Last Tuesday, he noticed something else.

That day, I thought we’d be in and out of the store quickly. But Ronan lingered in the store after something caught his eye. Walking through the bra and undies department, Ronan glanced above the bras to an advertisement and slowed his pace. I’d already gotten the few things that I needed and said, “Buddy, we can go pick out something for you now.” But Ronan didn’t budge. Maybe he didn’t hear me. “Ronan?” Staring at the shapely woman modeling a bra, Ronan slowly turned toward me. “Helloooooo. Ronan. We’re done. Come on….we can go now.” Without looking, Ronan reached for my hand. He slowly took a step forward, paused, and looked back at ad. “Oh, boy,” I groaned to our therapists who was holding Ronan’s other hand. But then I thought, Oh, boy! Ronan turns 13 next week. My almost teen-age son may not be catching up in all areas of development, but noticing the buxom woman in the photo leads me to believe that he might not be as far behind in others areas as I’d thought.

Ronan is still years behind in many of the skills that typical kids his age have long ago achieved, but every day, I get to encourage him to catch up. Some days, he’ll wow me by regaining a lost skill or by learning a new one.   Other days, when it turns into a rotten, horrible, no good and very bad day, I know to back off. As much as I’d like to push through a struggle, we switch roles. Ronan becomes the teacher, and I become the student. He communicates to me with his signs, with the few words he uses, and with his behavior that things are not working out. On those days, instead of trying to finish a lesson to fulfill the next goal I hope that he’ll achieve, we wait. We wait for things to calm down. We wait for things to get better. We wait for confidence to return. Waiting can be hard, but we always wait together. When that tough moment ends, Ronan and I try to pick up right where we left off. And now, thanks to our new therapists, we have some extra helpers ready to get us both back on track.

Not every child on the spectrum responds to therapy. Sometimes, what is a hit for one child will be a miss for another. Ronan has had more misses than hits with other therapies we’ve tried, but as we tip toe back into ABA and back into the world, it’s not just Ronan who’s gaining new skills and confidence. I am too.

Cathy Jameson is a Contributing Editor for Age of Autism.

Comments

L  Land

As mom to a twenty something with autism I agree that some things develop but I have not seen a connect to another person in that way. I would guess it was puzzlement over it being ok to not be all the way dressed that caught his eye.

ASusan

Tears for the both of you. My sister is an ABA therapist (and an awesome one, if I do say so myself), and she has also worked with pubescent boys on the spectrum. Yep, that's one thing that seems to develop on track! Even those whose challenges are so great that they are institutionalized have budding sexual feelings to manage. Love and Happy Holidays to your whole family.

Laura Hayes

Loved the positive and encouraging update, Cathy! 20 years in, we are still using ABA and running a full-time ABA program. It has become a way of life that has greatly increased our son's quality of life, and by extension, our family's quality of life, too. May Ronan's progress continue in earnest with his newly-reinstated ABA program!

MamaBear

Fantastic description of how you and Ronan navigate together. Eagerly awaiting the next installment ...

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