Asking Ann About Autism: Behavior interventions
Ann Millan, author and autism advocate, has some very real and meaningful understandings of autism spectrum. When Ann’s daughter, Robin, was diagnosed with autism in the 70’s, autism was an extremely rare disorder. There were no flurry of organizations, groups or social networking sites for support. Therefore, the Millan family’s path to independence for Robin is all the more astounding.Robin is an engaging, talented and caring woman who holds two jobs, drives her own car and owns her own condo. The diagnosis of classical autism is
still there, but it certainly does not have the power to define who she is. I am so pleased to be speaking with her mother, Ann, today.
Kathleen: Ann, Welcome and thanks for joining me again. Your book, Autism: Believe in the Future-From Infancy to Independence is an amazing book. Not only do you share your personal family story, but you give a complete description and road map for families to follow who are wondering where in the world to begin charting a productive path for their affected family members.
Today let’s talk a little about ‘Behavior Interventions’ that you used during Robin’s journey.
The chapter in your book regarding the ‘Interconnection of Therapies’ states the following observation which I believe is so important:
Today let’s talk a little about ‘Behavior Interventions’ that you used during Robin’s journey.
The chapter in your book regarding the ‘Interconnection of Therapies’ states the following observation which I believe is so important:
“Learning for Robin was like an orchestra without a woodwind section. An Orchestra needs all the instruments to be an orchestra. The same applies to Robin. Addressing her behavior but not her language and communication, or addressing her education, but not occupational therapy sensory integration, would fail to provide her with an appropriate education. Robin didn’t need one thing—she needed it all! And she needed it all to work like an orchestra in order to realize a benefit.”
Do you think, Ann, that what you stated here could be a missing puzzle piece for many families? Programs may SEEM ineffectual for individuals on the spectrum but are simply not operating with the proper synergy? I’m sure there are many good tools and therapies that have been branded ‘ineffective for this person’, by parents and educators, when the right ‘Mix’ just wasn’t in place.
Ann: Kathleen, it’s all about the mix. Isolating one intervention from another doesn’t build on anything. I cringe when I hear parents say, “That didn’t work for my child.” Actually, I feel sad for them. In some cases, this attitude is encouraged by professionals because they do not understand the mix.
My advice to families and professionals when they read today’s AAAA, is to block the work “can’t” out of your vocabulary. YES YOU CAN. What I did twenty-thirty years ago all built on where Robin is today. “Inappropriate Behavior is Unacceptable in Society, period...” From that realization, I moved forward and never said, “I can’t make this happen.” Behavior must be acceptable for individuals to feel accepted in society.
My advice to families and professionals when they read today’s AAAA, is to block the work “can’t” out of your vocabulary. YES YOU CAN. What I did twenty-thirty years ago all built on where Robin is today. “Inappropriate Behavior is Unacceptable in Society, period...” From that realization, I moved forward and never said, “I can’t make this happen.” Behavior must be acceptable for individuals to feel accepted in society.
Kathleen: Okay, returning specifically to Behavior….you shared the key components to addressing behaviors are:
· Structure
· Consistency
· Positive Behavior Modification and
· Multi-sensory stimulation
Would you cover those very briefly, bringing in some of Robin’s specific experiences.
Ann: I had to structure Robin’s environment. She could not occupy her time in a positive way so I had to occupy it for her. Otherwise, that’s when she’d have a meltdown or get into trouble.
I had to be consistent in occupying her time because she did not understand change. I could not allow her to be confused. If I said we were going to eat lunch and the phone rang, she would scream because she wanted lunch. Everyone’s heard the phrase, who has a child with autism: “She wants what she wants when she wants it.” Well, to help Robin learn to control that mindset, I had to be consistent. By the way, it took years to change that!
I had to be consistent in occupying her time because she did not understand change. I could not allow her to be confused. If I said we were going to eat lunch and the phone rang, she would scream because she wanted lunch. Everyone’s heard the phrase, who has a child with autism: “She wants what she wants when she wants it.” Well, to help Robin learn to control that mindset, I had to be consistent. By the way, it took years to change that!
Kathleen: What was your first step toward changing that mindset....for parents who understand exactly the behavior you are referring to, what can this first step look like?
Ann: I had to control Robin’s thinking pattern and get her to pay attention to me. Robin would much rather stay in her own little world of autism doing her own thing.
To do this Robin’s language therapist implemented positive behavior modification in the therapy environment and I carried it over into my home schooling. This structure with charts and rewards, focused on the positive things Robin was doing and I kept stretching her limits, when she’d achieve specific goals.
Kathleen, I am a very dramatic person, I’ve been told. Rewards, praise, even panic or anger at times, was very verbal with full body movements. We laughed a lot and I made a big deal out of the smallest things.
I had to be very dramatic for Robin to keep her attention focused with me.
To do this Robin’s language therapist implemented positive behavior modification in the therapy environment and I carried it over into my home schooling. This structure with charts and rewards, focused on the positive things Robin was doing and I kept stretching her limits, when she’d achieve specific goals.
Kathleen, I am a very dramatic person, I’ve been told. Rewards, praise, even panic or anger at times, was very verbal with full body movements. We laughed a lot and I made a big deal out of the smallest things.
I had to be very dramatic for Robin to keep her attention focused with me.
Kathleen: It sounds as though you set the momentum with your attitude always focused toward achieving the goals at hand.
Ann: Attitude - that’s what I’m trying to say. Thank you. Friends and relatives today tease me about things I used to do: 1) I always stood at the reviewing stand in parades ringing a cow bell to get the girls to smile for the judges. 2) Evidently, with overnight guests, I used to play John Phillip Sousa’s Washington Post as their wake-up call. Today, I laugh when I hear those involved sharing these stories. I guess I was a little dramatic!
Kathleen: You’ve already touched on positive reinforcement….but would you explain the ‘clicker’ reinforcement that you shared in your book? This struck me as a very powerful and immediate ‘gratifier’ and one that, as you pointed out, uses the sensory factor as well!
Ann: I have a video attached today using the clicker.
Kathleen: Oh wonderful.
Ann: The clicker was our graduation from the extensive chart system I used. This video is a reading assignment. You can see how intense we are sitting side by side. We had graduated from mind wandering, fidgeting, frustration, etc so it came as a natural progression.
In the video, I have the clicker in my hand, clicking as she reads to keep the speed and flow while reading. At the end of the video, I’m looking at the clicker and announcing how many points she has. We did this with every assignment in our school work.
In the video, I have the clicker in my hand, clicking as she reads to keep the speed and flow while reading. At the end of the video, I’m looking at the clicker and announcing how many points she has. We did this with every assignment in our school work.
Kathleen: So moving from concrete to abstract, starting with physical charts first and then moving to the clicker method seems the most logical progression in most cases?
Ann: Yes. I needed to move past the paperwork so she’d concentrate more on the assignments. Even with the clicker, there were times she’d say, “You forgot to click” and she was right. This told me she was very aware of her behavior and I think the sound of the clicks was a reassuring measure for her.
Kathleen: Ann have you ever thought about being a professional special education planning consultant? I know you are an amazing autism advocate, but I think you have quite a gift for sensing what direction a program needs to go in and are fluid enough to adapt on a moment’s notice.
Ann: Oh, thank you Kathleen. That’s very nice. Trust me, I thought of it many times. I do feel I have a wealth of knowledge to share - hence the book - however, I’m starting a blog on my website to have parents and professions come together to share ideas. Many parents and professionals do want to learn and many, not just myself, have incredible experience how things work for our children.
Kathleen: I’m so glad to hear that you have that resource coming up...and soon I hope!
Ann: Yes, it can be used on the web site now by contacting me. You know, I listened to a podcast (www.autismpodcast.org) this morning about autism and employment. They were generalizing about the importance of transition into adulthood. Employment starts with behavior, involvement with family, and wanting to be employed. All that happens in childhood, not teenage or adult years! Parents of ten year-olds need to know this NOW.
The second video today and the pictures, Kathleen, show what I’m talking about. I was very fortunate. I was referred to a psychologist when Robin was ten that pushed my priorities for community inclusion. Robin joined a majorette corps (I knew the instructor) and a 4-H club. Details how this happened are in the book but the point is that Robin’s life was inclusive even though she couldn’t relate to her peers . . . because her behaviors were appropriate. Twirling did not require language skills. Presentations were rehearsed word-for-word as part of our school assignments daily for months before the event.
All the background preparation required for Robin to be successful didn’t matter. What mattered was that she felt successful. Our family worked hard for Robin because we could see her success. Our philosophy was to keep moving forward. We never said “can’t”
The second video today and the pictures, Kathleen, show what I’m talking about. I was very fortunate. I was referred to a psychologist when Robin was ten that pushed my priorities for community inclusion. Robin joined a majorette corps (I knew the instructor) and a 4-H club. Details how this happened are in the book but the point is that Robin’s life was inclusive even though she couldn’t relate to her peers . . . because her behaviors were appropriate. Twirling did not require language skills. Presentations were rehearsed word-for-word as part of our school assignments daily for months before the event.
All the background preparation required for Robin to be successful didn’t matter. What mattered was that she felt successful. Our family worked hard for Robin because we could see her success. Our philosophy was to keep moving forward. We never said “can’t”
Kathleen: Robin realizing ‘gains’...this was the focus? I’m sure that there were times when it seemed the progress was excruciatingly slow, and families everywhere can identify with this, but not to lose sight of the fact that there IS progress being made is, I’m sure, of the utmost importance.
Ann: You know, parents don’t usually see the progress - it’s so slow and sometimes seems so insignificant. It is important for people around them to give praise and encouragement. Just last month Robin had her annual visit with Dr. Bradstreet. He raved about their conversation and how much better it was than the year before. Parents know how important that feedback is. I beamed and well as Robin! Of course, he pushed too. He told Robin he wanted her to make the long drive next year. Oh, well, another goal!
Kathleen: And I’m sure that this is also where video has been very very helpful to you and Robin....being able to look back, reflect and see the actually progression in a sort of ‘time lapsed’ medium.
Ann: Yes. Also in the book you’ll see I had charts for myself to keep me on task. Instead of getting frustrated she wasn’t doing something I expected, I’d chart the goal and write baby steps to make it happen.
Kathleen: I can see where this would have the added benefit of ‘normalizing’ the process of charting (from Robin’s perspective)....charting the process of goal progression becoming more of a typical practice than if she were the only one in her experience utilizing the process.
Ann: Yes. I remember I had a chart on the back of the bathroom door for the other girls. Wash hands, flush, put the towel back, etc. We had company and our friend, Tom, came out of the bathroom laughing. He said, “I did everything on the chart!”
Kathleen: That’s so funny....but effective!
Okay, we’ve talked a bit about structure, consistency and positive behavior modification….can you go into a little more detail about multi-sensory practices and how sensory input can help intensify the results of Behavior modification techniques?
Okay, we’ve talked a bit about structure, consistency and positive behavior modification….can you go into a little more detail about multi-sensory practices and how sensory input can help intensify the results of Behavior modification techniques?
Ann: Most individuals with autism learn through their vision. Auditory is weak. People use too many words in a sentence, muffled, whatever. To keep Robin’s vision on the task I needed objects, i.e., charts. The charts were visually simple, my sentences were short and to the point, and I got “in her face” to make sure she was looking at me.
I am amazed at teachers . . . and parents who give these long elaborate explanations, expecting understanding. A therapist told me one time that Robin probably gets the first two words of a sentence and the last two words. So, obviously, that wasn’t working for her. Reinforcement, reinforcement, reinforcement is what worked.
I am amazed at teachers . . . and parents who give these long elaborate explanations, expecting understanding. A therapist told me one time that Robin probably gets the first two words of a sentence and the last two words. So, obviously, that wasn’t working for her. Reinforcement, reinforcement, reinforcement is what worked.
Kathleen: Reggio Emilia, a teaching protocol/philosophy that isn’t widely used in this country but is used extensively in European countries (Italy in particular), has a chart system it uses when working with groups of children. It is called the KWL chart and it basically has three columns. The first stating what the child already knows, the second what he or she Wants to know and the last column is what the child has actually learned. In small groups the children are very active in the entire charting process. Your home plan based on observation seems to use the same technique.
In what manner did Robin, and do children in general, interact with the behavior modification charts that you outline in your book?
In what manner did Robin, and do children in general, interact with the behavior modification charts that you outline in your book?
Ann: Good question. Actually the chart I used for myself sounds like the Reggio Emilia protocol.
For Robin’s charts, we did them together. They were always on the table and the assignment focused around the behavior. She could see me chart something each time. She then grafted the points onto another chart, colored it and they all went on the refrigerator.
Example: I started charting basic behavior. Good feet on floor. I showed her my feet on the floor, she copied me and then I gave her a check mark for doing it right. I kept my feet appropriate and each time she was appropriate, I gave another check mark, smiled and said good. (Robin’s feet were always moving randomly in the past.) When this was 50% during a lesson, I added another goal on the same chart, Good sitting straight. Then another and another.
I focused on appropriate body movements, then internal behaviors like Good frustration, Good staying on subject.
Robin was proud of her charts and showed them to everyone who came into the house. She did get rewards but the charts were the real focus.
For Robin’s charts, we did them together. They were always on the table and the assignment focused around the behavior. She could see me chart something each time. She then grafted the points onto another chart, colored it and they all went on the refrigerator.
Example: I started charting basic behavior. Good feet on floor. I showed her my feet on the floor, she copied me and then I gave her a check mark for doing it right. I kept my feet appropriate and each time she was appropriate, I gave another check mark, smiled and said good. (Robin’s feet were always moving randomly in the past.) When this was 50% during a lesson, I added another goal on the same chart, Good sitting straight. Then another and another.
I focused on appropriate body movements, then internal behaviors like Good frustration, Good staying on subject.
Robin was proud of her charts and showed them to everyone who came into the house. She did get rewards but the charts were the real focus.
Kathleen: Fantastic. So this was not only a behavior modification chart…this became an interactive, ‘cross curricular’ learning experience that included language development, eye-hand coordination, visual spatial relationship activities and you also wove ‘body awareness’ into the process.
Would you say that at any point Robin progressed to ‘journaling’ rather than staying with charting?
Would you say that at any point Robin progressed to ‘journaling’ rather than staying with charting?
Ann: Robin had trouble with journaling. She was more concrete. She couldn’t express herself without my prompting and direction, partly because of her limited language and partly because of her academic ability. She did not recognize emotions or feeling or wants or consequences.
Kathleen: I understand completely. Her main communication was more visual so charting became a very appropriate way to both set and measure goals.
Ann: Yes. But more than that, it was my way of helping her to be acceptable by the people around her. She couldn’t have outbursts in 4-H or majorettes. She had to behave to be accepted. I was ALWAYS there. She was appropriate because I was her reinforcement. I never charted in public but she KNEW I was watching.
Some parents will say, I can’t do that (NO CAN’TS, remember) or that’s not .................... I say, it worked and I needed progress for Robin. Enough said!
Some parents will say, I can’t do that (NO CAN’TS, remember) or that’s not .................... I say, it worked and I needed progress for Robin. Enough said!
Kathleen: So it was imperative that if Robin was going to become independent she needed the behavior in place to allow that to happen. She needed to become ‘self regulated’...and it sounds like the Behavior modification practices were instrumental in achieving her independent life.
Ann: Exactly. You know, that word ‘self-regulating’ even today keeps creeping up. Obsessive Compulsive Disorder, spending money you don’t have, living in deplorable conditions, keeping a job, making friendships. These are all lack of self-regulating in adulthood. All of which many people, even without autism deal with on a daily basis.
Kathleen: Absolutely. Self regulation is an on going process for ALL of us. This seems like a very good place to end, particularly as our next discussion will include Socialization and Self Image...very important topics in the ‘journey to independence.’
Thank you again, Ann, for sharing your time and your knowledge with the autism community.
Thank you again, Ann, for sharing your time and your knowledge with the autism community.
Ann: I’m looking forward to next week. Thank you for allowing me to share.
For more insights from Ann and helpful autism information,
watch for our next segment of:
Asking Ann About Autism
Ann’s book can be found in bookstores and online at:
And at Ann’s website:
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