Attitudinal Training

The power of thoughts and feelings in reaching children with autism

by Steven R. Wertz and Kaitryn S. Wertz – Reprinted with permission

Ten-year-old Brian was profoundly autistic. As I sat with him, he repetitively twirled a piece of tissue between his fingers, tilted his head to the right, and looked up to the left. It seemed as though he was looking at the tissue that he was twirling with his peripheral vision. No matter what I did, no matter where I positioned myself, no matter what I said, this beautiful little boy did not ever give me even the slightest glance. If I was quiet, he looked past or through me. If I was more vocal and animated, he turned his back and continued twirling. Afterwards, I explored my thoughts and feelings about the session. I was frustrated with Brian’s lack of response. I felt that it meant something about me. I admitted that I needed this little boy to respond so that I could feel good about my time with him and about myself. I realized that this little boy had enough to deal with because of his autism without adding the responsibility of taking care of my feelings. That day I made a shift within myself. I decided that I could invite Brian to respond, without needing a response or pushing for one. The next time I worked with him, when I went into the room where he was twirling, I first sat across from him silently. Then, after a few moments, I told him that he did not have to look at me – that there was no pressure for him to do so. My words were genuine and heartfelt. Although he was reported to not speak or understand any language, Brian stopped his twirling and he looked at me. That look lasted several seconds. It was, for me, a powerful and transforming experience. Fifteen years later, I have this kind of experience daily, and I use what I learned from Brian to help others to become more effective in parenting and teaching children with autism by learning to shape their own thoughts and feelings.

Our attitude, thoughts and feelings are extremely important when we interact with a person with autism, whether we are living with them, or in a teaching situation. Often, our thoughts and feelings have a greater impact on our effectiveness than our techniques or strategies do.

This principle can be easily illustrated with extreme examples, but it also applies in more every day situations.

Let’s look first at challenging behaviors. I have had the opportunity to work with children who break glass, smear feces, bite, kick, spit (one boy was so skilled he could hit people consistently in the eye from 2 meters away!), pull their eyes forward out of the socket, etc. In order to explain why the thoughts and feelings of the teacher/caregiver are so important, let’s first review a behaviorist perspective on these challenging behaviors.

Why do children do these things? These behaviors are not caused by autism. Many autistic people do not do them, and many non-autistic people do engage in such extreme behaviors.

The behaviorists suggest that these behaviors may be shaped by environment and by reaction, that they are learned behaviors. But if that is true, who is teaching these children to act aggressively or in a self-injurious way? Certainly no parent has ever wanted to teach their child to bite, smear feces, tantrum, etc. The behaviorist model tells us that the learning takes place through reinforcers. A reinforcer is a type of payment; it’s like a twenty-dollar bill. Many people do not realize that the reactions that they have to some of their children’s behavior is like giving their child a twenty dollar bill every time they do something particularly outlandish.

There are three classes of reinforcer. The first kind is known as positive reinforcement, in which the child is getting something they want from the challenging behavior.

I met Kevin and his father Joe when Kevin was 12. Joe’s primary difficulty with Kevin’s autism was the fact that his son was becoming increasingly aggressive. In our first session together, I observed quietly while Kevin and his father interacted. Joe was attempting to lead Kevin into a specially designed playroom, but Kevin refused to go. Joe repeatedly asked Kevin to join him in the playroom so they could have fun together, with no apparent response from Kevin. Suddenly and without warning, Kevin kicked his father as hard as he could. Joe became angry. His whole body stiffened and his jaw thrust forward. His lips were tight. He grabbed Kevin by the arm, and Kevin kicked him again. Joe began to yell at Kevin and tried to restrain him.

Kevin often hit people, kicked, scratched, bit etc. He would even throw chairs through picture windows. The best way his father knew to get him to stop was to try to physically restrain him, or, if all else failed, to hit him. But Kevin’s aggressive behavior was constantly escalating, particularly with his dad. His parents were at their wit’s end. Kevin had become so difficult to handle that they felt they would soon need to have him medicated and placed in an institution, if his violence continued.

Over the next few sessions, I focused primarily on Joe’s reactions to Kevin’s violence. Underneath his anger, Joe believed that Kevin’s behavior was a reflection of his own poor parenting. Joe judged himself as an unfit father, and felt ashamed. As he had the chance to express and discuss his feelings, he began to change his outlook. Joe came to see that Kevin’s behavior was not a reflection of bad parenting – it was an indication that ‘normal’ parenting was being offered where extraordinary parenting was necessary. Joe came to realize that Kevin was, in fact, a very socially motivated person, that he was extremely desirous of personal contact that fit a pattern. Joe began to feel proud that his autistic son wanted social contact, and wanted it with his father, even if the form of the contact was bizarre. Instead of using these occurrences as times for anger and self-recrimination, Joe became motivated to use Kevin’s violent episodes as opportunities to find the extraordinary within himself. Instead of just focusing on how to stop Kevin, Joe now wanted to help Kevin learn to interact gently. Excited about his attitudinal shift, Joe decided to try again.

This time, the interaction between Kevin and his dad was heart wrenching. Joe went into the playroom while I observed through a 2-way mirror. Kevin followed Joe into the room, walked up to him and kicked him hard in the leg. Joe looked at Kevin and talked to him in a soft voice. He said “Kevin, no matter what you do, I am not going to hit you. I have learned about that and I am never going to hit you again.” Kevin appeared more agitated and went to kick his dad again. Joe moved his leg out of the way and repeated his statement “Kevin, no matter what you do, I will not hit you.” Kevin began to cry softly. Tears rolled down his cheeks. He appeared sad and lost. He said, “Dad, I’m supposed to kick you and then you’re supposed to hit me. That’s the way we do it.”

For Kevin, the violent interaction had become a ritual. It created a kind of control. It was consistent and predictable. It gave order to his otherwise chaotic and disorganized interactions and provided him with attention from another person. Often, people with autism would like some kind of attention, but they have no clear idea how to get it, how to control it, or what to do with it once they have it. Joe had unintentionally been playing a part in positively reinforcing Kevin’s behavior, by giving Kevin the reaction Kevin wanted when Kevin kicked him.

After years of escalating violence, Kevin began a period of intense mood swings from generally compliant and engaged, to occasionally very violent. Joe saw the violent incidents as tests and succeeded at not becoming reactive. Within several weeks, Kevin’s behavior became consistently gentle. Because Joe was attitudinally non-reactive, it was easier for him to stop behaving in ways that reinforced violence. Because Joe was genuine and consistent, it was easier for Kevin to see that the change was real, that the old way no longer worked, and that he would have to find new ways to cope and to interact.

A second class of reinforcer is negative reinforcement. The payment here has more to do with taking away something that the person does not want (instead of giving the person something in response to unwanted behavior). Escaping or avoiding something aversive rewards the person. It’s a little like saying “I will pay you by pulling that splinter out of your finger” or “If you behave well, you won’t have to listen to my nagging anymore.”

Todd was nine when I first saw him. He was playing serenely by himself in the playroom. He had just opened his favorite dinosaur book, when his mother, Fran, entered the room to work with him. Fran was enthusiastic, vocal, excited about his book, and dramatic in showing Todd that she was getting her own book to read. He exploded in a tantrum. He threw his head back and screamed. He fell on the floor and began to thrash around. Fran became uncomfortable because she felt that she had upset her son. It was painful for Fran to feel that she had caused her own child so much distress. Her voice became very quiet. She softly apologized. She became slow and soft in her movements. Her facial expression and everything else about her became devoid of animation and energy. She made herself unobtrusive and easy to ignore. Todd went back to his reading.

To me, this looked like a form of communication. Every scream told the world, “Don’t bug me, I’m reading.” And it worked perfectly to Todd’s advantage. If anyone ever intruded on his reverie, he had learned to tantrum and appear extremely distressed. When the “intruder” became uncomfortable and withdrew, Todd avoided a challenge and an interruption and was reinforcing his tantrum behavior.

In subsequent sessions, Fran looked at the belief that she was causing her son great distress. She realized that his tantrums were a way for him to tell her that he preferred to be left alone. She had become accustomed to leaving him alone almost all the time, due to fear of his tantrums. In a sense, she was making it easier for him to remain encapsulated and antisocial. Fran came to see that, even if Todd was distressed by interaction, it did not help him if she diminished her presence in his life. In order to help her son, it was necessary for her to assist him in going through his difficulties and getting over them.

It helped Fran to observe. At one point, I was playing with Todd in a very animated way. He threw his head back and screamed. I threw my head back and laughed. (It is important to note that I was not laughing at Todd, and that if there had been anything uncomfortable, mocking or insensitive about my attitude, my laughing would have been totally counterproductive.) Todd immediately stopped screaming and looked at me. I paused for a moment, beamed my appreciation of his attentiveness, and then threw my head back and laughed again. This time, Todd laughed too. Many people with autism are more socially aware than we suspect. When they notice that their action is not producing the desired effect on a new person, after a little testing, they often stop performing that action with the new person. After my first session with him, Todd laughed every time he saw me.

In the weeks that followed, Fran felt freer to encourage Todd to interact. When Todd appeared distressed, his behavior no longer had the same effect on her, because she no longer held the same beliefs about it. She became a mother whose love took the form of helping her child develop strength where there was once weakness. Todd’s level of interaction and self-confidence increased. He was no longer able to avoid a challenge or an interruption by appearing distressed. So after a while, he seldom appeared distressed.

The two forms of reinforcer described so far are social. The third class of reinforcer is more intra-personal. It has to do with the person’s attempt to balance or soothe themselves using their own sensations and biochemistry. This is an internal process, taking place within the person. For example, we have all learned that the body can produce it’s own natural equivalent of morphine (endorphins) in a variety of extreme situations. That is an example of the third class of reinforcer.

Mimi sat and banged her head on the wall in a steady rhythm. She did this when she was alone. Her mother and father were very disturbed by this behavior and frightened by it. They were concerned that, although she was not bruising or apparently injuring herself in any way, that she would escalate this behavior and eventually harm herself. Whenever they were near, they would stop her. Eventually, she avoided them and did this behavior privately whenever she could. Mimi was very exclusive and often avoided any form of contact with other people. Karen was a therapist that was invited to work with Mimi. She was not at all disturbed by Mimi’s behavior. She saw that Mimi had a very definite rhythm. Karen rocked, and sang in Mimi’s exact rhythm. She made no attempt to stop Mimi. In a short time, Mimi seemed interested in Karen’s singing. If Karen stopped, Mimi fussed and gestured toward her mouth until Karen sang again. Karen sat closer and closer. After twenty minutes of singing, rocking and head thumping, Karen said “Here, let me fix that for you.” Karen reached out and squeezed Mimi’s head, and then stopped, leaving her hands nearby. Mimi took Karen’s hands and put them on her head to have it squeezed again. After that, whenever Karen went into the room with Mimi, she placed her hands near Mimi’s head, and
Mimi placed them on her head to have pressure from Karen. Mimi allowed Karen’s touch, and if Karen sat at a distance, Mimi would approach her and sit near. Mimi’s parents had not seen Mimi behave that way with anyone else.

This example is not about accidentally reinforcing. The reinforcement in this case is that Mimi found this behavior soothing. But in this example, the people who were uncomfortable with the behavior were more likely to behave in ways that were ineffective. The person who was not uncomfortable was most able to introduce an alternative that was soothing, social, and not potentially self injurious.

For fifteen years, I have used attitudinal training to help parents, teachers and caregivers become more comfortable with the challenging behaviors of their children and students with autism. When caregivers learn to change their thoughts and feelings about challenging behaviors, both the frequency and the intensity of the incidents are almost immediately diminished. This attitudinal approach is not magic; it makes perfect sense in very mechanical and behaviorist terms. Why?

When we are uncomfortable, we behave differently. Our voices change. Our coloring changes. Our movements change. Our breathing changes. Our words and choices of actions are different. When we are uncomfortable, we are more likely to react in ways that reinforce the very behavior we want to change in the child. If someone is doing something that we might interpret as hurtful or frightening, as in Kevin’s case, we are more likely to restrain, yell, hit, or behave in a way that could be a reinforcer for that behavior. If we think we are distressing someone and we are uncomfortable about it, as in Todd’s case, we are more likely to become like wallpaper, or behave in other ways that would tend to strongly reinforce that behavior. In fact, these reactions become a predictable language and ritual of discomfort. When caregivers become more comfortable with the very behaviors that they found so disturbing, the caregivers’ behavior changes. As a result, they tend to act in ways that are less reinforcing of the challenging behavior.

Parents and teachers sometimes have thoughts and feelings that are indirectly expressed in their interactions with the autistic person and which result in difficulties. If a father is uncomfortable with specific behaviors, he will often inadvertently reinforce them. If he needs his daughter to perform so that he can feel good about his teaching ability, he will be ready to be uncomfortable if she does not perform. He might over prompt, not reward successive approximations, or keep going too long with teaching attempts. He might try to punish her for non-compliance. If a mother pities her son, she will be more likely to cushion and protect him rather than challenge him and help him get past his difficulties. If a teacher doesn’t believe deeply in a child’s capacity to grow and change, she will not design teaching experiences at the students level of ability. If the teacher is bored, passionless, and going through the motions, the reactions will become slower and less appealing and the child will be disengaged. If a parent is busy thinking “Why me?” and “What did I do wrong?” the parent will be self-absorbed and not fully engaged while they are interacting with their child. They will miss opportunities to respond– and so on.

An answer to this dilemma is attitudinal training. Attitudinal training has two aspects. The first aspect is to help the caregiver, by observation and self-exploration, identify the thoughts and
feelings that can get in the way of effective parenting and teaching. The second aspect is to help the caregiver find a way to change those thoughts and feelings. When parents, teachers, and caregivers receive attitudinal training, they can function with a greater comfort level in all of their interactions with the children. If they are unperturbed by various behaviors, the children learn that there are no social / magical outcomes that come from self-injury, violence, etc. Learned behaviors that can be the source of so many difficulties will not be inadvertently taught. While behaviorists employ a number of excellent strategies to deal with these challenging behaviors once they have been learned, these strategies would be less necessary if the challenging behaviors are not reinforced with intense reactions in the first place.

If we learn about our own attitudes and how they play a part, we can avoid certain difficulties. If we understand the dynamics of attitude, we can become much more motivating and effective parents and teachers, inspiring people with autism to develop self confidence, the desire to learn, the desire to communicate, and the desire to develop social skills.

When we focus on attitude, our primary job is not to teach a particular subject, skill, or action. Our primary job is to teach a love of that subject, skill or action. If, for example I am working with a non-verbal child, I want to teach the child to love making sounds and an utter delight in what happens when sounds are made. How do you teach a love for and delight in something?

Pairing

One strategy is to use successive “pairings”. If a baby is held in a certain way when nursing, the baby may come to love being held that way even when she has no interest in food. When the same child becomes a toddler who loves to snuggle, mother could read to her while they are snuggling together. The child could come to feel comfort and connection while being read to. In each instance, one pleasure is being paired with another experience. This often happens naturally and inadvertently when caregivers are comfortable and when they themselves enjoy the things that they are doing with the children. Things can happen to disrupt this process. The baby may not nurse and in reaction, the mother might become tense and uncomfortable. The way that she presents to the baby, in fact the entire feeding, can become too forceful or too rushed. If she is able to remain comfortable with the baby’s fussiness, she will have less tension in her touch, her timing will be better and she will be more likely to discover the behaviors that will help her baby past the difficulty. Attitude can affect the process of pairing because it affects the behaviors of the caregiver. A person who is uncomfortable and self-conscious reading to a child will not even begin to pair reading with comfort and coziness. A person who is comfortable and who loves various activities will create successive pairings without realizing it.

Modeling

When my daughter was 18 months old, we were not giving her dairy products. She had not had ice cream, and she had not seen us eat it. We went to a large dinner gathering. We had dinner. While we were all eating our broccoli, my daughter showed no special interest in anything that other people were eating. When the ice cream was served, the affect of the adults present changed. There was a lot more twinkle in their eyes, and people were looking more at what was in their bowls. People were making savoring motions and moving the ice cream in their mouths. People talked less and focused on eating and tasting. My daughter’s behavior changed. She appeared fascinated with watching the people eat and tried repeatedly to see into bowls or grab bowls. I had a bowl with frozen banana that I was making a fuss over, and I let her take it from me.

Adult and peer expressions of pleasure and aversion can become a communication system for a child, encouraging a child to be motivated toward or away from various experiences. With autistic children, this communication system is disrupted, often because the child hasn’t learned to attend to adult expressions and hasn’t seen how these expressions are “paired” with experiences. People who can genuinely love different experiences and be very expressive of that love can exaggerate and draw attention to expressions and experiences. This can build that non-verbal communication system and help the child see and understand expressions. It can also invite a child to desire certain experiences – to want to grab at what is in your bowl. This can be done most effectively if you can delight and exaggerate your expressions and behaviors of delight.

To teach attitude, we must learn the language of attitude. When we are not perturbed by violence, distress, or lack of interaction, we can be delighted by gentle touch, affection, eye contact, vocalizations, and every form of interaction, no matter how apparently small or insignificant. When we genuinely delight in these things, we tend to act, to vocalize, to move and to respond in ways that are incredibly reinforcing. Not only are our actions reinforcing, but we also become more charismatic to the child. This is important with children with autism. They are identified as having autism because of their difficulties in socializing and communicating with people. When we become more compelling and engaging, the child focuses on us more. As a result, they exercise and strengthen the “muscles” of relationship. Their social skills improve.

Sarah was three when she came for sessions. Her parents said that she was nonverbal. They said she babbled, but never imitated the sounds of others and never spoke words. Sarah had a great love in her life. She loved Cheerios, a cereal that was shaped like little O’s. I watched as Sarah sat on a stool by the wall. A bowl of Cheerios was across the room up on a high shelf, out of her vision and out of her reach. Sarah was babbling and disengaged. She had no eye contact with her facilitator. In the middle of her random sounds, she made a sound that was vaguely like the “O” sound. The sound was really not clear at all. The facilitator looked suddenly surprised. He smiled and said “O’s?” Then he got up and in a manner that was comedic and fun, he ran to the shelf, grabbed some O’s, ran back and jammed them into Sarah’s hand – repeatedly saying “O’s!” Usually, if Sarah had O’s in her hand, they went right to her mouth. But this time, there was something different. She looked at them in her hand. Then she looked up and off to the right. Very quietly, almost inaudibly, Sarah said “O’s”. With a laugh, the facilitator repeated “O’s” and ran again to the shelf, grabbed more O’s, ran back and put them into Sarah’s hand. Sarah smiled and loudly said “O’s!” and the facilitator ran for more. This time, before he could get back to Sarah, she yelled “O’s” again and he turned so fast toward the bowl that he fell. Sarah laughed. The facilitator got up quickly, grabbed the O’s, ran back to her and again Sarah yelled before he got to her. This was the start of an incredible game in which Sarah periodically called out “O’s” and, no matter what was happening, the facilitator ran to the bowl and brought back the cereal. One of the most striking and beautiful aspects of this activity was the look on Sarah’s face. Usually, her expression was neutral. While she was playing this game, her smile beamed from ear to ear. Sarah was not just making a sound for a particular event. She was delighting in the power of her sound.

The facilitator had as a main focus, a desire to enjoy interactions and to show that enjoyment to Sara. When the facilitator began the session and Sarah was very disengaged, the facilitator was not thinking, “ This is going to be tough. She’s not responding to me. I am not doing so well.” Instead, he was thinking, “This is perfect. This is the way that we begin. Even if she is unaware of me, I am aware of and enjoying her. Interaction is taking place because I am here interacting. Everything that she says and does, speaks to me whether she intends it to or not.” Whether it was a sound or the slightest movement the facilitator was ready to respond with delight as though it was a direct communication from Sarah to him. The facilitator was not trained in behaviorism, but was using the principles of behaviorism. He was reacting immediately to her sound as though it was a request, and he was reinforcing her for it immediately. In this instance, if there were more focus on the behavioral dynamics and less focus on the level of enjoyment of the interaction, the reinforcer might have been the Cheerios. But it wasn’t. Often, Sarah did not even eat the Cheerios that she obtained in this way. The main event and the reinforcer for Sarah, was the pleasure she derived from using a sound to move a person. The facilitator loved responding to Sarah. So his actions said, “Look how responsive I am? Isn’t this fun?” versus “Here are the Cheerios.” The child’s pleasure is paired with the person and his responsiveness. Our intention is to create within us a heightened enjoyment of the activity or interaction, and then to look for a way to draw the child into that enjoyment.

I have focused here on the attitudinal aspect of work with people with autism. But I am not suggesting that it is only “heart” that counts rather than educational techniques, nor am I suggesting that success is inevitable if our hearts are in the right place and we have mastered our thoughts and feelings. Technical skill and adherence to purely scientific assessment and teaching strategies, with little or no focus on underlying feelings and attitudes, tends to produce teachers and students who are less expressive and less emotionally alive. But a purely attitudinal approach which fails to incorporate educational skill, strategy and assessment tends to result in happier, more emotionally expressive, more interactive students who “plateau” in their learning at a point where appropriate use of more scientific assessment and educational methods could provide a most necessary benefit.

The most powerful approach to working with children with autism is a marriage of skill and feeling, science and faith, technique and heart. As parents and educators, we can rise to the challenge of raising and teaching children with autism by strengthening both our own hearts and our own minds. We can strengthen our hearts by helping each other to be more aware of our underlying thoughts and feelings, supporting each other in changing the thoughts and feelings that are counter-productive, and engendering in ourselves the love and delight that awakens love and delight in our children. We can strengthen our minds by teaching ourselves the educational techniques and behavioral principles that science and research are substantiating. When we combine these things within ourselves, we become more than the sum of the parts. We become more complete, more powerful, more the fullness of our own potential – and we become the parents and educators that are best suited to help our children become more complete, more powerful, and more able to achieve their own potential.

Special Solutions, Inc.
15096 115th Ave. North, Jupiter, FL 33478
Phone: 561-748-9697
www.autism-programs.com
Copyright © 2002 Steven R. Wertz

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