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Wednesday, 10 September 2014

Adaptive Behavior and Autism





Today’s post is rather off subject, since it is not about GABA or complex pathways mainly researched for cancer.  It is about struggling to put on your shrunken socks, that shirt that was left inside out, or finishing your Lego by yourself.


Adaptive Behavior / Coping Skills

Most people never need to think about adaptive behavior; it just comes naturally.  When adaptive behavior is very weak, then daily life becomes a challenge.

Adaptive behavior is a type of behavior that is used to adjust to another type of behavior or situation.  Adaptive behavior reflects an individual’s social and practical competence of daily skills to meet the demands of everyday living.

Adaptive behavior is often measured by psychologists using the Vineland Adaptive Behavior Scale .


This post looks as adaptive behavior and some ways to improve it.

What prompted this post was a recent post on the excellent Simons Foundation blog:-



Fragile X is rare, but is associated with autistic behaviors and often MR. It is viewed as the most widespread single-gene cause of autism.  Fragile X is frequently used by autism researchers because there is a mouse model of it.

In fact what the study showed was that the acquisition of coping skills in fragile X is much slower that with typical children and as they get older, the wider the gap becomes.  They do not lose their existing coping skills with age.  This fits perfectly with how Deborah Fein, my favored Neuropsychologist, describes skill acquisition in autism. 
Her chart below is actually more optimistic than how she actually describes it.










She is just past half way down the long list of lectures.

Fein’s small “recovered” group has a spurt of development that allows them to catch up. This is extremely rare, but evidently can happen.

By interfering with Nature’s chosen path, as is the objective of this blog, we should be able to change the trajectory of skill acquisition.  

  
ABA and Adaptive Behaviours

One of the good things about the ABA approach is that it includes, and indeed prioritizes, developing adaptive behavior, in the form of daily living and self-help skills and developing fine and gross motor skills.  

The “bible” of skills to teach is The Assessment of Basic Language and Learning Skills - Revised (ABLLS-R), when starting with a young, non-verbal child, the document is extremely daunting.  But looking back, it really does have all the key skills and what order to teach them.

People only slightly familiar with ABA might think that it is the opposite of “adaptive”, since ABA is teaching you to follow exact rules and instructions.  So what happens when the situation is slightly different? Then what?

Some of these situations are predictable, like what to do when you are brushing your teeth and the toothpaste tube is empty.

The options might include:-
1.     Start screaming
2.     Give up
3.     Ask for help
4.     Brush with water alone
5.     Find a new tube of toothpaste
I think that the early emphasis on fine/gross motor skills helps the brain develop pathways that can later be used for more complex processes.  So insisting on learning to catch a ball, control a pencil, stack colored block in order is much more important than it may seem.

ABA may be teaching the brain to structure itself, which may be a pre-requisite for it to become more adaptive later on.
 

Motor skills and adaptive behavior skills in children with ASD

Thanks yet again to funding from the Simons Foundation, the following study looks at just this very subject.  The abstract is rather better laid out than the copy of the full version that I managed to locate.



Abstract
Objective
To determine the relationship of motor skills and adaptive behavior skills in young children with autism.
Design
A multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.
Setting
Majority of the data collected took place in an autism clinic.
Participants
A cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were
recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of
scores indicted through calibrated autism severity.
Interventions
Not applicable.
Main outcome measures
The primary outcome measures in this study were adaptive behavior skills.
Results
Fine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with
weaker motor skills displayed greater deficits in adaptive behavior skills.
Conclusions
The fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.


Fine and gross motor skills were predictive of those important adaptive/living skills.
Does this mean that by improving fine/gross motors skills you will improve adaptive/living skills? This comes to the recurring issue of correlation and/or causality.  Since this my blog, we can apply that overriding factor which is “common sense”, and say yes, in most cases, it will.

Our Experience of Adaptive Behavior
After a few years of ABA, adaptive behavior did gradually improve, albeit from a baseline of near zero.
It is clear from the literature that some children do not respond to ABA; I think it is really a case that they do not respond to anything.  In these children overcoming the biological origin of their autism is a prerequisite for meaningful progress.
It is also likely that the earlier a biological intervention is made the better the final outcome.  Typical kids can spend twenty years in education and so the more time an autistic child has in full time education with a “re-tuned” brain the better.  Adaptive behavior typically emerges/develops from birth to early childhood, a time when many with ASD are not “present”. 
If you can progress with ABA, then additionally treating the biological dysfunctions should boost the learning trajectory.
Only recently though did I start to observe some spontaneous developments.  Getting dressed after swimming, when your feet are still a little damp, it can be hard for anyone to put their socks on, so I am really pleased that Monty, aged 11 with ASD, now manages all by himself.
In the not too distant past, untangling his inside out jeans, re-attaching the half detached belt would have been the source of great frustration.  You could use ABA to train somebody to untangle their jeans and thread their belt neatly, but we never did.  This he is figuring out all by himself.
Another recent example is his latest Lego model.  We are big Lego fans, but in the earlier times Monty was more interested in “crashing” his Lego than playing with it.  It was a case of build it, crash it and then somebody else look for all those tiny pieces. 
His latest toy plane has extremely fiddly little stickers that you have to stick on the bricks.  If you do not get them lined up nicely, you have to pull them off and start again.  It really is a test of both fine motor skills and patience.
So I was assuming that when Monty came to the stickers, either he would not bother or he would ask for help.  But no, he just said “stickers” and stuck them on.

Things are definitely changing for the better.  




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