Abstract
A therapeutic intervention program for young adults with severe autism at the Oasi Institute in Troina Sicily is examined. The program, which integrates gentle teaching, humanistic applied behavior analysis, and functional communication training, values human interactions and provides opportunities to acquire functional skills through errorless learning activities. Reported are the results of an 18-month study to determine whether significant improvements in functional communication skills and an accompanying reduction in maladaptive/stereotypic behaviors could be evidenced in the environment using gentle teaching and positive approaches. The guiding principles of the program, its design, and staff training components are described along with an analysis of program findings.
Adolescents and young adults with severe autism typically display significant impairments in social interaction and communication, and engage in high-frequency stereotypic behaviors that at times may also include self-injury. These individuals, depending upon their level of stress or frustration, may become aggressive and may direct those aggressive responses away from self and toward teachers, speech and language therapists, or other caretakers in the environment. To create an environment in which adolescents and young adults with severe autism can acquire functional communication skills and other important habilitation and social interaction skills requires an intervention approach that treats individuals holistically and one that is not predicated upon treating an array of separate and discrete behaviors. Such an approach differs significantly from many intervention programs that rely heavily on applied behavior analysis (ABA) and may be more consistent with programs that employ some behavioral technology as part of an overall treatment program.
In programs using a strict ABA approach, "behavior plans" are developed that either reward targeted behaviors or the absence of maladaptive behaviors with a range of reinforcers or employ time-out or restraint procedures to reduce self-injury, stereotypy, or aggression. These "behavior plans" may be limited in their utility because of three important factors: (1) they often assume a certain level of cognitive function that may not be present; (2) they often ignore comorbid psychiatric or neurologic conditions; and (3) they often employ data collection procedures that are far too demanding for staff to implement. In other words, the structure of the program itself and the goals established by the behavior plan may result in increased stress and frustration for both the adolescent or young adult and the staff members who work with this individual. An individual's failure to meet criteria may promote increased disapproval on the part of staff and heightened levels of frustration, which in turn may result in increased levels of aggression, self-aggression, and stereotypy for the adolescent or young adult.
To create an optimum therapeutic milieu so that self-care and functional communication skills can develop requires an emphasis on the relationship between therapist and client, one that provides intense nurturing and limits frustration and stress. This is necessary because acquisition of important skills can only take place when high-frequency competing behaviors including self-injury and stereotypy are minimized. Because communication skills and maladaptive behaviors in persons with severe disabilities are typically negatively correlated, providing opportunities to increase functional communication skills can foster decreases in maladaptive behaviors (Durand, 1992).