JOURNAL OF APPLIED BEHAVIOR ANALYSIS

IMPROVING SOCIAL SKILLS AND DISRUPTIVE BEHAVIOR IN CHILDREN WITH AUTISM THROUGH SELF-MANAGEMENT

LYiNN KERN Koiwom, ROBERT L. KoEGia, CsmI HuRuLy, AND WIn”IAM D. F”A

UNIVERSITY OF CAORNIA AT SANTA BARBARA

The literature suggests that children with autism typically are unresponsive to verbal initiations from others in community settings, and that such unresponsiveness can lead to problematic social interactions and severely disruptive behavior. The present study assessed whether self-management could be used as a technique to produce extended improvements in responsiveness to verbal initiations from others in community, home, and school settings without the presence of a treatment provider. The results showed that children with autism who displayed severe deficits in social skills could learn to self-manage responsivity to others in multiple community settings, and that such improve- ments were associated with concomitant reductions in disruptive behavior without the need for special intervention. The results are discussed in terms of their significance for improved development of social skills in children with autism. DESCRIPTORS: autism, self-management, social skills, language, disruptive behavior

Although language researchers traditionally have been concerned with syntax (i.e., structure) and semantics (i.e., referential meaning), a shift in the field has gradually emerged that emphasizes a func- tional approach to understanding communicative competence and stresses a social perspective of lan- guage use (Kaiser & Warren, 1985). With the shift toward pragmatics, a greater emphasis is now being placed on the social interaction of commu- nicators within a given context, thus resulting in the study of larger units of conversation. Some questions of prime concern for pragmatic assess-

Funding for this research was provided in part by Cali- fornia State Department of Education Special Study Grant No. 42-03651-N27 1-00-33 that funded pilot work (USPHS MH28210 and MH39434 from the National Institutes of Mental Health) and by NIDRR Cooperative Agreement G0087CO234 from the U.S. Department of Education. The authors thank Alfred Bimbela, Yong Cho, Amanda Damron, Diane De la Riva, Sherri Goldstein, Trina Gravelle, Julie Jacobson, Kimberly Mullen, Teresa Paslawski, Deborah Ru- more Parks, Annette Smith, Jodi Smith, Kimi Stahler, Shel- ley Weichman, Laura Wilde, school personnel, and parents for their assistance throughout the study. In addition, we thank Rob Homer, Ted Canf, Wayne Sailor, and Glen Dun- lap for their feedback on earlier drafts of this study.

Requests for reprints should be addressed to Lynn Kern Koegel, Autism Research Center, Counseling/Clinical/ School/Psychology Program, Graduate School of Education, University of California, Santa Barbara, California 93106- 9490.

ment are: (a) Does the child relay a message ac- curately? (b) Can the child adhere to a topic without abrupt transitions to new topics? and (c) Does the child respond to questions and statements appro- priately (Cole & Cole, 1989)?

This shift in focus has been especially important in the treatment of children with autism, whose social and interpersonal relationships are pathogno- monic to the syndrome. Even in Kanner’s follow- up study of his original sample approximately 30 years later (Kanner, 1971; Kanner, Rodriguez, & Ashenden, 1972), he observed that the original clients remained extremely aloof and continued to experience significant difficulties in interpersonal re- lationships. Relatedly, some researchers have sug- gested that social deficits may be the primary dif- ficulties in autism (Fein, Waterhouse, Lucci, & Snyder, 1985). Further adding to this problem is the fact that the smooth flow ofconnected discourse depends on the listener’s ability to monitor the speaker’s messages and to provide feedback to the speaker concerning their effectiveness (Fey & Leon- ard, 1983). This type ofdiscourse regulation during conversational turn-taking is necessary for fluent conversation. Although most typical children are taught to use appropriate communication during their preschool years, many children with disabil- ities who have difficulty with language skills at-

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tempt to avoid interactions, thereby disrupting the communicative interaction. Because these disrup- tions occur frequently in children with autism, their ability to fit into integrated community settings is limited. Thus, the critical need for attention to social skills is obvious and of utmost importance.

Integration is now being considered as a primary goal in special education research, and it is now realized that mainstreaming and integrating indi- viduals with disabilities by simply placing them together in the same program or setting without support can be problematic. That is, such place- ment can result in poor social acceptance of the individuals with disabilities, negative rates of social interaction among their peers, poor self-concepts of individuals with disabilities, and a generally neg- ative attitude toward mainstreaming by regular ed- ucators (Gresham, 1986). It is dear that social skills need to be an integral component of the treatment program for children with autism if successfuil in- tegration is to be realized.

Self-management (R. Koegel & Koegel, 1990) is one treatment technique that has been found effective with speech sounds of children (L. Koegel, Koegel, & Ingham, 1986), academic skills with learning-disabled children (Harris, 1986), and in the treatment of children with developmental dis- abilities. Teadcing self-management techniques al- lows the child to manage his or her own behavior in the absence of a treatment provider for poten- tially long periods (cf. Dunlap, Dunlap, Koegel, & Koegel, 1991; L. Koegel, Koegel, & Parks, 1991). The decreased need for staff assistance sug- gests that self-management techniques are ideal for persons with developmental disabilities in inte- grated academic and community settings (Lago- marcino, Hughes, & Rusch, 1989; Moore, Agran, & Foder-Davis, 1989; Ninness, Fuerst, Ruther- ford, & Glenn, 1991; Rhode, Morgan, & Young, 1983). The present study attempted to improve social

skills in children with autism in a number of in- tegrated community settings with as little clinician presence as possible. We were concerned primarily with these children’s lack of response when other individuals attempted to interact with them. Be-

cause we wanted the children to be able to interact socially without the continual presence of a treat- ment provider, self-management was chosen as an intervention strategy. We also reasoned that if the children responded more consistently with a com- munication partner, the overall interaction would become more positive and escape- or avoidance- driven disruptive behaviors would decrease. Two primary questions were addressed. First, we asked if self-management could be used as a means of improving social communication skills (i.e., appro- priate responding to others’ questions) in children with autism. Second, we asked if such skills were improved on an ongoing basis, would decreases in interfering disruptive behaviors occur when others (e.g., parents, peers, and adults) attempted to en- gage the children in social communicative inter- actions.

METHOD

Subjects Four children with autism participated. All were

diagnosed by outside agencies and referred to our clinic for treatment. Three were in classrooms for children with communicative handicaps, and 1 (Ian) was in a classroom for children with severe dis- abilities. During an initial intake interview, all 4 children demonstrated symptoms in accordance with the diagnostic criteria for autistic disorder described in the DSM III-R, including a lack of responsive- ness to other people, gross impairment in com- municative skills, bizarre responses to various as- pects of the environment, and ritualistic behavior. In addition, each exhibited lengthy histories of dis- ruptive behaviors (as described below).

Criteria for participation in this study were two- fold. First, the children had to be reported by par- ents and teachers as characteristically unresponsive to others’ verbal initiations, despite the fact that language assessments indicated their receptive and expressive language scores to be at least at the 3-year-old level. That is, assessments indicated these children were able to combine at least three words, speak in a fairly intelligible manner, and understand most question types, such as yes/no, what, what

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do, where, who, why, how, and when (it was noted during the sessions that Ian was unable to under- stand “where,” although he did understand “what place”). Second, parent and teacher reports indi- cated the children’s typical response to the verbal initiations of others to be disruptive behavior. In- dividual subject characteristics were as follows (see Table 2 for descriptions of individual children’s disruptive behaviors).

Tony was 6 years 10 months old at the start of the study. Tony’s data were collected over a 22- month period. His composite IQ score, as measured by the Stanford Binet, was 58. His nonverbal in- telligence score on the Leiter International Perfor- mance Scale was 100. On the Peabody Picture Vocabulary Test-R, he scored an age equivalent of 4 years 4 months, placing him at the 1st percentile. On the Assessment of Children’s Language Com- prehension, he scored 94% on the vocabulary sec- tion and 100%, 80%, and 50%, respectively, on two, three, and four critical elements. His mother reported that he had numerous disruptive behav- iors, induding self-injury (picking at his skin to the point of drawing blood), inappropriate emotions such as laughing and crying too easily, frequent temper tantrums, physical aggression, and self- stimulatory behaviors. Adam was 11 years 1 month old at the start of

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