By Ifigeneia Mourelatou
Autism Practitioner & ESDM Specialist at Re:Cognition Health www.recognitionhealth.com

-Emphasis on instructions by the therapist and compliance as well as ‘correct’ responses by the learner

Unfortunately, many autism interventions focus almost entirely on instructions, compliance and getting the ‘correct’ responses from the learner, failing to facilitate and enhance more natural social initiations from the child.

There are equally (if not more) important communication functions compared to responding to questions or instructions, such as the child initiating a social chat, sharing an interest, asking for help, protesting, asking wh-questions, making comments, negating and much more that sometimes require facilitation.

Autism interventions should focus on helping children develop all early social communication skills that will help them navigate their lives and relationships.

-Relying largely on external positive reinforcement instead of intrinsic motivation

Positive reinforcement, including the use of repetitive praise (e.g. well done) or other external reinforcement forms like edibles, screen time, tokens, etc can be problematic. The main reason is that they can damage intrinsic motivation, meaning that the child is behaving in a certain way because they get an immediate short-term reinforcer, not because they actually want or are motivated to behave in this certain way.

When behaviours happen due to a strong connection, engagement, warm relationship, and the fun the child has with their play partner, these are way more likely to become a long-term natural way of interaction. Learning through relating is a powerful and lifelong tool for parents, caregivers, and teachers to use.

-Differentiation of wanted versus unwanted behaviours

The traditional behavioural differentiation between ‘wanted’ behaviours that need to be reinforced and ‘unwanted’ behaviours that need to be redirected or stopped is deeply problematic.

Undoubtedly, when aggressive or self-aggressive behaviours are present, they need to be redirected and everyone needs to stay safe, but there are other behaviours often listed as ‘unwanted’ behaviours, such as stimming, that require more understanding.

Every person is different and even though as a society we have set up some norms and rules of what is acceptable and what is not, ‘unwanted’ or ‘maladaptive’ behaviours in autism, as they are called, are often an attempt to communicate a feeling or need. Having communication attempts ignored or redirected can erode trust and leave the child feeling frustrated, misunderstood, and helpless.

In addition, even though sometimes the communication message behind the behaviour might be clear to somebody who knows the autistic person very well (e.g. their parent or therapist), some other behaviours are more difficult to explain or understand (e.g. those relating to sensory needs or pain), which takes us to the next point.

-Lack of understanding of sensory differences and needs

Many people on the autism spectrum have difficulty processing everyday sensory information compared to neurotypical people. A child’s responses to sensory experiences may not only fluctuate from one day to the next, but also from one moment to the next.

These sensory processing problems can range from hypersensitivity to sensory stimuli, e.g. hypersensitivity to sounds is quite common, to under-sensitivity to sensory information and can also range in terms of their pervasiveness which obviously has a corresponding impact on the child’s mood and learning capacity.

It is important to acknowledge when the child is at an optimal level of energy and well settled and thus ‘ready’ to learn and when, on the other hand, sensory needs are evident and thus adaptations may need to take place, e.g. the child might be having a ‘sensory overload’ and thus needing a break from the interaction.

-Not applying multidisciplinary or comprehensive intervention: the issue with targeted interventions and inconsistent methods

Due to the plethora of online information, parents are sometimes led towards targeted interventions that might help with some aspects but do not cover all domains that might be affected. An issue might arise if multiple modalities are being used from different backgrounds and principles.

Inconsistency of interaction approaches and methods can also be damaging to the outcomes of autism interventions, thus it is recommended that, especially when several professionals are involved, multidisciplinary team (MDT) meetings should be held regularly. Parents and caregivers are also advised to implement evidence-based methods as much as possible. 

-Not respecting the child’s interests

Trying to place the adult’s agenda on what the child should play with or occupy themselves with not only sends the wrong message, but also is not effective in teaching skills such as shared engagement, play, imitation, etc. That’s why most evidence-based intervention models focus on following the child’s lead in the interaction and respecting the child’s choice of activity or toys before attempting any targeted teaching. 

-Not involving parents

Professionals working with children in the autistic spectrum might be the experts in autism interventions, but a child’s parents (and sometimes grandparents or other caregivers) are the ‘expert’ on their child and they are the people who know them better than anyone else.

So, combining the expertise of the professional and the expertise of the parent would ensure a better outcome for the child’s skills and learning, the parent-child dyad dynamics, as well as the parents’ empowerment and self-confidence.