Behavioral Intervention to Reduce Arousal Improves Compliance and Information Retrieval in Children with ASD

Background:  

Young children with autism experience difficulty with social interactions and communication, and have repetitive interests and behaviors. They are non-compliant to adult requests, often hyperactive, frequently display tantrums, avoid eye contact, and have delayed mental development. There is clear evidence that children with ASD also display resistant and non-compliant behaviour to task demands (Carr & Durand, 1985, Carr & Newsom, 1985, Rogers, Zelazo, Mendelson & Rotsztein, 1998). We hypothesized that avoidant/non-compliant behavior and errors in responding to requests for known material result from excessive arousal.

Objectives:  

To test this hypothesis, we created a procedure to shape calming behaviors following an avoidant response to a task demand, and predicted both compliance and a correct response to the same task demand that elicited avoidance initially.

Methods:  

A before-after design was used in which 30 children were exposed to differing numbers of control and experimental sessions, a total of 190 therapeutic episodes. For the first analysis, 21 children who had one control session and two experimental sessions, selected randomly, served as participants.  In experimental sessions, when the child displayed avoidant/non-compliant behaviors to a task demand, the parent initiated a calming procedure in which precise behaviors were rewarded with praise, a one second touch and/or a tiny edible.  In the control condition a calming procedure was not implemented when criteria for calming were reached. The exact method of McNemar’s test was used to investigate the association between type of session and outcome.

For the second analysis, all episodes were used and all 30 children served as participants. The effect of the type of session and quality of calming (Good, Moderate or Poor) on the probability of a successful outcome (compliance and correct answer), adjusting for age of the child, time elapsed from the previous session and number of previous experimental sessions, was examined using GEE logistic regression.

Results:  

For the first data set, Experimental session 1, in which a calming procedure was used following non-compliance to a task demand, elicited more compliance with a correct answer than the control condition in which no calming was used (McNemar’s test, p<0.001). Similarly, Experimental session 2 elicited more compliance with a correct answer than the control condition (McNemar’s test, p<0.0001). There was no difference between experimental sessions (McNemar’s test, p=0.18). For the second data set, a GEE analysis of quality of calming revealed that “Good quality” calming produced more compliance with correct responding than “Poor quality” calming (OR 18.6, 95%CI3.5, 97.8). Moreover, “Moderate quality” calming produced a statistically better outcome than “Poor Quality” calming.

Conclusions:  

These results support the hypothesis that the origins of an avoidant, non-compliant response to task demands in children with ASD is arousal that exceeds the child’s threshold for tolerance and triggers a biologically programmed stress (HPA Axis flight or fight) response (Zelazo, 2001). This view implies that an immature (Zelazo, 2001) or impaired (Hirstein, Iversen & Ramachandran, 2001; Mehlerk & Purpura, 2008) arousal modulation system that arrests the development of stress tolerance and self-regulation may be a fundamental component of autism.