Jan
25

The Low end of Adaptive: Behavior Support with Fitness

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I’ve worked with a range of individuals on the autism spectrum with respect to Physical, Adaptive, and Cognitive functioning.  On the low end of adaptive/behavioral abilities, aggressive or self-injurious behavior can be a concern.  As a fitness professional, or someone who is providing an ongoing adaptive PE, active play, or movement program, the questions becomes; “What do I do to safely eliminate this behavior and how do I modify programming?”

The easy thing to do would be to forego all demands/programming. However this is in nobody’s best interest.  First let’s consider what aggressive/self-injurious behavior actually signifies. ALL behavior has meaning, and all communication attempts to convey something. Typically with fitness programs, the instructor is providing a demand (whatever they want the individual to do), and regardless of how fun I, or any instructor thinks the activity may be, the individual wants no part. This can be activity-specific or simply because we’ve changed up the individual’s typical routine (which may very well have been walking in circles, but is still a routine).  Something new, something that requires effort, may be enough to elicit maladaptive behavior.

Aggression and/or self-injury are usually “escape-maintained” behaviors. Their purpose is to get the individual out of the current situation. Particularly with non-verbal individuals, who lack more appropriate means of expressing needs and wants, this strategy may be met with reinforcement (removal of the demand situation). In the immediate, we want to ensure safety. Given. Absolutely. However the contingency that may form would, from the individual’s perspective, look like this:

He/She wants me to do something I don’t want to do —> I hit/bite/kick myself or them —> I no longer have to do that thing I don’t want to do.

The first proactive step is a behavior modification program, preferably developed by a licensed BCBA or other clinical therapist. It is impossible to eliminate a problematic behavior, particularly one involving communication, without providing at least one (and preferably more) appropriate option. One strategy that has been quite successful is to provide breaks after completing a task.

Suppose Chris is currently able to perform three push throws with a medicine ball and the next goal is four throws. If we are providing secondary reinforcement following the fourth throw (access to a break or preferred activity), we may ALSO provide a break when he asks appropriately (rather than engaging in the aggressive or self-injurious behavior), establishing the contingency between asking/pointing to a picture or using a different mode of communication, and access to the reinfrocer (in this case, a break). This strategy serves two very important purposes; Preempting the maladaptive behavior and providing a more appropriate response in its place.

A high rate of reinforcement to workload/demand may be necessary when first introducing exercise to an individual with low adaptive skills. It may also occur with changes of environment. One of my long-term athletes will become self-injurious when we move our sessions from outdoor in the Spring, Summer, and Fall to indoors during the Winter.  It may be the confined space (he likes to wander around), or that fact that I am now instructing him in his home, but as soon as we move inside the hits to the head and arm biting (his, not mine) commence. So I back off the demands and give him longer breaks between activities. He can ask, appropriately, for a break at any point and it is granted. Eventually, we get some exercise in.

It is always easier to do nothing rather than something, or decide that an individual just “doesn’t want to” or “can’t” participate in an activity, particularly when an extreme behavior is involved. We have to promote more respect and regard for ASD individuals than relegating them to situations that are not challenging or promoting healthy new skills.

None of this is theoretical. Some of the athletes who I now coach through intense, fun sessions, were hitting or biting themselves or me (particularly if I intervened in their self-injurious behavior) when we first began together. Take things at the pace of individual, from all three areas of functioning (Physical, Adaptive, and Cognitive). Remember that something aversive can be made less-so (and even enjoyable), by pairing it with known reinforcers and, just as importantly, with consistency over time.  Becoming familiar with an instructor, program, activities, and new words/association can alleviate anxiety, which may also be contributing to problem behavior.

Everyone deserves an opportunity to move, grow stronger, and become physically healthier. As professionals and providers we sometimes have to strategize a bit more, be willing to change things almost immediately, and keep in mind our priorities. Good information used intelligently leads to positive outcomes.

Live Inspired,

-EC

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