Abnormal Psychology

640 CHAPTER 14

Even older children with autism who have developed some communication

skills may still have defi cits that prevent normal conversation. And, despite ade-

quate verbal skills, adults with autism often don’t understand elements of conversa-

tion involving a back-and-forth exchange of information and interest in the other

person, and so cannot interact normally.

Asperger’s disorder involves similar—although less severe—problems with so-

cial communication. However, there is very little research on how various factors

might contribute to autism as compared to Asperger’s disorder.

In sum, autism and Asperger’s disorder are primarily caused

by neurological factors (including those that are consequences of

genetics); the neurological factors give rise to symptoms of the dis-

order, which are psychological and social in nature. As noted ear-

lier, psychological and social factors also infl uence the course of

these disorders—indeed, every social interaction has the potential

to change the brain, if only by inducing learning (which occurs be-

cause of neural changes). However, at present, it appears that psy-

chological and social factors contribute to autism and Asperger’s

disorder only indirectly (e.g., by infl uencing where a person lives,

which in turn may be a risk factor for exposure to certain stimuli).

For this reason, in this section we do not discuss feedback loops for

autism spectrum disorders.

Treating Autism Spectrum Disorders

Treatment of autism generally focuses on increasing communication

skills and appropriate social behaviors. Unfortunately, there is no

cure for autism, and no one type of intervention is helpful for all those with the

disorder. The treatments that are most effective are time-intensive (at least 25 hours

per week), have strong family involvement, are individualized to the child, and be-

gin as early in the child’s life as possible (Rogers, 1998). Early treatment depends on

early diagnosis of the disorder; to ensure early diagnosis, the American Academy of

Pediatrics recommends that all children receive screening tests for autism before the

age of 2 (Johnson, Meyers, & Council on Children with Disabilities, 2007).

Targeting Neurological Factors

No treatments successfully target the neurological factors that appear to underlie au-

tism spectrum disorders. Medication may help treat symptoms of comorbid disorders

or of agitation or aggression. The medications most likely to be prescribed are anti-

psychotics and selective serotonin-reuptake inhibitors (SSRIs; des Portes, Hagerman, &

Hendern, 2003). Some research suggests that people with autism may be more likely

than other people to experience side effects from medications (Harden & Lubetsky,

2005). Medication is not usually prescribed for people with Asperger’s disorder

(Campbell & Morgan, 1998), unless it is for a comorbid disorder.

Targeting Psychological Factors: Applied Behavior Analysis

The technique most widely used to modify the maladaptive behaviors associated

with autism is called applied behavior analysis. This method uses shaping (de-

scribed in Chapter 4) to help individuals learn complex behaviors. The key idea

is that a complex behavior is divided into short, simple actions that are reinforced

and then ultimately strung together. For example, many children with autism eat

with their hands and resist eating with utensils, which can create problems when

eating with classmates or when the family goes out to eat. Thus, learning to use a

spoon is one behavior that is often shaped via applied behavior analysis. Initially,

the therapist looks for any spoon-related behavior—such as a glance at the spoon or

the child’s moving a hand near the spoon—and responds with verbal reinforcement

(“That’s right, there is the spoon, good job”) and perhaps some concrete reward,

such as a few small candies. After a few successful attempts at approaching the

spoon, the child is reinforced for picking up the spoon, then for putting the spoon

Jason McElwain, at 17, was manager of his high

school’s basketball team; he was thought to be

too small to be on the team. At the fi nal home

game, which his team was losing, with 4 minutes

to go, he was allowed to play. Here he is being

cheered by his teammates and the crowd after

he went on to score 20 points and win the game.

Jason was diagnosed with autism when he was

2 years old; he didn’t begin speaking until he

was 5 years old (Associated Press, 2006). As he

grew older his social skills improved (McElwain &

Paisner, 2008).

AP Photo/The Daily Messenger, Eric Sucar

Applied behavior analysis

A technique used to modify maladaptive

behaviors by reinforcing new behaviors

through shaping.