Title: Motivation and Reinforcement for Adolescents and Young Adults with Autism

Daniel C. Marston, PhD, ABPPPrivate Practice in Behavioral

PsychologyNorth Huntingdon, PA

Credentials

• Board Certified in Cognitive & Behavioral Psychology, American Board of Professional Psychology

• Fellow, American Academy of Cognitive & Behavioral Psychology

• Fellow, Pennsylvania Psychological Association• Member, American Psychological Association Division 6

(Behavioral Neuroscience)• Member, American Association of Intellectual &

Developmental Disabilities (AAIDD)• Over 15 years of practice specializing in providing

behavioral health services to individuals with neurological disorders

Purpose of this Presentation

• Understand basic neurological aspects of autism

• Recognize how neurological and personality aspects of autism effect motivation and reinforcers

• Identify ways to recognize what can help motivate teenagers and adults with autism

• Address issues to consider when trying to motivate individuals with autism

What is Motivation?

One definition: Internal and external factors that stimulate desire and energy in people to be continually interested in and committed to a job, role, or subject, and to exert persistent effort in attaining a goal.

Reinforcement Theory of Motivation

• Comes from the field of Behavioral Psychology

• Proposes that an individual’s behavior is a function of its consequences

• Theories involving reinforcement focus on behavior

• Behaviors that are effectively reinforced tend to occur more often

Reinforcement Theory (continued)

• Increased frequency of behaviors implies that person has been motivated to engage in those behaviors

• Reinforcers are the behaviors or items that provide the reinforcement for increasing the person’s behaviors

• Theory of motivation here goes that effective reinforcers increase the frequencies of target behaviors

• And that implies that they have increased the person’s motivation for engaging in those behaviors

• This presentation will focus on reinforcement and motivation for individuals with autistic spectrum disorders

• But before we get into that topic let’s address what autistic spectrum disorders are and how they effect teenagers and young adults

Autistic Spectrum Disorders

• General category of disorders that includes Autism, Asperger’s Disorder and Pervasive Developmental Disorder

• Main symptoms of disorders include deficits in socialization, communication problems, repetitive behaviors and significant restrictions in terms of interests

• Asperger’s Disorder does not include significant communication problems

• Pervasive Developmental Disorder is seen as an autistic spectrum disorder that includes some but not all of the symptoms of autism

• All of these disorders are considered to primarily be neurological disorders

NEUROLOGICAL ASPECTS OF AUTISM

• Evidence from number of disciplines support that Asperger’s Syndrome & autism are variations of the same neurological disease (Coleman & Betancer, 2005).

• Disciplines that address this issue and supported that conclusion include genetics & neurology.

In her book on the neurology of autism, Coleman (2005) offered a summary of the clinical symptoms of autism based on a review of the neurological research:

Coleman, 2005 (continued)

• Children with autistic syndromes have impaired social interactions

• Children with autistic syndromes lack empathy (defined as lack of ability to integrate the cognitive and affective facets of another person’s life)

• Children with autistic syndromes have a disabling need for sameness

• Children with autistic syndromes exhibit repetitive & stereotypal patterns of behaviors

Coleman, 2005 (continued)

• Children with autistic syndromes who do speak begin to talk at unusually late ages

• Children with autistic syndromes who speak often have qualitative impairments in communication

• It is not clear exactly what the specific neurological mechanisms are for these symptoms

What neurologists are able to say about the causes of autism

• Autism likely due to problems with neurological development at a very young age

• General understanding from neurological research is that likely culprit is impaired connections of neural pathways

• Cause is likely either abnormally varied neural circuit or abnormality of neural components of one or more neural pathways

• These problems lead to dysfunctional information processing of behaviors & cognition starting at a young age

Prefrontal Cortex

• Area if brain extensively implicated in autism

• Explains deficits in executive functioning, cognition, language, sociability & emotion

• Rinaldi, Peroddin & Markram (2008)

• Price (2006)

Pregenual anterior cingulate cortex

• DiMartino, Shehzad, Kelly, Krain et al (2009)—provided summary of research of role this area may play in autism

• Plays a major role in person’s capacity to reason about thoughts & beliefs of others

• Otherwise known as “theory of mind”• Hypofunction of this area in autism

revealed in meta-analysis by DiMartino, Ross, Uddin, Sklar et al (2009)

Anckarsater et al (2006)

• Conducted a study of the impact of autism on temperament, character & personality development

• Identified autism & ADHD as childhood-onset neuropsychiatric disorders

• Studied personality characteristics of 113 adults with autism

• Found that autism spectrum disorders were associated with low novelty seeking and low reward dependence

Reward Dependence (RD)

• Reflects the degree to which the person responds to cues of social reward

• Seen as being an inherited trait• Individuals high in RD tend to be tender-hearted,

sensitive, socially dependent, and sociable• Individuals low in RD tend to be practical, tough-minded,

cold, socially insensitive, irresolute, and indifferent if alone

• Advantage to high RD: sensitivity to social cues which facilitates affectionate social relations and genuine care for others

• Advantages to low RD: personal independence and objectivity not biased by efforts to please others

What research on neurology and personality characteristics says

about autism• Autism is caused by neurological problems at a

very young age or even prior to birth• Neurological aspects of autism lead to low

Reward Dependence• This leads person to have a low response level

of social reward• Individuals with autism do not respond strongly

to the social reinforcers (praise, attention) that tend to influence the behaviors of individuals without autism

Teenagers & Autism

• Neurological aspects of autism effect individual at young age

• Teenagers with autism face same issues as teenagers without autism

• They tend to deal with them differently• What motivates teenagers without autism do not tend to

motivate teenagers with autism• It is during teenage years that you tend to see even

more the limited effect that social reinforcers have for motivating individuals with autism

• Takes some work to determine what can be a reinforcer for teenagers and young adults with autism

Deciding what is a reinforcer for individuals with autism

• There is quite a bit of variability in autism• No one reinforcer is going to work for everyone• Asking the person about their interests and what

they find rewarding is a good starting point but will likely not be sufficient

• Many individuals with autism otherwise will let you know what they find reinforcing

• Topics of their perseverations and/or repetitive statements often show what might be reinforcing

What is perseveration?

• Common symptom in autism

• Individual tends to focus on certain topics or activities

• Engages in repetitive behaviors associated with that topic or activity

What is Perseveration? (continued)

• Usually involves verbal statements about the topic or activity

• Shows difficulty person with autism has with focusing attention away from that topic or activity

• Some research has shown that perseverative behaviors can lead into reinforcing behaviors

Study by Baker, Koegel & Koegel (1998)

• Took the topics in the perseverations of youth with autism

• Made a game based on those topics that could be played with peers

• Found that the youths increased significantly their level of social interaction with the games

• That increase continue even at a 2-mont follow-up

• Similar findings in study of a specific type of attention conducted by Vismara & Lyons (2007)

Effective way of Approaching Perseverative Behaviors

• They can be seen as a way of connecting with the autistic teenager or young adult

• Shows what the individual is interested in without needing to ask them

• If you can identify areas of strong interest you can find activities the person finds reinforcing

• And if you take a slow approach you might be able to find ways of using those activities to reinforce other behaviors.

• Kroegel, Dyer & Bell (1987)—autistic youths were much less likely to be socially avoidant whent they could engage in activities in which they had already shown an interest

You can also use scales and reinforcement surveys to identify specific reiforcers

• Scales involve series of questions that help identify reinforcers• Questions focus on specific types of situations, information from

those questions can help you identify the types of reinforcers that are likely to work with the specific individual

• Example I will use is Motivation Assessment Scale • Reinforcement surveys list specific reinforcers and the person is

asked to help chose which are likely to be most reinforcing• Reinforcement surveys focus more on identifying the specific

reinforcers that are likely to work with the individual• What is important is that the methods help identify what individuals

are likely to find reinforcing rather than assuming that certain reinforcers will work for anyone with autism

Motivation Assessment Scale (Durand, 1990)

• Can be found at www.autism.ca/aide.htm

• From Durand’s book on severe behavior disorders

• 16 items rated on scale from 0 to 4

• 0 = “Never”, 6 = “Always”

Sample items from Motivation Assessment Scale

• Would the behavior occur continuously, over and over, if this person was left alone for long periods? (For example, several hours)

• Does the behavior occur when any request is made of this person?

• Does the behavior occur whenever you stop attending to this person?

• Does this person seem to do the behavior to get you to spend time with him or her?

Four general categories of reinforcers assessed on this scale:

• Sensory

• Escape

• Attention

• Tangible

Reinforcement Surveys

• Basically involves a list of possible reinforcers or a list of questions designed to help identify reinforcers

• There are reinforcement survey generators online (putting “reinforcement survey generator” into Google brings up several)

• But you can also create your own• Create a list of possible reinforcers you have available

and then ask person to choose which ones he/she likes the most

• Choices of reinforcers should be from different general categories of reinforcers

• You can also use questions to identify reinforcements without giving specific choices

Sample items from reinforcement surveys

• What are your favorite foods? • If you had _____ dollars to buy whatever you

wanted, what would you buy? • If you had 30 minutes of free time at ______

(school, work, home), what would you really like to do?

• What are three of your favorite things to do _________ (at work, at home, at school, with friends)?

• Who are the people you prefer doing things with at ________ (home, school, work)?

Some general categories of reinforcers

• Escape/Avoidance• Positive Attention• Negative Attention• Tangible (e.g. toys, stickers)• Adult Approval• Competitive Approval (e.g. being declared the winner of

a game) • Peer Approval• Independent Rewards (e.g. being allowed to do things

alone or with one other person)• Consumable Rewards (e.g. food)

Presenting reinforcers to increase motivation

• As discussed so far, work with the individual to determine what the reinforcer will be

• Make sure that the person understands what is expected in order to obtain the reinforcer

• Also make sure that the person is paying attention when reinforcer is administered

• Poor attention also limits the effectiveness of reinforcers

CONCLUSION

• Autism is a neurological condition• Impacts on individuals functioning throughout their life

span• Neurological impact is such that teenagers & young

adults with autism often do not respond to reinforcers that might typically motivate same-age peers without autism

• So you need to work with the individual to identify what reinforcers will motivate to do things you want them to do

• You can talk with the individual and use their behaviors and comments to help identify what might be effective reinforcers

Conclusion (continued)

• Listening to topics of their perseverations or repetitive statements can be one helpful approach

• You can also use motivation scales or reinforcement surveys

• Make sure person understands what they need to do in order to obtain reinforcers and is paying sufficient attention when reinforcers are administered