Of course, our long-term goal for our students is success under realistic conditions, not just success during therapy. But evaluating success during realistic conditions too soon is likely to be extremely misleading.
Say Fred, a young boy with autism, loves pizza. But he has a dairy allergy, so he is not allowed to eat pizza. The school serves pizza for lunch every Friday. When the Fred sees all the other kids eating pizza and he can’t have any, he has severe tantrums, self-injurious behaviors, and dangerous aggression. There might be a wide variety of solutions to this type of problem. For example, maybe he could have dairy-free pizza every Friday, maybe he joins a lunch bunch on Fridays with kids who aren’t eating pizza, or maybe he has a special lunch with a favorite teacher. Through a combination of these 3 approaches the team eliminates this problem.
Fred’s classroom has art once per week. Due to fine motor issues, the occupational therapist is present during art class to help with his skills. She notices that he wants every project to be green, and problem behavior is extremely likely if not allowed to do so. So, she implements a successful program, “First, you use 2 other colors, then, you can use green,” which data show to be highly successful.
In music, Fred loves to play the drums, which the music teacher doesn’t mind, and allows him to do it for several minutes each class (if she didn’t it would cause a severe problem behavior). But she does mind when he runs into class in the middle of her other classes to play the drums. The team works together to successfully eliminate this problem by keeping the music room door closed. Fred just walks past the music room with his class if the door isn’t open.
After six months of intervention, the data on Fred’s problem behaviors are amazing. They are reduced by 95%. But, there still are some dangerous episodes from time to time. What happened on those days? Well…
- We were walking to lunch bunch and he heard on the loudspeaker that it was pizza day.
- The occupational therapist was sick and the art teacher didn’t remind him he had to use 2 other colors before using green.
- A child went to the bathroom and left the music room door open.
The above examples show how misleading data can be. We want to see practical data of how a plan is working in the “real world,” but obviously, these types of plans are not likely to make a long-term significant impact on the child’s life. They might solve an immediate problem, but, of course, they require constant attention or the problem behavior will come back. Generally, it’s not practical to do this over a whole lifetime.
Now, to be clear, I don’t think there is anything wrong with those types of interventions. They allow us to maintain the safety and dignity of the individual child. But just don’t confuse them with interventions that are likely to make a long-term significant difference in the lives of children with severe problem behaviors. The only thing that has a chance to do that is teaching skills, which can take some time.
So, sure–While we are carefully building the skills needed to be successful in therapy, make whatever modifications are necessary and practical to maintain the safety and dignity of the child when not in therapy. Just be careful not to confuse success under those modified conditions with the likelihood of success after therapy ends.