I am a psychologist. I have a client with ausbergers disorder or
possibly autism. He refuses to make eye contact with me. Is there a
behavioral training for improving eye contact in children?

Hello Jm1948,


 
 Behavior Modification
=======================
http://www.ldonline.org/ld_indepth/behavior/behavior_modification.html

http://www.autism-society.org/site/PageServer?pagename=BehavioralandCommunicationApproaches

http://autism.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=autism&zu=http%3A%2F%2Fwww.autism-society.org

http://info.med.yale.edu/chldstdy/autism/astreatments.html#behavior

http://www.cesa7.k12.wi.us/sped/autism/asper/asper11.html

Creating a behavior modification plan:
http://www.ehow.com/how_13758_create-behavior-modification.html

?Behavior modification There are several methods of behavior
modification that are used to treat inappropriate, repetitive, and
aggressive behavior and to provide autistic patients with skills
necessary to function in their environment. Most types of behavior
modification are based on the theory that rewarded behavior is more
likely to be repeated than behavior that is ignored. This theory is
called applied behavior analysis (ABA).

Behavior modification often involves highly structured, skill-oriented
activities that are based on the patient?s needs and interests. It
usually requires intense, one-on-one training with a therapist and
extensive caregiver involvement.?
http://www.neurologychannel.com/autism/treatment.shtml#behav 

  
?He may stand too close or make poor eye contact. He may have trouble
understanding age-appropriate humor and slang expressions. Many are
clumsy and have visual-perceptual difficulties. Learning difficulties,
subtle or severe, are common. The child may become fixated on a
particular topic and bore others with frequent or repetitive talk even
when the other children have given clear signals that they are no
longer interested in the topic. Some have difficulties tolerating
changes in their daily routine. Change must be introduced gradually.?
 
"The individual with Asperger's must learn concrete rules for eye
contact, social distance and the use of slang. Global empathy is
difficult, but they can learn to look for specific signs that indicate
another individual's emotional state. Social skills are often best
practiced in a small group setting. Such groups serve more than one
function. They give people a chance to learn and practice concrete
rules of interpersonal engagement. They may also be a way for the
participant to meet others like himself. Individuals with Asperger's
do best in groups with similar individuals. If the group consists of
street-wise, antisocial peers, the Asperger's individual may retreat
into himself or be dominated by the other members. "
 
"Because Asperger's covers a wide range of ability levels the school
must individualize programming for each student with Asperger's
Disorder. Teachers need to be aware that the student may mumble or
refuse to look him in the eye."
http://www.baltimorepsych.com/aspergers.htm
 
"Typical behavior modification methods used for children with
emotional disturbances are often ineffective for children with
Asperger disorder. Whenever possible, they should be educated in
mainstream settings with additional supports as needed. The Functional
Behavior Assessment approach is usually effective at finding the cause
of challenging behavior. Social skills training can be helpful, but
many children and adults with Asperger Disorder need ongoing social
support."
http://www.helpforkidspeech.org/articles/detail.cfm?ID=294

?Cognitive Therapy - Individual cognitive psychotherapy may be helpful
to older children, adolescents, and adults. The focus of individual
cognitive psychotherapy is to help them understand the social behavior
of other people and to see how their behaviors can be viewed as
unusual by other people, As many individuals with Asperger disorder
tend to insist to be ?perfect? in their academic works or even in
games they play, or have to be the "first to finish" or have to be the
?winner.? Intensive cognitive therapy should also focus on changing
such "attitude" through "daily therapy" till significant "attitude
change." Additional therapeutic group experiences would be helpful for
these individuals to gain more insight of their disabilities.?

Behavioral Modification Therapy - Interventions for individuals with
Asperger Disorder should also emphasize on family members and other
professional caretakers working closely to shape maladaptive behaviors
of these individuals. Some individuals with Asperger Syndrome may
argue about anything and everything (e.g., number of pages of story
book to read at bed time, which card game to play, disagreement with
house or school rules). Some persons with Asperger Disorder may have
frequent rage reactions or temper outbursts in response to stress
(e.g., frequently afraid of making mistakes or failing in academic or
non-academic activities) and frustration (e.g., preservative questions
not being responded to or ideas being disagreed). These maladaptive
behaviors, if not being dealt with at young age, can significantly
affect the outcome of these individuals.

On the other hand, it is critical to point out that while the
"traditional support therapy" which emphasizes understanding and
accepting the individual with a disability may not be an appropriate
intervention for individuals who are ego-centered, defensive, and
argumentative. It is better to use behavioral modification
intervention to teach these individuals to obey roles at home, school,
work place, and in community. Reasoning, debating, and justifying
should be avoided when dealing with children and adolescents with
Asperger Disorder because these approaches tend to reinforce their
argumentative behaviors.

A few points should be emphasized here. First, behavior therapy
program has to be designed for individual children because individuals
with Asperger Disorder vary greatly in their handicaps and family
circumstances. Some treatment approaches that work in certain cases
may not work in others. Second, children with Asperger Disorder tend
to have difficulty in generalizing learned experience from one
situation/setting to another.

 Hence, the skills they have learned in a hospital or school tend not
to be transferred to the home or other settings. Therefore, it is
crucial that specific strategies be included in the individual
intervention plan to ensure the changes of that individual's learned
behaviors are being carefully monitored, that the problems in each
setting are dealt with, and that steps are taken to encourage
generalization of behavior changes. Third, since one of the
intervention goals is to promote the person's social development and
ability to live in a regular community, a home-based intensive
behavioral therapy in early childhood, which trains parents, siblings,
and local special education teachers to carry out behavior therapies
has been instrumental in achieving maximum results.?
http://www.autism-mi.org/aboutautism/asperger5.html


?Applied Behavior Analysis - ABA
Many of the interventions used to treat children with autism are based
on the theory of applied behavior analysis (ABA) - that behavior
rewarded is more likely to be repeated than behavior ignored. Although
ABA is a theory, many people use the term to describe a specific
treatment approach with subsets that include discrete trial training
or Lovaas. While the terms discrete trial and Lovaas have been used
interchangeably, only practitioners who are affiliated with Lovaas can
be said to implement "Lovaas Therapy."

In discrete trial training, every task given to the child consists of
a request to perform a specific action, a response from the child, and
a reaction from the therapist. It is not just about correcting
behaviors but is designed to teach skills, from basic ones such as
sleeping and dressing to more involved ones such as social
interaction. Discrete trial training is an intensive approach.
Children usually work for 30 to 40 hours a week one-on-one with a
trained professional. Tasks are broken down into short simple pieces,
or trials. When a task has been successfully completed, a reward is
offered, reinforcing the behavior or task. This method is not without
controversy.

Some practitioners feel it is emotionally too difficult for a child
with autism, that the time requirement of 30 to 40 hours a week is too
intensive and intrusive on family life; and that while it may change a
particular behavior, it does not prepare a child with autism to
respond to new situations. However, research has shown that ABA
techniques show consistent results in teaching new skills and
behaviors to children with autism.?
http://www.autism-society.org/site/PageServer?pagename=BehavioralandCommunicationApproaches


?In, 1987 a UCLA project by Dr. Ivar Lovaas and associates. In this
study 19 children were given 40 hours/week of one-on-one behavioral
treatment for two years. The findings were as follows: 9 out of 19
(47%) children successfully completed regular first grade and obtained
average or above average scores
on IQ tests. 8 out of 19 (42%) successfully completed first grade in
classes for language delayed or learning disabled children. They had
made substantial gains in most areas but not enough to enable them to
participate fully in a regular classroom setting. 2 out of 19 (11%)
made little or no gain and were
placed in classes for the severely autistic or mentally retarded. The
follow up to the 1987 study in 1993 by McEachin and Smith indicated
that 47% (9/19) were able to attain normal functioning in school at
the age of 13.

 ABA therapy program is one that early intensive (30+ hrs /wk)
intervention greatly effects the outcome of the child and in some
cases actually enables autistic individuals to function at a normal
capacity when treatment is complete. Although most of these studies
indicate the greatest gains are made the earlier the intervention is
introduced (preferably before age 5), it has been demonstrated that
children of all ages can make tremendous progress from an ABA type
program. ABA is not a miracle cure for autism, but it is one of the
best treatments that is currently available today to enable autistic
individuals to reach their maximal potential."?
  http://www.brighttots.com/aba_therapy.html


Select your state for contact information for resources:
http://www.nichcy.org/states.htm


PEACFUL COEXISTENCE
http://www.hyperlexia.org/aha_winter9697.html


"If the Asperger's sufferer is made aware of their condition, they can
make changes in their life to compensate for their condition. The use
of visual and auditory aids (calendars, schedules, watch alarms, etc.)
is recommended (Online Asperger Syndrome Information & Support
[OASIS?], 2000, March 16)."
http://www.angelfire.com/ct/ams/aspergerpaper.html


"The Lovaas Institute for Early Intervention is a research-based
program that specializes in teaching children with autism, pervasive
developmental disorders, and related developmental disabilities. The
program provides services nationwide."
http://www.lovass.com/ 
http://www.lovass.com/services/index.html 

Other links:
=============

http://ici2.umn.edu/preschoolbehavior/strategies/genintro.htm

http://ici2.umn.edu/preschoolbehavior/strategies/default.html

http://www.advoserv.com/who.html

http://www.autism.org/interview/irlen.html

Behavior Modification Charts
http://www.latitudes.org/behavioral_charts.html

Books
=====
http://www.keepkidshealthy.com/cgi-bin/ae.pl?asinsearch=0890797277

http://www.amazon.com/exec/obidos/tg/detail/-/B0009S5AK8/104-5669967-9724728?v=glance

http://www.amazon.com/exec/obidos/tg/detail/-/0890796831/104-1626582-8500738?v=glance

http://www.tonyattwood.com.au/

I hope this answer has given you some information with which to work!
Judging by the amount of information online, you?d probably be better
off purchasing at least one of the books above. If you have a free
account with Amazon.com, you can use the ?Look Inside the Book?
feature to determine the most useful books.

If any part of my answer is unclear, please request an Answer
Clarification, before rating. I will be happy to assist further, if
possible.

Sincerely, Crabcakes

Search Terms
============ 
Asperger's +  behavior modification + intervention
print: behavior modification techniques + aspergers
print: behavior modification therapy + aspergers
behavioral intervention

You've given a well researched answer but there are a few things that
are likely coming in to play with this child.

Consider autism or Asperger's as processing disorders where the person
has difficulty processing more than one mode of sensory input at a
time. That child who makes little eye contact with you may actually be
listening and taking in what you say; in fact, sometimes eye contact
can get in the way of effective auditory processing. If given the
choice, would you rather your client look at you or listen to you?

Take a look at what authors such as Temple Grandin and Donna Williams
say about eye contact. Both these writers are intelligent, articulate
people who have autism and freely write and speak about their
experiences.

What specifically are the behaviours that concern you? Taking a look
at them and more importantly, what is likely behind them will guide
you as to what form of treatment you attempt. It may be a mistake to
counsel your client behaviourally when there are other factors at
play.

With autism, PDD and Asperger's, it's often productive to first look
at the possible sensory sensitivites that may be leading to the
undesirable behaviours. A good book to look at is Asperger's Syndrome
and Difficult Moments - Rages, Tantrums and Meltdowns. The author is
Brenda Smith-Miles.

Another book to consider is called Freaks, Geeks and Asperger
Syndrome. It's by Luke Jackson, who has Asperger's; he wrote the book
when he wa thirteen. It's excellent.

After considering the sensory implications, the next area to look at
is communication. Even though people with Asperger's have very good
verbal skills, there's still a difference between good verbal and good
language skills. While they may be able to talk fluently, particularly
about their area of special interest, they will likely have auditory
processing difficulties and auditory sensitivities thay may be behind
the behaviours you're seeing.

Try visiting www.autismtoday.com and listening to the audio file of
Little Rainman, a boy with high functioning autism talking about how
life is for him. He speaks frankly about the behaviours and why he
feels he engages in them.

I'm a special education consultant, provincial autism consultant and
mother of a university student with Asperger's.  Please contact me if
I may be of assistance at questions@autismsite.ca.

Sharon A. Mitchell
www.autismsite.ca