Understanding Behavior training in Autism Spectrum Disorder

By: Dr. Vishal A Ganar

By: Dr. Priyadharshini G R

Autism is a neurodevelopmental disorder exhibiting stereotyped and repetitive behavior. Behavior training in autism and its implementation, practicalities, time duration and method of training may lead to a successful transition of a behavior modification program.

The frequent reoccurrence of a problem behavior demands a lot of retrospective analysis and identification of appropriate triggers. This article gives insight on the overall understanding of behavior and a prospects for training in children and aduts with autism. Key Words:Habit, Reward, Learning, Memory Introduction: Autism spectrum disorders are neurological developmental disorders that impact behavior in three main domains i.e. Social interaction, communication and behavior. (1)The diagnosis is by the DSM 5 classification(2) whichfocuses on the clinical characteristics of the disorder. The rationale behind the problem behavior, in autism, has been explained as lack of imitation learning (1,3), structural and functional atypicalities in the brain region (4–6), misregulation of the brain circuits (7) etc. Dealing with problem behavior has been a comprehensive team approach, wherein, different domains are attended by the medical and rehabilitation professionals. Application of the learning principles, principles of neuroplasticity and medications to combat the neurobiological responses are the common rehabilitation process for children and adults with autism. In consideration, of, which age group benefit the best from a training? It’s deceitful to say children learning process are superior and rapidly progressive to the adult counterpart. The connectionism in an artificial life perspective (CLAP) considers behavioral change as an adaptation from the inheriting genotype, i.e. the learning, passed on by the previousgeneration thatinteracts with the individual’s experience encountered within the current population.(8) Understanding the importance that environment and exposure, has on behavioral change, learning and development, it is fundamental to consider forming habits which is energy efficient. Formation of habits gives an opportunity for the professional to further work on the cognitive enhancement training that overall progress the individual towards independent living.

Major aspect of our human behavior is attributed to habits that comes from education. The neural plasticity allows the nervous system to adapt new habit with initial inflexibility later developed to relative permanence(9)Habits here is classified as the change in the pattern of neural activity when simple habits are formed and broken via the habit circuits i.e. through the multiple processing signal in the brain.(10)The more routine the behavior,lesser the consciousness. In Autism, there is frequent action repetition which are habits in its extreme form leading to a problem behavior. (11)

Habit formation and its Clinical Relevance in Autism: Habitas in a behavior spectrum has a core feature of stubbornness that is, performing even though it’sunnecessary. Habit formation,wherein, the brain lay patternsin the form of memory chunks that with repetition and reinforcement contingencies favors a well imprinted habit in the brain, which could be a desirable or an undesirable behavior. (11) The outcome either desirable or undesirable behavior rely on the reward prediction errors. (12) The habits may transit toan obsession and compulsion affecting the motor and cognitive responses. Further, the neural signals mediating habits in obsession and compulsion state is hyperactive and inaccessible to a stop signals. (13)This creates a hindrance where in a behavior has no halt. Overall, the reward prediction errors alongside the obsession compulsion may lend an undesirable or a problem behavior. Habit may be automatic, this automaticity orstubbornness makes a habit difficult to erase and relearn.After a successful behavior training,overcoming an undesirable old habit, there is a possibility of reoccurrence. This may bedue to the chunking mechanism in the basal ganglia circuit (11) The basal ganglia circuit affects the cognitive and the motor behavior responses thus triggering repetitive and stereotyped behavior in neuropsychiatric disorders or addictive states. (14) Even though it hard to break a habit, but, the participation of the neocortex, todetermine the appropriate circumstances to enact the behavior with constantmonitoringgives room for behavior training, understanding the trigger of a behavior and ways to modulate it. Clinical Implication: There is emerging evidence that there is structural and functional abnormality in the basil ganglia impeding the normal flow in the neuronal circuits (15) Basil ganglia has a key role to play in learning and memory function. (16)Although there is altered structural and functional abnormalities in the brain, observation and identification of triggers and thesequence of events in a behavior gives an insight on the behavioralconfiguration and itsresponses. Cognitive and motor functional training has a key role to play in the formation of new habits. With appropriate planning and engaging in a purposeful activity through the day shall impart desirable behavior. The duration of behavior training, the decision of learning principle and its application, thetype of practice session block vs part practices, schedulingall depend on the age, set up, routine, socio economic status, the geographical location etc. All these aspects when considered has a greater probability for a successful transformation. The most important of all is the parent education on maintaining a long term commitments to behavioral modification training, which shall benefits the overall process of alleviating problem behavior, reducing reoccurrence and further, the cost effective ratio in course of rehabilitation.

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Dr. Vishal A Ganar

HOD; Dept. of Psychology; Neurogen Brain and Spine Institute Navi Mumbai
Director of Bhumika Foundation, Vocational Training and Adult Independent Living Center, Navi Mumbai

Dr. Priyadharshini G R

HOD; Clinical and Research; Bhumika Foundation Vocational
Training and Adult Independent Living Center, Mumbai