Teen with severe autism compulsively follows adults leaving classroom

Perspective and advice on helping student learn appropriate behavior from a specialist in the Autism Speaks Autism Treatment Network

I work in a severe-learning-handicap classroom with students who have autism. One boy, age 15, compulsively follows aides, teachers, counselors and assistants leaving the classroom. He will bolt from his seat, knocking students out of his way to chase after them. It’s a huge challenge during times of transition throughout the day. We’ve tried explaining that this behavior isn’t acceptable. Can you help us understand what drives his compulsive need? How can we help him understand that it’s not acceptable? I really appreciate your feedback.”

This week’s “Got Questions?” answer is by child psychologist Michelle Spader, of Ohio’s Nationwide Children’s Hospital, one of 14 centers in the Autism Speaks Autism Treatment Network.

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

Thank you for your question. Issues such as the one you describe present a great challenge for teachers, parents and other caregivers of a child – or an adult – severely affected by autism.

Deciphering motivations

When addressing challenging behaviors, we often find ourselves asking “why” a person does this or that. It’s a good place to start, and a functional assessment is a good way to find answers. For readers not familiar with the term, a functional behavioral assessment is a problem-solving process for addressing problem behavior. It relies on a variety of techniques and strategies to identify the possible reasons a specific behavior is happening and select interventions that directly address these reasons in a constructive way.

I suggest speaking with your school’s behavior specialist about which of several methods you might use to assist with this type of assessment. We consider the following functions in trying to identify the reason for a behavior:

Positive Reinforcement: The behavior stems from a desire to get something. It may be attention. That is, the student seeks a social interaction – be it positive or negative. Or it may be a desired activity such as going outside.
Negative Reinforcement: The behavior is an attempt to escape, avoid or minimize something unpleasant.
Automatic reinforcement: The behavior simply feels good. It’s providing some form of enjoyable sensory experience. Common examples include the repetitive actions we often see with autism (flapping, spinning, staring at a whirring fan, etc.).

Once we determine the purpose of a behavior, we can develop strategies to address it in constructive ways. For instance, let’s assume that following people out of the classroom simply feels satisfying for your student. That would be an example of automatic reinforcement.

Perhaps there’s also some positive reinforcement, likely in the form of attention. That attention doesn’t have to be “positive” in the conventional sense. It could be any interaction – positive or negative – that the student receives when he chases after someone leaving the room. Though it may seem counter-intuitive, even a scolding can reinforce attention-seeking behavior.

Strategies for teaching more appropriate behaviors

The overall approach I recommend is to encourage new and more appropriate behaviors that take the place of the behavior you want to discourage. In other words, you can decrease the student’s attempts to follow people out of the classroom by supporting behaviors such as staying seated and/or asking appropriately to get up and approach teachers.

My recommended strategies include:

Reward staying on task

Several times a day, when the classroom is calm, sit next to your student with some small rewards. Use your knowledge of the things and activities this student likes to guide your choice. For example, a short clip of a favorite song or video, stickers or small portions of a healthy snack.

Have a consistent phrase or two to signal the behavior you want to support. For example, “Please stay seated” and/or “That’s great; keep doing [appropriate activity].” If your student stays seated or engaged for, say, 1 minute, offer praise and the reward. Next …

Gradually increase the amount of time the student needs to stay seated or engaged to earn the reward.
Gradually increase the distance between you and the student when you give the verbal prompt for the appropriate behavior.

Once you feel the student understands the prompt, ask a teacher or aide to leave the classroom in view of the student. Make sure to be near the student and give the stay-seated prompt.

Immediately reward the student if he stays put. If he gets up, make sure the teacher he approaches does not speak or interact with him, even if he gets too close, speaks loudly or touches the teacher. This is important for removing any attention (positive reinforcement) he might be receiving for the inappropriate behavior. The teacher or aid should simply leave immediately and close the door.

Have patience. You may need several practice sessions for each level of this intervention.

Encourage appropriate communication

In addition, you may want to teach this student how to appropriately ask to approach a teacher or aide. We call this Functional Communication Training. It can be an effective way to decrease the inappropriate following by replacing it with an appropriate request to approach a teacher or aide.

If your student is verbal, you can teach him to use a spoken request such as “May I get up?” or “May I talk to [teacher’s name]?

If he is nonverbal or minimally verbal, you can help him make the request using visual supports (pictures), sign language or a communication device.

Learn more about visual supports and download the Autism Speaks ATN/AIR-P Visual Supports Tool Kit.

As described above, I suggest teaching this new skill with brief learning sessions several times a day. In the beginning, try to allow the student to approach the teacher each time he asks appropriately. This may seem excessive, but we want to encourage the new behavior by giving the student the reward he seeks.

Once the student is asking appropriately most of the time, you can progress to asking him to wait for a short time. You might say, “Not yet. Please do [small task] first.” Again, reward each successful compliance with praise and a small reward. Gradually increase the amount of time the student has to wait – or the frequency of saying “no” – as the student masters this new skill.

Permission tickets

Another helpful strategy is to give your student a set number of “get up and approach tickets” at the beginning of each day. Using the teaching methods described above, show him how to turn in one of these tickets each time he wants to approach a teacher. Explain that once the tickets are used up, the student needs to stay seated and keep on task. Remember to praise and reward each step as he masters this new system – both when he uses the tickets and when he stays put once they are gone.

Personalized teaching stories

In addition to the visual supports described above, I’ve found that personalized teaching stories can help convey and encourage new appropriate behaviors. The story describes a student – maybe your student – as he or she successfully learns and uses the new skill you are teaching. You can illustrate the story with drawings or even actual photos of your student.

Download the free Autism Speaks Personalized Story Templates, developed with the University of Washington READI lab.

Thanks again for your question. Please let us know how you’re doing in the comment section below or by emailing us again at gotquestions@autismspeaks.org.

Best of luck to you!