Functional independence skills are necessary for daily living and establishing quality of life. For ‘neuro-typical’ individuals, we exercise functional independence every day without thinking much about it. We get ourselves up, bathed, dressed, fed and out the door instinctually. For children with autism, however, these functional skills are often not always innate.
It’s important to develop these skills in order to foster greater independence. Personal hygiene and self-care are the cornerstones of functional independence skills. For people to maximize their potential, they have to understand the basic skills of bathing, feeding, and clothing themselves. To be “functionally independent” also includes communication, decision making, personal safety, recreational play and vocational skills.
We have a multi-faceted treatment approach at Springbrook Autism Behavioral Health that includes recognizing and rewarding incremental successes as it pertains to teaching functional independence skills.
Functional independence skills are about more than just behavior. When dealing with autism, people often focus on the maladaptive behaviors associated with the condition. A lot of those maladaptive skills–temper tantrums, violent outbursts, etc.–are the result of frustration from not having those basic skills.
Autism manifests differently in each person. No two people are going to be affected by autism in the same way. Knowing this, we have to approach each patient at Springbrook individually when it comes to teaching and implementing functional independence skills, as well as tailoring our positive reinforcement for each individual’s incremental successes.
When I talk about incremental successes, I’m referring to the process of measuring success based on where a patient is on the spectrum. For example, if I’m working with a patient who is prone to throwing tantrums and I’m trying to break him of that habit, I set a realistic goal he can meet–for example, going five minutes without throwing a tantrum–and then reward them him accordingly. By measuring the incremental success, it gives the patient an attainable goal, allows him to reach that goal and gives him a positive experience to build on going forward.
In teaching functional independence skills, we break it down into several domains: adaptive behavior, emotional issues, behavioral issues, cognitive issues, sensory motor issues, socialization and speech, and language. It’s critically important that we address all of the areas of a child’s life because our main goal is for the child to make it in the world. Any one of these individual issues could be promoting non-compliant behavior. Our goal is to focus on positive skills and begin dealing with areas that need improvement.
It’s imperative to start teaching functional independence skills at an early age. Ideally, parents should start teaching these skills as early as two or three years old, but that isn’t always feasible because of a late autism diagnosis. Regardless, it’s never too late to begin teaching these skills, and it’s never too late for a child or adult to learn them. I worked with a patient at Springbrook who was nonverbal and on the autism spectrum who never had any therapy until he was 33. We helped him break through speech barriers, and he learned to talk.
The key to teaching functional independence skills is helping the child be successful long-term, so we build on the skills they already have. The adaptive skills–getting dressed, eating a meal, cleaning, etc.–are usually the easiest to teach, and we “train” the child based on the skills he already has. If a child has demonstrated an aptitude for getting dressed, we break down the task into its most basic steps. For example, if he already knows how to put on socks, we start there even though he can perform that task. Once the child has mastered the task of putting on his socks and is rewarded for doing so, he sees the pattern of reinforcement and understands being successful in something he can already do. Then, we build on that and incorporate new tasks until the child can complete the entire task of getting dressed without assistance.
At Springbrook, we use the Functional Independence Skills Handbook, or FISH Developmental Program, as our base curriculum. When a child arrives at Springbrook, we give him a week or so to settle in and then give him a full assessment. From that assessment, we get a developmental profile, which shows us the child’s needs and where there are opportunities for growth.
The curriculum is designed to meet the child where he is and begin working there. For example, if I’m teaching him how to use a fork, I may ask, “Do you know what a fork is? Do you know how to hold a fork?” It’s called task analysis. You break the task down into the tiniest steps. We think of using a fork in two steps: picking up the fork and getting food in our mouths. When we’re teaching this skill to a child with autism, we may take that one event and break it down into as many as 100 different steps and teach each one of those steps.
Sometimes we have to guide or prompt a child through those steps. The key is to reduce that prompting. I’ve seen a number of parents who are very well meaning and prompt their child too much. As we pull back on prompting through those tasks, it creates and fosters a sense of independence that’s impossible to attain if we get to a point where the child can only perform tasks when prompted to do so.
Springbrook uses the graph included in the FISH curriculum to track the skill sets in the patients we work with. The graph measures the patient’s skill set when they arrive, tracks it every three months and then offers a final evaluation when the patient leaves Springbrook. Our interdisciplinary team, which includes occupational therapists, recreational therapists, speech therapists, etc., meets once a week. All of these disciplines come together and each has its own measures of success.
In our weekly meetings, the Treatment Team talks about a child as a group to discuss where we are and where we’re going regarding the child’s treatment. That tells us about progress more narratively but each of our assessments has a measurable score, and from that, we can objectively chart the course of success.
In my experience, everyone can learn some level of functional independence skills, no matter how high or low they are on the spectrum. The whole key to teaching these skills is to improve a person’s functional independence. We’re not here to cure autism (because we’re not going to), but we can minimize the impact of the disability. Typically, there are always areas where we will see positive gains.
At Springbrook Autism Behavioral Health, we work with your child to discover which treatments and therapies will have the best result. Our goal is to promote growth and independent living for every child, using the means that are most effective for each individual. Contact us today for a private consultation or to tour our campus.
This article was featured in Issue 78 – Back to School Success
