Naomi’s Story (Age 31)

Adult with Autism and ADHD

Naomi is a 31-year-old woman, who has been diagnosed with Autism Spectrum Disorder (ASD) and attention deficit hyperactivity disorder (ADHD).  When Naomi was first referred to Vista Center for Behavior Analysis (Vista) in early 2011, she was living with her parents and working during the week as a YMCA activity instructor.  In some areas, Naomi functioned as a typical 31-year-old adult.

CHALLENGES
In many adaptive skills areas and in her social-emotional development, on the other hand, she was significantly behind her peers.  Her parents took care of most of her needs.  They did the household chores, took her on community outings, drove her to and from work, reminded her about appointments, and shopped for her clothes.  The family only consumed take-out food, most of which was unhealthy.  Naomi did not express her emotions in an age-appropriate manner.  If she felt sad or angry, she would burst into tears, scream, and/or walk away from the situation.  Naomi was able to speak in full sentences; however, she struggled with social interactions and had difficulty initiating a conversation.  She rarely asked questions and mostly replied with a very brief “Yes” or “No” response.

APPLIED BEHAVIOR ANALYSIS (ABA) SOLUTION
In 2011, Vista began providing parent training to her family, and, approximately 10 months later, Vista initiated an Adaptive Skills Program (ASP) based on ABA.

Positive changes in Naomi’s life were apparent early on as she gained increased independence and developed more age-appropriate social-emotional skills.  Like many other clients, Naomi benefited from an ABA approach.  Naomi’s Case Manager and her team of Behavior Interventionists (BIs) have been very efficiently using ABA strategies, and, in the sections that follow, we describe the details of Naomi’s ASP and the results of her treatment.

IDENTIFYING TREATMENT GOALS

A Case Manager from Vista conducted a comprehensive behavioral evaluation and needs assessment and decided, along with input from the family, to focus on the following social and living skills goals:

  • Increase social interaction skills

Vista’s team used procedures like behavior rehearsal (role-playing), prompting and positivereinforcement to improve Naomi’s social interaction skills.

  • Shop independently

Shopping skills were first practiced in the home setting using behavior rehearsal, and then theywere performed in community settings.  ABA procedures that were used included positivereinforcement, modeling (imitating), and prompting.  A reward system was implemented such that after a successful trial, Naomi received tokens.

  • Express emotions and feelings in an age-appropriate manner

Initially, skills were practiced during behavior rehearsal with the participation of Naomi’s parents.  Prompting, which involves verbal, gestural, or physical cues to perform the desired behavior, was used and the BIs also used positive reinforcement, or rewards.  Also, the BIs prompted the parents to use differential reinforcement to shape Naomi’s appropriate behaviors during and outside of the sessions.

Vista provided Naomi with a tool: an emotion thermometer. On this thermometer, a 0 rating means “I am feeling relaxed.”  Higher ratings on the thermometer correspond to more intensefeelings of anger or sadness.  Strategies to reduce anger or sadness were also listed on Naomi’s emotion thermometer.  Using this tool, Naomi was able to identify feelings of anger or sadness, calmly verbally express her emotions to herself and to her parents, and identify what strategies to use to reduce these emotions.

  • Increase healthy food choices

Naomi was given homework assignments that involved using the Internet to gather information on healthy foods and how to cook healthy foods.  Her homework also included cooking aminimum of one healthy meal per week. The BIs and parents modeled appropriate behaviors and used positive reinforcement and prompts.

RESULTS ACHIEVED

The results of Vista’s ASP with Naomi have been broad-based.

  • Goal 1:  Increase social interaction skills

Naomi currently performs these skills in up to 100% of the opportunities! She greets others, asks appropriate questions, answers questions and expands on the answers, and asks a friendout for an outing.  Naomi reports that she really likes going on outings with friends, so the goal itself provides a natural reward.

  • Goal 2:  Shop independently

Naomi is now able to shop independently.  She asks for assistance, picks out clothes that she likes, and makes purchases.

  • Goal 3:  Express emotions and feelings in an age-appropriate manner

Naomi’s social-emotional development is getting much closer to an age-appropriate level.  Shescores up to 85% in this goal area, which means that in 85% of the opportunities, sheexpresses her emotions appropriately, that is, she either verbally expresses her feelings or excuses herself.  When Naomi feels an emotion, she uses the emotion thermometer.  She points to a figure on the scale that corresponds with her emotions, and she expresses what she isfeeling. Currently, she is still learning to verbalize what she needs, such as a break, silence or some water, in order to decrease her anger and sadness.

  • Goal 4:  Increase healthy food choices

Naomi now chooses healthy meals in up to 75% of the opportunities. She has also learned to cook healthy meals.  Naomi has good Internet skills and she is able to look up healthy recipes online.

In addition to improvements in Naomi’s health, her accomplishment of this goal has led to anincrease in Naomi’s overall independence.  And this is one of her most important goals:  Naomiwants to be independent.

FOLLOW UP

Vista continues to work with Naomi on the goals listed above, as well as on other important goals. For example, one goal that still presents a challenge for Naomi is doing chores.  This is often a less preferred goal for clients.  However, by teaching Naomi to self-manage her behaviors and to use self-reinforcement (e.g., rewarding herself after a non-preferred activity), she may be motivated to complete less preferred activities.

Naomi has made remarkable progress since Vista began working with her and her family.  Both Naomi and her parents now have hope that Naomi will one day be able to lead an independent and fulfilling life.