A Review of Self-Help Skills for People with Autism: A Systematic Teaching Approach, by Stephen R. Anderson, Amy L. Jablonski, Marcus L. Thomeer, and Vicki Madaus Knapp

Abstract

An overriding goal for all children on the autism spectrum is for them to function independently in their completion of daily routine skills, such as getting dressed, eating, and using the toilet. Unfortunately, most published curricula and teaching guidelines have focused on communication and academic skills rather than on self-help skills. The book, Self-help skills for people with autism: A systematic teaching approach, by Anderson and colleagues, provides parents and professionals with a systematic method for planning and teaching these valuable skills using scientifically proven methods of applied behavior analysis (ABA). This book is reviewed in terms of the strengths and limitations of the content, as well as its importance as a practical educational tool for assisting those who train individuals with autism.

It is well understood that many children with autism will experience significant difficulty in their development of self-help skills as a function of the social, behavioral, and communication deficits that define the neurological disorder. Self-help skills are of key importance, as they are critical for maintaining physical health and well being and form the foundation for other essential skills that follow. There exists considerable empirical evidence for the use of applied behavior analytic (ABA) methodologies for teaching a variety of skills that produce lasting functional improvements in many children with autism (e.g., Cohen, Amerine-Dickens, & Smith, 2006; Eikeseth, Smith, & Eldevik, 2002; Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Sallows & Graupner, 2005). Nonetheless, few published books, curricula, or teaching guidelines have focused exclusively on self-help skills. A newly published book by Anderson and colleagues, Self-help skills for people with autism, provides a systematic approach, derived from the science of ABA, for teaching self-help skills to children with autism spectrum disorders (ASD) with skill levels between 24 months and early teenage years. The book is intended to be a practical guide for helping parents and educational professionals teach children with ASD skills in the areas of eating, dressing, toileting, and personal hygiene.

The purpose of this paper is to provide a critical analysis of this book by outlining the highlights and limitations of the information presented by the authors. Chapters will be briefly described and evaluated in light of their utility for the intended audience and others with related interests.

General Overview of Book

The authors describe a five-part process for teaching self-help skills: (a) specifying the target skill, (b) task-analyzing the skill, (c) systematically instructing the skills training, (d) evaluating progress of the learner, and (e) making program modifications as needed. An illustrative feature of this text is the use of case studies at the start of each chapter that give a brief account of individuals with deficits in specific self-care tasks and demonstrate how a well-coordinated and systematic approach is effective in teaching more complex skills.

The book is divided into 11 chapters, each including a brief summary discussing the relevance of the information presented, and an appendix that includes a skills inventory and forms for planning and carrying out instruction. References and resources for self-help curricula are provided at the end of the book for those interested in pursuing the chapter information in greater detail. The intended readers for the book are parents, caregivers, and professionals who may not be familiar with formal educational practices or behavioral methodologies. With this audience in mind, the procedures in the text are described using general terminology, and definitions of methodological terms are given in language that is easy to understand.

Many tables are provided throughout the chapters to assist in understanding the concepts being discussed as well as implementing the procedures being taught. Illustrations are provided to assist parents in completing such tasks as assessing individual needs, arranging the instructional setting, developing task analyses, measuring progress, and more. Throughout the book, the authors make the point, both directly and indirectly, that common parenting practices alone are unlikely to be sufficient to teach self-help skills. Instead, it will require a highly coordinated and systematic approach that includes understanding of ways to motivate children to learn.

Chapters 1 and 2: “Reducing Long-Term Dependence” and “Identifying Individual Differences”

These initial chapters lay out the rationale for choosing to teach self-care skills to children with autism. The authors also describe individual differences among children and issues that may affect a child's development of these self-care skills. Their discussion of relevant factors, such as the importance of imitation skills and training for generalization, is adequate for the non-behavioral professional, but further expansion and more detailed examples from the research literature would have been an attractive addition for ABA practitioners.

Chapter 3: “Determining What to Teach and When”

This chapter takes the reader through the decision-making process used to select the specific skills to teach a particular child. This process begins with assessing a child's readiness to learn, as well as a parent's readiness to teach, using checklists that the authors provide. The authors do an effective job of defining and describing functional skills and teaching parents how to set reasonable expectations for their children as they continue to grow. The authors' discussion of the common difficulties and time requirements in teaching self-help skills was relevant and necessary, as these facts may better prepare parents for the realities they will face in teaching their children.

Chapters 4 and 5: “Establishing a Context for Learning” and “Motivating Your Child to Learn”

These chapters present a concise and readable treatment of the preliminary steps for implementing a training program: (a) Creating an effective learning environment, and (b) motivating children to learn. The discussion on preparing the physical and social environment, as well as the instructions for identifying, using, and fading reinforcers, will be useful to parents. An important area that was missing from this section, however, was the use of more natural reinforcers and ideas for making the learning tasks more reinforcing for the learner (e.g., using specially flavored toothpaste or toothbrushes that vibrate or light up, allowing a child to pick out his or her favorite clothes to wear prior to teaching the dressing sequence). The use of natural, non-contrived reinforcers during these teaching tasks may allow for more efficient and effective implementation of the training procedures by parents. Behavioral practitioners recommending this text to parents may want to provide supplemental information in this area.

Chapter 6: “Using Effective Tools For Change”

This chapter provides a detailed description of the systematic, five-step approach outlined in the introduction. Several examples are provided for each of the steps, along with detailed tables that illustrate how to carry out the specific activities associated with each step. For example, Table 6-1 (p. 51) provides a simple guide to understanding how to develop objective measures of progress. The authors describe specific teaching methods, including prompting, shaping, forward and backward chaining, and video modeling. The authors also include a brief, simplistic discussion on how to determine the most appropriate method for teaching a given skill set. The content on utilizing visual supports in this section seems somewhat incomplete and oversimplified. However, the authors refer readers to a specific publication for additional information. The authors' treatment of prompting and shaping offers some valuable information that may positively impact the effectiveness of a parent's teaching intervention. The section on using video modeling to develop daily self-care skills highlights a potentially effective technique that might not be familiar to parents. However, only one reference related to this topic was included in the reference section. Additional sources of information for using this teaching method would have been appropriate given the recent increase in available research on this topic. This chapter also contained some redundancies from previous sections (i.e., task analyzing), but this duplication may have been intended to insure comprehension of the complete teaching process.

Chapter 7: “Evaluating Progress”

This chapter outlines the process of program evaluation. The authors effectively explain the importance of data collection and provide useful instruments for making data collection simple for parents and non-behavioral professionals. By taking the reader through an actual ongoing teaching sequence with data collection, this text better prepares parents and teachers for implementing this process with their own children or students. The final section includes helpful recommendations for troubleshooting common problems, such as acquiring difficult steps and managing challenging behaviors that interfere with learning. These sections were relatively brief, however, and may not include enough information for a parent to adequately understand and effectively address severe challenging behaviors. Again, behavioral practitioners who provide this text to parents may wish to provide supplemental information on these topics.

Chapters 8, 9, 10, and 11: Teaching Specific Self-Help Skills and “Planning for Generalization”

These chapters provide detailed behavioral descriptions for teaching four primary self-help skills - dressing and personal hygiene skills (Chapter 8), eating (Chapter 9), and toileting (Chapter 10). Each of these chapters includes procedures for assessing individual needs, planning instruction, developing task analyses, and solving common difficulties. By including these essential components in the teaching process for each of these individual skill sets, the readers are not simply given procedures to carry out. Instead, they are given detailed directions regarding appropriate instruction as well as the rationale for using certain procedures to facilitate successful skill development. The many tables included in these key chapters supply useful tools, such as instructional planning and data collection instruments, checklists, procedural guidelines, and references to stages of self-feeding. These chapters provide an excellent synthesis of behavioral teaching methods in relation to the development of specific self-help skills. The book concludes with a short chapter on specific empirically supported behavioral strategies for promoting generalization.

Conclusions

Overall, this book provides a user-friendly, detailed description of the behavioral application of structured teaching of self-help skills for the exceptional child. Although the authors identify individuals diagnosed with autism as their target population, the behavioral training methods outlined in this book have been demonstrated to be effective for individuals with other developmental disabilities and should appeal to a wider audience beyond those who live and work with children with autism (e.g., Baker & Brightman, 2004, Cicero & Pfadt, 2002; Foxx & Azrin, 1973). This text does just what it set out to do — provide practical advice and simple tools that will enable parents and professionals to teach children with developmental disabilities valuable self-help skills that can lead to greater independence. The information is presented in an easy-to-follow, nontechnical format that is ideal for parents or teachers who may not have had any experience with systematic instructional techniques. As such, it should be of interest to a wide range of caregivers, teachers and clinicians. This book would also serve as an effective resource for applied behavior analysts to offer to parents and teachers looking to address some of these self-help skills.

Anderson and colleagues have filled a tremendous gap that exists in the instructional textbook market with Self-help skills for people with autism: A systematic teaching approach. With the exponential increase in the numbers of children diagnosed with ASD over the last 10 years, there has also been a growing body of research literature and practical books dedicated to disseminating various methods for teaching these individuals. However, the vast majority of the methodological training books and manuals solely address the teaching of communication, socialization, and academic skills. With the exception of a few skill specific textbooks, individual human service agency handbooks, and individual research studies, very few publications are dedicated specifically to the instruction of the core group of skills addressed in Self-help skills for people with autism. As such, this book appears to fill an important niche in the behavioral practice literature.

Despite the fact that the majority of the techniques highlighted in this book are not new, the approach that the authors take in disseminating these longstanding, sound behavioral methods to the non-behavioral reader is novel and useful. This book provides indispensable information for parents, teachers, and other professionals and does so with much encouragement for their efforts, as well as acknowledgement of the realistic limitations that caregivers will face when carrying out the teaching process. The use of illustrative case studies and easy to understand terminology make this book a tremendous resource for anyone who teaches, serves, or cares for individuals with exceptionalities related to autism or other developmental disorders.