Talk to any parent with a child with autism spectrum disorder and they’ll tell you that small events, like brushing teeth or getting dressed, can cause untold amounts of stress. Children with autism with behavior difficulties may not be willing to do an assignment at school or cooperate with a parent wielding a toothbrush, and many parents would call that a spectacular understating of the challenges they face in establishing everyday routines to get a child to take over that responsibility.
Many parents, however, feel ill-equipped to handle the tantrums and aggressive behavior of a child who cannot communicate his or her needs. Autism is a mysterious neurological disorder that strands children in their own private world, sometimes oblivious to others, without the curiosity and instinct to socially imitate, which makes learning possible. Many have no meaningful language, are prone to tantrums that disrupt schooling and cling to ritualistic behavior that takes the place of play.
When parents cannot explain their children’s behavior or have reached a breaking point in dealing with the stress related to caring for a child with autism, they turn to people like Amanda Hastings, a clinical psychologist and a 2015 graduate of the Post-Master’s Certificate Program in Applied Behavior Analysis at the Johns Hopkins School of Education. Since graduation, she has worked for the nonprofit HSC Health System, which serves people with disabilities and complex health care needs in the Washington, D.C., metropolitan area.
She sees an average of 20 children ages 6 and younger for an hour a week with varying levels of disability, but specializes in children with high-functioning autism who have trouble with behavioral and emotional regulation. She develops plans to decrease disruptive behavioral problems and increase communication skills, and teaches parents how to implement those plans. The children and their parents are treated on an outpatient basis either for 12 weeks or up to a year and a half depending on the severity of the difficulties.
“I want to help reduce stress for parents raising children with special needs who have behavioral challenges,” said Hastings. “I really love children, I like to teach and I’m pretty patient.”
The Post-Master’s Certificate in ABA program is designed for special educators, administrators and school counselors who are seeking this specialized training to improve outcomes for children and youth in various school settings. Candidates who receive preparation in the evidence-based practice of ABA are better prepared to meet the needs of a growing population of students requiring special education services.
“Dr. Hastings is an excellent example of the impact of this program, outside of a typical school system, to help improve outcomes for students with special needs and specifically students with autism,” said Tamara Marder, an associate professor and program coordinator of the certificate program at the School of Education.
Hastings gravitated to the field as a result of her experience with a cousin who has high-functioning autism. He was diagnosed late in life, and her aunt told her that she wished there had been more professional support for him when he was younger.
“That conversation stuck with me,” said Hastings.
Applied Behavior Analysis, or ABA, is the application of the principles of behavior to improve learning of specific behaviors or skills in all individuals. ABA has its roots in the research of B.F. Skinner, a pioneer of modern behaviorism, by examining how behaviors can be changed by the reinforcers and punishers easily accessible in our environment. For nearly 50 years, research in ABA has examined the impact of these principles of behavior, and over the past few decades ABA has been proven to be effective in addressing the learning needs of children with autism.
Self-help skills, like independent hand-washing, are taught one step at a time and may require hundreds of repetitions until they are mastered. Tantrums and other idiosyncratic behaviors must be assessed and improved to increase a child’s likelihood of successfully attending school or participating in community activities, such as speech and language therapy and occupational therapy that support daily functioning.
“In order to better formulate treatment plans, I wanted to have more knowledge about ABA therapy and that’s why I sought out the program at Hopkins,” said Hastings. “I was the only psychologist, among teachers, in the program. It was a really good learning opportunity, because I was able to tailor more realistic recommendations to school teachers after completion of the program.”
One of her patients is a young girl who hadn’t been diagnosed with a developmental delay and was referred to her a year ago by another psychologist because she was non-verbal. The child was prone to tantrums, and her parents often had to help calm her down by feeding her snacks.
“I evaluated her and diagnosed her with autism and severe social-communication deficits,” said Hastings. “I initiated training for the parents for the behavioral concerns.”
The child’s behavior was so difficult that she wasn’t able initially to participate in speech and language therapy at HSC without support. Hastings implemented a plan that helped decrease the child’s behavioral problems by having her use an iPad to communicate her needs and to teach her to wait for highly preferred items. Then she worked with the parents to implement the plan at home.
“I let the parents know that what may be hard now will pay off in the long run,” she said.
Over time the tantrums got shorter and less intense, and the girl now goes to speech and language therapy with very few behavioral challenges. Hastings also referred her to more intensive ABA therapy after school to improve her academic and self-help, or adaptive, skills such as brushing her own teeth, dressing on her own and improving her safety awareness when engaging in community activities.
“She’s definitely a different child than a year ago,” said Hastings. “It makes me feel proud. I’m fortunate to work for an institution that supports families with children who are more difficult to parent.”
Hastings said her School of Education degree has given her professional recommendations more weight among teachers than if she were to consult with only a psychology title. In addition, she said there aren’t many people in the D.C. area with a psychology degree and a BCBA—the board-certified behavior analyst certification that is available only after completion of ABA-specific coursework.
“My education at Hopkins broadened my whole outlook on where this child is going to go in years to come,” she said, “and the degree has opened so many doors professionally.”