Friday, March 07, 2014

Autism and the value of adaptive functional living skills

Autism is a neuro developmental disorder, characterised by impaired social interactions, impaired verbal and non-verbal communication and by restricted and repetitive or stereotyped behaviour. It typically presents before a child is three years old, although in some instances children appear to regress after developing along an age-typical trajectory.

Along with the characteristic symptoms of autism, many individuals with the disorder also have deficits in their ability to function independently and need extensive assistance or instruction to complete daily living activities.

It is important to teach adaptive functional living skills to such individuals to increase their independence, provide the ability to make choices and to alleviate stress on the family.

There are four primary skill sets that should be taught to individuals with autism and two secondary skill sets that can be taught depending on the individual's functioning.

The primary skill sets are:

Basic living skills

This includes basic self-help, self-care, self-management, hygiene routines, and core communication skills. These skills are considered a prerequisite for any functional skills program for any individual regardless of age, setting or disability.

These essential skills, if not mastered, will have a profound impact on an individual's ability to live independently, to be successful in school, and to take advantage of various social and recreational activities throughout their life.

Home skills

Regardless of the individuals living arrangement (living with parents, in a group home or independently), home skills provide essential skills required for living in the home. Some examples include meal preparation, laundry and general housekeeping.

Community participation skills

Participating in the community begins with learning to physically navigate the environment in a safe manner as well effectively communicate with people encountered while walking or while being transported. To be able to shop in grocery and department stores (independently or with a caregiver), use public transit or travel in a private vehicle in a safe manner and eat a fast food or sit-down restaurants requires a wide variety of skills.

The ability to tell time and use time related concepts, making and keeping appointments and other skills to help the individual interact with others in the community are also considered.

School skills

It is important for the individual to be an active participant in a variety of skills, routines and social situations in educational settings. These skills are essential in striving for independence and successful functioning in different types of classrooms, in all parts of the school campus, and with peers and various staff. Some examples include following instructions, following routines and social skills.

The two secondary skill sets are the following:

Vocation skills

It is important to teach vocation skills if an individual is of a higher level of functioning and can learn skills that will enable that individual to find meaningful employment. Vocation skills need to be paired with a workplace that will be willing to accommodate the individual.

The individual, family, clinician involved with training and the workplace management need to agree upon certain rules and guidelines which both the individual and workplace will follow and create a job task list for the individual to independently execute.

Independent living skills

These are skills that an individual needs to learn to live independently (or semi-independently). Most individuals with autism typically live with a family member who cares for them; although there is a certain population that also find themselves in a group home type setting. It is important that these individuals learn independent living skills to gain independence with their lives and the choices they make as well as to be safe.

Adaptive Functional Living Skills (AFLS) should be taught when the child is young and more malleable to learn. When routines for learning these skills are put in place early, it is easier for the child to understand and follow, for the clinician to teach and for the family to maintain.

As the child gets older, if any maladaptive routines and behaviours exist (or lack of any routine exist) they become stronger and more persistent.

The longer these behaviours are exhibited, the longer they will be reinforced. The longer such behaviours are reinforced, the harder it will be to replace those behaviours.

Thus, the individual will be more resistant to change and may exhibit behaviours such as aggression or withdrawal if the existing situation is altered.


As the individual gets older, it becomes harder for the family to continue shouldering the responsibility of carrying out adaptive living functions for the individual and this can cause excessive stress and burnout for the main caregiver or the family as a whole.

As the main caregivers get older and ultimately become unable to care for the individual with autism, the individual is often left helpless, as they do not have the skills to help themselves or know how to receive help from others. Furthermore, it becomes more challenging for unfamiliar adults to assist adults with autism who have no AFLS (as opposed to children). Other issues to keep in mind with this population are the individuals’ inability to understand and accept change (e.g. A different adult attending to them, a different living arrangement), change related aggression as well as the risk of being taken advantage of and abuse by unknown individuals.

Understanding how an individual learns is vital in deciding which teaching strategy to use to teach adaptive functional living skills.

Furthermore, teaching these skills properly and accurately the first time is imperative, as it is difficult for individuals with autism to ‘unlearn’ what they have already learned. If you or a family member will benefit from learning adaptive functional living skills it is important to connect with an experienced and qualified behaviour therapist to get the process started.

The writer is a Consultant Behaviour Therapist.

by Ishanthi Perera - Sunday Observer