Treatment of Rigidity and Compulsion In a Child with Autism: A Case Study In An Intensive Treatment Center

Background: The Diagnostic and Statistical Manual of Mental Disorders—IV—Text Revisions (DSM-IV-TR) criteria for Autistic Disorder highlights repetitive patterns of behavior as a major qualitative characteristic of children with an autism spectrum disorder.  Clinicians who work with children with an autism diagnosis often struggle with rigidity that may border on compulsion in their clients.  These rigid and restrictive patterns of behavior often impact the quality of interventions as the clinician is often compelled to modify their own behavior to the child’s desires.  When dealing with rigid behavior, it is frequently seen as an “unavoidable characteristic” of autism that cannot be altered and when attempts to alter the behavior are made, significant problem behavior can emerge. 

Objectives: This study aimed to examine rigid and compulsive behaviors in a child with autism and determine what strategies may be successful in reducing these characteristics in an intensive learning setting. The participant was rigid around the manipulation or restriction of any materials that surrounded him in the classroom environment or directly on his workspace. It was the objective to gain the ability to move, withhold, and restrict these items when necessary during instruction time.

Methods: The dependent variables were screaming and aggression.  Before each session, the participant was allowed to choose items to bring to his work station.  In session, these items moved from the work space or removed from sight.  Initially, the participant was rewarded for the absence of screaming during brief intervals of item restriction.  The intervals of restriction were gradually lengthened and the participant was required to tolerate longer and longer delays before the items were returned to his control.  Gradually instructional demands were faded back into the work session.  An ABAB reversal with a Changing Criterion design was used to evaluate treatment effects. 

Results: Screaming was reduced by greater than 80% of original levels and instructional demands were successfully faded into the session. The participant tolerated his items being removed and controlled by the therapist during instruction.

Conclusions: These results indicate that the extensive restrictive and rigid behavior of a child with autism is a behavior that can be modified.  Addressing rigid behavior emitted by children with autism is of significant value, particularly in intensive treatment settings or academic arenas, due to the necessity of controlling the environment in which the child is learning.