How Autism Differs in Boys vs. Girls

Autism Spectrum Disorder, better known as Autism, is a very complex neurodevelopmental disorder that affects cognitive and executive functioning. To find out more about Autism itself, visit this page for a simplified look. Autism has been studied more and more throughout the years, and an interesting area of study has been looking at the difference between boys/males with Autism vs. girls/females. It has been suggested that Autism is diagnosed 4 times more often in males versus females (Autism Speaks, 2020), but, why? Within the research, we have determined how signs and symptoms can look different, along with how males and females may internalize Autism differently. Although there may be some differences between males and females, it is important to remember that Autism presents uniquely in every individual, regardless of sex or gender. This blog will take a look at how different components of Autism have been proposed to differ between gender populations. 

Why are boys diagnosed 4X more often than girls?

It has been suggested throughout the literature that Autism is more heavily studied in boys rather than girls. Consequently, there are a few theories as to why females present significantly lower rates of Autism than males. One theory has to do with differing levels of hormones in the body and biological sex differences. This theory ultimately suggests that females with Autism may not be diagnosed as often because they present milder symptoms due to hormone variation (Soloman, Miller, Taylor, Hinshaw & Carter, 2012). Additionally, another theory emphasizes that some girls may in fact be more impaired than boys with Autism. This theory explains that girls may either require a higher genetic or environmental load to be affected, or that males present higher rates of less severe Autism symptoms (Soloman et al., 2012). Both of these theories have been supported through journal articles, however it still remains unclear exactly why males are diagnosed more frequently than females.

How does ASD differ between males and females?

A famous quote from Stephen Shore details, “if you have met one person with Autism, you have met one person with Autism”. This amazing quote outlines how broad the spectrum is, and how every single individual has their own strengths and areas of need. Keeping this quote in mind, we know how unique each child with Autism is, but is it common for Autism to present differently in boys versus girls? Many studies have suggested sex differences for displaying characteristics of Autism, such as boys exhitbiting higher levels of repetitive behaviours and stereotypical play (Soloman et al., 2012). Girls, on the other hand, have been suggested to be at an increased risk for internalizing their symptoms (Soloman et al., 2012), meaning they keep their feelings inside their mind rather than expressing it with behaviours. Unfortunately, there are considerable gaps in the literature that fully determine significant differences between males and females with Autism. This is most definitely a topic for further research, and it will be interesting to see what is to come. 

References

Autism Statistics and Facts. (n.d.). Retrieved April 7, 2020, from http://www.autismspeaks.org/autism-statistics 

Solomon, M., Miller, M., Taylor, S., Hinshaw, S., & Carter, C. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(1), 48–59.

ABA: Why the Controversy?

ABA wasn’t established as a field until 1968, much later than similar fields like medicine that have been around in some form for thousands of years. ABA has since been scientifically validated to be an effective treatment for those diagnosed with autism and its related disorders (Simmons, D., 1995). Due in part to its effectiveness in treating those with autism, news and media make it seem as though those in the ABA field can only work with individuals with autism. however; those trained in ABA have successfully worked in many different fields and on many different behaviours. Here are just some of the things that ABA has been used for;

• Reduction/cessation of smoking

• Eating Disorders

• Criminal Forensics

• Animal Training

• Training Athletes 

  • Gymnasts

  • Footballers

  • Ballet Dancers

• Addressing Addiction

• Business

So why the controversy? Beginning in the late 1960’s the field of ABA was just being established and it looked very different. While we know today that ABA is a safe and effective therapy for many behaviours, early practitioners had no guide on how to apply the principles they learned about behaviour to improving people’s lives. The use of behaviour principles in therapy was called “behaviour management” and early practitioners and programs relied too heavily on punishment strategies (meaning consequences that reduce a behaviour) due to their immediate results on reducing unwanted behaviours. Common punishers in those days included very loud noises, electric shocks, and water or food being withheld. As the field has grown so has our understanding of the principles of behaviour.

What About Punishment?

Early ABA practitioners used punishment strategies because they worked rapidly to reduce problem behaviours, so what was the problem? The problem was that they didn’t teach their client what to do instead. What often happened was a circle where a behaviour (like biting one’s self) was punished and would cease, only to be replaced by another, more intense behaviour (like banging one’s head on the floor. By the 1980’s the heavy use of punishment had reduced drastically and the field shifted toward a focus on what really changes behaviour, motivation. For a more in depth look at punishment check out our article on punishment and negative reinforcement. 

Moving Toward Rewards and Motivation

Practitioners applying new research from the field of ABA found that using rewards for appropriate behaviour was vastly more effective at creating and changing behaviour. This shift was reflected in the field of ABA as a whole as therapists and practitioners prioritized rewarding clients for appropriate behaviour while making sure that inappropriate behaviour was simply not rewarded, rather than punished. 

Is ABA Too Tough on Kids?

In the 1960’s there was a push to provide services at 40 hours per week for every client. This is no longer the norm and, while some research has shown that such high intensity of services is effective for some clients, most of those in ABA services today tend to receive from 10 to 30 hours per week of behavioural services, depending on personal need.

Research has demonstrated that humans, especially children, tend to learn best during play (Zosh et al, 2017) and ABA practitioners are typically trained to make services feel like play. ABA also focuses on training those providing direct services to be as animated and energetic as possible, so that services feel light and fun.

As an example; if I am working with a child on making eye-contact when spoken to and following directions I might tell the child that we are going to play a game of soldiers. I would let the child know that before we start the game I need to know they are listening and looking at me. The game of following directions as a soldier gives me the opportunity to have my client practice all of the directions they need to know and have fun doing it. As the client gets better and better at the game, we can start to practice in more serious ways and I can describe why it is important to follow directions by using statements like,  “Stopping when we hear the word “stop” helps keep us safe and healthy”.  

Is ABA Only For Problem Behaviours?

Some see ABA as a treatment only for “problem behaviour”; things like hitting, screaming, and running away. This is mainly due to “a few bad apples spoiling a batch”. Some practitioners fail to account for teaching their clients new, appropriate behaviours to replace the ones that were not safe or effective. This leads into a treatment cycle where the therapist is able to reduce an unwanted behavior, only to have another rise in its place. At Cayman ABA we have a 1:1 rule which is; if you are going to reduce a problem behaviour (tantruming for a cookie), you have to increase, or teach, an appropriate behaviour also (asking politely for the cookie).

Most ABA practitioners today use the science of ABA not only to reduce behaviour for their clients, but to teach all sorts of skills, from tying shoes and stating maths facts, to learning about sarcasm and how to change your tone when telling a joke. At Cayman ABA we tailor our interventions to our clients as individuals and typically have many more programs teaching or increasing a behaviour than we have for decreasing a behaviour.

Additionally, many in the field of ABA apply its principles not just for their clients, but for themselves. I used the principles of ABA to study for an important test and had a colleague use it to increase their exercise per week. ONce you know how effective rewards and motivation can be, it becomes the way you view the world. Want to increase a behaviour of your own, like studying or responding to emails? Start rewarding yourself when you study, or when you respond to an email right away.

A Message of Hope

The initial stated mission of the science of behaviour analysis was to save the world through the knowledge that the scientific study of behaviour brings. At Cayman ABA we realize that we probably can’t change the world, but we can teach kids the skills they need to thrive in the world and we can help families feel like they are not alone.

References

Simmons, D.A. The NAAEE Standards Project: Papers on the Development of Environmental Education Standards; North American Association for Environmental Education: Troy, OH, USA, 1995. [Google Scholar]

Zosh, J.M., Hopkins, E. J., Jensen, H., Liu, C., Neale, D., Hirsh-Pasek, K., Solis L.S., & Whitebread, D. (2017). Learning through play: a review of the evidence.Demark: LEGO Foundation

Behaviour Intervention Plans: What They are and Why They are Useful

What is a Behaviour Intervention Plan?

A Behaviour Intervention Plan (BIP) is an outline that describes, monitors and aims to replace a targeted behaviour. A targeted behaviour is typically one that is harmful or inappropriate, and causes disruption in other aspects of daily life. Targeted behaviours can include non-compliance, tantrums, and self-injurious behaviours. By creating a BIP after an assessment of the client, behaviour analysts are able to determine and describe the target behaviour, and create a treatment plan to decrease the occurrence of said behaviour. Every BIP is specific to the client, meaning we decide what intervention approach to use based on the strengths and needs of each individual. We realize each individual learns differently, which is why we spend quality time ensuring the BIP is the best practice for that client. 

Breaking Down a BIP

Now, when looking at a BIP for the first time, it may seem daunting and confusing. Let’s break it down into the individual components, along with an example to really paint a picture of what exactly a BIP looks like. For example purposes, we will use the random name “Bobby” as our client.

Date: The date the BIP was created.

Ex: 15 April 2018

Behaviour: The target behaviour we are aiming to reduce, and the setting we are working in, i.e. at home, school or in the clinic.

Ex: Tantrum (Clinic)

Operational Definition: Defining the behaviour in a way that can be observed and measured.

Ex: Any episode of crying, flopping to the floor, disrupting objects and/or screaming. Onset is 10 seconds; offset is when he’s calm for 30 seconds. Does not include crying when he is hurt.

Measurement: How we measure the behaviour appropriately; do we measure how often the behaviour occurs, or how long the behaviour occurs for? (These are a few examples, among others, of how we can measure a behaviour).

Ex: Duration

Functional Behaviour Assessment Date: The date the client was assessed to determine the “where”, “when” and “why” of their challenging behaviour.

Ex: 14 April 2018

Function(s): The “why”, or the reason behind, the target/challenging behaviour.

Ex: Attention and Escape 

Function Statement: Specifically describing the function of behaviour.

  Ex: Bobby engages in tantrum behaviour to escape non-preferred tasks, and to gain attention from therapists/peers.

Baseline: Data collected before the intervention starts. 

Ex: January 2018: Baseline data was taken over a period of 10 days and 25 individual sessions in the clinic. Bobby engaged in tantrum 55% of sessions, ranging in duration from 0 seconds to 55 minutes. 

Current Goal: The goal, which is specific, measurable, achievable, realistic and timely, in place for the target behaviour.  

Ex: By August 2018, the behaviour of tantrums will last no longer than 1 minute per episode in the clinic setting, across two different therapists, for a period of 2 weeks. 

Progress: The data collected to determine whether or not the client has made progress with the intervention plan. If this is a new behaviour plan, this section will not be applicable until therapy has started. 

Ex: N/A, as this is a new goal and behaviour plan. 

The next 3 sections of the BIP are the specific intervention strategies used for the client, and are all based on the client’s specific strengths and areas of need. 

Antecedent Manipulations: Preventative strategies must be done before the behaviour happens, not as a reaction to it.

Functionally Equivalent Replacement Behaviour(s): Replacement behaviours are the healthy behaviours we are reinforcing, instead of the challenging/target behaviour we are trying to decrease 

Consequence Manipulations: Reactive strategies are planned responses that all stakeholders must follow, across all environments 

Putting it all Together: Why do we use a BIP?

A BIP is an essential element of ABA therapy. The BIP provides us with all the information needed to implement a behaviour plan and monitor the client’s targeted behaviour(s). As time goes on, we analyze the data taken during therapy sessions, and determine if this behaviour plan is allowing the client to make any progress towards the current goal. If progress is not being made, behaviour analysts will take a step back, and make changes accordingly. A client’s BIP is the foundational resource that is used to ensure the best practices and measures are implemented for their specific needs.