Kent, a high school student with autism, began regularly soiling himself on the school bus for no apparent reason. In addition, he began to smear his feces. This new behavior was very upsetting to everyone. Several interventions were attempted, including behavior modification and an intensified bathroom schedule, but none worked. In desperation, an autism specialist was consulted. In the end, a very simple solution was found. The thought process that led to this solution involved a thorough understanding of Kent and a clear understanding of autism.

From the perspective of the Individuals with Disabilities in Education Act of 1997, children with autism have difficulties in three main areas: social interaction, communication and behavior. Let's look at those three areas individually.

Social interaction

Children with autism often display impairment in appropriate non-verbal behaviors such as eye contact, facial expression, body postures and other social gestures. There is often a failure to develop peer relationships appropriate to developmental level. In addition, children with autism often lack spontaneous initiation to share interests, enjoyment or achievements with other people.

In Kent's case, he did not understand the social impact of his new bus behavior. He was unaware of the extreme stress he was causing others, yet he was delighted with the new, excited reaction he was eliciting from the adults and other students around him.

Communication

Children with autism may be nonverbal, some unable to communicate even through gesture or mime. Autistic children who can speak may be unable to initiate or sustain a conversation. Often, children with autism use stereotyped and repetitive or peculiar language. In addition, autistic children often don't play in a varied, spontaneous way or in a socially imitative way appropriate to their developmental level.

Kent was non-verbal. His picture exchange communication book that contained his entire vocabulary was safe at school on a shelf. So even if he wanted to communicate with anyone on the bus, he had no words at his disposal. He did know a lot of repetitive syllables that he vocalized when he was stressed. He used those frequently and very loudly on the bus.

Behavior patterns

Children with autism often display repetitive and stereotyped patterns of behavior, interests and activities. The intensity of their behavior is often atypical, such that a rigid adherence to non-functional routines or rituals interferes with functional behavior. Stereotyped and repetitive motor mannerisms are common, as is a persistent preoccupation with people, events or objects. Children with autism can have an unusual reaction to sensory input, and sometimes engage in behavior patterns that produce a sensory response, such as spinning or hand-flapping.

The people who knew Kent well reported that Kent seemed to appreciate the strong organic smell of his own bowel movement. It seemed to calm him. Kent was also interested in smelling feet, hands and pantyhose. When stressed, Kent would hit his head and repeat unique but meaningless vocal patterns.

Quadrant theory

In addition to these three main areas of difficulty, children with autism may exhibit some of the characteristics in the quadrant variables chart below. Children with autism are very complex and deal not only with the common challenges of socialization, communication and behavior, but also with the many variables associated with being verbal or non-verbal and having a low or a high IQ. Each child is different, but having a basic understanding of where each child is coming from will help you develop a system for communicating with him or her.

Kent's characteristics mainly fell in the Low IQ/Low Verbal quadrant. He knew the sign for "toilet," but neither the driver nor the bus aide knew what the sign meant. Kent did have a picture communication system and often used it to make requests at school. He was very rigid and routine-oriented and used the picture schedule board to help manage his day.

The solution

The solution was simple and magical. Inquiry revealed that Kent's new bus behavior started about the same time the bus route changed. A young girl had moved and the bus no longer needed to pick her up. It was clear that Kent did not understand this change, and he seemed stressed about it. A picture story about the little girl moving and what the new bus route looked like was written. Appropriate bus behaviors were included in the story. Kent's mother and teacher read it to him every day before he got on the bus. A visual schedule of the bus route was taped to the seat in front of Kent so he could follow the landmarks. The bus driver and aide learned Kent's signs and what they meant. A communication book with vocabulary specific to the bus route, appropriate bus behaviors and consequences for no "accidents" was made available to Kent for his bus ride.

An empty baby food jar with some strong smelling cheese in it was made available to Kent on the bus. He could open the jar and smell the cheese when he was feeling stressed. The option to smell the cheese when he was stressed was explained in his picture story. The result was dramatic.

The adults worked on eliminating their "getting excited" behaviors when Kent displayed inappropriate behaviors. Instead, a number of positive behavioral supports were put in place. The positive consequences of a bus trip without an accident were described in the picture story. The adults followed through on those consequences. (One of them was a turn to spin a wheel on a contraption created by the bus driver just before Kent got off the bus.)

When the adults working with Kent viewed the problems from Kent's perspective with an understanding of autism, they were able to help Kent. Understanding the reasons for his behavior and creating a coordinated plan allowed the adults to react to an extremely challenging behavior in a way that supported Kent's success.

About the Author: Jocelyn Taylor is an education specialist for the Utah State Office of Education.