Introduction to the Neuro-Strength-Based Approach to Writing Functional Goals for Autistic Individuals

What is the underlying rationale for a Neuro-Strength-Based Approach (NSBA) to Writing Functional Goals for Autistic Individuals?

Current approaches to teaching children on the autism spectrum tend to focus on modifying and teaching behaviors to enable autistic children to perform more like typical children, using either a behavioral or developmental approach. Assessment focuses on what the autistic child is unable to do, then treatment strategies are selected to teach them to do what they currently can't do (remediating the deficits, i.e., missing skills, in their functioning). Research into autism, however, is pointing to neurological (along with biochemical) differences to explain the altered behavioral and developmental challenges that autistic individuals face in acquiring skills and performing in ways that typical children do. It makes sense then that a new approach is needed, one that focuses on what we now know about the challenges that autistic individuals experience in learning. It is also time to change the focus from remediating deficits to building on strengths and respecting differences that define the individual as the person they know and want to be.

The NSBA is a way of working with autistic clients that respects their neurological differences and capitalizes on their personal strengths. The NSBA is an updated approach based on the current research in autism. What is new in the NSB approach is how knowing about these neurological differences can help educators and therapists to identify what is a strength verses a weakness and how goals can be developed, and strategies selected, based on those strengths. The NSBA does not promote specific techniques that are expected to work with all individuals on the autism spectrum. The focus in the NSB approach is on selecting strategies to teach skills that will enable function by using a combination of techniques (or methods) that most closely match that individual’s strengths while respecting their neurological differences. It makes sense that the focus for therapists and educators needs to be on improving the individual's functioning in their current role and environment(s), not merely acquiring skill sets in the clinic or classroom settings. What good is acquisition of skills if the client is unaware of the reason for learning that skill and therefore does not use it where it is most needed, in the home and community environments? For this reason, the most important step in the NSBA approach is establishing the functional priorities that the autistic individual is facing every day. This includes the functional priorities of those who live and work with the individual but also the priorities that the individual has for themselves. This concept, that the individual may have their own functional goals in life and their own ways of achieving those goals, is often ignored in other approaches when working with autistic individuals. It is assumed that their goals are the same as ours…to be like everyone else…which is why remediation of their perceived deficits or ways of functioning become the targeted goals. Yet, what motivates or works for the autistic individual is their greatest strength. It is therefore important to recognize and incorporate the autistic individual's goals into the goals we set for them. As humans, we are all open to finding better, faster, easier ways of accomplishing our goals in life. Thus, the focus should be on helping the individual find socially acceptable ways of achieving their goals or modeling for them how they can achieve their goals AND what others want for and from them at the same time.  The goal should never be to take away what is important to an individual or deny them the only way they know to function.

The need for a strength-based approach to working with autistic individuals is not a new concept. An article from 2006 published in Research and Practice for Persons with Severe Disabilities recommends, four areas that need to be included within the assessment process: (1) child choice of items and activities; (2) family strengths; (3) child strengths; and (4) environmental assets. All of these, and more, are included in the NSBA. I have listed at the end of this section 4 other references that emphasize the need for a strength-based approach when working with autistic individuals. The one that I strongly recommend that you read is Authentic Strength-Based Practice, Can Neurotypical Professionals Make A Paradigm Shift?  (https://autismspectrumnews.org/authentic-strength-based-practice-can-neurotypical-professionals-make-a-paradigm-shift/?fbclid=IwAR0ExrSoarILpUh5-gQeY39i5vKNRVJEkcEU2ET4rtoV_zdiCBjD_I7-k90). 

 Theories on how the brain learns are abundant (https://www.learning-theories.com/). Solid research into the neuroanatomy of brain function in learning is more limited. Current research on autism has only recently recognized that there are sensory processing differences, not just anatomical differences, in the way the autistic brain works. Since Sensory Processing theory has explored the neuroanatomical foundations of brain functioning, I have included these neurological findings in the NSB approach to autism. In addition to finding and building on a person’s strengths, it is important that those working with individuals with neurological differences understand and respect those differences, not confuse them with defects or deficits that need to be fixed or corrected.  Everyone has strengths. Everyone has weaknesses. Weaknesses are merely strengths we are lower in (i.e., potential strengths). Physical and mental strengths can help an individual find a way around these weaknesses. Focusing on weaknesses exclusively is not motivating to anyone and can trigger highly negative reactions. How much better is it to help an individual identify their strengths and then learn to use those strengths to get around their weaknesses to achieve goals that help them function more effectively in their world? Thus, learning to share control and developing a reciprocal communication system between the individual, teacher/therapist, and family that taps into each other’s strengths and respects each other’s limitations is a strong part of the NSB approach to autism.

The Catch22 with any strength-based approach when working with individuals on the autism spectrum with severe challenges is that their neurological differences typically involve difficulties in communicating their needs and wants…at least in ways that the typical person can easily understand. Making choices is difficult when input from the environment is either overwhelming or meaningless to them. The way in which an autistic individual functions (executes an intended or purposeful action) may be not perceived by others as “appropriate” or "normal" and these actions or behaviors may be discouraged (if not outright prevented). Because the autistic person’s way of communicating (remember behavior IS communication) is so poorly understood people ignore it or assume the autistic person is incapable of thinking, learning, or making decisions for themselves and must be taught how to think, learn and behave so that they can be like other people. Conformity has social value, but it should not be at the expense of individuality. No one can truly understand what they have never experienced. Therefore, understanding the neurological differences in how the autistic brain functions is important in understanding what the autistic person is communicating about themselves and their needs as individuals via their behaviors.

What can you expect to learn by using this approach?

            Hopefully, the most important thing you will gain by using this approach is a better understanding of, and respect for, the differences between how your brain and the autistic brain learn and communicate. The behaviors that you see will make more sense as you are able to interpret them as communication, not an inability or resistance to learning from you. Keep in mind that the autistic person is as perplexed by your behavior and ways that you communicate as you are by their ways. I guarantee they would love to learn from you, once you learn how to communicate with them in ways they can understand.

            In the process of learning this approach you will be challenged to use critical thinking to gather observations of behaviors and analyze them from a neurological perspective to better understand their meaning. You will be asked to discriminate between what is, and should be considered, a strength (despite it not appearing to be “normal”) and what is a limitation that impedes learning or progress. You will learn how to explain and/or model, in ways the client can understand, the unspoken social rules and thought processes that non-autistic people “pick up” without being taught that can help your client to make sense of WHY people keep expecting them to know things they obviously don’t know or understand. You will be encouraged to ease up on your image of yourself as the authority figure who controls and directs decisions in your therapy sessions if you want your client to develop a sense of self-actualization and a desire to assert and advocate for themselves (the lack of which creates fear, anxiety, and the reluctance to engage with others). You, and the client, are more likely to enjoy your sessions together as you will be learning from each other and developing a relationship based on trust and respect for each other.

            You will not be asked to give up or replace the methods and strategies that you have already learned. You will be given additional tools and options to choose from in planning your client’s goals and activities and the clinical reasoning needed to determine which ones will best fit that particular client’s functional needs and motivate them to want to achieve goals that are tailored to, and use, their strengths. You are likely to have greater compliance from parents in following home program recommendations once you pass on this change in perspective to look at strengths rather than limitations and the effect that it has on the child’s willingness to engage in these activities.

What will you be helping your clients to learn when you use the tools that are integrated into the NSB approach?

•  When you use rapport building strategies, you will be modeling social interaction skills (the power of, as well as the give-and-take in, communication; exploring likes/dislikes; finding fun in playing together or comfort when you are upset; building trust by turn-taking and sharing control).
• By setting goals and selecting methods for achieving them that are based on their strengths, you will be pointing out to them that they do have strengths (not just limitations due to their differences) and that those strengths can be valuable contributions to society.
• By exploring each of you as a generator of sensory input, you are teaching them about non-verbal communication cues and their meaning.
• When you make changes in the environment or adapt an activity to make it less or more stimulating, you are teaching your client how to adapt and how to advocate for what they need.
• By using the problem-solving tool, you are teaching them that they always have choices, but choices come with consequences, so they need to choose thoughtfully.
• When you explain not just what they will be learning but also the why, how, and when, you are helping them to understand the value in asking when they don’t know or understand something.
• By giving them shared power in making decisions about what they do, in what order, and for how long, you are teaching them to not only make decisions but accept responsibility for following through with those decisions. 
• When you review what they have accomplished or learned at the end of the session, you are helping them to store memories that they can use to plan and make wise choices the next time.
• By giving them options to deal with stress and then always respecting their decision when they use them, you are teaching them self-calming strategies as well as self-advocacy skills.
• When you explore the use of assistive devices in making tasks faster, easier, or better, you are expanding their awareness of how they might use these tools to compensate for their limitations or tasks they would otherwise avoid as too difficult.
• By using the self-measurement tool to monitor their successes, you are showing them that failure is a part of learning and nothing to fear.
• Rather than you directing what they learn and how they learn it (which leads to learned dependence), you will be using these tools to help your client think and make decisions and accept responsibility for their own actions and choices.
• I’m sure that there are more benefits to this approach than I have listed. I leave it to you to discover them.

Additional reading recommendations

*  Thinking and learning strengths in children with autism spectrum disorder.  https://raisingchildren.net.au/autism/learning-about-asd/about-asd/learning-strengths-asd
*  A Strengths-Based Approach to Autism.  https://www.health.harvard.edu/blog/a-strength-focused-approach-to-autism-2017042011607
*  A Strength-Based Approach Helps Children Learn to ask "What’s Right" instead of "What’s Wrong"   https://www.psychologytoday.com/us/blog/worrier-warrior/201504/strength-based-approach-helps-children*  Strength-Based Assessment for Children With Autism Spectrum Disorders, Merith Cosden, Lynn Kern Koegel, Robert L. Koegel, Ashley Greenwell, and Eileen Klein, Research & Practice for Persons with Severe Disabilities 2006, Vol. 31, No. 2, 134–143*  Autism And Sensory Integration Dysfunction (Sensory Processing Disorder), https://www.sensory-processing-disorder.com/autism-and-sensory-integration.html*  Ten Things Every Child With Autism Wishes You Knew, https://www.sensory-processing-disorder.com/10-things-every-child-with-autism-wishes-you-knew.html*  Characteristics of Brains in Autism Spectrum Disorder: Structure, Function and Connectivity across the Lifespan, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688328/*  “The Nature of Brain Dysfunction in Autism: Functional Brain Imaging Studies”, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975255/

©  Susan J. Golubock, M.Ed., O.T.    1/12/2020