Presentation addressing the issues of motivation and reinforcement for adolescents and young adults diagnosed with autistic spectrum disorders

1. Title: Motivation and
Reinforcement for Adolescents
and Young Adults with Autism
Daniel C. Marston, PhD, ABPP
Private Practice in Behavioral
Psychology
North Huntingdon, PA

2. Credentials
• Board Certified in Cognitive & Behavioral Psychology,
American Board of Professional Psychology
• Fellow, American Academy of Cognitive & Behavioral
Psychology
• Fellow, Pennsylvania Psychological Association
• Member, American Psychological Association Division 6
(Behavioral Neuroscience)
• Member, American Association of Intellectual &
Developmental Disabilities (AAIDD)
• Over 15 years of practice specializing in providing
behavioral health services to individuals with
neurological disorders

3. Purpose of this Presentation
• Understand basic neurological aspects of
autism
• Recognize how neurological and
personality aspects of autism effect
motivation and reinforcers
• Identify ways to recognize what can help
motivate teenagers and adults with autism
• Address issues to consider when trying to
motivate individuals with autism

4. What is Motivation?
One definition: Internal and external
factors that stimulate desire and energy in
people to be continually interested in and
committed to a job, role, or subject, and to
exert persistent effort in attaining a goal.

5. Reinforcement Theory of Motivation
• Comes from the field of Behavioral
Psychology
• Proposes that an individual’s behavior is a
function of its consequences
• Theories involving reinforcement focus on
behavior
• Behaviors that are effectively reinforced
tend to occur more often

6. Reinforcement Theory (continued)
• Increased frequency of behaviors implies that
person has been motivated to engage in those
behaviors
• Reinforcers are the behaviors or items that
provide the reinforcement for increasing the
person’s behaviors
• Theory of motivation here goes that effective
reinforcers increase the frequencies of target
behaviors
• And that implies that they have increased the
person’s motivation for engaging in those
behaviors

7. • This presentation will focus on
reinforcement and motivation for
individuals with autistic spectrum disorders
• But before we get into that topic let’s
address what autistic spectrum disorders
are and how they effect teenagers and
young adults

8. Autistic Spectrum Disorders
• General category of disorders that includes Autism,
Asperger’s Disorder and Pervasive Developmental
Disorder
• Main symptoms of disorders include deficits in
socialization, communication problems, repetitive
behaviors and significant restrictions in terms of interests
• Asperger’s Disorder does not include significant
communication problems
• Pervasive Developmental Disorder is seen as an autistic
spectrum disorder that includes some but not all of the
symptoms of autism
• All of these disorders are considered to primarily be
neurological disorders

9. NEUROLOGICAL ASPECTS OF
AUTISM
• Evidence from number of disciplines
support that Asperger’s Syndrome &
autism are variations of the same
neurological disease (Coleman &
Betancer, 2005).
• Disciplines that address this issue and
supported that conclusion include genetics
& neurology.

10. In her book on the neurology of autism,
Coleman (2005) offered a summary of the
clinical symptoms of autism based on a
review of the neurological research:

11. Coleman, 2005 (continued)
• Children with autistic syndromes have impaired
social interactions
• Children with autistic syndromes lack empathy
(defined as lack of ability to integrate the
cognitive and affective facets of another
person’s life)
• Children with autistic syndromes have a
disabling need for sameness
• Children with autistic syndromes exhibit
repetitive & stereotypal patterns of behaviors

12. Coleman, 2005 (continued)
• Children with autistic syndromes who do
speak begin to talk at unusually late ages
• Children with autistic syndromes who
speak often have qualitative impairments
in communication
• It is not clear exactly what the specific
neurological mechanisms are for these
symptoms

13. What neurologists are able to say
about the causes of autism
• Autism likely due to problems with neurological
development at a very young age
• General understanding from neurological
research is that likely culprit is impaired
connections of neural pathways
• Cause is likely either abnormally varied neural
circuit or abnormality of neural components of
one or more neural pathways
• These problems lead to dysfunctional
information processing of behaviors & cognition
starting at a young age

14. Prefrontal Cortex
• Area if brain extensively implicated in
autism
• Explains deficits in executive functioning,
cognition, language, sociability & emotion
• Rinaldi, Peroddin & Markram (2008)
• Price (2006)

15. Pregenual anterior cingulate cortex
• DiMartino, Shehzad, Kelly, Krain et al
(2009)—provided summary of research of
role this area may play in autism
• Plays a major role in person’s capacity to
reason about thoughts & beliefs of others
• Otherwise known as “theory of mind”
• Hypofunction of this area in autism
revealed in meta-analysis by DiMartino,
Ross, Uddin, Sklar et al (2009)

16. Anckarsater et al (2006)
• Conducted a study of the impact of autism on
temperament, character & personality
development
• Identified autism & ADHD as childhood-onset
neuropsychiatric disorders
• Studied personality characteristics of 113 adults
with autism
• Found that autism spectrum disorders were
associated with low novelty seeking and low
reward dependence

17. Reward Dependence (RD)
• Reflects the degree to which the person responds to
cues of social reward
• Seen as being an inherited trait
• Individuals high in RD tend to be tender-hearted,
sensitive, socially dependent, and sociable
• Individuals low in RD tend to be practical, tough-minded,
cold, socially insensitive, irresolute, and indifferent if
alone
• Advantage to high RD: sensitivity to social cues which
facilitates affectionate social relations and genuine care
for others
• Advantages to low RD: personal independence and
objectivity not biased by efforts to please others

18. What research on neurology and
personality characteristics says
about autism
• Autism is caused by neurological problems at a
very young age or even prior to birth
• Neurological aspects of autism lead to low
Reward Dependence
• This leads person to have a low response level
of social reward
• Individuals with autism do not respond strongly
to the social reinforcers (praise, attention) that
tend to influence the behaviors of individuals
without autism

19. Teenagers & Autism
• Neurological aspects of autism effect individual at young
age
• Teenagers with autism face same issues as teenagers
without autism
• They tend to deal with them differently
• What motivates teenagers without autism do not tend to
motivate teenagers with autism
• It is during teenage years that you tend to see even
more the limited effect that social reinforcers have for
motivating individuals with autism
• Takes some work to determine what can be a reinforcer
for teenagers and young adults with autism

20. Deciding what is a reinforcer for
individuals with autism
• There is quite a bit of variability in autism
• No one reinforcer is going to work for everyone
• Asking the person about their interests and what
they find rewarding is a good starting point but
will likely not be sufficient
• Many individuals with autism otherwise will let
you know what they find reinforcing
• Topics of their perseverations and/or repetitive
statements often show what might be reinforcing

21. What is perseveration?
• Common symptom in autism
• Individual tends to focus on certain topics
or activities
• Engages in repetitive behaviors
associated with that topic or activity

22. What is Perseveration? (continued)
• Usually involves verbal statements about
the topic or activity
• Shows difficulty person with autism has
with focusing attention away from that
topic or activity
• Some research has shown that
perseverative behaviors can lead into
reinforcing behaviors

23. Study by Baker, Koegel & Koegel
(1998)
• Took the topics in the perseverations of youth
with autism
• Made a game based on those topics that could
be played with peers
• Found that the youths increased significantly
their level of social interaction with the games
• That increase continue even at a 2-mont follow-
up
• Similar findings in study of a specific type of
attention conducted by Vismara & Lyons (2007)

24. Effective way of Approaching
Perseverative Behaviors
• They can be seen as a way of connecting with the
autistic teenager or young adult
• Shows what the individual is interested in without
needing to ask them
• If you can identify areas of strong interest you can find
activities the person finds reinforcing
• And if you take a slow approach you might be able to
find ways of using those activities to reinforce other
behaviors.
• Kroegel, Dyer & Bell (1987)—autistic youths were much
less likely to be socially avoidant whent they could
engage in activities in which they had already shown an
interest

25. You can also use scales and reinforcement
surveys to identify specific reiforcers

26. • Scales involve series of questions that help identify reinforcers
• Questions focus on specific types of situations, information from
those questions can help you identify the types of reinforcers that
are likely to work with the specific individual
• Example I will use is Motivation Assessment Scale
• Reinforcement surveys list specific reinforcers and the person is
asked to help chose which are likely to be most reinforcing
• Reinforcement surveys focus more on identifying the specific
reinforcers that are likely to work with the individual
• What is important is that the methods help identify what individuals
are likely to find reinforcing rather than assuming that certain
reinforcers will work for anyone with autism

27. Motivation Assessment Scale
(Durand, 1990)
• Can be found at www.autism.ca/aide.htm
• From Durand’s book on severe behavior
disorders
• 16 items rated on scale from 0 to 4
• 0 = “Never”, 6 = “Always”

28. Sample items from Motivation
Assessment Scale
• Would the behavior occur continuously, over and
over, if this person was left alone for long
periods? (For example, several hours)
• Does the behavior occur when any request is
made of this person?
• Does the behavior occur whenever you stop
attending to this person?
• Does this person seem to do the behavior to get
you to spend time with him or her?

29. Four general categories of
reinforcers assessed on this scale:
• Sensory
• Escape
• Attention
• Tangible

30. Reinforcement Surveys
• Basically involves a list of possible reinforcers or a list of
questions designed to help identify reinforcers
• There are reinforcement survey generators online
(putting “reinforcement survey generator” into Google
brings up several)
• But you can also create your own
• Create a list of possible reinforcers you have available
and then ask person to choose which ones he/she likes
the most
• Choices of reinforcers should be from different general
categories of reinforcers
• You can also use questions to identify reinforcements
without giving specific choices

31. Sample items from reinforcement
surveys
• What are your favorite foods?
• If you had _____ dollars to buy whatever you
wanted, what would you buy?
• If you had 30 minutes of free time at ______
(school, work, home), what would you really like
to do?
• What are three of your favorite things to do
_________ (at work, at home, at school, with
friends)?
• Who are the people you prefer doing things with
at ________ (home, school, work)?

32. Some general categories of
reinforcers
• Escape/Avoidance
• Positive Attention
• Negative Attention
• Tangible (e.g. toys, stickers)
• Adult Approval
• Competitive Approval (e.g. being declared the winner of
a game)
• Peer Approval
• Independent Rewards (e.g. being allowed to do things
alone or with one other person)
• Consumable Rewards (e.g. food)

33. Presenting reinforcers to increase
motivation
• As discussed so far, work with the individual to
determine what the reinforcer will be
• Make sure that the person understands what is
expected in order to obtain the reinforcer
• Also make sure that the person is paying
attention when reinforcer is administered
• Poor attention also limits the effectiveness of
reinforcers

34. CONCLUSION
• Autism is a neurological condition
• Impacts on individuals functioning throughout their life
span
• Neurological impact is such that teenagers & young
adults with autism often do not respond to reinforcers
that might typically motivate same-age peers without
autism
• So you need to work with the individual to identify what
reinforcers will motivate to do things you want them to do
• You can talk with the individual and use their behaviors
and comments to help identify what might be effective
reinforcers

35. Conclusion (continued)
• Listening to topics of their perseverations
or repetitive statements can be one helpful
approach
• You can also use motivation scales or
reinforcement surveys
• Make sure person understands what they
need to do in order to obtain reinforcers
and is paying sufficient attention when
reinforcers are administered