Expert: Catherine Ridenour - 12/8/2008

Question
I am wondering if you can help me with a client I am giving in-home support services to; I am actually managing her case. She is a 21 year old young woman with autism living in her aunt and uncle's home. She receives in home support 7 days a week from direct care support staff. Recently she visited the dentist, and the dentist just happened to mention that her bottom front teeth were a little crooked, and that she could get braces if she wanted to and her aunt said it was OK. At that point, she became obsessed with wanting the braces, since she knows people at school who have them, and wants to have colored bands on them. The staff and her aunt and I have tried to tell her that they are painful, and are very expensive, too expensive to get right now, but she ends up not processing it. She really enjoys instant gratification, and has been upset for the entire week because she cannot get them right now. When she becomes upset, she will throw things, become self-injurious, and agress at others. Staff has had to use a hold on her this past week. We have tried everything to redirect her behavior, but she continues to obsess. Is there anything else we could be trying? I have really tried to praise her positive behavior in dealing with her anger appropriately- i.e. talking it out, using sensory activities, etc. Any advice you could give would be wonderful, even if you could direct me to someone who could help!

Answer
Hi Michelle,

Sorry, I was slow to answer this.

I think the key issue, for your client, is that her aunt said it was "OK." To an autistic person, that means OK NOW.

I know of no way to dissuade her of an obsession like this. Your technique of positive reinforcement is probably the most effective. No one should argue with her about her desire to have braces. The topic should be headed off, if possible. Time will lessen her attachment to this idea but it is likely to be replaced with another.

If she does not have a cognitive/behavioral therapist, it might be worth a try.

Practicing delayed gratification can be helpful. This would consist of her receiving a greater reward for waiting. Start small, "we can have a small ice cream cone now, or we can have a sundae in half an hour." I suspect her parents or caregivers would give her what she wanted, as a child, just to avoid tantrums. So, the behavior has a long history of reinforcement.

Best wishes,
Catherine