Cleveland_Clinic_Host: Welcome everyone. Today’s chat is with autism specialists Leslie V. Sinclair MA, CCC/SLP BCBA, Aletta Sinoff PhD, CCC/SLP BCBA and Travis Haycook MEd from the Cleveland Clinic Center for Autism. Thank you for being with us to discuss managing the challenging behaviors of autism. We look forward to an interesting chat today. Let's begin with the questions!

Beginning to Understand Autism

grannyj: As a grandparent, I am really worried about my grandson. What are some resources that I can offer to his parents in order to get them some help? They don't seem to recognize he has problems and I feel they are in denial.

Speaker_-_Aletta_Sinoff_Ph_D__CCC_SLP_BC : First, I would sit down with the parents and describe the behaviors that are of concern. I would encourage them to seek out a reputable physician and/or diagnostic center such as the Cleveland Clinic to obtain consultation and referral for diagnosis if necessary. It is important to emphasize to the parents that the earlier autism is diagnosed, the better, as early intervention is key for their child's development and optimum success.

helpneeded: What resources are available to begin to understand autism?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: Autism Speaks is a national organization. The best resources for parents who have newly diagnosed children with autism include the following: Autism Speaks website ( There are multiple links listed in this site.  For parents who want to find out more about using a home-based ABA program with their child , the book called "Let Me Hear Your Voice" by Catherine Maurice is an excellent resource.

Speaker_-_Aletta_Sinoff_Ph_D__CCC_SLP_BC: Another excellent resource is a book titled “Graduated Applied Behavior Analysis” by authors Bobby Newman et al. The title may sound scary, but the book is very well written and easy to understand for parents or anyone else interested in the topic.

Applied Behavior Analysis

maddiegirl: Is ABA therapy just for autism?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: ABA therapy stands for Applied Behavior Analysis and is part of the field of behavioral psychology. The therapy associated with applied behavior analysis is used across numerous conditions and is not exclusive to autism treatment. It has, however, been applied to autism for over 30 years and is considered the most data driven and scientific evidence based approach for treating individuals with autism.

sassylady: ABA therapy – what is it?

Speaker_-_Travis_Haycook_M_Ed_: It involves strategic use of positive reinforcement and other strategies to increase the display of desired behavior and teaching alternatives for challenging behaviors.

solly: Can you explain ABA (Applied Behavioral Analysis) therapy?

Speaker_-_Aletta_Sinoff_Ph_D__CCC_SLP_BC: ABA therapy utilizes the principles of social learning theory to teach individuals with autism a variety of skills including academic skills, communication, literacy, play, self-help skills, social reciprocity, toileting, functional vocational training and other adaptive behavior. In order to teach such skills ABA provides the methodology for breaking tasks down into the smallest parts. Each step is systematically taught using a critical amount of repetition & practice to achieve competency and fluid demonstration of learning.

Understanding Behavior

man: My son gets upset and sometimes has a tantrum in public when we have to change our routine or schedule of what we were going to do. Is there was way to teach him flexibility?

Speaker_-_Travis_Haycook_M_Ed_: Individuals with autism work well when scheduling parameters have been clearly identified and keep the child informed by giving him early warnings of potential changes to the routine or schedule. In addition, you can have items that are reinforcing to the individual with you that can be offered as they appropriately work through the change. Reinforcement is your most valuable tool to motivate appropriate behavior.

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: The concept behind schedules is to teach the individual to follow the day -to-day routines, but not be concerned about the content of the routines. "I can follow the schedule regardless of the activity." You can build schedules that teach flexibility versus rigid adherence to routine. By systematically manipulating specific variables of the schedule you are encouraging flexibility and tolerance to change.

cookie: What do you suggest about a child who tends to wander a lot?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: A child who wanders is exhibiting a particular behavior and the wandering behavior is referred to as 'elopement'. Such behavior requires a functional assessment as people wander for many different reasons. To eradicate elopement, one must first understand why the person is doing it in order to develop a plan to stop it and replace it with appropriate behavior. This behavior at times can be life threatening, especially if children are non-verbal, have no sense of danger or are vulnerable socially. Therefore, it is strongly recommended that parents do as much as possible to secure the home and yard environment for their child. There are also simple and effective tracking devices which will give the parent the location of their child within a range. Parents can Google "ION Tracking devices" for more information.

queenofthenight: What are the behaviors of an autistic adult?

Speaker_-_Aletta_Sinoff_Ph_D__CCC_SLP_BC: Adults with autism demonstrate the same range of symptoms as children and adolescents. The diagnostic criteria that is set forth by the American Psychiatric Association does not change based on age.

steveh: My child’s behavior problems are “mild” - will they stay that way, or should I expect them to get worse at some point in the future?

Speaker_-_Aletta_Sinoff_Ph_D__CCC_SLP_BC: Autism is a life-long, complex spectrum disorder. There is no way of predicting the future severity or the course of symptom onset. The likelihood of behavior intensifying is high if no intervention or ineffective intervention is provided.

nbush: What is the main cause of negative or “bad” behavior in my child? Is she just looking for attention? Is it a form of communication? Or is it a lack or communication?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: First, it is important to understand the 'bad' behavior in what we call operational terms. That means describing the behavior as clearly as possible so that anyone who reads your definition can identify it in your child when it occurs. There are many reasons why the challenging behavior could occur. In order to find out which reason is really the driving force behind your child's behavior, one must conduct a functional behavior assessment. There are excellent resources for parents and professionals in learning how to understand behavior and go about assessing its function. For resources in functional behavior, you can contact the Cleveland Clinic Center for Autism Outreach Department for the resource listing of direct service providers that can assess your child.

issemma: Is Risperdal effective?

Speaker_-_Travis_Haycook_M_Ed_: Risperdal is the only medication to date that has been FDA approved as a medication for use with people who have autism. Risperdal has been shown to be effective for a large number of individuals with autism. Consult your physician regarding the use of this medication with your child.

maddog: Does a gluten free/casein free diet really have an impact on behavior like tantrums? What about Vitamin B6?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: To date, there is no empirical research that supports the use of casein gluten free diet to treat the symptoms of autism. The same is true for vitamin B6. There are anecdotal parent reports which suggest that vitamin therapy and casein gluten free diets are somewhat helpful in increasing adaptive skills such as eye contact and expressive communication. But again, unsubstantiated in the literature.

Educating Others

lilymeister: I have an adolescent with autism and his school teachers are struggling to develop goals and objectives for his IEP. What can I do?

Speaker_-_Travis_Haycook_M_Ed_: The Center for Autism will be publishing a curriculum that is geared toward adolescents and adults with autism covering a wide range of learning domains. Publishing date is scheduled for later this year. Visit the Cleveland Clinic Autism web site for upcoming release date.

ballplayer: Are there any books that you would recommend to read to other kids so they would understand my child better?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: There are many books written for all ages of children - from pre-school to teenage years which help individuals understand autism spectrum disorders (ASD). To access resources for child and teen literature, there are a couple of web sites such as and (publishers) that list appropriate literature. Also, the Autism Society of America features links to books which educate neurotypically developing children about ASD.

candycane: My older son is having a hard time dealing with some of my autistic child’s behavior. What resources are available to help him deal with this better?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: You should seek counseling and sibling groups. For more information, please contact the Cleveland Clinic Center for Autism at 216.721.5400 and ask for an appointment with pediatric psychology. Also, make sure to request services for upcoming sibling groups through the Center for Autism's Outreach Department. If you are out of the area, please call the center anyway for referral resources.

Kelly: When is the Autism Walk this year?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: In Cleveland, Ohio the autism walk is scheduled for Sunday, September 28, 2008 at Progressive Field. For upcoming information, log onto and click on "walks."

Insurance and Legislation

KS: Insurance companies – do they view autism as a mainstream condition and provide coverage?

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: On average autism treatment still remains an exclusion from insurance coverage especially for treatments like ABA, speech therapy and occupational therapy. There are initiatives in the state of Ohio for mental health parity bills so that autism will receive the necessary insurance coverage. Across the nation, there have been 5 states which have passed legislative bills mandating insurance coverage for autism and incorporating ABA into what is covered. There is a committee through the Autism Society of Ohio which is spearheading initiatives in our state for parity and insurance coverage.

Cleveland_Clinic_Host: We are at the end of our chat time today and I feel like we are just touching the tip of the iceberg concerning the topic of autism and behavior management. We have been fortunate to chat with autism specialists Leslie V. Sinclair M.A., CCC/SLP BCBA, Aletta Sinoff Ph.D., CCC/SLP BCBA and Travis Haycook M.Ed. from Cleveland Clinic Center for Autism. Thank you again for taking the time to answer our questions today.

Speaker_-_Leslie_V__Sinclair_M_A__CCC_SL: Thank you for allowing us the opportunity to communicate important topics related to autism treatment and education. It has been a pleasure to read such thoughtful questions about autism. We wish you all the very best success in your daily journey with your children and adults with autism.

Cleveland_Clinic_Host: If you would like more information regarding Autism, please visit the Cleveland Clinic Children’s Hospital Center for Autism web site. For general health information you may also wish to visit

This chat occurred in April 2008.

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