Children with autism may have a difficult time expressing and regulating their emotions --especially when being told “no” to a preferred activity or item. The National Autism Association states that, “Autism impacts the normal development of the brain in the areas of social interaction, communication skills, and cognitive function” (National Autism Association, para. 1). 1 in every 54 children is diagnosed with autism (National Autism Association, para. 2). Helping a child with autism manage emotional stress when being told “no” can seem like a daunting task to parents, teachers, and caregivers. An ABA (Applied Behavioral Analysis) case study done by Mace et al. (2011) may help to provide alternate strategies. Mace et al. (2011) “evaluate[d] the relative effects of three different methods of saying ‘‘no’’ to requests to engage in a preferred activity on the occurrence and escalation of oppositional, disruptive, and aggressive behavior” (p. 85-86). This is also pertinent information for Music Therapists in regards to managing behaviors and keeping a safe environment within a session.

At the beginning of the study, target behaviors --negative behaviors that occur after “no”-- of the participant with high-functioning autism were recorded. These behaviors included: oppositional vocalizations, loud vocalizations, disruption, aggression and/or threat of aggression (Mace et al., 2011, p. 86). Many of these behaviors are commonly seen amongst people with autism, specifically when told “no.” Mace et al. (2011) studied three different methods of saying “no” to a requested activity “to prevent occurrences of escalating behavior” (p. 91). The three methods include: 

  1. “[saying] no and then offering an explanation for the refusal 

  2. denying access to the requested activity but offering an opportunity to engage in a preferred alternative activity

  3. denying immediate access to the requested activity, but permitting delayed access contingent on the completion of a low-preference demand” (Mace et al., 2011, p. 91).

Of the three methods, the last two alternative methods rarely caused the target behaviors. 

The first method did not include the child receiving anything in return other than “no,” which escalated all target behaviors. The last two methods included the child receiving “no,” but was offered the opportunity to engage in an alternative activity instead, such as playing baseball. The other strategy presented required a non-preferred activity where he had to engage in that activity first, then was able to receive the requested activity. The second alternative method was proven to extinguish most of the presented problem behaviors. 

In conclusion, the alternative methods of saying "no" are the best practice for dealing with problem behaviors. This case study had one participant, therefore further research is needed for generalization of this population. Autism Spectrum Disorder is on a "spectrum," therefore one method may not work for all children with autism. Parents may use this article and others to use creative ideas of alternate methods of dealing with inappropriate or unsafe activities other than the simple word, “no.”



Below is an example of a chart a Music Therapist may utilize with a patient with autism to remember how to sit at the piano. It is a great visual reminder that can sit at the piano while practicing music. When the patient is able to follow all three steps they are rewarded with a sticker on their music for the day, but if they struggle to follow the three steps they are unable to receive a sticker. Not receiving a sticker can provoke problem behaviors, but the Music Therapist can utilize “no” with an explanation to work harder next week so they can get a sticker. Again, every child is different and with some patients having a goal to work towards for next week is very motivating so they can transition fine without extreme problem behaviors out of the session. 



-Kennedi Walz, Music Therapy Intern

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References

Mace, F., Pratt, J., Prager, K., & Pritchard, D. (2011). AN EVALUATION OF THREE METHODS OF SAYING “NO” TO AVOID AN ESCALATING RESPONSE CLASS HIERARCHY. Journal of Applied Behavior Analysis, 44(1), 83–94. https://doi.org/10.1901/jaba.2011.44-83. 

Autism Fact Sheet. National Autism Association. (n.d.). https://nationalautismassociation.org/resources/autism-fact-sheet/.

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