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A token economy

is a system of contingency management based on the systematic reinforcement of target behavior. The reinforcers are symbols or "tokens" that can be exchanged for other reinforcers. A token economy is based on the principles of operant conditioning and behavioral economics and can be situated within applied behavior analysis. (Source:


The Augmentative and Alternative Communication (usually abbreviated as A.A.C.) is the term that describes all the communication methods that help people with difficulty in using the most common communication channels, above all language and writing, to communicate better.

It is called an alternative because it uses alternative methods of communication that are different from the traditional ones. It is defined as augmentative because it does not substitute but increases the natural communication possibilities of the person.

It is a set of techniques, strategies and technologies aimed at the non-speaker, his interlocutors and his living environment with the aim of facilitating communication and improving participation in contexts of life and relationships.

 There are many different technical approaches. It is necessary to choose and apply the most correct and effective approach to the needs and characteristics of the single non-speaker subject (age, basic pathology, residual communication skills, visual skills, etc.).


is the acronym of Applied Behavior Analysis and is the applied science that derives from Behavior Analysis.

This area aims at applying data derived from the analysis of behavior to understand and improve the relationships between certain behaviours and external conditions. It has several functions including that of describing the interactions that occur between organism and environment, explain how these interactions occur, predict the characteristics and the probability of future occurrence, influence the shape, frequency and function etc.

A key feature of ABA is to be evidence-based.

The attention of the ABA is directed to socially significant behaviours such as:

❖      School skills

❖      Social skills

❖      Communicative skills

❖      Adaptive skills

This makes it suitable to be applied to any area of intervention and not only as commonly (and incorrectly) is expected, only autism. It arises, as an application of the behavioral analysis principles and therefore can be applied to various fields.

It is widely adopted and applied in the context of disability in general and autism in particular for scientific and methodological rigor that characterize it, but NOT created to autism.

In summary, it is a term that refers to the application of the information obtained by a careful examination (analysis) of what a person says or does (behavior) in a given situation or set of circumstances.

The learning theory has shown that a person's behavior is largely determined by various factors (called antecedents) involved in the situation he is in, and the results (called "consequences") for his behavior in previous occasions.

Knowing and understanding what these antecedents and consequences are, it can adopt strategies to modify them and then modify the behavior of the person.

Adaptive skills

Adaptive behavior means the set of activities that a subject must perform on a daily basis to be sufficiently independent and adequately fulfil the tasks resulting from his social role, so as to meet the expectations of the environment for an individual of the same age and context cultural (Doll, 1965; Grossman, 1973,1983; Sparrow, Balla and Cicchetti, 1984; Nihira 1999; Thompson, McGrew and Bruininks, 1999).

Adaptive behavior is a distinct construct but related to that of intelligence as measured by normal tests in use, and this relationship is greater in subjects of pre-school age or severe disability.

The personal and social self-sufficiency in real-life situations, and to observe how cognitive abilities are practically translated into the management of one's own autonomy in everyday life.


Adaptive behavior:

• It is age-specific

• It is context-specific

• It is an expression of a typical performance

• It is a multidimensional construct

Associated Features Supporting Diagnosis

Many individuals with autism spectrum disorder also have intellectual impairment and/or language impairment (e.g., slow to talk, language comprehension behind production). Even those with average or high intelligence have an uneven profile of abilities. The gap between intellectual and adaptive functional skills is often large. Motor deficits are often present, including odd gait, clumsiness, and other abnormal motor signs (e.g., walking on tiptoes). Self injury (e.g., head banging, biting the wrist) may occur, and disruptive/challenging behaviours are more common in children and adolescents with autism spectrum disorder than other disorders, including intellectual disability. Adolescents and adults with autism spectrum disorder are prone to anxiety and depression. Some individuals develop catatonic-like motor behavior (slowing and "freezing" mid-action), but these are typically not of the magnitude of a catatonic episode. However, it is possible for individuals with autism spectrum disorder to experience a marked deterioration in motor symptoms and display a full catatonic episode with symptoms such as mutism, posturing, grimacing and waxy flexibility.

The risk period for comorbid catatonia appears to be greatest in the adolescent years.

Autism: DSM-V Diagnostic Criteria 299.00 (F84.0)

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.



The Behavior Analysis is the science which has as its object the study of the psychological interactions between individual and environment and how the scientific method of the natural sciences own. It includes three main branches including Applied Behavior Analysis.



The target behavior is divided into steps that are gradually reinforced up to the realization of the complete behavior


Development and Course

The age and pattern of onset also should be noted for autism spectrum disorder. Symptoms are typically recognized during the second year of life (12-24 months of age) but may be seen earlier than 12 months if developmental delays are severe, or noted later than 24 months if symptoms are more subtle. The pattern of onset description might include information about early developmental delays or any losses of social or language skills. Typically, this would occur between 12 and 24 months of age and is distinguished from the rare instances of developmental regression occurring after at least 2 years of normal development.

The behavioral features of autism spectrum disorder first become evident in early childhood, with some cases presenting a lack of interest in social interaction in the first year of life. Some children with autism spectrum disorder experience developmental plateaus or regression, with a gradual or relatively rapid deterioration in social behaviours or use of language, often during the first 2 years of life. Such losses are rare in other disorders and may be a useful "red flag" for autism spectrum disorder. Much more unusual and warranting more extensive medical investigation are losses of skills beyond social communication (e.g., loss of self-care, toileting, motor skills) or those occurring after the second birthday (see also Rett syndrome in the section "Differential Diagnosis" for this disorder).

First symptoms of autism spectrum disorder frequently involve delayed language development, often accompanied by lack of social interest or unusual social interactions (e.g., pulling individuals by the hand without any attempt to look at them), odd play patterns (e.g., carrying toys around but never playing with them), and unusual communication patterns (e.g., knowing the alphabet but not responding to own name). Deafness may be suspected but is typically ruled out. During the second year, odd and repetitive behaviours and the absence of typical play become more apparent. Since many typically developing young children have strong preferences and enjoy repetition (e.g., eating the same foods, watching the same video multiple times), distinguishing restricted and repetitive behaviours that are diagnostic of autism spectrum disorder can be difficult in preschoolers. The clinical distinction is based on the type, frequency, and intensity of the behavior (e.g., a child who daily lines up objects for hours and is very distressed if any item is moved).

Autism spectrum disorder is not a degenerative disorder, and it is typical for learning and compensation to continue throughout life. Symptoms are often most marked in early childhood and early school years, with developmental gains typical in later childhood in at least some areas (e.g., increased interest in social interaction). A small proportion of individuals deteriorate behaviourally during adolescence, whereas most others improve.

Only a minority of individuals with autism spectrum disorder live and work independently in adulthood; those who do tend to have superior language and intellectual abilities and are able to find a niche that matches their special interests and skills. In general, individuals with lower levels of impairment may be better able to function independently.

However, even these individuals may remain socially naive and vulnerable, have difficulties organizing practical demands without aid, and are prone to anxiety and depression.

Many adults report using compensation strategies and coping mechanisms to mask their difficulties in public but suffer from the stress and effort of maintaining a socially acceptable facade. Scarcely anything is known about old age in autism spectrum disorder.


Functional Consequences of Autism Spectrum Disorder

In young children with autism spectrum disorder, lack of social and communication abilities may hamper learning, especially learning through social interaction or in settings with peers. In the home, insistence on routines and aversion to change, as well as sensory sensitivities, may interfere with eating and sleeping and make routine care (e.g., haircuts, dental work) extremely difficult. Adaptive skills are typically below measured IQ. Extreme difficulties in planning, organization, and coping with change negatively impact academic achievement, even for students with above-average intelligence. During adulthood, these individuals may have difficulties establishing independence because of continued rigidity and difficulty with novelty.

Many individuals with autism spectrum disorder, even without intellectual disability, have poor adult psychosocial functioning as indexed by measures such as independent living and gainful employment. Functional consequences in old age are unknown, but social isolation and communication problems (e.g., reduced help-seeking) are likely to have consequences for health in older adulthood.

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