Supporting individuals with autism and other developmental challenges can sometimes feel like solving a very intricate puzzle. No two learners are the same, and this becomes even more evident when comorbidities – additional diagnoses or conditions occurring alongside autism—are part of the equation.
For professionals in Applied Behavior Analysis (ABA), understanding how to address these complexities can lead to more effective interventions and, ultimately, better outcomes. But how do we truly meet the needs of individuals with multiple diagnoses and ensure our approaches are as effective as possible?
What are Comorbidities in ABA?
The term “comorbidities” refers to the coexistence of two or more diagnoses or conditions. For instance, many children with Autism Spectrum Disorder (ASD) may also have Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, or sensory processing disorders. These overlapping conditions aren’t uncommon, but they can add complexity when planning, assessing, and implementing interventions.
It’s important to remember that we don’t treat labels; we treat behaviors. While a diagnosis may provide helpful context, our job as ABA practitioners is to address the specific skills and behaviors that need support. However, recognizing what diagnoses may “overlap” can give us insight into the physiological, emotional, or environmental factors at play.
For example, some children with ASD and ADHD share behavioral characteristics like difficulty focusing or increased impulsivity. While the labels might differ, understanding the nuances behind each condition can help guide interventions more effectively.
The Importance of Individualized Strategies
One thing is clear in ABA: there’s no such thing as a one-size-fits-all approach. Just because a strategy worked for one child doesn’t mean it will work for another. This is especially true when supporting learners with comorbidities. Each individual has unique strengths, preferences, and challenges; treatment plans must reflect that.
Here’s an Example
Take, for instance, a child who struggles with sitting still during circle time. It can be easy to assume this is a “won’t do” problem due to a lack of motivation. However, a closer look may reveal that it’s more of a “can’t do” situation – the child might not have the developmental readiness or sensory regulation skills to sit through extended periods of group activity. Breaking circle time into smaller chunks or building in movement breaks could significantly reduce frustration and enhance participation.
Similarly, if a child has both ASD and a medical condition like gastrointestinal problems, their behavior during therapy sessions might be influenced by pain or discomfort. This highlights the importance of zooming out and considering the whole picture rather than relying solely on surface-level observations.
The Role of Collaboration
Supporting individuals with multiple diagnoses often goes beyond what one professional can address. That’s why teamwork is such a crucial part of navigating complex needs.
Bringing in expertise from other disciplines can transform how we support our learners. Medical doctors, occupational therapists (OTs), physical therapists (PTs), speech-language pathologists (SLPs), social workers, and other professionals are often essential pieces of the larger puzzle.
Here’s an Example
Suppose your learner’s performance or cooperation fluctuates dramatically depending on the time of day. On your own, you might attribute the behavior to motivation or fatigue.
However, medical collaboration could reveal that the learner’s ADHD medication is wearing off by early afternoon, contributing to these behavioral changes. Small environmental modifications or adjustments in medication timing could drastically improve outcomes.
When we lack access to a multidisciplinary team, advocating for an integrated approach is still possible. Start by consulting with the family and exploring who else is involved in the learner’s care. Collaboration doesn’t always mean formal meetings; sometimes, sharing observations or strategies informally can lead to valuable insights.
“Can’t Do” Versus “Won’t Do”
One concept that’s essential for navigating comorbidities is distinguishing between “can’t do” and “won’t do” behaviors. It’s tempting to assume they’re unwilling when a child resists a task or doesn’t meet expectations. But often, the reality is more complex – they may genuinely lack the skills needed to complete the task successfully.
Here’s an Example
For example, tying their shoes might be a significant hurdle if a learner has fine motor challenges due to comorbid conditions. It’s not that they don’t want to – they physically or developmentally might not be capable of mastering that skill right now. Rather than focusing on the shoe-tying skill itself, shifting toward a more functional alternative, such as choosing slip-on shoes, can reduce stress and build independence.
Similarly, incorporating proactive supports like visual schedules, movement breaks, or tools for emotional regulation can give learners additional pathways to success. These supports acknowledge challenges without removing the opportunity to build skills over time.
Flexibility & Compassion
When working with individuals who have comorbidities, flexibility isn’t just a nice to have; it’s a necessity. Sometimes, data may show that an intervention isn’t working, and in these cases, it’s crucial to pivot and explore other options.
Being able to switch gears doesn’t mean that you’re abandoning an individual’s progress; it simply reflects an informed and adaptive approach rooted in data and observation. It’s also essential to take a compassionate and trauma-informed perspective with learners who have experienced significant stress or medical challenges.
Repeated medical interventions or stressful life events can impact behavior and well-being for some. When this happens, it’s essential to ensure strategies are respectful, gentle, and tailored to the whole person; not just the behavior we’re trying to improve.
A Big-Picture Perspective
Ultimately, success in ABA often requires balancing focusing on granular, specific goals and considering the bigger picture. Especially for learners with comorbidities, some life skills may need to take precedence over others.
For example, while teaching a child to tie their shoes is great, ensuring they can prepare a snack or express basic needs may take priority in terms of functionality.
Comorbidities and multiple diagnoses undoubtedly make ABA more complex, but they also provide an opportunity to sharpen our skills as practitioners. By exploring the full picture – diagnoses, behaviors, environmental influences, and more – we can meet our learners where they are and guide them toward meaningful growth and progress.
With the right strategies, collaboration, and compassion, we truly can make a difference for individuals with complex needs. Whether it’s modifying goals, rethinking reinforcement strategies, or engaging with other professionals, every layer of effort contributes to the bigger picture of success in ABA.
