Kimberly B. Marshall, Ph. D., BCBA-D, University of Oregon
Jessica L. Rohrer, Ph. D., BCBA-D, Endicott College, The Center for Children with Special Needs

Autism Treatments SummaryDescription: Self-management interventions are classified under the umbrella of applied behavior analysis as they focus on improvements in socially significant behaviors. Self-management interventions teach individuals to engage in actions that change their environment (e.g., setting a meeting reminder on their phone) in ways that lead to changes in their own behavior (e.g., arriving on time for the meeting; Epstein, 1997; Skinner 1953). These interventions teach individuals to engage in behaviors that we often refer to as self-control (Baum, 2017; Skinner, 1953). Individuals engage in actions that “control” their own behaviors in a way that makes them more successful.

Self-management interventions are beneficial for supporting all people in meeting their goals. These interventions can be especially meaningful for autistics/individuals diagnosed with autism spectrum disorder (ASD), as they can promote independence and decrease reliance on prompting or support from others (Koegel et al., 1992; Newman et al., 1995). Prompting is an evidence-based procedure that is commonly used to teach autistics/individuals diagnosed with ASD to engage in appropriate behavior (Cooper et al., 2019; Wilson et al., 2014). However, if prompts are not faded, an individual may become dependent on the prompt (i.e., learning to respond to the prompt instead of the cues in the environment that should signal that the behavior is appropriate). Consequently, the individual may struggle to engage in the appropriate behavior in the appropriate situation without assistance (Bryan & Gast, 2000). Self-management can decrease that likelihood by teaching the individual to cue themselves to engage in the appropriate behavior at the appropriate time. As such, self-management strategies are an effective method for promoting independence and decreasing reliance on support from others (e.g., Stahmer & Schreibman, 1992). For example, a child with autism may be learning to respond to questions from their peers. If prompting from an adult (e.g., “This weekend you went to the beach”) is needed for the child to respond, this could disrupt the flow of conversation and decrease the likelihood of independent social behavior. On the other hand, if the child had a small cue chart to remind themselves of possible responses (e.g., I went to the beach, I ate ice cream), they could respond independently of adult support.

Interventions involving self-management have been shown to be effective for autistics/individuals diagnosed with ASD across a variety of domains including academic, social, and vocational skills. Self-management interventions can be used to both increase appropriate behaviors and to decrease inappropriate/challenging behaviors. These interventions are comprised of various components, some or all of which may be part of an intervention package. Package components can include goal setting, self-monitoring, self-evaluation, self-reinforcement, and self-instruction (Carr et al., 2014; Cooper et al., 2019). While self-management interventions can include just one of these components, it is more common for packages including multiple components to be used to support autistics/individuals diagnosed with ASD in meeting their goals.

    • Goal setting is when an individual selects a performance standard that they want to achieve, with the goal of changing their behavior (Bandura, 1977). For example, an individual with ASD may set a goal of eating at least two healthy foods per day. Goal setting is often combined with other components of self-management, such as self-monitoring and self-evaluation. While practitioners, parents, or others may support an individual in setting an appropriate goal, ultimately, the goals selected should be those that the individual believes are important, valuable, and will improve their quality of life.
    • Self-monitoring involves an individual observing their own target behavior and recording, or in some way responding to, the occurrences or non-occurrences of that specified behavior (Cooper et al., 2019). So, the individual in the previous example might record a checkmark on a weekly chart each time that they eat healthy food.
    • Self-evaluation takes self-monitoring a step further by checking if the information recorded about the target behavior matches another observer’s record and/or checking if the information recorded meets some other criterion (e.g., the goal set). In the previous example, the individual’s parent might also record the individual’s healthy foods eaten on their own chart, and then together, the parent and child evaluate if the information they recorded matches. Furthermore, the child reviews their data to see if they recorded at least two checks for the day to meet their goal.
    • Self-reinforcement involves an individual selecting and/or accessing a desirable object, event, or activity after they have met a predetermined goal for their target behavior (Goldiamond, 1976). In our example, the child may get their iPad and play a game when they see that they have met their goal of eating two healthy foods for the day.
    • Self-instruction is when the individual provides themselves with instructions (in any form [e.g., spoken, written, video]) that increase the likelihood that they will engage in the target behavior (Cooper et al., 2019). For example, the individual tells themselves at the start of dinner, “I need to eat one vegetable before I can eat “

All people use self-management strategies to support their success and quality of life. For example, the use of checklists, calendar reminders, and self-talk are commonly engaged in by individuals with and without disabilities across the lifespan. Autistics/individuals diagnosed with ASD may have a greater need than their typically developing peers for explicit self-management intervention to learn to use these self-control methods.

Research Summary: Self-management interventions have been used to improve a wide array of skills including social skills (e.g., Cohen et al., 2022; Koegel et al., 2014), academic skills (e.g., Asaro-Saddler & Saddler, 2010; Shogren et al., 2011; Soares et al., 2009), independent living and vocational skills (e.g., Ferguson et al., 2005; Savage et al., 2022; Smith et al., 2015), and to decrease challenging behaviors (e.g., Coyle & Coyle, 2004; Mancina et al., 2000; Singh et al., 2011) for autistics/individuals diagnosed with ASD.

In teaching social skills, self-management affords a level of independence that other interventions may not and is therefore a viable intervention for promoting independence for autistics/individuals diagnosed with ASD (Stahmer & Schreibman, 1992). Self-management allows the individual to monitor and adjust their own responses in the absence of a practitioner’s immediate involvement. Self-management procedures have been used to teach a variety of social skills, including responsiveness to social initiations (Koegel et al., 1992), appropriate play (Stahmer & Schreibman, 1992), varied play responses (Newman et al., 2000), appropriate social communication (Koegel & Frea, 1993), conversation skills (Koegel et al., 2014) and compliment-giving (Apple et al., 2005). Hughes and colleagues even demonstrated the effectiveness of self-management interventions to increase social interactions between typical students and their peers with ASD (Hughes et al., 2013). Recent studies have also shown the effectiveness of self-management interventions to teach adults with ASD to recognize and respond to nonverbal expressions of boredom and confusion during social conversation (Cohen et al., 2022).

Self-management interventions have been used to improve a variety of academic skills including writing (Asaro-Saddler & Saddler, 2010; Delano, 2007), following directions (Agran et al., 2005), on-task behavior (Harris, 1986; Simmons et al., 2022), classroom behavior (Shogren et al., 2011), and independent work skills (Sainato et al., 1990). For example, an intervention package using self-video modeling to instruct students on self-management strategies was effective in increasing the number of words written, the number of functional essay elements included, and the duration of writing time for the skill of writing a persuasive essay (Delano, 2007). Recently, Simmons and colleagues (2022) demonstrated the effectiveness of a parent-implemented intervention consisting of self-monitoring, self-evaluation, and contingent reinforcement on increasing the on-task behavior of three autistics/individuals diagnosed with ASD. Importantly, self-management procedures focused on improving academic responding have also been associated with reductions in disruptive behavior (e.g., Koegel et al.,1992, Soares et al., 2009).

Generally, there is less research on the use of self-management interventions specific to daily living skills for autistics/individuals diagnosed with ASD, though there is ample evidence to suggest that self-management strategies have been effective in this domain across individuals with developmental disabilities (e.g., Carr et al., 2014; Harchik et al., 1992; Pierce & Schreibman, 1994). The preliminary research using self-management interventions to improve daily living skills for autistics/individuals diagnosed with ASD has been efficacious. Researchers demonstrated increased independence with at-home task completion for an adolescent diagnosed with ASD through the use of a personal digital assistant (Ferguson et al., 2005), and recently, Savage and colleagues (2022) found that a self-management and Fitbit technology program increased physical health targets including increasing steps counts and weight loss for adults with ASD and ID. Moreover, the program implemented by Savage and colleagues had high levels of acceptability and feasibility for the participants.

Reviews and task force reports have found that self-management is an evidence-based practice for autistics/individuals diagnosed with ASD (e.g., Hume et al., 2021; Mantzoros et al., 2022; National Autism Center, 2015). For example, Carr and colleagues (2014) identified 29 studies that focused on increasing appropriate behaviors through the use of self-management interventions for autistics/individuals with autism. Social skills were the most commonly targeted domain, although other targets included academic skills and daily living skills, and five of the studies reported decreases in challenging behavior as a byproduct of the intervention. The authors found that there was strong evidence for the effectiveness of self-management across age groups, populations, and ability levels.

The National Standards Project is an initiative of the National Autism Center that is designed to evaluate research targeting the core symptoms of ASD and, relatedly, offer recommendations for evidence-based practice for autistics/individuals diagnosed with ASD. In Phase 2 of the National Standards Project, a total of 31 articles using self-management interventions were reviewed. The interventions included in these articles focused on increasing academic, interpersonal, self-regulation, and communication skills and decreasing restrictive, repetitive, nonfunctional patterns of behavior, interests, or activities. The authors found that self-management interventions were an effective, evidence-based intervention for autistic adolescents between the ages of 15-21 years old. Furthermore, they highlighted some specific benefits of self-management including “building awareness of [one’s] behavior, accountability for carrying out a task, and decreasing social stigma that occurs when an adult’s assistance with simple and personal tasks is required.” (National Autism Center, 2015, p. 66).

Two more recent reviews have evaluated evidence-based practices for autistics/individuals diagnosed with autism, and both found that self-management procedures were amongst those interventions that qualified (Hume et al., 2021; Mantzoros et al., 2022). Mantzoros and colleagues (2022) evaluated treatments specifically targeting vocal stereotypy in autistics/individuals diagnosed with ASD and found that self-management, as part of a treatment package or used in isolation, was effective for decreasing vocal stereotypy. Hume and colleagues (2021) evaluated evidence-based practices for children, youth, and young adults with autism more generally (i.e., not related to a specific behavior). The authors identified 26 articles that displayed the positive effect of self-management across behaviors including academic/pre-academic skills, adaptive/self-help skills, challenging/interfering behaviors, communication, play skills, school readiness skills, self-determination, social skills, and vocational skills. Based on the findings of these studies, the authors highlighted self-management as an evidence-based practice for autistics/individuals diagnosed with autism across the lifespan in a variety of domains.

Another recent review has highlighted gaps in the self-management literature. Sulu and colleagues (2022) investigated the maintenance and generalization of improvements in on-task behavior as a result of self-monitoring interventions (one of the many potential components of a self-management intervention). While the researchers evaluated studies that focused on participants with a variety of disabilities, the majority, 23 out of the 24 studies, included individuals diagnosed with ASD. The authors found that only 12 (50%) of the studies assessed maintenance and two (8%) of the studies assessed the generalization of the intervention effects. The results of the studies including maintenance and generalization were variable, with only seven of the studies showing consistent maintenance over time and no studies showing generalization of on-task behavior across settings. These results display that, at least for self-monitoring alone, the initial results of a self-management intervention may not last over time or lead to changes in other settings. Consequently, it is important for practitioners and families to work together to ensure that self-management interventions carry over across settings and people, and maintain over time.

Recommendations: Clinical applications of self-management interventions have been shown to have utility in increasing appropriate behavior and decreasing inappropriate behavior across a broad range of skills and populations. Numerous reviews (e.g., Hume et al., 2021; Mantzoros et al., 2022), task forces (e.g., National Autism Center, 2015), and individual studies (e.g., Carr et al., 2014; Savage et al., 2022) support the use of self-management interventions as an evidence-based practice for increasing desired skills and decreasing undesired skills for autistics/individuals diagnosed with ASD. As discussed above, self-management interventions are often implemented as treatment packages with multiple components (e.g., goal-setting, self-monitoring, and self-reinforcement). As such, self-management interventions may vary significantly and must be individualized based on a person’s needs, skills, and values. Practitioners must have the skills to individualize such treatments, including the capacity to work with clients on selecting goals for intervention that are important to them. Therefore, self-management interventions should only be used by providers, such as behavior analysts or other trained individuals, who are practicing within their scope of competence.

While self-management interventions are evidence-based for autistics/individuals diagnosed with ASD, there is only preliminary support showing the long-term effects of these interventions. Further research is needed to identify the features of self-management interventions that can lead to effective maintenance and generalization of treatment effects. In addition, future researchers should continue to evaluate the use of self-management interventions to improve vocational and daily living skills specifically in individuals with autism, as well as the use of self-management interventions across behaviors with younger children and older adults (as the majority of research has focused on adolescents and younger adults). Even with these areas of needed additional research, there is substantial support for the use of self-management interventions to increase skills and they are recommended to improve the lives of individuals with autism.

Selected References

Systematic Reviews and Task Forces

Carr, M. E., Moore, D. W., & Anderson, A. (2014). Self-management interventions on students with autism: A meta-analysis of single-subject research. Exceptional Children, 81(1), 28-44. https://doi.org/10.1177/0014402914532235

Harchik, A. E., Sherman, J. A., & Sheldon, J. B. (1992). The use of self-management procedures by people with developmental disabilities: A brief review. Research in Developmental Disabilities, 13(3), 211-227. https://doi.org/10.1016/0891-4222(92)90026-3

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., … & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 51(11), 4013-4032. https://doi.org/10.1007/s10803-020-04844-2

Mantzoros, T., McCoy, A. R., & Lee, D. L. (2021). Treatments for automatically reinforced vocal stereotypy for individuals with autism spectrum disorder: A literature and meta-analytic review. Behavioral Interventions, 37, 485-504. https://doi.org/10.1002/bin.1856

National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Author.

Sulu, M. D., Martella, R. C., Grimmet, K., Borosh, A. M., & Erden, E. (2022). Investigating the effects of self-monitoring interventions with students with disabilities on the maintenance and generalization of on-task behavior: A systematic literature review. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-022-00304y

 

Selected Scientific Studies

Agran, M., Sinclair, T., Alper, S., Cavin, M., Wehmeyer, M., & Hughes, C. (2005). Using self-monitoring to increase following-direction skills of students with moderate to severe disabilities in general education. Education and Training in Developmental Disabilities, 40(1), 3-13. http://www.jstor.org/stable/23879767

Apple, A. L., Billingsley, F., Schwartz, I. S., & Carr, E. G. (2005). Effects of video modeling alone and with self-management on compliment-giving behaviors of children with high-functioning ASD. Journal of Positive Behavior Interventions, 7(1), 33-46. https://doi.org/10.1177/10983007050070010401

Asaro-Saddler, K., & Saddler, B. (2010). Planning instruction and self-regulation training: Effects on writers with autism spectrum disorders. Exceptional Children, 77(1), 107-124. https://doi.org/10.1177/001440291007700105

Bryan, L. C., & Gast, D. L. (2000). Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Journal of Autism and Developmental Disorders, 30(6), 553-567. https://doi.org/10.1023/A:1005687310346

Cohen, S., Koegel, R., Koegel, L. K., Engstrom, E., Young, K., & Quach, A. (2022). Using self-management and visual cues to improve responses to nonverbal social cues in adults with autism spectrum disorder. Behavior Modification, 46(3), 529-552. https://doi.org/10.1177/0145445520982558

Coyle, C., & Cole, P. (2004). A videotaped self-modelling and self-monitoring treatment program to decrease off-task behaviour in children with autism. Journal of Intellectual and Developmental Disability, 29(1), 3-16. https://doi.org/10.1080/08927020410001662642

Delano, M. E. (2007). Improving written language performance of adolescents with Asperger syndrome. Journal of Applied Behavior Analysis, 40(2), 345-351. https://doi.org/10.1901/jaba.2007.50-06

Ferguson, H., Smith Myles, B., & Hagiwara, T. (2005). Using a personal digital assistant to enhance the independence of an adolescent with asperger syndrome. Education and Training in Developmental Disabilities, 40, 60-67. https://www.jstor.org/stable/23879772

Harris, K. R. (1986). Self-monitoring of attentional behavior versus self-monitoring of productivity: Effects on on-task behavior and academic response rate among learning disabled children. Journal of Applied Behavior Analysis, 19(4), 417-423. https://doi.org/10.1901/jaba.1986.19-417

Hughes, C., Harvey, M., Cosgriff, J., Reilly, C., Heilingoetter, J., Brigham, N., Kaplan, L., & Bernstein, R. (2013). A peer-delivered social interaction intervention for high school students with autism. Research and Practice for Persons with Severe Disabilities, 38(1), 1-16. https://doi.org/10.2511/027494813807046999

Koegel, R. L., & Frea, W. D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. Journal of Applied Behavior Analysis, 26(3), 369-377. https://doi.org/10.1901/jaba.1993.26-369

Koegel, L. K., Park, M. N., & Koegel, R. L. (2014). Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1055-1063. https://doi.org/10.1007/s10803-013-1956-y

Mancina, C., Tankersley, M., Kamps, D., Kravits, T., & Parrett, J. (2000). Brief reports brief report: Reduction of inappropriate vocalizations for a child with autism using a self-management treatment program. Journal of Autism and Developmental Disorders, 30(6), 599-606. https://doi.org/10.1023/A:1005695512163

Newman, B., Buffington, D. M., O’Grady, M. A., McDonald, M. E., Poulson, C. L., & Hemmes, S. (1995). Self-management of schedule following in three teenagers with autism. Behavioral Disorders, 20(3), 190-196. https://doi.org/10.1177/019874299502000304

Newman, B., Reinecke, D. R., & Meinberg, D. L. (2000). Self-management of varied responding in three students with autism. Behavioral Interventions, 15(2), 145-151. https://doi.org/10.1002/(SICI)1099-078X(200004/06)15:2<145::AID-BIN50>3.0.CO;2-3

Pierce, K. L., & Schreibman, L. (1994). Teaching daily living skills to children with autism in unsupervised settings through pictorial self-management. Journal of Applied Behavior Analysis, 27(3), 471-481. https://doi.org/10.1901/jaba.1994.27-471

Sainato, D. M., Strain, P. S., Lefebvre, D., & Rapp, N. (1990). Effects of self-evaluation on the independent work skills of preschool children with disabilities. Exceptional Children, 56(6), 540-549. https://doi.org/10.1177/001440299005600605

Savage, M. N., Tomaszewski, B. T., & Hume, K. A. (2022). Step it up: Increasing physical activity for adults with autism spectrum disorder and intellectual disability using supported self-management and fitbit technology. Focus on Autism and Other Developmental Disabilities, 37(3), 146-157. https://doi.org/10.1177/10883576211073700

Shogren, K. A., Lang, R., Machalicek, W., Rispoli, M. J., & O’Reilly, M. (2011). Self-versus teacher management of behavior for elementary school students with Asperger syndrome: Impact on classroom behavior. Journal of Positive Behavior Interventions, 13(2), 87-96. https://doi.org/10.1177/1098300710384508

Simmons, C. A., Ardoin, S. P., Ayres, K. M., & Powell, L. E. (2022). Parent-implemented self-management intervention on the on-task behavior of students with autism. School Psychology. https://doi.org/10.1037/spq0000501

Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S., Singh, A. N., Singh, J., & Singh, A. D. (2011). A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 1153-1158. https://doi.org/10.1016/j.rasd.2010.12.012

Smith, K. A., Shepley, S. B., Alexander, J. L., Davis, A., & Ayres, K. M. (2015). Self-instruction using mobile technology to learn functional skills. Research in Autism Spectrum Disorders, 11, 93-100. https://doi.org/10.1016/j.rasd.2014.12.001

Soares, D. A., Vannest, K. J., & Harrison, J. (2009). Computer aided self-monitoring to increase academic production and reduce self-injurious behavior in a child with autism. Behavioral Interventions, 24(3), 171-183. https://doi.org/10.1002/bin.283

Stahmer, A. C., & Schreibman, L. (1992). Teaching children with autism appropriate play in unsupervised environments using a self-management treatment package. Journal of Applied Behavior Analysis, 25(2), 447-459. https://doi.org/10.1901/jaba.1992.25-447

 

Other Works Cited Above

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191. https://doi.org/10.1037/0033-295X.84.2.191

Baum, W. M. (2017). Understanding behaviorism: Behavior, culture, and evolution (3rd ed.). Wiley Global Research (STMS). https://bookshelf.vitalsource.com/books/9781119143666

Cooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied behavior analysis. Pearson Education.

Epstein, R. (1997). Skinner as self-manager. Journal of Applied Behavior Analysis, 30(3), 545-568. https://doi.org/10.1901/jaba.1997.30-545

Goldiamond, I. (1976). Self-reinforcement. Journal of Applied Behavior Analysis, 9(4), 509-514.

Koegel, R. L., Schreibman, L., Loos, L. M., Dirlich-Wilhelm, H., Dunlap, G., Robbins, F. R., & Plienis, A. J. (1992). Consistent stress profiles in mothers of children with autism. Journal of Autism and Developmental Disorders, 22(2), 205-216. https://doi.org/10.1007/BF01058151

Skinner, B. F. (1953). Science and human behavior. The MacMillan Company.

Wilson, B., Beamish, W., Hay, S., & Attwood, T. (2014). Prompt dependency beyond childhood: Adults with Asperger’s syndrome and intimate relationships. Journal of Relationships Research, 5, e11. https://doi.org/10.1017/jrr.2014.11

 

Citation for this article:

Marshall, K.B., & Rohrer, J. L. (2023). Self-Management Interventions: A treatment summary. Science in Autism Treatment, 20(02).

 

#Academic #Adults #BehaviorAnalysts #ChallengingBehavior #Independence #School #SchoolAge #Teachers

 

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