Compliance Training: Teach Cooperation While Preserving Individual Rights

This post covers a valuable strategy, but let’s make sure we are all on the same page first.  Compliance Training sometimes gets a bad reputation from people who are trying to preserve the dignity and rights of individuals with autism (for more on the debate about ABA read our post Understanding the Debate About ABA).  When done carelessly, Compliance Training can appear degrading and controlling.  It’s critical to be aware of this before getting started so you ensure to carefully implement the strategies we are going to talk about.

Before beginning Compliance Training, be very clear about why you want to teach compliance.  Ensure that you are using this strategy for the child’s benefit, not your own.  While no one should be expected to blindly comply with authority, there are many reasons why both children and adults need to be comfortable following directions from others.

Why Compliance?

Even independent adults and children without disabilities encounter numerous opportunities to comply with directions from others every day. Consider the following situations:

  • Success in school depends on doing a large number of things the teacher asks
  • Playing team sports requires doing what the coach says
  • When driving through or walking past a construction zone, you must comply with the person directing traffic or other safety signs
  • Children need to follow rules when playing a game with peers
  • Keeping a job requires doing what your boss asks

Compliance is also necessary to maintain the safety of the child. A child who fails to comply with demands such as, “Stop” when a car is coming can find themselves in serious danger.

When deciding to use Compliance Training, it should be with these ends in mind.  Compliance Training should lead to improved quality of life and improved independence for the child. Avoid Compliance Training that solely benefits or makes things more convenient for an adult or caregiver. It should also be a fun and motivating experience for the child.  Through compliance training, you teach the child that doing what you ask gets him something good.  What you ask of him should always be well within his skill set.  

Additionally, Rowan University conducted a study titled Using applied behavior analysis to increase compliance with a child with autism (Simon, R. 2004). On page 16 of this study they explain that compliance is necessary for most interventions. A child must comply with a prompt in order for the intervention to be effective. An inability to follow simple directions prevents progress in many important areas of development including communication, play and academic skills.

Children should not be taught to “perform” but encouraged to cooperate. When teaching compliance, don’t incorporate actions because they are “cute.” Choose actions that are comfortable or fun for the child, especially at first. Introduce harder tasks and demands only once the child reliably follows easier tasks or demands.

When deciding whether Compliance Training is right for your learner, consider these examples:

Compliance is important

  • Your learner is in danger because he’s about to run into the street.
  • A caregiver is running late for work and they need their child to get dressed.
  • Your learner refuses to eat anything except M&Ms.
  • The teacher asks your learner to line up with the other kids to leave the classroom during a fire drill.

Compliance is less important

  • Your learner will eat only “white” food.
  • After dinner your learner refuses to take his plate to the kitchen when a caregiver asks.
  • Your learner refuses to wear anything but his superman pajamas.

Remember, it is normal for any child to limit their cooperation at times. Decide when compliance is truly important, and when it’s not. Not only is it better for you to pick your battles, your learner should also be allowed to express himself.

Obtaining Assent

As with any treatment, the strategies discussed here should only be used with the assent of the learner. Read our post Understanding Assent and Assent Withdrawal in ABA for more information on how and why to obtain assent.

Understanding Cooperation and Children with Autism

Do your learner’s caregivers ever relate these stories?  

  • They’re trying to get their child ready for school.  He just needs to get his shoes on and he continues to push their hands away.  
  • It’s dinner time and he won’t sit for longer than a few seconds before he’s up and running around again.  
  • It’s time to clean up, but he runs away from them instead.  
  • They spend half an hour trying to corral him for a bath, but he dodges them or throws a fit every time they get close.

Merriam-Webster defines cooperation as “the actions of someone who is being helpful by doing what is wanted or asked for.”  Many professionals use the term “compliance” interchangeably with “cooperation.”  The intent is the same. There are times when you need a child to do something.

When thinking about cooperation, think about what specific behavior you or a caregiver wants from your learner. If a caregiver wants the family to sit down together every night for dinner then consider these two scenarios.

The uncooperative child:

Sarah ask her son Jimmy to sit down at the table for dinner. He ignores her until she physically lifts him up from the coffee table where he’s been playing with matchbox cars and places him in his seat. At this point he picks up a chicken nugget, takes one bite, throws it at his sister and then bolts back to the living room to play.

The cooperative child:

Sarah ask her son Jimmy to sit down at the table for dinner. He ignores her at first, but as she moves into the living room she gets his attention. Eventually he comes to the table and sits in his chair. He takes one bite of his chicken nugget and says, “I only like the dinosaur ones!” He puts it on the table next to his plate and eats his french fries instead.

In the second scenario Jimmy still asserts his independence (his preference for eating only dinosaur-shaped chicken nuggets), but has demonstrated cooperation by sitting with the family at dinner.

One study on cooperation and children with autism found that children with autism had a harder time with cooperative tasks than other children. In fact, the study found that “Fewer children with autism were successful compared to the children with developmental delay in three of four tasks.” (Liebal, K., Colombi, C., Rogers, S.J. et al 2008).

One challenge children with autism face with cooperation lies in their social deficits. They are less aware of how their behavior affects those around them. They may also struggle to realize the importance of cooperating with your demand or they might not understand what you are asking them to do. Although this can be frustrating, understanding where your learner is coming from can help you approach the problem calmly.

How to Teach Compliance

Studies such as An evaluation of evidence-based interventions to increase compliance among children with autism have demonstrated Applied Behavior Analysis is the best approach when working with children with autism. This study focused on interventions related to cooperation specifically and found that the “results represent a systematic evaluation of evidence-based treatments to increase compliance and highlight the need for individualized interventions; clearly, what is effective for one child may be ineffective for another.” (Fischetti, Anthony T. et al, 2012).

The essence of Compliance Training with ABA is reinforcing cooperative behavior.  It’s quite simple yet can lead to significant benefits for the child.  Let’s take a look:

  1. Identify potential reinforcers
  2. Determine what the child is likely to do when asked (high probability/high P behavior)
  3. Make a list of other behaviors that are well within the child’s abilities but which the child is gradually less likely to comply with
  4. Reinforce compliance with high P behaviors
  5. Gradually made the demands less and less preferred until the child frequently complies with important requests such as to complete school work or follow safety rules.

Many children refuse to follow any direction, including demands to engage in activities that they enjoy. For these children, you may need to start with a behavior that the child is highly unlikely to refuse (i.e. eat the cookie) or that the child is already in the act of completing (i.e. push the train, while the child is pushing the train).  

Compliance Training always follows the same sequence: 

Discriminative stimulus (SD) –> Compliance  or Noncompliance–>  Reinforcement or No Reinforcement

Take a look at the following examples:

In the image below, David presents the SD “copy me.” If Ann imitates David she receives a reinforcer. If she doesn’t then she receives no reinforcer. During compliance training avoid the use of punishment for noncompliance. Simply help the child associate doing what she’s asked to do with getting things she likes.

Compliance training example

Below is an example of how you might sequence task preference or difficulty to help the child accept more difficult or less preferred tasks over time.

High P behavior:

Compliance training with high probability discriminative stimulus.

Mid-preference activity:

Compliance training with mid-preference discriminative stimulus.

Simple behavior:

Compliance training with simple behavior discriminative stimulus.

Simple behavior:

Compliance training with simple behavior discriminative stimulus.

Lower probability behavior:

Compliance training with lower probability discriminative stimulus.

Vanderbilt University provides this useful download: Compliance Strategies.

What to do if the child doesn’t comply?

While the steps are simple and effective, it’s entirely possible that the child chooses not to comply when you provide the SD. If the child doesn’t comply, don’t provide any attention or reinforcement. First do the following:

  • Check your reinforcer to make sure it’s motivating enough
  • Consider your SD to make sure the child understands what you’re asking
  • Make sure the child is paying attention when you deliver the SD

If you are confident that you have a strong reinforcer, the child understands what you’re asking, and the child is attending, simply withhold reinforcement and wait for another opportunity.  The same is true if the child engages in challenging behavior.

Check out this fun example of compliance training:

Finding an Effective Reinforcer

If you’re unsure about the quality of the reinforcer, look for a new one by performing a preference assessment. Choose from many different preference assessments (free-operant, multiple stimuli with replacement, multiple stimuli without replacement or forced choice) depending on the needs of the child. Our post Choosing Reinforcers: Reinforcer Assessments or Preference Assessments provides more information about conducting these types of assessment:

Free-operant: For a free-operant preference assessment, you will let the child move freely about the room and watch to see what she is interested in. Often, you will choose to use free-operant because you want to quickly see what the child is interested in at that moment.

Multiple Stimuli With Replacement (MSWR): When conducting a multiple stimuli with replacement assessment, you place an array of items in front of the child for him to choose from. When he selects an item, he should be allowed to play with the item for a short period of time. You then represent the array in a different sequence with the item initially chosen back in the array. This assessment tells you how strong a reinforcer might be based on the number of times the child chooses that same item. If a child chooses the same item each time you present the array, you know that item is motivating to the child.

Multiple Stimuli Without Replacement (MSWO): Using a multiple stimuli without replacement provides you with a hierarchy of potential reinforcers. You present an array of potential reinforcers and ask the child to choose one. Once the child makes a choice, allow him a short period of time with the item. At the end of that time, represent the array without the initially selected item. By not including the first item, you build a hierarchy of potential reinforcers. Keep in mind that this hierarchy is only true for this moment in time and will not necessarily always be the case for the child.

Forced Choice (or Paired Choice): For a forced choice preference assessment, take two items known to have been effective reinforcers in the past for the child and present only those two items. This is a “quick and dirty” preference assessment that is useful when you want to move very quickly between tasks. It provides no hierarchy, but will give you a quick snapshot of what the child is interested in.

When to Practice Compliance Training

Once you decide to implement compliance training, incorporate it throughout your time with the child. Build practice into a variety of activities. Make it fun and informal. Here’s an example:

The child is having a quick snack. You conduct a quick forced choice assessment and determine that he’s really interested in the corn chips you have in your bag. You give him one corn chip for “free” to see how motivated he might be. When he reaches for the bag in your hand for another, you say “clap your hands!” When he claps his hands, you immediately say “great clapping!” and hand over a chip. You repeat this practice through multiple different simple tasks.

By incorporating quick compliance tasks into a variety of activities, you can help the child develop a positive response to demands.

Generalize Skills Across Environments

Children with autism often have difficulty generalizing skills from one environment, or one individual, to the next. If a child demonstrates compliance in a clinic or classroom setting, he might not do the same when out in the community.

References

Fischetti, Anthony T. et al, 2012. An evaluation of evidence-based interventions to increase compliance among children with autism. Journal of Applied Behavior Analysis, 45(4): 859-863

Liebal, K., Colombi, C., Rogers, S.J. et al. J Autism Dev Disord (2008) 38: 224. https://doi.org/10.1007/s10803-007-0381-5, Helping and cooperation in children with autism. Journal of Autism and Developmental Disorders

Simon, R. (2004), Using applied behavior analysis to increase compliance with autism, Rowan Digital Works

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