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The "Refrigerator Mother" Hypothesis of Autism

James R. Laidler, MD

Description: A specific sequence of responses in which the completion of each response provides a cue to engage in the next response. For example, when an individual puts on a t-shirt, placement of the shirt on top of the individual's head is a cue for the individual to pull the shirt over the head; having the shirt around the individual's neck is a cue for the individual to put each arm through the armholes, etc. Other examples include independent living skills (e.g., brushing teeth), carrying out daily routines such as getting ready for bed (e.g., changing into pajamas may be a cue to go brush teeth; completion of this task may be a cue to go get a story book, etc.), and following activity schedules [see earlier entry]). Behavior chains also may be associated with disruptive behavior. For example, getting off the bus when arriving at school is a cue for walking into the school building; walking into the school building is a cue for walking down a particular hallway; walking down a particular hallway is a cue to engage in tantrum behavior. In this situation, having the child enter the school building by a different entrance and therefore walking down a different hallway may prevent the tantrum behavior.

To teach a behavior chain, a complex skill or sequence of behaviors is first broken down into smaller units that may be easier to learn than the entire chain. For example, if a child is being taught how to make a baloney sandwich, the first step taught is to take out the bread, followed by taking out the baloney, then getting a plate, etc. The instructor then chooses one of three strategies: Forward chaining, backward chaining, and total-task presentation. In forward chaining, the steps of the sequence of behavior in the task are taught in temporal order (first step to the last). Thus, in the example of making a sandwich, the instructor would focus on teaching the individual to take out the bread until this step is mastered, then on taking out the baloney, etc. Following the completion of each step, some reward (reinforcer) is provided for completion. In backward chaining, the last step in the chain is taught first (e.g., placing the second piece of bread on top of the baloney). Once learned, the second to last step is taught (e.g., spreading mustard on the baloney) followed by the last step. Then the third to last step is taught, etc. The potential advantage of backward chaining is that the learner always "knows" what the next step is whenever a new step is learned. In total task (or whole task) presentation, a child is guided or prompted through the entire behavior chain without requiring that each step is learned before proceeding to the next. As the child learns each step, the guidance or prompting is removed.

Research Summary: Behavior chains are well-established learning procedures and research evidence supports the use of all behavior chain procedures with children with autism. These procedures have been applied successfully to teach skills such as vocational tasks, and activities of daily living. Additional recent research in the use of behavior chains can be found in the area of activity schedules (see earlier entry).

Recommendations: Behavior chains are effective procedures for teaching children with autism a variety of multi-step skills, including self-help activities, vocational skills, and communication.

Selected References:

Selected scientific studies

  • Azrin, N.H., & Foxx, R.M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4, 89-99.
  • Frank, A.R., Wacker, D.P., Berg, W.K., & McMahon, C.M. (1985). Teaching selected microcomputer skills to retarded students via picture prompts. Journal of Applied Behavior Analysis, 18, 179-185.
  • Griffen, A.K., Wolery, M., & Schuster, J.W. (1992). Triadic instruction of chained food preparation responses: Acquisition and observational learning. Journal of Applied Behavior Analysis, 25, 193-204.
  • Pelios, L.V., MacDuff, G.S., & Axelrod, S. (2003). The effects of a treatment package in establishing independent academic work skills in children with autism. Education and Treatment of Children, 26, 1-21.




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