ACT, Autism, and Play: A Case Study

children at the swimming pool

I recently worked with a kid with high functioning autism who liked playing tennis but was deeply afraid of messing up at game time. He had never experienced anything like that, but he read about a kid getting cyber-attacked and humiliated by others after losing a wrestling match, and that was all it took.

He did everything he could to miss the tournaments, and at that he was successful! The funny thing was that he would have dominated – he was that good. I could have used graduated exposure techniques if the parents had given me enough time to do that, but there was only time for three sessions over the course on one week.

Without the ACT toolkit, I probably would not have accepted the case. But since I was skilled at using ACT, I decided to give it a try. I modified the ACT model into a three-word mantra: Watch Me Try. This is just a single, clinical case, so don’t confuse this for scientific evidence. There are plenty of well-designed studies to examine for those purposes. But this is a nice illustration of how ACT elements worked with one kid with high functioning autism.

Watch meant that I taught Peter (not his real name) to watch his thought just like he was watching a neon tennis ball. Slow your thoughts down like you do when you see the seams on the ball. When you slow the ball down like that, you find the sweet spot. Try that with a difficult thought and watch what happens. This transformed the function of private events so that he could attend to the direct-acting contingencies and contact available reinforcement.

Watch also meant to watch what your body feels like when you feel crappy and you don’t try. That can mean not showing up, showing up unprepared, or showing up and not playing full out. Now watch what happens when you try. What does that feel like? Peter initially reported no difference, so I surmised that maybe he wasn’t obtaining quality reinforcement fast enough at game time.

I then manipulated the context to increase the reinforcement for showing up – more kudos from others, more kudos delivered faster for individual plays, and a brand-new pair of kicks just for showing up and playing. And then I asked him to continue to watch. Watching improved discrimination of contingencies in a concurrent operant choice situation that led us to more precise matching over time of his rate of behavior to the rate of reinforcement.

Me was about Peter noticing all the names he came up with for himself: spastic, chicken, fat, and then listing all the names others came up with for him: boss, acer, dude, The Service (I guess that’s a tennis thing). It was kind of funny. So many names. It was also funny to look at all the names people called Rafael Nadal, and he was the reigning prince of men’s tennis. Apparently, people had some choice words for that guy.

I didn’t have time to use graduated exposure, so instead, I used a flooding technique. I had Peter scream out each of those names as he has hitting the ball during practice. Wow, was that tough for him – a wild ride with exposure to verbal, aversive stimuli! But oddly, he had fun with it, because no one could make out what he was saying. He did it during the next tournament too, without telling me. I probably wouldn’t have approved, but it worked for him. In the end, the opportunity to shout out the names (in public!) functioned as a reinforcer that was available immediately upon hitting the ball.

Me was also about Peter in this moment, right here, right now. What was Peter smelling, what colors was he seeing, what did his ankles feel like, what did his breath taste like? Okay, weird, but it worked during practice sessions with me and later, during tournament games, to transfer stimulus control from events in the future to stimuli in the present environment.

Like the other skill sets, Trying had two parts. To try is to verbally state that what matters to Peter is playing full out, giving it 100%. The reinforcement is in the playing, not the winning. What others say is what others say. Sure, people might cyber-bully, and people did. Trying became something that Peter did not want for himself but for all the kids out there who’d been bullied. It became his way of saying that it hurts, it’s wrong, and in the end, he would show up and stand against it. This was a reinforcement strategy that sounds like self-reinforcement, but Peter got a lot of press out of this. The world rallied behind him.

Try also meant that Peter would set mini-goals, get himself in action, track his behavior, and focus on small improvements over time. These behavioral momentum and self-monitoring skills payed off, because they kept his situational awareness on things that were within his control, rather than on the behavior of others. In other words, Peter found ways to bring his own behavior under relevant stimulus control in ways that mattered and worked for him.


Tom Szabo, PhD, BCBA-D, is a faculty member in the Hybrid Master’s Degree Program for Professional Behavior Analysis at the Florida Institute of Technology, site director at the Center for Autism and Related Disorders, an internationally recognized ACT trainer, a practicing Board Certified Behavior Analyst, and a graduate of the University of Nevada, Reno, where he studied under Steven C. Hayes and W. Larry Williams. Over the last 10 years, Tom has focused his practice on teaching people ways to ignite behavioral flexibility in their personal lives and with others in clinical practice, schools, board rooms, shop floors, and community centers. 

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