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A Sampling of Treatment Approaches Used Currently

Treatment

Assumptions &
Guiding Principles

Goals

A Sampling of
Major Strategies

Parental Role

Applied Behavior Analysis (ABA)

Intensive Behavioral Intervention (IBI)

*Autism is a syndrome of behavioral deficits and excesses that are amenable to change through specific, carefully programmed, constructive interactions with the environment
*Children with autism do not learn readily from typical environments prior to treatment.
*Studies show that (1)Intensive early behavioral intervention can result in age-appropriate performance for almost 50% of children with ASD and that (2)all children with ASD can benefit greatly from an ABA approach to instruction
*By targeting areas of weakness as well as areas of strength, the developmental profiles of children with autism can become more even and more similar to age-expectations
*Learning should be fun
*To teach simple and complex pivotal skills that will enable children in the average environment.
*To develop a behavioral profile that is as typical as possible
*To move towards inclusion at a level that is consistent with the acquisition of requisite skills
*To develop skills which will enable an individual to function as independently as possible and to participate in the life of his family and community with joy as fully as possible.
*Intensity (30 to 40 hrs/wk)
*Curriculum is designed in
 consideration of a child's  current skills and the skills expected of same-age peers
*Functional Analysis
*Task Analysis
*Individualized reinforcement systems
*Repeated practice through discrete trials
*Prompting
& Prompt Fading
*Modeling
*Shaping and Chaining
*Incidental Teaching
*Mind-Model
*Systematic Generalization training
*Instructional groupings that begin with 1:1 and then progress to small groups up to classroom size
*Data-based decision making
Parents play a central role as                 therapists, as coordinators and administrators of their children's home programs, and as key consultants to their child's center-based programs or included classrooms
Auditory Processing Therapy

e.g., Fast Forward

*Some children with autism do not discriminate the individual sounds within words (or the boundaries between these sounds) unless the rate of the speech signal is reduced
*This problem may interfere with children's acquisition of conventional language skills
*To assist children in learning to discriminate between phonemic boundaries within increasingly larger units of speech. *Listening tasks are adapted to meet the specific processing abilities of each child
*As a child gains proficiency, the response requirements are modified correspondingly until age-appropriate processing rates are attained
*All adjustments are made automatically by a computer based on the child's performance data
*This is sometimes called "classes for the ears"
Parents do not play a role in the therapy
per se. However, participation in this program requires a daily commitment of time over a period of 5 or more weeks.

Communication Modality Options

e.g., PECS

 

*For some children, the desire to communicate specific intents develops earlier than the ability to use oral language
*All children should have a means of communicating their intentions
*Some children will find it easier, to use miniature objects, photographs, visual symbols, printed words, etc., rather than speech as signals to carry a message
*To enable children to communicate their intentions even if oral language is not yet a primary option
*To teach the use of signals for initiating as well as responding
*To encourage the use of vocalization and speech to the fullest extent possible
*Assessment of communicative needs
(e.g., current strategies, motivations, etc.)
*Identification of the most universal and least restrictive devise or system
*Use of the system in a variety of communicative contexts
*Encouragement for speaking or vocalizing simultaneously while using alternative modalities

 

 

Parents provide info about child's communicative history; create situations which motivate and reinforce communication & generalization
Developmental Social-Pragmatic Approach to Language Intervention

 

*Children with autism present with a major deficiency in
(1) the development of a normal range of communicative intentions and
(2) in the socially appropriate uses of communication signals
*An intervention approach which utilizes the child's internal motivations in a typical environment can reduce these deficits
*To build a complete range of social-communicative functions
*To facilitate the use of language forms which are consistent with a child's communicative intents
*To develop increasingly higher levels of meaning, organization, and expression
*Selecting developmental targets
*Following the child's lead
*Developing Joint Activity   Routines (JARs)
*Increasing the flexibility
of JARs
*Expanding the content of JARs
*Teaching peers to engage children with autism in JARs
*Alternate modalities used when needed

 

Parents are encouraged to participate as much as is comfortable within their family system.
Floor Time (Greenspan)

 

*Children with Multisystems Developmental Disorders (MSDD) (including many with PDD) can benefit from "floor time"
*Floor time moves children through developmental stages
(1) Regulation and interest in the world
(2) Forming relationships
(3) Intentional two-way communication
(4) Behavioral organization
(5) Behavioral elaboration
(6) Representational capacity
(7) Representational
elaboration
(8) Development of emotional ideas
(9) Development of emotional thinking
*To develop the highest level of functioning that a child can achieve
*To motivate increasingly higher levels of performance through relationship-based interactions that are highly sensitive to the child's affect
*Intensive floor time involving 5 key procedures:
(1) observe the child
(2) open the circle of communication by acknowledging the child's affective tone
(3)Follow the child's lead by being a supportive play partner
(4) Extend and expand play
(5) Allow the child to close the circle of communication
*Utilize support services to address other issues in the multi-system developmental disorder (e.g., OT and/or PT, SLP, integrated early education program with special education support)

 

Parents participate  as                 therapists and coordinators and administrators of their children's home programs. They also participate as key consultants to their child's school programs
Inclusion e.g., LEAP (=Learning Experiences, an Alternative Program for Preschoolers & their Parents) *children should be taught in the least restrictive environment
*children with autism can benefit from the learning opportunities in a typical classroom
*To provide ASD children with typical role models
*To assist children in functioning in a typical environment
*To expose typical peers to children with ASD
*Exposure to typical peer models
*Provide shadow aides to support a child's participation
*Train peers to engage children with autism in communicative exchanges
Parents generalize skills to home and in the community
Sensory Integration

(Auditory, Visual, Tactile, Proprioceptive, Vestibular, Gustatory, Olfactory)

 

*Learning requires normal sensory processing
*Normal sensory processing requires neurological integrity
*Neurological integrity can be achieved through an individually designed sensory diet
*Without a normalized sensory diet, children with autism may develop self-stimulatory behaviors to keep their systems alive
*To normalize sensory experiences so that a signal is not so powerful or so weak as to interfere with the perception of its meaning
*To assist children in moving through the development stages which are basic to information processing at successive levels
*To support children in following their natural motivations for leisure activities
e.g.,
*Sensory Diet
*Graded Experiences
*Intrinsically motivating activities
*Vestibular Stimulation
*Deep Pressure
(e.g., Squeeze Machine)
*Brushing
Parents can provide children with appropriate experiences and toys. They can also help to generalize newly acquired skills
Social Stories

 

*Learning opportunities can be optimized by providing children with relevant models
*The most relevant models are ones in which
(1) the child herself is at the center and
(2) the theme is based on activities in which the child engages
*To provide children with models of appropriate behavior through individually-designed social stories about themes pertinent to the child's life e.g.,
*Write social story with child at center of an activity that is difficult for him or her
*Read story to child prior to the activity
*Talk about the story with child
Parents play a major role in writing and presenting the stories to their children
TEACCH

(=Treatment and Education of Autistic and Related Communication Handicapped CHildren)

*Autism is a life-long disability
*Children with autism constitute a kind of subculture with a unique set of strengths, weaknesses, and range of tolerance for variation
*The educational environment should accommodate their communication, social and cognitive patterns
*Instruction should capitalize on natural strengths
*To Minimize frustration
*To Develop skills that will enable individuals to earn a living, to live as independently as possible, and to participate in the life of their community as much as possible
 
*Structured teaching in a center-based and community-based context
*Provide a classroom that has clearly defined work areas
*Use visual schedule systems to organize activities throughout the day
*Process materials from left to right
*Utilize work systems ("jigs") which involve visual prompts to scaffold a sequence of steps
*Observe the rule of
"First work, then play"
Parents help to generalize a child's acquired skills to the home and community, and parents are key consultants to the design of the child's program

Koenig (1998)

 

 

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