Autism
News
Network
Packet of Information for Parents New to Autism,
(on-line version)
Autism Spectrum
Disorders
Common Intervention Techniques
(the following verbatim from ASA except where I added a * to
indicate
that
more info/local sources may be found elsewhere in this packet.)
Parents of children who fall on the Autism Spectrum Disorder are
frequently
overwhelmed when confronted with the many the many
treatment/educational
approaches suggested for working with their children. The
following
is an explanation of some of the most widely used
techniques.
This list is not exhaustive. Some of these techniques are
comprehensive
programs, while others are designed to target a specific area of
difficulty.
There is little or no evidence to show that children with
autism
learn in group situations. Research findings indicate
that
children with autism learn only in one-on-one situations for
approximately
the first six months of treatment.
Discrete Trial Training (ABA)*
Discrete trial training is based on applied behavior analysis
principles.
This method involves breaking down tasks into simple elements and
teaching
the child through repetition. An individualized program is
designed
for each child to that the child's specific strengths and
weaknesses
can be addressed. The goal of the program is to teach the child
everything
that is required of a normally developing child of the same age,
so that the gap between the child's chronological and mental age
can be narrowed or eliminated. The content of instruction
includes
speech and language skills, gross and fine motor skills, academic
skills, self-care and social skills.
This program involves from 10 to 40 hours per week of one-to-one
discrete
trials. Play breaks of 20 to 30 minutes are included between each
hour of work. Proponents of this treatment recommend that
it
start early in life and continue for a long period of time.
The individual instruction is usually performed in the home, with
trained psychologists assisting parents and "therapists" (trained
professionals or paraprofessionals) in administering this
program.
The program emphasizes the importance of parents in following
through
with the treatment.
Floor Time*
This therapeutic approach seeks to improve developmental skills
through
analysis and intervention in six areas of functioning. The first
area has to do with a child's ability to regulate his or her
attention
and behavior, while being presented with a full range of
sensations.
The second area has to do with the child's ability to maintain
quality
and stability of engagement in relationships. The third
area
has to do with a child's ability to enter into two-way,
purposeful
communication. At its most basic level, this program
involves
helping the child open and close circles of communication.
A circle of communication is opened and closed when a child
evidences
some interest or behavior and the parent responds to that
interest
in a way that is acknowledge by the child.
The fourth level involves stringing together many circles of
communication
into larger patterns. This level is very important because many
children
who have command of a number of words are still unable to
maintain
a flow of two-way communication, which is necessary for
negotiating
many of the most important emotional needs of life. The
fifth
level has to do with the child's ability to create mental
representations
or emotional symbols through the ability to engage in pretend
play
or use words, phrases or sentences to convey some emotional
intention
("want that," "me mad" etc.). The last level has to do with
the ability to build bridges or make connections between different
internal
representations or emotional ideas (e. g., "I am mad because you
are mean.") This capacity is a foundation of higher level
thinking,
problem solving and such abilities as separating reality from
fantasy,
modulating impulses and mood, and learning how to concentrate and
plan.
The ideal treatment program for a child with emotional and
developmental
challenges according to proponents of this approach, would include
speech
therapy, sensory integration based occupational therapy, and an
educational
placement which includes typically developing peers. The focus of
the educational program should be on improving and increasing
interaction
patterns. However the cornerstone of this program is home-based,
where it is recommended that parents and care givers do "Floor
Time"
with the child in 20 to 30 minute intervals six times per day.
Floor
time involves building and increasing interactions, and opening
and
closing circles of communication all the time through following
and
building on the child's lead in play activities. This is an
intervention based upon engagement at an emotional level, so that
the child seeks interaction and is satisfied by engagement with
the
caregiver.
Picture Exchange Communication System (PECS)
The Picture Exchange Communication System (PECS) is a communication
training
system developed within the Delaware Autistic Program. PECS is
used
at the Delaware Autistic Program with students from the ages 2
through
21 years. Prior to using a picture exchange system,
intensive
verbal imitation training, sign language training and picture
pointing
programs were used with non-vocal students with limited
success.
According to proponents of this program possible reasons for the
limited success of these previously used training programs
include:
the use of arbitrary reinforcers, transient or temporally bound
stimuli,
oral-motor difficulties, speaker/listener role confusion, etc.
Students using PECS are required to give a picture of a
preferred
item
to a communicative partner in exchange for the item. The
initial
communicative behavior targeted is requesting. In the
request,
preferred items are presented as reinforcement of the
response.
Further, request training takes place in a social context.
Teaching students to request is a useful skill, and may
facilitate
the teaching of other communicative intents. The only
prerequisite
to beginning request training is the identification of those
items
or activities that are preferred by the student. Two therapists
are
initially required so that one sits behind the child and physically
prompts
him/her to give a picture in exchange for the reinforcer.
Physical
prompts are quickly faded in order to ensure independent
communication.
Once the requesting with pictures is firmly established the child
is then encouraged to verbalize the request.
Pivotal Response Training (PRT)
This intervention technique is based on the principles of applied
behavior
analysis. The intervention identifies certain behaviors for
treatment
that will produce simultaneous changes in many other
behaviors
"Pivotal behaviors" are thought to be central to wide areas of
functioning
and positive changes in pivotal behaviors should be widespread
effects
on many other behaviors. Two important pivotal behaviors
addressed
using this technique are motivation and responsivity to multiple
cues. The program works to increase motivation while
increasing
important skills, typically language acquisition, social
interaction,
and play skills, in hard to teach children with autistic spectrum
disorders. The training uses the following components:
The question/instruction/opportunity to respond should:
* Be clear, uninterrupted and appropriate to the task
* Be interspersed with maintenance tasks
* Be chosen by the child
* Include multiple components when appropriate
Reinforcers should be:
* Contingent upon behavior
* Administered following any reasonable attempts to respond
* Related to the desired behavior in a direct way
Pivotal Response Training provides parents, teachers and caregivers
with a method of responding to their child with autism/PDD, which
provides teaching opportunities throughout the day. It can
be used in structured one-on-one teaching or in the "natural
setting."
Important aspects of training include turn taking, reinforcing
attempts
at correct responding, frequent task variation, allowing the
child
a choice of activities, interspersing maintenance tasks, and
using
natural consequences. This type of training is flexible and
allows the teacher, parent or other caregiver to require more
difficult
responses as the child progresses. It was specifically designed
for
use by parents and can easily be integrated into everyday life in
order
to facilitate generalization and maintenance of behavior change.
RDI
Social Stories*
Many persons with autism have deficits in social cognition, the
ability
to think in ways necessary for appropriate social
interaction.
This deficit can be addressed by a technique, which is used to
help
individuals with autism "read" and understand social
situations.
This technique, called "Social Stories," presents appropriate
social
behaviors in the form of a story. There are a number of
ways
a social story can be implemented. For a person who can
read,
the author introduces the story by reading it twice with the
person.
The person then reads it once a day independently. For a person
who
cannot read, the author reads the story on an audiotape with cues for
the
person to turn the page as he/she 'reads' along. These cues could
be a bell or verbal statement when it is time to turn the
page.
Once the autistic individual successfully enacts the skills or
appropriately
responds in the social situation depicted, use of the story can
be
faded. This can be done by reducing the number of times the
story is read each week and only reviewing the story once a month
or as necessary. Fading can also be accomplished by
rewriting
the story or gradually removing directive sentences from the
story.
Social stories are useful for helping individuals with autism
learn
appropriate ways to interact in social situations. They can
be
individualized to incorporate the specific needs of the person for whom
the story is written. Activities are taught using flexible
directive statements such as "I will try to stay in my bed until
morning," to encourage the individual to try to reach the final
goal.
They can teach routines, how to do an activity, how to ask for
help
and how to respond appropriately to feelings like anger and
frustration.
TEACCH: Treatment and Education of Autistic and Communication
Handicapped
Children*
TEACCH is a state funded public health program available in North
Carolina,
which provides services from the level of diagnosis and early
counseling
for parents and professionals to adult community based
centers.
Educational strategies are established individually on the basis
of a detailed assessment of the person with autism's learning
abilities,
trying to identify potential for acquisitions rather than
focusing
on deficits. Educational programs are revised frequently,
according
to the child's maturation and progress.
A hallmark of the TEACCH program is to provide 'structured
teaching.'
This technique is based upon the observation that children with
autism
learn and integrate information differently than other
children.
Many noncompliant behaviors of children with autism are a result
of their difficulty understanding what is expected of them.
Structured teaching places heavy reliance upon teaching through
visual
modes due to difficulties that most children with autism have
with
processing verbal information. Visual structure is provided
at many levels, such as organizing areas of the classroom,
providing
a daily schedule using pictures or written words, visual
instructions
and visual organization signaling the beginning and end of
tasks.
Successful education of the child with autism demands a continuum
of
services. A continuum of services can best be conceived by
covering
a wide range of different approaches and different sites for
children
within the same age group.
Such a structured teaching system helps the child with autism
- Understand expectations
- Remain calm
- Focus on relevant information through visual cueing
- Achieve independence for tasks
- Manage behavior
Schedules
Being able to predict or anticipate the activities of the day gives
the
child a sense of control, security and independence.
Schedules
can be used in the home or classroom. They help to clarify
communication between parent/child and teacher/student.
Presenting information in a visual form:
- Helps establish and maintain attention
- Gives information in a form that the child can quickly and easily
interpret
- Clarifies verbal information
- Provides a concrete way to teach concepts such as time, sequence,
cause/effect
- Gives the structure to understand and accept change
- Supports transitions between activities or locations
Schedules are very helpful to children with autism who also have
problems
processing verbal commands. Children with autism as a whole are
visual
learners, so schedules are a natural and easy way to learn and
understand.
Schedules are made up of cards with pictures of activities or items
with
the name of the activity or item on it.
The schedule gives the child information such as:
* What is happening today (regular activities)
* What is happening today (something new, different, unusual)
* What is not happening today
* What is the sequence of events
* What is changing that I normally expect
* When it is time to stop one activity and move on to another one
The Autism Society of America does not endorse individuals or
programs.
References regarding programs, resources, treatment, etc. should not
be interpreted as an indication of endorsement by The Autism
Society
of America. They are provided for information only.
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