The main goals when treating children with autism are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes.
No single treatment is best and treatment is typically tailored to the child’s needs. Families and the Educational system are the main resources for treatment.
This article is part 1 of a two part set of articles.
Educational interventions attempt to help children not only to learn academic subjects and gain traditional readiness skills, but also to improve functional communication and spontaneity, enhance social skills such as joint attention, gain cognitive skills such as symbolic play, reduce disruptive behaviour, and generalize learned skills by applying them to new situations. Several model programs have been developed.
They can take place at home, at school, or at a centre devoted to autism treatment; they can be done by parents, teachers, speech and language therapists, and occupational therapists.
Applied Behaviour Analysis
Applied behaviour analysis, or ABA, has been used to teach communication, play, social, academic, self-care, work and community living skills, and to reduce problem behaviours in learners with autism.
ABA methods use the following three step process to teach:
•An antecedent, which is a verbal or physical stimulus such as a command or request. This may come from the environment or from another person, or be internal to the child;
•A resulting behaviour, which is the child’s response or lack of response to the antecedent;
•A consequence, which depends on the behaviour. The consequence can include positive reinforcement of the desired behaviour or no reaction for incorrect responses.
ABA targets the learning of skills and the reduction of challenging behaviours.
Most ABA programs are highly-structured. Targeted skills and behaviours are based on an established curriculum. Each skill is broken down into small steps, and taught using prompts, which are gradually eliminated as the steps are mastered. The child is given repeated opportunities to learn and practice each step in a variety of settings. Each time the child achieves the desired result, he receives positive reinforcement, such as verbal praise, or something else that the child finds to be highly motivating, like a small piece of candy.
Discrete Trial Training
One type of ABA intervention is Discrete Trial Teaching (also referred to as DTT, “traditional ABA” or the Lovaas Model).
Discrete trial teaching (DTT) methods use stimulus-response-reward techniques to teach foundational skills such as attention, compliance, and imitation.
These students are also taught with naturalistic teaching procedures to help generalize these skills. In functional assessment, a common technique, a teacher formulates a clear description of problem behaviour, identifies antecedents, consequences, and other environmental factors that influence and maintain the behaviour, develops hypotheses about what occasions and maintains the behaviour, and collects observations to support the hypotheses.
Pivotal Response Training
It is a behavioural intervention model based on the principles of ABA. PRT is used to teach language, decrease disruptive/self-stimulatory behaviours, and increase social, communication, and academic skills by focusing on critical, or “pivotal,” behaviours that affect a wide range of behaviours.The primary pivotal behaviours are motivation and initiation of communications with others.
The goal of PRT is to produce positive changes in the pivotal behaviours, leading to improvement in communication skills, play skills, social behaviours and the child’s ability to monitor his or her own behaviour.
Unlike DTT, which targets individual behaviours based on an established curriculum, PRT is child-directed. Motivational strategies include varying tasks, revisiting mastered tasks to ensure the child retains acquired skills, rewarding attempts, and using direct and natural reinforcement. The child plays a crucial role in determining the activities and objects. For example, if a child attempts a request for a stuffed animal, the child receives the animal.
Another behavioural (based on the principles of ABA) therapy method with a different approach to the acquisition and function of language is Verbal Behaviour (VB) therapy. Verbal Behaviour teaches language and shaping behaviour.
All language can be grouped into a set of units, which he called operants. Each operant he identified serves a different function.
1. Mand: The function of a “mand” is to request or obtain what is wanted. E.g. The child learns to say the word “cookie” when he is interested in obtaining a cookie.
2. Echo: The child is taught to ask for the cookie any way he can (vocally, sign language, etc.). If the child can echo the work, he will be motivated to do so in order to obtain the desired object.
3. Tact: The operant for labelling an object is called “tact”. E.g., the child says the word “cookie” when seeing a picture and is thus labelling the item.
4. Intraverbal: An “intraverbal” describes conversational or social language. Intraverbals allow children to discuss something that isn’t present. For example, the child finishes the sentence, “I’m baking…” with the intraverbal fill-in “Cookies.”
VB is designed to motivate a child to learn language by developing a connection between a word and its value.
Early Start Denver Model (ESDM)
The Early Start Denver Model (ESDM) is a developmental, relationship-based intervention approach that utilizes teaching techniques consistent with ABA.
The goals are to foster social gains – communicative, cognitive, and language and to reduce atypical behaviours associated with autism.
ESDM is appropriate for children with autism or autism symptoms who are as young as 12 months of age, through preschool age.
The content of intervention for each child comes from assessment using a comprehensive ESDM Curriculum Checklist which covers all domains of early development: Cognitive Skills, Language, Social Behaviour, Imitation, Fine and Gross Motor Skills, Self-help Skills and Adaptive Behaviour.
Adults delivering ESDM focus on behaviours involved in capturing and holding children’s attention, fostering their motivation for social interaction through highly enjoyable routines, using joint play activities as the medium for treatment, developing nonverbal and verbal communication, imitation, and joint attention, and using reciprocal, turn-taking exchanges inside joint activity routines to foster social learning.
Part 2 will come next week. Follow the blog to stay updated!
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Want to read more?
- Equine Assisted Therapy: An Unconventional Treatment
- Autism – Understanding the Basics
- 7 Tips for Teaching Autistic Children
About the School For Autism, Hyderabad
School For Autism is based in Hyderabad and provides therapy to people with autism, irrespective of age. To know more about the school, click here.