Autism is a complex disorder that has no common cause and therefore no universal cure. There is no single treatment, for example a drug or therapy, which will work for all affected by autism. The best treatment is often a plan designed to meet the areas of need for a particular individual.The areas to explore when creating a plan are those that are most affected by the disability of autism: social skill development, communication, behavior, and sensory integration.
When considering any treatment for a person with autism, it is important to read all information about the treatment, including any scientific research that has been done, and any studies that support positive outcomes. The more knowledgeable parents or caregivers become, the more likely they will be able to choose appropriate options.
Professionals who work in the field agree that individuals with autism respond well to structured, specialized education programs specific to individual need. Programs often include several components, such as speech therapy, social skill development, and behavioral therapy. No single option fills the needs of everyone with autism. A comprehensive plan needs to be developed, with options that are most appropriate for the individual.
Following are some options that are frequently part of a program for a child with autism. The Autism Society of Ohio does not endorse or recommend any treatment or program; information is provided to assist parents and caregivers in making appropriate choices for their child.
Communication ProgramSocial Skills
Behavior
Applied Behavioral Analysis (ABA)
Discrete Trial Training (DTT)
Verbal Behavior (VB) Intervention
Pivotal Response Therapy (PRT)
Sensory Based
Educational Models
TEACCH
SCERTS Model
Relationship Development Intervention (RDI)
Developmental-Individual Differences-Relationship (D.I.R.)/Floortime
Biomedical Interventions
Medications
Nutritional and Dietary Interventions
In Conclusion
Treatment options include:
Communication Program
Communication difficulties, both verbal and nonverbal, are inherent in the diagnosis of ASD. The typical sequence of communication development is disrupted. As a result, communication skills can range from nonverbal, gestural, the use of single words, to verbal conversation. Communication programs, guided by speech/language therapists, may focus on acquiring language skills, developing pragmatic language skills, or improving social communication. Communication aides such as electronic communication devices or picture communication boards may assist in communicating more effectively. Some children respond positively to sign language.
Facilitated Communication is a technique by which a trained professional (facilitator) supports the hand, arm, or shoulder of a person with communication impairments. The method assists the individual to either point to or press keys of a communication device. If successful, the individual can then communicate through typing or spelling out words.
Ohio Speech Language Hearing Association: www.ohioslha.org
Social Skills
A core issue in autism is a lack of social ability or the understanding of social cues. Programming in this area may include assisting the individual with autism to recognize facial expressions and emotions, communicating in social settings, or learning appropriate behavior in public. Social skills programming may be part of a behavior plan supervised by a psychologist or behavior specialist. A speech/language therapist may be involved if social communication is part of the plan.
Behavior
Many treatment programs include techniques to deal with the often-challenging behavioral manifestations of autism. Behavior analysis can be helpful in dealing with challenging behaviors. It stems from the idea that behaviors, even when they are challenging or confusing, can be understood as a result of careful observation, record keeping, and analysis. Once behaviors are understood, they can be modified based on the needs and desires of the person whose behavior is at issue.
Treatment programs models include:
Applied Behavioral Analysis (ABA), which is a systematic approach to analyzing and changing behavior. Behavior analysis is a scientific approach to understanding behavior and how it is affected by the environment. "Behavior" refers to all kinds of actions and skills (not just misbehavior) and "environment" includes all sorts of physical and social events that might change or be changed by one's behavior. The science of behavior analysis focuses on principles (that is, general laws) about how behavior works, or how learning takes place. For example, one principle of behavior analysis is positive reinforcement. When a behavior is followed by something that is valued (a "reward"), that behavior is likely to be repeated. Through decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may be harmful or that interfere with learning. Applied behavior analysis (ABA) is the use of those techniques and principles to address socially important problems, and to bring about meaningful behavior change.
ABA includes finding out the connection between an individual’s behavior and his/her environment. In other words, what is causing the behavior? ABA uses direct observation and measurement of behavior and environment. Measurement looks at how often, what time, how long, to whom, or how intense a behavior occurs. ABA also looks at what happens in or to the environment right before a behavior occurs, otherwise known as the antecedent behavior. Antecedent behavior includes verbal, gestural or physical prompts, cues, materials, language, and environmental factors (sensory input: noise, light, smell, taste, touch), either naturally occurring or intentionally manipulated to affect a behavior. The consequence of the behavior is what occurs after the behavior. Consequences include reinforcement, both positive and negative, and punishment. Reinforcement increases the likelihood of the behavior occurring again. Punishment procedures increase the likelihood of the behavior diminishing or disappearing (known as extinction). The sequence of ABA is sometimes referred to as ABC: antecedent, behavior, consequence.
Association for Behavior Analysis International: www.abainternational.org
Clinical Behavior Analysts: www.abatherapy.net
Discrete Trial Training (DTT), also called the "Lovas Model" is an ABA strategy. ABA is not synonymous with discrete trial training (DTT), although many erroneously use the terms interchangeably. DTT is a distinct and complete behavioral event that includes a discriminative stimulus or the antecedent (what happens before the behavior), the response or behavior (what the child is required to do), and the consequence for the behavior (reinforcement). The term “Lovaas Therapy” comes from Dr. O. Ivar Lovaas, whose landmark research led to the application of DTT techniques to teach children with autism.
The Lovaas Institute for Early Intervention: www.lovaas.com
Wisconsin Early Autism Project: www.wiautism.com
Verbal Behavior (VB) Intervention, also called applied verbal behavior, is a type of ABA that is based on B. F. Skinner’s 1957 analysis of verbal behavior. Like the Lovaas model, VB emphasizes the importance of using very structured and organized learning environments, including readily accessible reinforcers delivered after a correct response. The model teaches both speaker and listener behavior. The VB format uses discrete trial instruction as well as natural environment training (NET), a practice that differentiates itself from the Lovaas model. The NET supports the generalization of responses in different settings and different stimulus conditions.
The VB model focuses on teaching the functions of language. This includes teaching children the many uses of language such as requesting, labeling, speech imitation, describing, categorizing, reading and commenting. (Skinner used the words mand, tact, echoic, and intraverbal to describe these functions.) VB begins with teaching “mands,” which are commands, demands, requests; then “what do you want?” to elicit language; moving on to echoic, receptive, “tacting” (labeling objects); then receptive language by function (“what does it do?”), feature (“what does it look like or what are characteristics?”), and class (category); and finally “intraverbals,” both simple and complicated, which are word “associations.”
B. F. Skinner Foundation: www.bfskinner.org
Dr. Vincent J. Carbone: www.drcarbone.net
Pivotal Response Therapy (PRT), previously called the Natural Language Paradigm (NLP), which has been in development since the 1970s. It is a behavioral intervention model based on the principles of ABA. Pivotal Response Treatment was developed by Dr. Robert L. Koegel and Dr. Lynn Kern Koegel at the University of California, Santa Barbara.
PRT is used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills by focusing on critical, or "pivotal" behaviors that affect a wide range of behaviors. The primary pivotal behaviors are motivation and child's initiations of communications with others.
The goal of PRT is to produce positive changes in the pivotal behaviors, leading to improvement in communication skills, play skills, social behaviors and the child's ability to monitor his own behavior. Unlike the Discrete Trial Teaching (DTT) method of teaching, which targets individual behaviors, based on an established curriculum, PRT is child directed. Motivational strategies are used throughout intervention as often as possible. These include the variation of tasks, revisiting mastered tasks to ensure the child retains acquired skills, rewarding attempts, and the use of direct and natural reinforcement. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. For example, a child's purposeful attempts at functional communication are rewarded with reinforcement related to their effort to communicate (for example, if a child attempts a request for a stuffed animal, the child receives the animal).
PRT for Autism: http://www.koegelautism.com/
Sensory Based
An area of difficulty in autism is the integration of sensory messages. Some individuals may have unusual reactions to touch, pain, and input from the senses of sight, hearing, smell, and taste. There are different treatments, depending on the sense that is affected.
Sensory Integration focuses on the sensory processing needs of the child as critical to the learning process. It utilizes equipment to assist the child in meeting proprioceptive, vestibular, and tactile needs. An individual "sensory diet" is prescribed.
Auditory Integration Training is a treatment for some individuals with autism who are oversensitive to sound. It involves listening to a variety of different sound frequencies. An audiologist trained in this particular method performs auditory integration.
Educational Models
Children with the label of autism may be educated in regular classrooms, separate classrooms, or a combination of the two. Federal law requires that children receive educational services in the "least restrictive environment" possible. Placement choices should be made based in the individual needs of the child and support services should be put in place, as appropriate.
There are several educational model programs designed for students with autism, each of which may be tailored to the needs of the child:
TEACCH was developed in the early 1970s by Eric Schopler. The TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) approach focuses on the person with autism and designing a program around her skills, interests, and needs. Thus, the individual, rather than the instructional method, is the priority.
The program uses structured teaching in a variety of settings. Organizing the physical environment, developing schedules and work systems, making expectations clear and explicit, and using visual materials have been found to be effective ways of developing skills and allowing people with ASD to use these skills independently of direct adult prompting and cueing.
Cultivating strengths and interests, rather than drilling solely on deficits, is another important priority. The relative strengths of those with autism in visual skills, recognizing details, and memory, among other areas, can become the basis of successful adult functioning (Mesibov & Shea, 2006).
Division TEACCH: www.teacch.com
SCERTS Model™ stands for Social Communication, Emotional Regulation, and Transactional Support. The SCERTS Model™ is a comprehensive model that is based on a developmental perspective and was designed to support individuals with ASD. SCERTS is interdisciplinary in its approach, in that it addresses social communication and emotional regulation throughout the child’s daily activities and routines, and guides and supports parents and caregivers through a multidisciplinary team effort. The model uses the knowledge base and experience of general and special educators, speech language pathologists, occupational therapists, child psychologists, psychiatrists, and social workers.
The SCERTS Model™ is not prescriptive, nor is it a curriculum. Instead, it is based on fundamental beliefs and values that address the core deficits of ASD. The model is systematic, semi-structured, but flexible, so that the individual goals of the family and child with ASD can be addressed at specific developmental levels. The model is based on the belief that children learn best when they are emotionally regulated and can communicate within a social context. The SCERTS Model™ was systematically developed to be implemented based on those beliefs. It is does not exclude other educational models, but accepts them within its framework of intervention as appropriate.
SCERTS Website: http://www.scerts.com/
Relationship Development Intervention (RDI), created by Steven Gutstein, Ph.D., is modeled on how typical children become competent in the world of emotional relationships. It is an intervention approach quite different from the typical social skills programs currently available.
RDI uses assessment information to develop clear, specific, developmentally appropriate treatment objectives and customized activities. The RDI curriculum is composed of six levels, each representing a dramatic developmental shift in the central focus of relationships. The six levels are: Novice, Apprentice, Challenger, Voyager, Explorer, and Partner. RDI provides a path for people on the autism spectrum to learn friendship, empathy, and a love of sharing their world with others. Language comes alive when integrated with real emotion. People with ASD learn not only to tolerate but to enjoy change, transition, and going with the flow. The path begins at the edge of each person’s current capability and carefully, systematically teaches the skills needed for competence and fulfillment in a complex world.
Connections Center: www.rdiconnect.com
Developmental-Individual Differences-Relationship (D.I.R.)/Floortime model was created by Dr. Stanley Greenspan and his colleague Serena Weider as an intervention for children with autism and other developmental delays. Greenspan and Weider (1998) specify six functional milestones of development in this order: self-regulation and interest in the world, intimacy, two-way communication, complex communication, emotional ideas, and emotional thinking. According to the authors, these milestones lay a foundation for more advanced learning since they are based upon emotional interactions usually developed early in life.
The D.I.R. model uses a comprehensive evaluation, including developmental history, biomedical assessment, current functioning, child-caregiver interactions, auditory processing, sensory processing, sensory modulation, motor and perceptual motor functioning, and family patterns, to develop a comprehensive intervention plan for the child and family. The primary goal of the D.I.R.-based intervention is to enable children to form a sense of themselves as intentional, interactive individuals and to develop cognitive language and social capabilities from this basic sense of intentionally.
Part of the D.I.R. method uses “floortime,” which is an intensive, one-to-one experience during a 20- to 30-minute period when a caregiver physically gets down on the floor and interacts with the child. The focus is on relationships, based on Greenspan and Weider’s belief that the more intellectual functions of the brain do not develop without a constant source of relating. During floortime, the adult follows the child’s interest or intent, even if the interest is a self-regulatory behavior, in order to encourage interaction. For example, if the child spins the wheels on a car, the adult may help him or spin a different wheel. The adult may limit the number of toys available so that the child has to interact to get more toys. The goal is not just to follow the lead of the child but to help the child expand his interactions. According to the authors, the four goals of floortime are two-way communication, logical thought, attention and intimacy, and the expression and use of feelings and ideas.
Floortime/DIR Model: www.play-to-learn.com/dir_floortime.htm
Medications: A variety of medications have been prescribed for individuals with ASD, and several have been researched. However, no one medication works for every person with ASD. Hyperactivity, sleep problems, obsessive tendencies, anxiety, aggression, and self-injury are some of the symptoms that may be targeted with specific medications.
Nutritional and Dietary Interventions: Individuals with autism may exhibit low tolerance or allergies to certain foods or chemicals. While not specific causes of autism, food intolerances or allergies may contribute to behavioral issues. Nutritional therapies may be used for a variety of reasons. Some parents and professionals have reported changes when specific substances are eliminated from the child’s diet. These include: The Gluten Free Casein Free Diet which eliminates gluten and casein, the Feingold Diet which is a food elimination diet, and the Specific Carbohydrate Diet which is a strict grain-free, lactose-free, and sucrose-free dietary regimen. Nutritional supplements such as B6 and Magnesium, Vitamin B12, Dimethylglycine (commonly known as DMG) and Melatonin are also used for individuals with autism.
It is important to remember that no one option or program will fully educate children with autism spectrum disorder. Intervention must be based on the strengths and challenges of each individual and it should combine selected components from a variety of intervention models.
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