Treatment for autism is a very intensive, comprehensive undertaking that involves the child’s entire family and a team of professionals. There are many different programs and options.
The Developmental, Individual Difference, Relationship-based (DIR®/Floortime™) Model is a framework that helps clinicians, parents and educators conduct a comprehensive assessment and develop an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders (ASD) and other developmental challenges. The objectives of the DIR®/Floortime™ Model are to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors.
The D (Developmental) part of the Model describes the building blocks of this foundation. Understanding where the child is developmentally is critical to planning a treatment program. The Six Developmental Milestones describes the developmental milestones that every child must master for healthy emotional and intellectual growth. This includes helping children to: 1) develop capacities to attend and remain calm and regulated; 2) engage and relate to others; 3) initiate and respond to all types of communication, beginning with emotional and social affect-based gestures; 4) engage in shared social problem-solving and intentional behavior, involving a continuous flow of interactions in a row; 5) use ideas to communicate needs and think and play creatively; and 6) build bridges between ideas in logical ways which lead to higher level capacities to think in multicausal, grey area and reflective ways. These developmental capacities are essential for spontaneous and empathic relationships as well as the mastery of academic skills.
The I (Individual differences) part of the Model describes the unique biologically-based ways each child takes in, regulates, responds to, and comprehends sensations such as sound, touch, and the planning and sequencing of actions and ideas. Some children, for example, are very hyper-responsive to touch and sound, while others are under-reactive, and still others seek out these sensations. Biological Challenges describes the various processing issues that make up a child’s individual differences and that may be interfering with his ability to grow and learn
The R (Relationship-based) part of the Model describes the learning relationships with caregivers, educators, therapists, peers, and others who tailor their affect based interactions to the child’s individual differences and developmental capacities to enable progress in mastering the essential foundations.
Central to the DIR®/Floortime™ Model is the role of the child’s natural emotions and interests which has been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together and to build successively higher levels of social, emotional, and intellectual capacities. Floortime™ is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities. With young children these playful interactions may occur on the “floor”, but go on to include conversations and interactions in other places. The DIR®/Floortime™ Model, however, is a comprehensive framework which enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths. It often includes, in addition to Floortime™, various problem-solving exercises and typically involves a team approach with speech therapy, occupational therapy, educational programs, mental health (developmental-psychological) intervention and, where appropriate, augmentative and biomedical intervention. The DIR®/Floortime™ Model emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child. For more information see: http://icdl.com/
PECS (PICTURE EXCHANGE COMMUNICATION SYSTEM)
A picture exchange communication system (PECS) is a form of augmentative and alternative communication (AAC) that uses pictures instead of words to help children communicate. PECS was designed especially for children with autism who have delays in speech development. Go here for more information: http://www.pecs.com/
The SCERTS® Model is a research-based educational approach and multidisciplinary framework that directly addresses the core challenges faced by children and persons with ASD and related disabilities, and their families. SCERTS® focuses on building competence in Social Communication, Emotional Regulation and Transactional Support as the highest priorities that must be addressed in any program, and is applicable for individuals with a wide range of abilities and ages across home, school and community settings. Go here for more information: http://www.scerts.com/
Occupational Therapy can benefit a person with autism by attempting to improve the quality of life for the individual. The aim is to maintain, improve, or introduce skills that allow an individual to participate as independently as possible in meaningful life activities. Coping skills, fine motor skills, play skills, self help skills, and socialization are all targeted areas to be addressed.
SENSORY INTEGRATION THERAPY
Sensory Integration Therapy is a type of occupational therapy (OT) that places a child in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to encourage movement within the room.
Sensory Integration Therapy is driven by four key principles (1):
- The child must be able to successfully meet the challenges that are presented through playful activities (Just Right Challenge).
- The child adapts her behavior with new and useful strategies in response to the challenges presented (Adaptive Response).
- The child will want to participate because the activities are fun (Active Engagement).
- The child’s preferences are used to initiate therapeutic experiences within the session (Child Directed).
Speech Therapy focuses on receptive language, or the ability to understand words spoken to you, and expressive language, or the ability to use words to express yourself. It also deals with the mechanics of producing words, such as articulation, pitch, fluency, and volume. Some children only need help with language, others have the most problems with the mechanics of speech, and some need every kind of speech help there is.
Based on the work of psychologist Steven Gutstein, Relationship Development Intervention (RDI) focuses on improving the long term quality of life for all individuals on the spectrum. The RDI program is a parent-based treatment that focuses on the core problems of gaining friendships, feeling empathy, expressing love and being able to share experiences with others. RDI works on 6 abilities which are called dynamic intelligence:
- Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others.
- Social Coordination: The ability to observe and continually regulate one’s behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions.
- Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.
- Flexible Thinking: The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances.
- Relational Information Processing: The ability to obtain meaning based upon the larger context. Solving problems that have no “right-and-wrong” solutions.
- Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner.
For more information, see: http://www.rdiconnect.com/
The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.”
Building on the fact that autistic children are often visual learners, TEACCH brings visual clarity to the learning process in order to build receptiveness, understanding, organization and independence. The children work in a highly structured environment which may include physical organization of furniture, clearly delineated activity areas, picture-based schedules and work systems, and instructional clarity. The child is guided through a clear sequence of activities and thus aided to become more organized.
For more information, http://www.teacch.com
Verbal Behavior Intervention is often seen as an adjunct to Applied Behavioral Analysis (ABA). Though both are based on theories developed by Skinner there are differences in concept. In the late 1950s and early 60’s when Dr. Ivar Lovaas was developing his ABA principles, Skinner published Verbal Behavior which detailed a functional analysis of language. He explained that language could be grouped into a set of units, with each operant serving a different function. The primary verbal operants are what Skinner termed echoics, mands, tacts, and intraverbals.
The function of a mand is to request or obtain what is wanted. For example, the child learns to say the word “cookie” when he is interested in obtaining a cookie. When given the cookie, the word is reinforced and will be used again in the same context. There is an emphasis on “function” of language(VB) as opposed to form (Lovaas-based). In a VB program the child is taught to ask for the cookie anyway he can (vocally, sign language, etc.). If the child can echo the word he will be motivated to do so to obtain the desired object.
Applied Behavioral Analysis (ABA) uses positive reinforcement and other principles to build communication, play, social, academic, self-care, work, and community living skills and to reduce problem behaviors in learners with autism of all ages.
Some ABA techniques involve instruction that is directed by adults in a highly structured fashion, while others make use of the learner¹s natural interests and follow his or her initiations.
All skills are broken down into small steps or components, and learners are provided many repeated opportunities to learn and practice skills in a variety of settings, with abundant positive reinforcement.
Performance is measured continuously by direct observation, and intervention is modified if the data show that the learner is not making satisfactory progress.