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December 5th, 2006

Treatment Approaches for ASD

autistic_child_556.jpgThere are so many different treatment approaches for ASD that I could write a book on this topic.  For now, I will share with you a general overview of many (of course not all) of the different approaches for treatment.  Unfortunately, there is no gold standard treatment for this population, nor is there a well-documented strategy for choosing the appropriate intervention or figuring out which approach might be best for your child.  The most important thing to keep in mind when choosing an appropriate intervention stratopbg.giftegy for a child is to understand that each child with autism is an individual and has unique needs.  This means, that regardless of what anyone may have told you in the past, one size does not fit all, and that there is no one treatment approach that works for every single child with autism, anyone who makes that claim is false.  Most good clinicians pull from several treatment approaches to create an individualized intervention program that fits the child’s skills and needs and that fits into the lifestyle of the families and that is appropriate to use in the home and school environments.  Many people claim that they can cure autism, and while a treatment may be successful and many children may look very different after quality intervention, there is no one treatment approach that can make the claim that they can cure autism in all children.  Studies comparing different treatment approaches are rare and so there is little evidence to suggest that one approach is better than any other.  The best advice I can give parents is to choose based on your gut instinct and carefully monitor your child’s progress.  Also, continue to educate yourself about different interventions so that you will feel that you always have choices when your program is no longer working for your child. 

HomeworkThere are a few general philosophical approaches to treatment, and while many people choose a particular philosophical path, many choose to pull elements from different approaches for a more eclectic treatment approach.  There is no right or wrong choice here as long as progress is regularly measured to evalute whether or not the intervention is working for that child.  More than a couple of weeks without progress should be a red flag to re-evaluate the treatment program.95105.jpg

Behavioral Approaches: This approach focuses on increasing and decreasing skills using the science of Applied Behavior Analysis (ABA).  There are MANY treatment approaches under the ABA umbrella, and the interventions tend to be very research based and data driven.  Some of these approaches are not strictly behavioral and incorporate aspects of other philosophical approaches (e.g. TeachTown, PECS, TEACCH).

666359_brilliant_smile_1.jpg1) Discrete Trial Training (DTT):  In this approach, children are taught skills using a stimulus-response-consequence pattern in a massed trial format.  This is one of the more structured teaching approaches and is often helpful for introducing new skills or working on skills which require memorization or rote learning.  This approach is nicely decribed at polyxo.com!640264_dear_ruby.jpg

2) Verbal Behavior:  This approach, first introduced by B.F. Skinner, uses operant conditioning to teach language.  This approach requires understanding the vocabulary used such as mands, tacts, intraverbals, etc.  These operants are all taught systematically in a discrete trial type of teaching.  This is also a fairly structured approach to teaching.  For more information, check out the description on the Autism Speaks website.

620423_homework.jpg3) Fluency/Precision Teaching:  This approach focuses on increasing the frequency of behaviors and the rate at which they occur.  This approach requires a good deal of training to be able to implement the program and use the charting that is required.  The Autism Teaching Tools website does an excellent job in outling this approach.

4) Pivotal Response Training:  This ABAservices_pic1.jpg approach is a less structured, naturalistic approach to teaching.  It focuses on pivotal behaviors such as motivation and multiple cues to teach a variety of skills.  UCSD nicely outlines this approach on their website.

wia_photo1.jpg5) Incidental Teaching:  This is a very natural teaching paradigm where the teacher sets up the environment in a manner that increases learning opportunities in a natural way.  Graduated prompting procedures are used to increase and improve responses and initiations.  The Burkhart Project in Autism Education nicely outlines this treatment approach.

6) Picture Exchange Communication System (PECS):  This is an augmentative communication trainingphase1j.jpg approach which teaches the child to exchange pictures to communicate with others.  This approach requires a fair amount of training and requires 2 adults per child at least in the initial stages of training.  The best source of information for this approach as well as available workshops and training sessions is the Pyramid Educational Consultants, the creators of the PECS approach.

000_51_Clark_reading.png7) TEACCH: This approach focuses on working with the child’s strengths to introduce new skills.  The main goal is to increase the child’s independence and visual supports are often used to accomplish this.  This approach is popular in schools and is often also used in home settings to increase independence with leisure skills, chores, and homework.  For more information, check out their website - TEACCH.

8) TeachTown:  This child-centered program pulls from years of research in ABA, developmental psat_computer.jpgychology, education, and speech pathology.  It includes on-computer ABA-like learning on the computer and off-computer activities that are more focused on development and relationship building.  Check out our website for more information: www.teachtown.com

2002-6-Aug1.jpg9) Other Software-Assisted Programs: For a fairly good list, check out Mouse Trial.  You should also check out these software programs if you are interested in technology (these are not autism-specific programs but are pretty good programs for many kids with autism): Animated Speech Co., Social Skill Builder, and Headsprout.  Also check out Autism Pro, it is not intervention for children but looks like a great program for the adults to build a solid program.

Developmental Approaches

1) Floortime/DIR:  DIR is the Developmental, Indhost_photo.jpgividual Differences, Relationship-based approach.  The goal of this approach is to build relationships with the child and teach the child to master emotional milestones that may affect the child’s other skills.  This approach works toward the cause rather than the symptoms associated with autism.  Floortime is the teaching approach where the teacher builds on the child’s strengths to achieves developmental milestones.  For more information, check out the Floortime Foundation.

pointing.jpg2) Relationship Development Intervention (RDI): This is another relationship based approach which teaches the child to become more socially aware of the surroundings through nonverbal cues such as joint attention, body language, and emotional regulation.  The primary goal is to get children to share emotional experiences with others.  For more information on RDI, check out the FACT website which nicely describes what it is and the RDI site for information about the programs available and how to get training.

3) Milieu Teaching: This approach is based on over 10 years of research and is cited as an intervention approach in many scientific publications.  This technique also works on relationship building by teaching overall communication (e.g. joint 50134.jpgattention, gestures, facial expressions, body language) rather than just language.  The approach uses child motivation and focuses on the child’s interest (similar to PRT) but the focus is more on increasing the child’s social motivation.  For more information, check out the University of Kansas site.

4) Social Communication Emotion Regulation Transactional Support (SCERTS): This is a multi-disciplinary model of 50249.jpgintervention that is grounded in the science of child development and learning.  I recently attended the training for this and was impressed not only with the intervention approach, but with the systematic tracking and progress reports that go with it.  The SCERTS model provides a comprehensive curriculum that focuses on social communication, emotional regulation, and transactional supports (i.e. adults maximizing learning environments and providing positive support for the child)(e.g. providing visual supports to ease anxiety and increase learning).  For more on SCERTS and their training programs, check out their site.  I also highly recommend the books, they are very clear and very good resources for using this kind of intervention.

Other Approaches

1) Biomedical: These therapies tend to be somewhat controversial and often focus on the underlying cause of autism rather than on the symptoms.  Because the cause of autism is still unknown, it is difficult to know what the biomedical treatment should be.  For instance, some doctors and researchers believe that vaccines portrait_showcase_children_80.jpgmay be to blame for autism.  However, the research on this is mixed and so it is confusing for many parents on whether or not they should refrain from vaccinating their child.  Some of the biomedical treatments can be risky and potentially unsafe, yet, there are families who truely believe that their child’s progress can be attributed to these interventions, so again, it is a tough decision for parents to make.  These treatments includes things like chelation treatment which is believed to remove metals from the child’s system.  Hyperbaric Oxygen Chamber therapy uses increased atmosphere pressure and Secretin is often used to stimulate digestive fluids from the pancreas.  Research for these treatments varies immensely and as a whole has not demonstrated efficacy (e.g. research on secretin).  Ultimately, it is just the parents choice, which they need to make based on their own beliefs and judgment.  Some biomedical treatments focus on vitamins and supplements.  Again, the research on these treatments is mixed and it is up to the family to decide if it is appropriate for their child.  

3) Pharmaceutical: There is no one drug to cure autism or even remeliorate the majority of the symptoms.  However, there are many drugs that can be effective for certain symptoms photo_services_consultation1.jpgassociated with autism including anxiety, depression, sleep issues, self-injury, aggression, or seizures.  Finding appropriate medical treatment for children with autism is a difficult and complex process and all medications should be carefully monitored and the child’s behavior and progress should be looked at very closely on a daily basis.  Most good doctors will recommend a drug journal where the parent documents the drug, the dose, and the child’s behavior.  It is tough to look back in time and remember what worked and what didn’t so keeping data and notes is very important, especially when using drugs or other medical interventions.

3) Facilitated Communication: In this controversial approach, the child is assisted to use a communication device (e.g. keyboard or picture communication technology) through guiding the child’s arm, wrist, etc.  There are many people who claim that this approach can teach completely nonverbal children to communicate sophisticated exchanges with others.  There are others who think 2005_11Nov.jpgthat it is not a legitimate approach to intervention and that there are even some who inappropriately use this approach to make allegations of child abuse.  The National Autistic Society nicely describes both sides for this approach.

There are many other intervention approaches that I have not touched on here, but hopefully this will help many of you to know where to look for more information.  Ultimately, your child’s progress will tell you what the appropriate treatment is for your child.  It is a tough road to find a good fit, but many families have seen immense progress in their children and many of these approaches can be life-changing when done properly. 

 

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