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Top Autism Treatments

In a recent About: Autism Spectrum Disorders posting, the top 10 treatment approaches for autism were listed along with helpful links for each of these approaches.  The top 10 were determined by popularity, research, and most effective overall.

The top 10 listed were:100_0152.JPG

1) Applied Behavior Analysis (ABA)

2) Speech Therapy

3) Occupational Therapy

4) Social Skills TherapyB and Trish.jpg

5) Physical Therapy

6) Play Therapy

7) Behavior Therapy/Positive Behavior Support

8) Developmental TherapiesEl 1.jpg

9) Visually-based Therapies

10) Biomedical Therapies

I would like to see a similar list, in order, of those that are the most research-based and have evidence of effectiveness with the largest number of children with autism.  Organizations such as the National Autism Center are dedicated to coming up with good ways to make these kinds of lists and to develop rankings for treatment approaches which will be based on research and effectiveness for ASD.  This project is called the National Standards Project and the expert panel and conceptual reviewers include a prestigious group of autism researchers including several of our TeachTown science advisory board members including Dr. Ilene Schwartz, Dr. William Frea, and Dr. Aubyn Stahmer.

J computer.jpgI would also like to see more studies on technology and which programs are effective and which ones are not.  It won’t be long before Computer-Assisted Instruction is added to the list above, I just hope that developers, and perhaps more importantly, university researchers continue to conduct the necessary research to keep improving these programs.

**Please see comments from the author of the ABOUT blog, she makes some excellent comments and I completely agree with her!**

Positive Behavior Support (PBS)

index_r2_c1.gifThe goal of PBS (Positive Behavior Support) is to apply the principles of behavior analysis in the community to reduce problem behaviors and increase appropriate behaviors which promote a rich lifestyle.  PBS is a type of ABA and is not necessarily in competition (despite the controversy among some that they are different approaches) with other types of ABA as it is often very suitable to use in conjunction with other treatments such as Discrete Trial Training, Pivotal Response Training, Picture Exchange Communication System, and other popular ABA techniques.  PBS typically refers more to dealing with challenging behaviors such as aggression, tantrums, self-injury, etc. and focuses on teaching more appropriate replacement behaviors such as functional communication.

The Association of Positive Behavior Support describes PBS and provides success stories and useful links and resource guides that you can download.  They also host an annual conference, the next one is March, 2007 in Boston, MA and they are now accepting proposals for presentations.  They also have a good newsletter which is free to download and print.

From the Association of Positive Behavior Support:index_r1_c1.gif

Positive behavior support (PBS) involves the changing situations and events that people with problem behaviors experience in order to reduce the likelihood that problem behaviors will occur and increase social, personal, and professional quality in their lives. It is an approach that blends values about the rights of people with disabilities with a practical science about how learning and behavior change occur.  PBS is a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person’s environment. Positive behavior support combines valued outcomes, behavioral and biomedical science, validated procedures; and systems change to enhance quality of life and reduce problem behaviors such as self-injury, aggression, property destruction, pica, defiance, and disruption. The overriding goal of PBS is to enhance quality of life for individuals and others within social settings in home, school, and community settings. 

biting.jpgPBS is now used in many different situations and settings and with different types of social challenges. Children with and without disabilities participate in the PBS process in schools, at home, and in community settings. In school settings, PBS strategies are used to build a positive climate and include all students, not just children who may engage in more serious problem behavior. Adults with disabilities are actively involved in PBS team processes regardless of their age and where they live and work. The Association for Positive Behavior Support (APBS) has been created to build a community of individuals who are interested in the PBS process and who represent many different voices and perspectives. Family members, school professionals, psychologists, adult service providers, higher education professors, researchers, and community members are all involved in APBS. Regardless of the different settings and individuals involved in PBS processes, the key elements remain the same for individual planning. The PBS process involves a team of individuals working together collaboratively to gather information and create strategies for preventing problem behavior.

Functional Assessment. The cornerstone of PBS is the design anportrait_showcase_children_50.jpgd use of functional (behavioral) assessment to understand what maintains an individual’s problem behavior. Individuals engage in a behavior because it is functional; it helps them acquire some form of reinforcement (e.g., they get something desirable or pleasant, or they avoid something undesirable or unpleasant). A person may engage in problem behavior because circumstances in both the internal and/or external environment (i.e., antecedents, setting events) trigger or ‘set the stage’ for behavior to occur. Functional assessment is a process for identifying the events that trigger and maintain problem behavior. This process involves information gathering through record reviews, interviews, and observations and the development of summary statements that describe the patterns identified. Primary outcomes of the functional assessment process include:

  • A clear description of the problem behaviors
  • Events, times, and situations that predict when behaviors will and will not occur (i.e., setting events)
  • Consequences that maintain the problem behaviors (the function)
  • Summary statements or hypotheses
  • Direct observation data to support the hypotheses

Comprehensive Intervention. The team that forms around a child or adult in order to create a PBS plan should represent all of the situations and settings that are part of the person’s life. Information that is gathered from a functional behavioral assessment helps this team develop and implement behavioral intervention plans that are positive, proactive, educative, and functional. PBS plans include a number of interventions that can be implemented across situations and settings. These interventions include: 1) proactive strategies for changing the environment so triggering events are removed, 2) teaching new skills that replace problem behaviors, 3) eliminating or minimizing natural rewards for problem behavior, and 4) maximizing clear rewards for appropriate behavior. A hallmark of PBS planning is emphasis on improving overall lifestyle quality (relationships, activities, health) as an integrated part of behavior support.

Mindy2sm.jpgLifestyle Enhancement. PBS focuses not only on reducing behavior problems, but on enhancing a person’s overall quality of life. Outcomes include lifestyle improvements such as participation in community life, gaining and maintaining satisfying relationships, expressing personal preferences and making choices, and developing personal competencies. Such improvements in quality of life are facilitated by establishing a positive long-range vision with the individual and his/her family (e.g., through person-centered planning) and establishing natural supports through effective teamwork.

jpbi.jpgA great resource for staying on top of the research and clinical work in PBS is to subscribe to one of my favorite journals, the Journal of Positive Behavior Interventions (JPBI).  If you are going to subscribe to one journal and you work with or have a child with autism, this is one of the most practical journals I have seen as  the research is very applied and accessible to anyone.

Another useful journal, which is a free online journal, on PBS is the Journal of Early and Intensive Behavior Intervention

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