Autism Treatment & Therapy

All available research strongly suggests that intensive early
intervention makes a critical difference to children with autistic
spectrum disorders. Without early identification and diagnosis,
children with autism are unlikely to learn the skills they need to
benefit from education.

Applied Behavior Analysis – ABA

Many of the interventions used to treat children with autism are based
on the theory of applied behavior analysis (ABA) – that behavior
rewarded is more likely to be repeated than behavior ignored. Although
ABA is a theory, many people use the term to describe a specific
treatment approach with subsets that include discrete trial training or
Lovaas. While the terms discrete trial and Lovaas have been used
interchangeably, only practitioners who are affiliated with Lovaas can
be said to implement “Lovaas Therapy.”

In discrete trial training, every task given to the child consists of a
request to perform a specific action, a response from the child, and a
reaction from the therapist. It is not just about correcting behaviors
but is designed to teach skills, from basic ones such as sleeping and
dressing to more involved ones such as social interaction.

Discrete trial training is an intensive approach. Children usually work
for 30 to 40 hours a week one-on-one with a trained professional. Tasks
are broken down into short simple pieces, or trials. When a task has
been successfully completed, a reward is offered, reinforcing the
behavior or task. This method is not without controversy. Some
practitioners feel it is emotionally too difficult for a child with
autism, that the time requirement of 30 to 40 hours a week is too
intensive and intrusive on family life; and that while it may change a
particular behavior, it does not prepare a child with autism to respond
to new situations. However, research has shown that ABA techniques show
consistent results in teaching new skills and behaviors to children
with autism.

More information available at www.behavior.org.

TEACCH(Treatment and Education of Autistic and Related
Communication Handicapped Children)

The first US statewide program for treatment and services for people
with autism, TEACCH (Treatment and Education of Autistic and Related
Communication Handicapped Children) was developed at the School of
Medicine at the University of North Carolina in the 1970s. It is a
structured teaching approach based on the idea that the environment
should be adapted to the child with autism, not the child to the
environment. It uses no one specific technique, but rather is a program
based around the child’s functioning level.

The child’s learning abilities are assessed through the Psycho
Educational Profile (PEP) and teaching strategies are designed to
improve communication, social and coping skills. Rather than teach a
specific skill or behavior, the TEACCH approach aims to provide the
child with the skills to understand his or her world and other people’s
behaviors. For example, some children with autism scream when they are
in pain. The TEACCH approach would search for the cause of the
screaming and then teach the child how to signal pain through
communication skills.

More information at: www.teacch.com.

Picture Exchange Communication Systems – PECS

One of the main areas affected by autism is the ability to communicate.
Some children with autism will develop verbal language, while others
may never talk. An augmented communication program, such as Picture
Exchange Communication Systems (PECS), is helpful to get language
started as well as to provide a way of communicating for those children
that do not talk.

PECS was developed at the Delaware Autistic Program to help children
and adults with autism to acquire functional communication skills. It
uses ABA-based methods to teach children to exchange a picture for
something they want – an item or activity.

PECS begins with teaching a student to exchange a picture of a desired
item with a teacher, who immediately honors the request. Verbal prompts
are not used, thus building immediate initiation and avoiding prompt
dependency. The system goes on to teach discrimination of symbols and
then puts them all together in simple “sentences.” Children are also
taught to comment and answer direct questions. Many preschoolers using
PECS also begin developing speech. The system has been successful with
adolescents and adults who have a wide array of communicative,
cognitive and physical difficulties.

More information on PECS and materials available at www.pecs.com.

Floor Time

An educational model developed by child psychiatrist Stanley Greenspan,
Floor Time is much like play therapy in that it builds an increasing
larger circle of interaction between a child and an adult in a
developmentally-based sequence. Greenspan has described six stages of
emotional development that children meet to develop a foundation for
more advanced learning – a developmental ladder that must be climbed
one rung at a time. Children with autism may have trouble with this
developmental ladder for a number of reasons, such as over-and
under-reacting to senses, difficulty processing information, or
difficulty in getting their body to do what they want.

Through the use of Floor Time, parents and educators can help the child
move up the developmental ladder by following the child’s lead and
building on what the child does to encourage more interactions. Floor
Time does not treat the child with autism in separate pieces for speech
development or motor development but rather addresses the emotional
development, in contrast to other approaches, which tend to focus on
cognitive development. It is frequently used for a child’s daily
playtime in conjunction with other methods such as ABA.

Stanley Greenspan’s book is:

THE CHILD WITH SPECIAL NEEDS: ENCOURAGING INTELLECTUAL AND EMOTIONAL
GROWTH. Stanley I. Greenspan, M.D. and Serena Wieder, Ph.D., Addison
Wesley: (1998, Reading, MA).

Social Stories

Social Stories were developed in 1991 by Carol Gray as a tool for
teaching social skills to children with autism. They address “Theory of
Mind” deficits, that is, the ability to understand or recognize
feelings, points of view or plans of others. Through a story developed
about a particular situation or event, the child is provided with as
much information as possible to help him or her understand the expected
or appropriate response. The stories typically have three sentence
types: descriptive sentences addressing the where, who, what and why of
the situation; perspective sentences that provide some understanding of
the thoughts and emotions of others; and directive sentences that
suggest a response. The stories can be written by anyone, are specific
to the child’s needs, and are written in the first person, present
tense. They frequently incorporate the use of pictures, photographs or
music.

Information available at: Carol Gray Social Stories

Sensory Integration

Children with autism frequently have sensory difficulties. They may be
hypo- or hyper-reactive or lack the ability to integrate the senses.
Sensory integration therapy, usually done by occupational, physical or
speech therapists, focuses on desensitizing the child and helping him
or her reorganize sensory information. For example, if a child has
difficulties with the sense of touch, therapy might include handling a
variety of materials with different textures.

Auditory integration therapy reduces over-sensitivity to sound. It may
involve having the child listen to a variety of different sound
frequencies coordinated to the level of impairment.

More information available at www.out-of-sync-child.com and www.sensoryint.com.

Biomedical and Dietary Treatments

Biomedical intervention is a relatively new field. While there are no
drugs, vitamins or special diets that can correct the underlying
neurological problems that seem to cause autism, parents and
professionals have found that some drugs used for other disorders are
sometimes effective in treating some aspects of or behaviors associated
with autism.

Changes to diet and the addition of certain vitamins or minerals may
also help with behavioral issues. Over the past 10 years, there have
been claims that adding essential vitamins such as B6 and B12 and
removing gluten and casein from a child’s diet may improve digestion,
allergies and sociability. Not all researchers and experts agree about
whether these therapies are effective or scientifically valid.

There is a study of parent ratings of behavioral effects of biomedical
interventions available at the Autism Research Institute www.autismwebsite.com as well as some
articles on special diets and biomedical supplements.

References:
Powers, Dr. Michael. What is autism? In: Dr. Michael Powers, editor.
Children with Autism: A Parents’ Guide, 2nd edition. Bethesda, MD:
Woodbine House; 2000. pp.
1-44.

Autism Society of America

www.autism-society.org

Ontario Adult Autism Research and Support Network
www.ont-autism.uoguelph.ca