Autism Treatment

Autism Treatment - INTERVENTIONS

Early intervention is the key.

A new report from the National Research Council of the National Academies USA (2003) encourages promotion of routine early screenings of children for autistic spectrum disorders, much like they are promoted for vision and hearing problems. Early diagnosis is important because prompt educational intervention is the key to greater progress in children’s mastery of fundamental communication, social, and cognitive skills. Deficits in joint attention, affective reciprocity and theory of mind can be identified early and then specific intervention can be implemented. Early intervention uses the plasticity of the brain to maximize potential. An intensive instructional program wherein the child is engaged in systematically planned, and developmentally appropriate educational activity toward identified objectives is crucial. The priorities of focus include functional spontaneous communication, social instruction delivered throughout the day in various settings, cognitive development and play skills, and proactive approaches to behaviour problems. To the extent that it leads to the acquisition of children’s educational goals, young children with an autistic spectrum disorder should receive specialized instruction in a setting in which ongoing interactions occur with typically developing children.

There are many behaviors that ordinary children learn without special teaching, but that children with autism may need to be taught (Klin et al., 1992). A preschool child with autism may have learned to count backwards on his own, but may not learn to call to his mother when he sees her at the end of the day without special teaching. A high school student with autism may have excellent computer skills but not be able to decide when she needs to wash her hair. Educational goals for these students, as part of addressing independence and social responsibility, often need to address language, social, and adaptive goals that are not part of standard curricula. Understanding the nature of autistic spectrum disorder and the full range of developmental sequel that follow from the deficits assist the development of teaching approaches and curricular content that address each of these areas. The exact skills, which need to be taught, will depend on the degree of impairments seen in that child. However, they should cover the main developmental areas affected in autism. These include social interaction, communication and language and flexible and creative thinking.

Apart from the curricular content, teaching strategies also need to take account of specific psychological dynamics in both the social and cognitive processing of learning in autism. Robinson (1998) summarised the principles of more effective teaching strategies that take into account the difficulties with social interaction, communication and imaginative/creative thinking and the relative strengths in visual skills, visual memory, good focus in repetition, precision and consistent accuracy. The strategies included low arousal; specifically focused stimuli; directive interventions; reductions in transitioning; and structured and cued teaching with the presentation being more visual.

Apart from education, other intervention programmes to enhance social and communication development are available for children with autism. The two highly debated approaches are the traditional behavioural approach (Lovaas 1981) and the relationship based developmental model (Greenspan 1992). The former is based on learning theory principles. Intervention entails specificity of purpose, goals and activity structure. Skill acquisition reflects the mastery of a series of discrete sub skills. The model emphasizes precision and organisation during instructions. There is complete adult control during the sessions. Through prompting and shaping techniques and immediate reinforcement of correct target responses, the adult shapes the child’s learning. Some of the criticisms raised to this form of intervention are the artificial nature of the instructional setting, an emphasis on specific child responses to adult directed interactions and the lack of clear link between the instruction and social use of the skill (Quill 2000). Koegal and Koegal (1995) remarked that discrete trial approaches are counterproductive for spontaneous, self-initiated social and communication skills.

The relationship-based developmental model is framed within the study of typical child development. Intervention emphasizes the development of skills through active exploration and positive social interactions. It emphasizes naturally occurring situations as the context for instructions, child directed activities, and the adult’s role as merely a facilitator. The child’s internal motivation propels active engagement and the responses of the adult to the child’s initiations and interests lay the foundation for the developmental process. Internationality and meaning are assigned to the child’s behaviour (Greenspan 1992). The drawbacks of the relationship-based model are the open –ended quality of the instructional environment and reliance on the child’s initiations to guide the interactions.  In autism, where children may lack the skills like joint attention, imitation and the desire to interact, this model may not be beneficial (Quill 1995).

Quill advocates combining behavioural and developmental approaches for a more ecelectic and ‘Best Practice’ approach. Creating motivating, meaningful activities in natural environments to promote spontaneous social and communication skills along with specialised supports to compensate for the various core skills deficit are recommended.

 Some Well Established Therapies

 SOME MEDICATIONS USED

To summarise, autistic spectrum disorders is a complex developmental disorder with social and communication dysfunction at its core. Wing (1996) showed that a wide spectrum of conditions have a common triad of impairments. Deficits include those in social communication, social interaction and social imagination (flexible and creative thinking). Since autistic spectrum disorders occur on a continuum, the clinical expressions differ widely. They can range from a severely handicapped child to a child with normal intelligence attending mainstream school.  Hence persons with superior intellect with asd will also have social and communication difficulties. Even mild or subtle difficulties can have a profound and devastating impact on the child. To be able to provide suitable treatments and interventions the distinctive way of thinking and learning of autistic children has to be understood. The core areas of social, emotional, communication and language deficits have to be addressed at all levels of functioning. The interventions have to be adapted to the individual’s chronological age, developmental phase and level of functioning. Nonetheless, there should be a general emphasis on teaching social cognition, on learning communicative and social skills and on enhancing motivation. In addition to the content of the intervention programme, the strategies of curriculum delivery and teaching the child with autism is distinctive and requires consideration at all levels of the spectrum.  The general principles include presence of structure to increase predictability and strategies to reduce arousal of anxiety.

For more information on our therapies, please visit the Therapy page.