Autism: Learning Approaches (page 3)
The behaviors exhibited by children with autism are frequently the most troubling to parents and caregivers. These behaviors may be inappropriate, repetitive, aggressive and/or dangerous, and may include:
- Placing objects in one's mouth
Children with autism may also engage in self-mutilation, such as eye-gouging or biting their arms; they may show little or no sensitivity to burns or bruises; and may physically attack someone without provocation. The reasons for these behaviors are complex, but some professionals think that sensory integration issues contribute to them.
Communication skills, both the spoken and written word, are also an issue for children with autism. They have difficulty understanding how communication works and may have difficulty with reciprocal conversation. Many also have language difficulties, either being nonverbal throughout their lives or having delayed speech. Some children use language in unusual ways, such as repeating the words or sentences said to them (echolalia) or using only single words to communicate. Language difficulties may contribute to behavioral problems a child with autism may resort to screaming (because of an inability to use language to communicate his/her needs).
Many treatment approaches have been developed to address the range of social, language, sensory, and behavioral difficulties.
These include Discrete Trial Training (discrete trials), as part of:
- Applied Behavior Analysis (ABA)
- Treatment & Education of Autistic and Related Communication of Handicapped Children (TEACCH)
- Picture Exchange Communication Systems (PECS)
- Pivotal Response Treatment
- Floor Time
- Social Stories
- Sensory Integration
- Facilitated Communication
- Complementary Approaches
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.
Treatment & Education of Autistic and Related Communication of Handicapped Children (TEACH)
The first 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. TEACCH uses 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 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.
There have been criticisms that the TEACCH approach is too structured, that children with autism, particularly high-functioning individuals, become too focused on the charts, organizational aids, and schedules, and that it discourages mainstream behavior (meaning that they may only respond to specific stimuli as taught in their curriculum and not everyday situations). Others feel that, in an environment conducive to learning, ultimately the child with autism understands what is expected and how to respond.
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.
The advantage to PECS is that it is clear, intentional, and initiated by the child. The child hands you a picture, and his or her request is immediately understood. It also makes it easy for the child with autism to communicate with anyone - all they have to do is accept the picture.
Pivotal Response Treatment
Regarded as one of the top state-of-the-art treatments for autism in the United States*, Pivotal Response Treatment (PRT) is a naturalistic intervention model producing positive changes in critical behaviors, leading to generalized improvement in communication, social, and behavioral areas. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations. By targeting these critical areas, PRT results in widespread, collateral improvements in other social, communicative, and behavioral areas.
The underlying motivational strategies of PRT are incorporated throughout intervention as often as possible, and they include child choice, task variation, interspersing maintenance tasks, rewarding attempts, and the use of direct and natural reinforcers. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. For example, intentful attempts at functional communication are rewarded with a natural reinforcer (e.g., if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer). Pivotal Response Treatment is used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills.
* National Research Council of the National Academy of Sciences, 2001
An educational model developed by child psychiatrist Stanley Greenspan, Floor Time is much like play therapy in that it builds an increasingly 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 that tend to focus on cognitive development. It is frequently used for a child's daily playtime.
Reprinted with the permission of the Autism Society.
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