Applied Behavior Analysis

Applied Behavior Analysis (ABA) is perhaps the most popular approach in the treatment of autism and other pervasive developmental disorders. This teaching strategy has roots deep in the Behaviorist approach to psychology. It also serves to break complex tasks down into their most fundamental elements.

The child is introduced to a task on its most fundamental level. Once the child masters the first step he is introduced to the next. The process is called chaining. One skill is linked to the next until the child has mastered the task.

For example, if a therapist is using ABA to teach the student to color, he would begin with picking up the crayon. If the student follows through correctly, he is immediately rewarded. Once he demonstrates that he consistently follows through the next step would be introduced.

Applied Behavior Analysis relies heavily on rewarding desired behavior and redirecting negative behavior. Negative behavior is typically ignored unless it is a non-negotiable like hitting.

This approach is the foundation for drills and activities used in the treatment for autism such as discrete trial.

PECS

Communication is a tremendous obstacle in most cases of pervasive developmental disorders like autism. PECS is a Picture Exchange Communication System that uses images to help facilitate communication.

PECS is a valuable treatment for autism in that it can be used in a variety of ways. It helps the child transition between activities and it can help reduce tantrums since the child has a means of communicating with others.

The approach recognizes that autistic children are very visual. Instead of trying to process spoken language the instructor uses the visual PECS treatment to convey thoughts and ideas.

There are six phases in the PECS treatment approach. Each step is introduced successively. The first step in this treatment for autism begins with no spoken language at all. The child simply exchanges a picture for a desired object or activity. Progressively, the PECS treatment approach leads to the sixth phase in which the child uses the pictures as an independent means of communication.

Floortime

The floortime treatment approach to autism and related pervasive developmental disorders recognizes that all children learn through play. Floortime was developed by Dr. Stanley Greenspan who contends that children can regulate their behavior once they are able to regulate their emotions.

Greenspan's floortime is a treatment that does not take a behavioral approach. The play activities are rewarding in nature and the focus is social rather than behavioral. The floortime approach is child-centered and the adult involved with the process follows the child's lead as he plays.

Floortime involves observation and gradual interactions that are helpful in shaping the child's behavior. A child may love to line objects in a row and the parent can use this activity as a way to open the doors of interaction.

The parent would simply add items to the line of objects at first then gradually begin to alter the activity. He could begin by branching the line in different direction. Later, the parent can make the items walk or dance while encouraging the child to respond or imitate.

Fluency

One of the biggest obstacles that the treatment of autism and related developmental disorders faces is the loss of previously mastered skills. Fluency is designed to maintain and strengthen skills that the child has learned in the past.

Fluency poses new challenges for the student in that the child may be asked to demonstrate skills while distractions are present. The treatment for autism also requires the student to generalize the skills in a number of different settings.

Speed and accuracy are also factored into the fluency treatment for autism as well. Time limits are introduced into tasks. For example, a child may be prompted to identify as many numbers as he can within a 30 second time frame.

Fluency is a great approach to generalizing mastered skills. It can also be used to help the child understand that "cat" refers to more than just one specific animal. The child may be encouraged to identify various images of cats, three dimensional cats, cartoon cats and live pets during the process.

Sensory Integration

Many individuals who have autism are faced with significant sensory problems. Basically, they don't know which sensory input to block out and which sensory input to process. The sensory dysfunction affects all five senses and can significantly interfere with the individual's ability to attend to tasks. It also is a factor in some behavior problems.

Sensory integration activities are designed to help the student process sensory input. By presenting the sensations systematically.

There are a plethora of sensory integration activities that can yield great results. The child can sit in a bean bag chair and the parent can hug the chair around the child. Hugging large stuffed animals or bouncing on a exercise ball are great activities as well.

The child can put his hands in a container full of beads looking for larger items hidden withing the tactile elements. Many children love to swing on a swing set or catch bubbles. Any of these activities help the child focus his attention on specific sensory input.

RDI: Relationship Development Intervention

RDI or Relationship Development Intervention is like Greenspan's floortime in that it focuses on emotional development rather than taking a behavioral approach. This approach is unique in that it is an entire program rather than a component to other treatments for autism unless the child is nonverbal.

Relationship Development Intervention was developed by Dr. Steven Gutstein. The focus of RDI is to create a systematic approach to social interaction and relationship development. The development of social and emotional attachment is strongly tied to the student's communication and cognitive development as well.

The fundamental basis for RDI is Experience Sharing, a model developed by Dr. Steven Gutstein. Dr. Gutstein considers normal emotional development as well as the special circumstances and obstacles individuals within the autism spectrum of disorders face.

A parent can engage the child in a game of peek-a-boo. This game is ideal because it encourages the child to reference the adult's face.

Social Stories

An autism consultant named Carol Grey developed social stories to help individuals with an autistic disorder navigate through social situations. The social stories work in a number of ways to make some experiences less stressful for the individual.

The stories are specifically designed to help the individual recognize social cues as well as what to expect in the situation. The social story is written from the student's perspective to help him internalize the words. It also helps the student recognize other people's emotions as well.

The structure of social stories involves four types of sentences: descriptive, perspective, directive and control sentences. The descriptive sentences provide information about where and when the activity will take place as well as who will be involved. For example, "Sometimes I want to say something to my teacher when I am in class."

The perspective sentences in social stories helps the individual recognize emotions and thoughts that others might have during the activity. For example, "My teacher is happy when I raise my hand before talking."

The directive sentences help the student understand what is expected of him. For example, "When I want to say something, I raise my hand."

Finally, the control sentence is one that the student can write himself. This sentence is not used in all social stories but it is helpful in making the story memorable to the student.

Diet and Medication

Medication is often used in the treatment of autism and related pervasive developmental disorders. Dietary interventions are used in some cases as well.

Common medications uses in the treatment of autism include stimulants, antidepressants, anti-anxiety and psychotropic medications. Stimulants include medication used for hyperactivity in children. Antidepressants and anti-anxiety medications like Zoloft and Paxil are often used to help reduce self-stimulatory behaviors and ease anxiety.

One psychotropic medication, Risperdal is commonly used to treat schizophrenia and bipolar disorder. Risperdal has recently been approved for the treatment of autism as well.

Dietary intervention includes vitamin supplements and casein and gluten-free diets are believed to reduce the symptoms of autism. The casein and gluten free diets hold the contention that individuals with autism are unable to digest certain proteins found in some foods. The excess proteins build up in the system and affect the brain in the same way an opiate drug would.

The casein and gluten free diets require that all foods containing these substances be removed. Even a trace could ruin the effort.

Discrete Trial

Discrete trial is a teaching strategy that uses the principals of Applied Behavior Analysis. This approach helps the child to build new skills on previously mastered skills. Each discrete trial has a specific beginning, middle and end.

The focus of discrete trials is to help the child understand cause and effect. Each trial is designed to teach a specific skill. When the student gives an appropriate response to a directive he is immediately rewarded.

The approach is used to help the child develop the ability to stay on task. Attention is a major factor in discrete trial. Discrete trial also helps to develop communication and social skills as well.

Focus of Treatment for Autism

Currently, there is no cure for pervasive developmental disorders. However, a number of treatment approaches have been developed over the years that have yielded great results. The focus on treatment for autism lies in communication, behavior, social interaction and self care.

Each individual is different and the treatment that an autistic child receives should be tailored to his specific needs. The approaches should also embrace his strengths to maximize his potential.

A treatment plan is typically developed in a collaborative effort. The child's caretakers, caseworkers and doctor build the treatment plan by recognizing the child's needs and strengths and developing goals.

The goals are outlined in the individual's treatment plan. The focus of treatment for autism will rest on those goals and the treatment plan outlines specific interventions and strategies that will help the child attain them.

When a treatment plan is developed the parents outline specific areas of concern. For example, the child may not use words to access wants and needs. The goal for the child would be:

"Child will use words, sign language or gestures to access wants and needs with 80 percent accuracy."

The parents are encouraged to prompt the child to use some form of functional communication to access wants and needs. The therapists on staff will engage the child in drills specific to this goal.

A common drill that would be used is to prompt the child to sign or say, "want" in the presence of a desired object or activity. When the child follows through, he is immediately given the reward.

Typically, the doctor will evaluate the child's progress and determine if the treatment plan needs to be reworked. Meetings are commonly held to evaluate the treatment plan on a quarterly basis. The physician may also prescribe medication in the treatment of autism in some cases.