an overview of various treatment options mimi lou, ph.d. clinical director children’s hospital...

An Overview of Various Treatment Options

Mimi Lou, Ph.D.Clinical Director

Children’s Hospital Autism Intervention (CHAI) Program

Psychoeducational Approaches in Autism/PDD

• Developmental Models• Behavioral Approaches

– Applied Behavioral Analysis (ABA)– Discrete Trial – (Lovaas) – Contemporary ABA

• Group/Classroom Instruction: TEACCH

Developmental Models

• DIR, Floortime (Greenspan & Wieder); SCERTS (Prizant & Wetherby); Hanen, More Than Words

• Learning understood within context of developmental processes (typical child development)– Development proceeds from both external

experience and internal, biological maturation– Different aspects/domains of development are

interdependent– Child learns more than s/he is taught, or experience

is more than instruction

Developmental Models(cont.)

• Use of interactive-facilitative (versus directive) strategies:

• Child “leads”: active in selecting, directing own activities

• Adult builds on child’s initiations; expands on child’s interests

• Adult entices, actively engages child• Adult facilitates play by providing support and

helping to structure experience and mediate the environment

Developmental Models(cont.)

• Naturally occurring and motivating contexts for learning

• Central roles for play and functional learning; importance of affects, learning has meaning for child

• Individual profile of sensory and motor processing

Applied Behavioral Analysis(ABA)

• Reinforce/reward appropriate behavior to teach new skills

• Ignore/extinguish inappropriate behavior• Shape existing behaviors into new and useful

ones• Functional Analysis: examine antecedents,

behaviors, consequences for problem behaviors in order to correct

Discrete Trial(Lovaas)

• Direct instruction: verbal direction, prompting, reinforcement, with rapid repetition of short trials

• Focus on 1 specific skill at a time• Highly structured context/setting• Adult control: determines activity, focus of

attention, correctness of response• Child compliance• Prescribed sequenced curriculum

Contemporary ABA

• Natural Language paradigm, Pivotal Response Training(Koegels & Schreibman); Modified Discrete Trial (Leaf, McEachin); Incidental Learning (McGee); Picture Exchange Communication System (PECS) (Bondy & Frost)

• More naturalistic instruction incorporating child’s choice/preference, naturally rewarding consequences

Contemporary ABA(cont.)

• Teaching in context of play and functional activities

• Control of teaching interaction shared, with child initiating communicative exchanges more and adult responding

Group/Classroom Instruction: TEACCH

• Primary purpose: Improve each individual’s adaptation, level of skill

• Modify, structure the environment to accommodate autism deficits

• Aim to increase independent functioning (emphasis on visual components of structure)

• Structured teaching = framework in which vocational, social, and living skills taught

Group/Classroom Instruction: TEACCH (cont.)

• 4 major components of structured teaching:– physical organization– schedules– work systems– task organization

Characteristics of Effective Preschool Programs

• Low adult:child ratio to teach core skills • Highly structured, predictable classroom

routines • Functional approach to challenging behaviors • Direct instruction in “survival skills” for

transition • Family involvement in intervention • Intensity of intervention (15 – 40 hours/week)

Characteristics of Effective Preschool Programs (cont.)

• Curriculum Content (Direct instruction in core skills): – Attention to environment, especially to

people– Ability to imitate others– Ability to comprehend and use language– Ability to play appropriately with toys– Ability to socially interact with others

Other Therapies

• Complementary Medicine • Treatments specifically for

sensory-motor issues• Auditory Processing• Treatments specifically for social

relationships• Reading Intervention

Complementary Medicine

• Medications• Vitamins• Nutritional Supplements• Dietary Interventions• Immune System• Allergy treatment• Heavy Metals (Chelation)

Treatments specifically for sensory-motor issues

• Sensory Integration Therapy – Focuses on sensory processing issues

and difficulties from poor integration of information from sensory systems, especially, proprioceptive, vestibular, and tactile; motor planning problems, regulatory issues of arousal

– Through sensory stimulation and sensory-motor challenges

Auditory Processing

• Auditory Integration Therapy– Berard Tomatis, Others– Treatment for sound sensitivity;

modulated music through headphones with filtering of certain sound frequencies

• Processing Speed– FastForWord

Treatments specifically for social relationships

• Integrated Playgroups (Pamela Wolfberg)

• Social Stories (Carol Gray)• Relationship Development Intervention

(Steven Gutstein)•  Reading Intervention

– Lindamood-Bell (Patricia Lindamood, Phyllis Lindamood, Nanci Bell)