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)