Interventions & Therapies

Autism Society NL does not endorse treatments, interventions and therapies but lists them so people can make informed choice.  This site is for information purposes only and is a starting point for readers to look into options that may fit or resonate.  Remember, interventions and therapies for autism, like any condition, should be discussed with a trusted medical practitioner or certified therapist before use. Below, you will find a list of interventions that are commonly referred to. Please treat this information as a starting point.

For your interest, there is a National Standards Project (Phase 2) based out of the National Autism Centre in Massachusetts. “The project is designed to give educators, parents, practitioners, and organizations the information and resources they need to make informed choices about effective interventions that will offer children and adults on the spectrum the greatest hope for their future. ” 

 

Applied Behaviour Analysis (ABA)

What is Applied Behaviour Analysis?

Behavior analysis focuses on the principles that explain how learning takes place. Positive reinforcement is one such principle. When a behavior is followed by some sort of reward, the behavior is more likely to be repeated. Through decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may cause harm or interfere with learning.

Applied behavior analysis (ABA) is the use of these techniques and principles to bring about meaningful and positive change in behavior.

As mentioned, behavior analysts began working with young children with autism and related disorders in the 1960s. Early techniques often involved adults directing most of the instruction. Some allowed the child to take the lead. Since that time, a wide variety of ABA techniques have been developed for building useful skills in learners with autism from toddlers through adulthood.

These techniques can be used in structured situations such as a classroom lesson as well as in “everyday” situations such as family dinnertime or the neighborhood playground. Some ABA therapy sessions involve one-on-one interaction between the behavior analyst and the participant. Group instruction can likewise prove useful.

How does ABA Benefit those with Autism?

Today, ABA is widely recognized as a safe and effective treatment for autism. Over the last decade, the nation has seen a particularly dramatic increase in the use of ABA to help persons with autism live happy and productive lives. In particular, ABA principles and techniques can foster basic skills such as looking, listening and imitating, as well as complex skills such as reading, conversing and understanding another person’s perspective.

What does Research Tell Us About ABA and Autism?

A number of completed studies have demonstrated that ABA techniques can produce improvements in communication, social relationships, play, self care, school and employment. These studies involved age groups ranging from preschoolers to adults. Results for all age groups showed that ABA increased participation in family and community activities.

A number of peer-reviewed studies have examined the potential benefits of combining multiple ABA techniques into comprehensive, individualized and intensive early intervention programs for children with autism. “Comprehensive” refers to interventions that address a full range of life skills, from communication and sociability to self-care and readiness for school. “Early intervention” refers to programs designed to begin before age 4. “Intensive” refers to programs that total 25 to 40 hours per week for 1 to 3 years.

These programs allow children to learn and practice skills in both structured and unstructured situations. The intensity of these programs may be particularly important to replicate the thousands of interactions that typical toddlers experience each day while interacting with their parents and peers.

Such studies have demonstrated that many children with autism experience significant improvements in learning, reasoning, communication and adaptability when they participate in high-quality ABA programs. Some preschoolers who participate in early intensive ABA for two or more years acquire sufficient skills to participate in regular classrooms with little or no additional support. Other children learn many important skills, but still need additional educational support to succeed in a classroom.

Across studies, a small percentage of children show relatively little improvement. More research is needed to determine why some children with autism respond more favorably to early intensive ABA than others do. Currently, it remains difficult to predict the extent to which a particular child will benefit.

In some studies, researchers compared intensive ABA with less intensive ABA and/or other early intervention or special education programs for children with autism. Generally, they found that children who receive intensive ABA treatment make larger improvements in more skill areas than do children who participate in other interventions. In addition, the parents of the children who receive intensive ABA report greater reductions in daily stress than do parents whose children receive other treatments.

ABA and Adults with Autism

A number of recent studies confirm that ABA techniques are effective for building important life skills in teens and adults with autism. Many comprehensive autism support programs for adults employ and combine ABA techniques to help individuals transition successfully into independent living and employment. However, the benefits of intensive ABA programs remain far less studied in teens and adults than they have been with young children.

What does ABA Intervention Involve?

Effective ABA intervention for autism is not a “one size fits all” approach and should never be viewed as a “canned” set of programs or drills. On the contrary, a skilled therapist customizes the intervention to each learner’s skills, needs, interests, preferences and family situation. For these reasons, an ABA program for one learner will look different than a program for another learner. That said, quality ABA programs for learners with autism have the following in common:

Planning and Ongoing Assessment

  • A qualified and trained behavior analyst designs and directly oversees the intervention.
  • The analysts development of treatment goals stems from a detailed assessment of each learner’s skills and preferences and may also include family goals.
  • Treatment goals and instruction are developmentally appropriate and target a broad range of skill areas such as communication, sociability, self-care, play and leisure, motor development and academic skills.
  • Goals emphasize skills that will enable learners to become independent and successful in both the short and long terms.
  • The instruction plan breaks down desired skills into manageable steps to be taught from the simplest (e.g. imitating single sounds) to the more complex (e.g. carrying on a conversation).
  • The intervention involves ongoing objective measurement of the learners progress.
  • The behavior analyst frequently reviews information on the learners progress and uses this to adjust procedures and goals as needed.
  • The analyst meets regularly with family members and program staff to plan ahead, review progress and make adjustments as needed.

ABA Techniques and Philosophy

  • The instructor uses a variety of behavior analytic procedures, some of which are directed by the instructor and others initiated by the learner.
  • Parents and/or other family members and caregivers receive training so they can support learning and skill practice throughout the day.
  • The learners day is structured to provide many opportunities “ both planned and naturally occurring – to acquire and practice skills in both structured and unstructured situations.
  • The learner receives an abundance of positive reinforcement for demonstrating useful skills and socially appropriate behaviors. The emphasis is on positive social interactions and enjoyable learning.
  • The learner receives no reinforcement for behaviors that pose harm or prevent learning.

What Kind of Progress Can be Expected with ABA?

Competently delivered ABA intervention can help learners with autism make meaningful changes in many areas. However, changes do not typically occur quickly. Rather, most learners require intensive and ongoing instruction that builds on their step-by-step progress. Moreover, the rate of progress “ like the goals of intervention “ varies considerably from person to person depending on age, level of functioning, family goals and other factors.

Some learners do acquire skills quickly. But typically, this rapid progress happens in just one or two particular skill areas such as reading, while much more instruction and practice is needed to master another skill area such as interacting with peers.

Early Start Denver Model (ESDM)

What Is the Early Start Denver Model?

The Early Start Denver Model (ESDM) is a comprehensive behavioral early intervention approach for children with autism, ages 12 to 48 months. The program encompasses a developmental curriculum that defines the skills to be taught at any given time and a set of teaching procedures used to deliver this content. It is not tied to a specific delivery setting, but can be delivered by therapy teams and/or parents in group programs or individual therapy sessions in either a clinic setting or the child’s home.

Psychologists Sally Rogers, Ph.D., and Geraldine Dawson, Ph.D., developed the Early Start Denver Model as an early-age extension of the Denver Model, which Rogers and colleagues developed and refined. This early intervention program integrates a relationship-focused developmental model with the well-validated teaching practices of Applied Behavior Analysis (ABA). Its core features include the following:

  • Naturalistic applied behavioral analytic strategies
  • Sensitive to normal developmental sequence
  • Deep parental involvement
  • Focus on interpersonal exchange and positive affect
  • Shared engagement with joint activities
  • Language and communication taught inside a positive, affect-based relationship

Who can benefit from the Early Start Denver Model? What Has Research Shown?

The Early Start Denver Model is the only comprehensive early intervention model that has been validated in a randomized clinical trial for use with children with autism as young as 18 months of age. It has been found to be effective for children with autism spectrum disorder (ASD) across a wide range of learning styles and abilities. Children with more significant learning challenges were found to benefit from the program as much as children without such learning challenges. A randomized clinical trial published in the journal Pediatrics showed that children who received ESDM therapy for 20 hours a week (15 hours by trained therapists, 5 hours by parents) over a 2-year span showed greater improvement in cognitive and language abilities and adaptive behavior and fewer autism symptoms than did children referred for interventions commonly available in their communities.

Who is qualified to provide ESDM?

An ESDM therapist may be a psychologist, behaviorist, occupational therapist, speech and language pathologist, early intervention specialist or developmental pediatrician. What’s important is that they have ESDM training and certification. 

How can professionals become trained in ESDM?

Qualified professionals attend a training workshop and then submit videotapes showing them using ESDM techniques in therapy sessions. Certification requires that the therapist demonstrates the ability to implement ESDM techniques reliably and according to high standards set by leading ESDM therapists.

This ensures that a certified professional has the knowledge and skills to successfully use the teaching strategies with children with autism. Details on training qualifications and the certification process can be found here

How can parents be trained in the techniques?

Parental involvement is a crucial part of the ESDM program. If your child is receiving ESDM therapy, the instructor will explain and model the strategies for you to use at home.

In addition, Drs. Dawson and Rogers saw the need for a separate training manual for parents. Earlier this year, they published An Early Start for Your Child with Autism , with coauthor Laurie Vismara, PhD. The book has useful tips and hands-on strategies that integrate smoothly into daily activities and play. You can even use it while waiting for your child to begin therapy.

Pivotal Response Treatment (PRT)

What is Pivotal Response Treatment?

Pivotal Response Treatment (PRT) is one of the best studied and validated behavioral treatments for autism. Derived from applied behavioral analysis (ABA), it is play based and child initiated. Its goals include the development of communication, language and positive social behaviors and relief from disruptive self-stimulatory behaviors.

Rather than target individual behaviors, the PRT therapist targets pivotal areas of a child’s development. These include motivation, response to multiple cues, self-management and the initiation of social interactions. The philosophy is that, by targeting these critical areas, PRT will produce broad improvements across other areas of sociability, communication, behavior and academic skill building.

Motivation strategies are an important part of the PRT approach. These emphasize natural reinforcement. For example, if a child makes a meaningful attempt to request, say, a stuffed animal, the reward is the stuffed animal, not a candy or other unrelated reward. PRT strategies are a core component of the Early Start Denver Model early intervention approach.

Though used primarily with preschool and elementary school learners, studies show that PRT can also help adolescents and young adults. Indeed, autism-affected persons of all ages may benefit from its techniques. In all age groups, the learner plays a crucial role in determining the activities and objects that will be used in a PRT exchange.

What is the History of PRT?

Pivotal response treatment was developed in the 1970s by educational psychologists Robert Koegel, Ph.D., and Lynn Kern Koegel, Ph.D., at the University of California, Santa Barbara. Since its inception, Pivotal Response Treatment has been called Pivotal Response Training, Pivotal Response Teaching, Pivotal Response Therapy, Pivotal Response Intervention and the Natural Language Paradigm. These terms all refer to the same treatment delivery system.

Who provides PRT?

Many psychologists, special education teachers, speech therapists and other providers pursue training in PRT. The Koegel Autism Research Centers offers training and certification. (More information here.)

What is a typical PRT therapy session like?

Each program is tailored to meet the goals and needs of the individual learner and his or her school and home routines. A session typically involves six segments during which language, play and social skills are targeted with both structured and unstructured interactions. As the learner progresses, the focus of each session changes to accommodate more advanced goals and needs.

What is the time commitment involved?

PRT programs usually involve 25 or more hours per week for the learner as well as instruction for parents and other caregivers. Indeed, everyone involved in the learners life is encouraged to use PRT methods consistently. PRT has been described as a lifestyle adopted by the affected family.

Verbal Behaviour Therapy

What Is Verbal Behavior Therapy?

Verbal Behavior Therapy teaches communication using the principles of Applied Behavior Analysis and the theories of behaviorist B.F. Skinner. By design, Verbal Behavior Therapy motivates a child, adolescent or adult to learn language by connecting words with their purposes. The student learns that words can help obtain desired objects or other results.

Therapy avoids focusing on words as mere labels (cat, car, etc.) Rather, the student learns how to use language to make requests and communicate ideas. To put it another way, this intervention focuses on understanding why we use words.

In his book Verbal Behavior, Skinner classified language into types. Each has a different function. Verbal Behavior Therapy focuses on four word types. They are:

  • Mand. A request. Example: Cookie, to ask for a cookie.
  • Tact. A comment used to share an experience or draw attention. Example: airplane to point out an airplane.
  • Intraverbal. A word used to answer a question or otherwise respond. Example: Where do you go to school? Castle Park Elementary.
  • Echoic. A repeated, or echoed, word. Example: “Cookie?” Cookie! (important as the student needs to imitate to learn)

Verbal Behavior Therapy begins by teaching commands, or requests, as the most basic type of language. For example, the individual with autism learns that saying “cookie” can produce a cookie. Immediately after the student makes such a request, the therapist reinforces the lesson by repeating the word and presenting the requested item. The therapist then uses the word again in the same or similar context.
Importantly, students don’t have to say the actual word to receive the desired item. In the beginning, they simply need to signal requests by any means. Pointing at the item represents a good start.

This helps the student understand that communicating produces positive results. The therapist builds on this understanding to help the student shape the communication toward saying or signing the actual word.

Importantly, Verbal Behavior Therapy uses errorless learning. The therapist provides immediate and frequent prompts to help improve the students communication. These prompts become less intrusive as quickly as possible, until the student no longer needs prompting. Take, for example, the student who wants a cookie. The therapist may hold the cookie in front of the students face and say cookie to prompt a response from the child. Next, the therapist would hold up the cookie and make a sound, to prompt the response. After that, the therapist might simply hold a cookie in the child’s line of sight and wait for the request. The ultimate goal, in this example, is for the student to say cookie when he or she wants a cookie “ without any prompting.

What would a session look like?

In a typical Verbal Behavior Therapy session, the teacher asks a series of questions that combine easy and hard requests. This increases the frequency of success and reduces frustration. Ideally, the teacher varies the situations and instructions in ways that catch and sustain the student’s interest.

Most programs involve a minimum of one to three hours of therapy per week. More-intensive programs can involve many more hours. In addition, instructors train parents and other caregivers to use verbal-behavior principles throughout the students daily life.

Who Responds to Verbal Behavior Therapy?

Reports suggest that Verbal Behavior Therapy can help both young children beginning to learn language and older students with delayed or disordered language. It likewise helps many children and adults who sign or use visual supports or other forms of assisted communication.

What is the History and Scientific Support of Verbal Behavior Therapy?

Skinner published Verbal Behavior in 1957 to describe his functional analysis of language. In the 1970s, behavior analysts Vincent CarboneMark Sundberg and James Partington began adapting Skinners approach to create Verbal Behavior Therapy.

Many small studies have supported the effectiveness of Verbal Behavior Therapy with children. (Dr. Sundberg summarized these in 2001, here.) However, a 2006 review of the scientific literature concluded that more research is needed to confirm effectiveness and identify who is most likely to benefit from the approach.

Floortime

Floortime therapy derives from the Developmental Individual-difference Relationship-based model (DIR) created by child psychiatrists Stanley Greenspan, M.D. and Serena Wieder, PhD. Its premise is that adults can help children expand their circles of communication by meeting them at their developmental level and building on their strengths.

According to the organization Greenspan Floortime Approach, the technique challenges children with autism to push themselves to their full potential. It develops who they are, rather than what their diagnosis says.

As its name suggests, Floortime encourages parents to engage children literally at their level by getting on the floor to play. Families can combine it with other behavioral therapies or use it as an alternative approach.
In Floortime, therapists and parents engage children through the activities each child enjoys. They enter the child’s games. They follow the child’s lead. Therapists teach parents how to direct their children into increasingly complex interactions. This process, called “opening and closing circles of communication,” remains central to the Floortime approach.

Overall, Floortime aims to help children reach six developmental milestones crucial for emotional and intellectual growth. They are: 

  • Self-regulation and interest in the world
  • Intimacy, or engagement in human relations 
  • Two-way communication 
  • Complex communication 
  • Emotional ideas 
  • Emotional thinking 

Floortime does not target speech, motor or cognitive skills in isolation. Rather, it addresses these areas through its focus on emotional development.

How does Floortime work?

Ideally, Floortime takes place in a calm environment. This can be at home or in a professional setting. Formal treatment sessions range from two to five hours a day. They include training for parents and caregivers as well as interaction with the child. Therapists encourage families to use Floortime principals in their daily lives. 
Floortime sessions emphasize back-and-forth play interactions. This establishes the foundation for shared attention, engagement and problem solving. Parents and therapists help the child maintain focus to sharpen interactions and abstract, logical thinking.

For example, if the child is tapping a toy truck, the parent might tap a toy car in the same way. To encourage interaction, the parent might then put the car in front of the childs truck or add language to the game.

As children mature, therapists and parents tailor the strategies to match a childs developing interests and higher levels of interaction. For example, instead of playing with toy trucks, parents can engage with model airplanes or even ideas and academic fields of special interest to their child.

What is the history of Floortime?

In the 1980s, Dr. Greenspan developed his DIR model as therapy for children with a variety of developmental delays and issues. In practice, he called DIR Floortime.

In 1998, Dr. Greenspan and clinical psychologist Serena Wieder, Ph.D., published The Child with Special Needs. The book explains and adapts the Floorplay approach for parents and caregivers. By exciting a childs interests, Floortime creates parent-child connections and brings out a childs creativity and curiosity, Dr. Greenspan said.

In a 2003 study, Dr. Greenspan and Dr. Weider studied Joey, a child on the autism spectrum who spent three years engaging in Floortime with his father. Over that time, Joey enjoyed six daily Floortime sessions. He continuously improved, and the two scientists concluded that Floortime helped Joey progress.

In 2007, a pilot study conducted by independent researchers likewise showed benefit for children with autism. Two other 2011 studies”one conducted in Thailand and one in Canada”further supported Floortime as significantly improving emotional development and reducing autisms core symptoms.

How can I learn more?

Many child psychologists, special education teachers, speech therapists and occupational therapists have formal training in Floortime techniques. The Greenspan Floortime organization also offers parent workshops. Parents and caregivers can also learn Floortime techniques from books and websites. You can find more information on Floortime at Greenspan Floortime Approach, the Interdisciplinary Council on Developmental and Learning Disorders and the Profectum Foundation.

TEACCH

The TEACCH Autism Program is a clinical, training, and research program based at the University of North Carolina “ Chapel Hill.  TEACCH, developed by Drs. Eric Schopler and Robert Reichler in the 1960s, was established as a statewide program by the North Carolina legislature in 1972, and has become a model for other programs around the world.

TEACCH developed the intervention approach called Structured TEACCHing, an array of teaching or treatment principles and strategies based on the learning characteristics of individuals with ASD, including strengths in visual information processing, and difficulties with social communication, attention, and executive function.  In response to this profile of strengths and challenges, Structured TEACCHing includes: 

  1. External organizational supports to address challenges with attention and executive function
  2. Visual and/or written information to supplement verbal communication
  3. Structured support for social communication

Structured TEACCHing is not a curriculum, but instead is a framework to support achievement of educational and therapeutic goals.  This framework includes:

  1. Physical organization
  2. Individualized schedules
  3. Work (Activity) systems
  4. Visual structure of materials in tasks and activities

The goal of Structured TEACCHing is to promote meaningful engagement in activities, flexibility, independence, and self-efficacy.  Sometimes Structured TEACCHing strategies are integrated into other evidenced-based practices.

Training

TEACCH is committed to developing training programs for students and professionals who serve individuals with ASD.  In addition to training University-based graduate students, TEACCH conducts training nationally and internationally and provides consultation for teachers, residential care providers, and other professionals from a variety of disciplines. TEACCH uses a unique training model that combines traditional lecture-style activities with hands-on learning activities to train professionals to employ Structured TEACCHing techniques

TEACCH Autism Program has established a comprehensive Professional Certification Program in response to the increasing number of professionals trained by TEACCH and the growing demand for quality services for individuals with Autism Spectrum Disorder.  This certification program is for educators, psychologists, social workers, speech therapists and other service providers in the field of autism..

For more information about the TEACCH Autism Program, please go to the website www.teacch.com