Treatments for as d

8/10/2019 Treatments for as d

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Treatmentsfor AutismSpectrumDisorders

Navigating theMaze

Lynda ManiscalM.S. CCC-SLP

AUTISM

SPECTRUM


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IntroductionT e dia!nosis of an Autism SpectrumDisorder presents parents and clinicians"it a #erita$le ma%e of pro!rams andt erapies. & at is out t ere' & ic pro!rams are $est for my

c ild(student'& at are t e pros and cons'


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). & at "ill t e role of t e clinician *+T,PT, SLP $e in implementin! t ispro!ram or t erapy'

. /or t e ne0t fe" minutes "e "ill loo1 atan o#er#ie" of t e most standard andpopular treatment pro!rams andt erapies for indi#iduals on t e Autism


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Treatments for Core SymptomsTreatments for Autism Spectrum Disorderscan $e di#ided into t"o cate!ories2Treatments for Core Symptoms " icaddress $e a#ioral, de#elopmental andeducational needs speci3c to autism.+t er t erapies suc as +ccupational,P ysical, or Speec T erapy t at " ileessential to t e treatment of Autism is note0clusi#e of ot er disorders suc asde#elopmental delays or cere$ral palsy.


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Applied 4e a#ioral

AnalysisT is treatment pro!ram *A4A is $asedon t e principles of positi#ereinforcement of 4./. S1inner.Simply, it is t e repetiti#e use of positi#ereinforcement to teac speci3c s1ills anddecrease inappropriate $e a#iors.

& at is occurrin! in t e c ild5sen#ironment to cause ne!ati#e$e a#iors'


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A4A T ree Step Procedure

Antecedent2 T e #er$al or p ysicalstimulus suc as a command or re6uest.Resultin! 4e a#ioral response tostimulus or a lac1 of responseConse6uence2 t e positi#e reinforcement

or no response for inappropriate$e a#ior


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A4A Inter#entionA4A is not synonymous "it Discrete TrialTrainin!. DTT "as de#eloped $y Dr. +. I#arLo#ass. DTT is a strate!y used in A4AIn A4A, s1ills are $ro1en do"n into small,discrete tas1s " ic are tau! t usin!prompts, " ic are faded out !radually asa s1ill is mastered.Students are positi#ely reinforced "iteit er #er$al praise or somet in! tan!i$let at e(s e 3nds re"ardin!.


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A4A pro!rams are carried out at sc oolor in t e ome "it a one on one aide

T e !oal is t e carryo#er of t e s1ills toot er en#ironments./acilitated play "it peers is also part oft is pro!ram.

T e A4A pro#ider is responsi$le for datacollection and analysis.


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Pro#iders must $e $oard certi3ed $e a#ioranalysts. T e pro#ider is responsi$le for"ritin! and mana!in! t e pro!ram.Indi#idual 7Trainers8, " o are not necessarily$oard certi3ed pro#ide t e daily inter#ention.Sessions last $et"een -9 ours "it ):-);minute $rea1s at t e end of eac our forincidental teac in! and play time.Inter#ention re6uires 9;-


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& ile punis ments are not !enerallyused, a t erapist may inter#ene if a c ildis urtin! imself $y non-in=uriousmet ods suc as a li! t spray of "ater int e face.


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>Pros>>

> ? Cons- --

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Pros2 A4A is reputed $y many to $e t e mostsuccessful t erapy a#aila$le.7 &e found t at


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T e T erapist5s Role in A4AA4A is usually paired "it speec t erapy in earlyinter#ention. T e SLP must $e a"are of t especi3c plan for eac c ild and re!ularly

communicate t e t e A4A t erapist.Speec T erapy, +ccupational T erapy, andP ysical T erapy are often areas " ere t e c ildcan !enerali%e and practice s1ills learned in A4AT erapy.

Eac discipline $rin!s to t e A4A pro!ram diFerin!!oals and o$=ecti#es in terms of communicationmodalities, positionin! and sensory needs.

""".slp-a$a.net


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Pi#otal Response TreatmentT is pro!ram "as de#eloped at t eUni#ersity of California at Santa 4ar$ara$y Dr. Ro$ert Goe!el, Dr. Lynn GernGoe!el, and Dr. Laura S ru$man.It is also referred to as t e HaturalLan!ua!e Paradi!m and is $ased on A4Aprinciples.


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T e !oal of t is inter#ention is to teaclan!ua!e, decrease inappropriate$e a#iors, and increase social s1ills andacademics. T e focus on inter#ention ison t ose s1ills pi#otal to t e normalde#elopment of many ot er s1ills and$e a#iors.Pi#otal s1ills include2 communications1ills, play, social s1ills, and t e a$ility tomonitor one5s o"n $e a#ior.

Pi#otal Response Treatment


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PRT diFers from A4A in t at it is c ilddirected

PRT is pro#ided $y psyc olo!ists, SPEDteac ers, Speec Pat olo!ists, and ot erpro#iders speci3cally trained in PRT.PRT Certi3cation is oFered t rou! t e

Goe!el Autism Center2""".education.UCS4.edu(autism


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>Pros>>

> ? Cons- --

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PRT pro!rams re6uire at least ; ours ofinter#ention "ee1ly.All family mem$ers are encoura!ed to useP T met ods consistently "it t e student.Some disad#anta!es include2 3nancin!,3ndin! local pro#iders and tryin! to li#e a7normal8 family life " ile constantly in7t erapy mode8.


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T e T erapist5s Role in PRTAs in A4A, t e SLP, +T, and PT "or1 "it t ePRT pro#ider in de#elopin! a treatmentpro!ram. T e PRT pro#ider s ould pro#ide

su!!estions to ot er professionals ontar!etin! pi#otal $e a#iors. Communication$et"een t erapists and families is a must.All pro#iders s ould focus on usin! t e samepromptin! strate!ies.PRT $lends especially "ell "it SpeecT erapy as it can $e adapted to teac a #arietyof s1ills includin! sym$olic and sociodramaticplay and =oint attention.


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er$al 4e a#iorT is pro!ram uses S1inner5s analysis oflan!ua!e as a system to teac lan!ua!eand modify $e a#iors.It encoura!es t e student to learnlan!ua!e $y de#elopin! a connection$et"een a "ord and its meanin!.

er$al 4e a#ior is $ased on t e idea t att e "ay "e tal1 inJuences o" sensiti#eor a"are "e are of c an!es to ouren#ironment.


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T e inter#ention 3rst focuses on usin!lan!ua!e to re6uest or 7mands8.T en t e focus turns to namin! orla$elin! referred to in t e pro!ram as7Tact8/inally t e focus of treatment mo#es to

7Intra- er$al Communication8 " icincludes understandin! and use of " -6uestions and con#ersation.


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>Pros>>

> ? Cons- --

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er$al 4e a#ior and t e

Clinician5s role


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/loor TimeT is approac is$ased on t eDe#elopmentalIndi#idual DiFerenceModel from Dr.Stanley Kreenspan./loor Time is simplyt e idea t at a c ild5scommunication s1illscan $e impro#ed $y$uildin! on is( erstren!t s " ileplayin! to!et er on

t e Joor.


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/loor Time2

T e o#erall !oalSi0 de#elopmental milestonesSelf re!ulation and interest in t e "orld

Intimacy or a special lo#e for ot ersT"o "ay communicationComple0 communicationEmotional ideasEmotional t in1in!


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Implementation T e t erapist enters t e c ild5s acti#itiesand follo"s t e c ild5s leads in play and!uides t e c ild in e0pandin! is( erinteractions.Parents are instructed on o" to mo#e t ec ild to more complicated interactions" ic are referred to as 7+penin! and

Closin! Communication Circles.Speec , motor, and co!niti#e s1ills areaddressed 7T rou! a synt esi%edemp ases on emotional de#elopment.


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/loor Time is sometimes used in con=uction "it A4A.Inter#ention is deli#ered in a lo" stimulus en#ironment

from -; ours per day "it t e c ild5s family usin! t eprinciples in daily life.

""".Joortime.or!""".stanley!reenspan.com

Interdisciplinary Council on De#elopmental Learnin!Disorders """.icdl.com""".play-to-learn.com(dir Joortime. tmKreespan, S., ? &eider, S. *) @ . 7T e C ild "itSpecial Heeds8. Readin!, MA2 Addison-&esley.


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>Pros>>

> ? Cons- --

-


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/loortime2 Playtime

for t e Clinician

T e principles of /loortime can easily $eincluded in t e t erapy tec ni6ues ofSpeec , +T and PT./loortime allo"s for a fun, naturallyreinforcin! t erapy en#ironment.SLP5s, +T5s, and PT5s already employ a#ariety of play t erapy tec ni6ues int eir inter#entions.


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Relations ip De#elopment

Inter#entionDe#eloped $y Dr. Ste#enKutstienIt is a parent $asedpro!ram usin! t efollo"in! 7DynamicIntelli!ence +$=ecti#es8


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Dynamic Intelli!ence +$=ecti#es

Emotional Referencin!2t e use of emotionalfeed$ac1 to learn from t e

e0periences of ot ersSocial Coordination2 t ea$ility to o$ser#e andcontinually re!ulate ones$e a#ior in order toparticipate in spontaneousrelations ips in#ol#in!colla$oration ande0c an!e of emotion.


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Declarati#e Lan!ua!e2 usin! lan!ua!eand non-#er$al communication toe0press curiosity and in#itin! ot ers tointeract and s are perceptions andfeelin!s and to corridinate one5s action"it ot ers./le0i$le T in1in!2 a$ility to adapt rapidlyand c an!e strate!ies and alter plans$ased on c an!in! circumstances.

Dynamic Intelli!ence+$=ecti#es


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Relational Information Processin!2 t ea$ility to o$tain meanin! $ased on alar!er conte0t and sol#in! pro$lems t at

a#e no clear ri! t or "ron! ans"ers./oresi! t and indsi! t2 t e a$ility toreJect on past e0periences andanticipate potential future scenarios.

Dynamic Intelli!ence+$=ecti#es


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Inter#entionIn t is pro!ram, t e c ild $e!ins "or1in!one on one "it t e parent. T en anot erpeer is added " o is at a similar le#el ofrelations ip de#elopment. As t e c ildpro!resses, ot er c ildren are added to t e!roup and t e en#ironments are c an!ed.T e curriculum consists of si0 le#els2

Ho#ice, Apprentice, C allen!er, E0plorer,and Partner. T e pro!ram !uides t e c ildto de#elop friends ips, and s o" empat y.


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Parents learn t e pro!ram t rou!trainin! seminars from an RDI certi3edconsultant""".rdiconnect.com

Inter#ention


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Pros and ConsRDI is not considered a completetreatment pro!ram.It is a pro!ram desi!ned speci3cally forparent implementation.


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RDI2 A T erapists

Perspecti#eSince RDI is meant for implementation$y t e parent only, it "ould $e importantfor t e SLP, +T, and PT to $e a"are oft e principles of RDI and t e pro!ress oft e student in t is inter#ention.Communication "it parents and Joortime inter#ention specialist is #ital to t ede#elopment of a multi-disciplinary teamapproac .


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TEACCTrainin! and Education of Autistic andRelated Communi Cation for

andicapped C ildren *TEACCDe#eloped $y Eric Sc opler, P D of t eUni#ersity of Hort CarolinaT is is a i! ly structured pro!ram$ased on t e 7Culture of Autism8.


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Culture of Autism

T is term refers to t e 7relati#estren!t s and di culties s ared $ypeople "it autism and t at are rele#antto o" t ey learn8.(""".autismspea1s.com )


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Inter#entionIn t is approac , c ildren are e#aluatedto determine emer!ent s1ills andinter#ention is desi!ned to $uild ont ese s1ills.T e inter#ention plan is de#eloped foreac indi#idual c ild to elp planacti#ities and e0periences.T e c ild refers to #isual supports sucas picture sc edules to elp t empredict and cope "it daily acti#ities.


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T e TEACC pro!ram is for ome orsc ool inter#entions.Trainin! is a#aila$le t rou! TEACCCenters in Hort Carolina and $y TEACCtrained ps yc olo!ists, SPED Teac ersand SLPS

""".teacc .com


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Pros and ConsT is pro!ram focuses on culti#ation oft e c ild5s stren!t s and interests rat ert an focusin! on is( er de3cits alone.T e stren!t s of t ose "it autism*#isual s1ills, reco!ni%in! details, andmemory can $ecome t e $asis ofsuccessful adult functionin! *+ io5sParent Kuide to Autism SpectrumDisorders N Mesi$o# and S ea, ::O .


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TEACC and t e

T erapistSLPs, +Ts, and PT5s can easily includeTEACC procedures in t eir t erapysessions.T erapists can incorporate t e use ofsc edules, social stories and ot ertec ni6ues in t eir t erapy plans,encoura!in! s1ill !enerali%ation.


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SCERTSSocial Communication, EmotionalRe!ulation, and Transactional SupportDe#eloped $y 4arry Pri%ant, P D., Amy&et er$y, P D, Emily Ru$in and AmyLaurentSCERTS dra"s from ot er pro!rams sucas A4A, Pi#otal Response Treatment,TEACC , /loor Time and RDI.


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T e main diFerence $et"een SCERTSand A4A is t at SCERTS encoura!es c ildinitiated communication in daily life.SCERTS aim is to elp t e c ild ac ie#e7Aut entic Pro!ress8, " ic is de3ned ast e a$ility to learn and spontaneouslycarry o#er functional s1ills into #arioussettin!s and "it many communicationpartners.

SCERTS


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T e /ocal Aspects of SCERTSSocial Communication2 spontaneousfunctional communication, emotionale0pression and secure and trustin!

relations ips "it ot ersEmotional Re!ulation2 t e a$ility tomaintain a "ell-re!ulated emotionalstate and t e a$ility to cope "it daily

stresses.


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Transactional Support2 de#elopment andimplementation of supports to assistcommunication partners to adapt t een#ironment and pro#ide t e tools to

en ance learnin!*picture communication,"ritten sc edules, sensory supports .Speci3c plans are de#eloped to pro#ideeducation and emotional support for

families and to encoura!e team"or1amon! t e inter#ention team.


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Inter#entionT is pro!ram pro#idesfor c ildren "it Autismto learn "it and from

ot er c ildren " o are!ood social and lan!ua!emodelsTransitional supports

*en#ironmentalaccommodations andlearnin! supports*picture sc edules or

#isual or!ani%ers


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T is pro!ram is usually pro#ided in t esc ool settin!s $y SCERTS trainedprofessionals""".scerts.com""".$arrypri%ant.com


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Pros and ConsUnli1e A4A, t is pro!ram focuses on!roup inter#ention rat er t an one onone treatment.Uses a multidisiciplinary team approacSCERTS is not an e0clusi#e pro!ram andaccepts ot er educational models t att e team deems appropriate.


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T erapist5s Perspecti#eT e SCERTS model is an interdisciplinaryapproac . T e model uses t e1no"led!e $ase and e0perience of!eneral and special educators, SLPs, +Ts,PTs, and ot er professionals.T erapists s ould $e familiar "itSCERTS principles and tec ni6ues andcommunication "it t e SCERTSpro#ider, parents ot er mem$ers of t einter#ention team is critical to t esuccess of t e pro!ram.


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T e anen ApproacT is approac is $ased ont e $elief t at parentss ould $e t e c ild5slan!ua!e teac ers,$ecause t ey a#e t estron!est $ond and a#emany opportunities to

teac lan!ua!e in t enatural conte0ts of dailyli#in!.Parents are trained $y

anen certi3ed SLPS.


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Trained parents can t en adapt t eapproac to meet t e indi#idual and uni6ueneeds of t eir c ild.

Pro!rams for Parents include27It Ta1es T"o To Tal18- anen pro!ram forparents.7More T an &ords8- anen pro!ram for

parents of c ildren "it Autism SpectrumDisorders7Tar!et &ord8 N anen pro!ram for parentsof Late Tal1ers.

T e anen Approac


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T e anen Centre as also de#elopedsupports for teac ers *Learnin!Lan!ua!e and Lo#in! It N A Kuide toPromotin!C ildren5s Social, Lan!ua!e, and LiteracyDe#elopment second edition N &eit%manand Kreen$er, :: .""". anen.or!

T e anen Approac


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Pros and ConsParents are to $e t e sole pro#iders fort is approac .It is not intended to $e a curriculumIt does not e0clude of ot er educationalmodels.

K


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Kroups

De#eloped $y Pamela . &olf$er!, P D.Promotes sociali%ation and ima!inationin c ildren "it ASD or De#elopmental

Delays t rou! play "it non-disa$ledpeers.Inte!rated Play Kroups follo" rules forcreation of an appropriate playen#ironment and selection of materials,preparation of peers for play,measurement of pro!ress and !uidedplay.

K


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/ocus is on social communication int e areas of imitation, =oint attention,and ima!inati#e and creati#e play.+ io5s Parent Kuide to AutismSpectrum Disorders&olf$er!, P. . * ::9 . 7Peer Play andt e Autism Spectrum2 T e art of!uidin! c ildren5s sociali%ation andima!ination. S a"nee Mission, GS2Autism Asper!er Pu$lis in! Company.

Kroups

d


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Pros and Cons

T is is a "onderful #enue foraddressin! social s1ills andde#elopin! peer relations ips.Care must $e ta1en to follo"procedures for t e appropriateen#ironment, selected materials, peer

preparation, and data collection.

Pl d T QQ


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Play and T erapyQQ

As in /loortime, Inte!rated play !roupsfall in line easily "it play t erapytec ni6ues across professions.

T e SLP "ould see si!ni3cant $ene3tsto t e inclusion of Inte!rated PlayKroups in addressin! social s1ills.


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T e Son-Rise Pro!ram

T e Son-Rise Pro!ram "as de#eloped $y4arry Heill Gaufman and is "ife " ent eir son Raun "as dia!nosed asse#erely and incura$ly autistic.T e pro!ram is a system of treatmentand education focusin! on =oinin!c ildren instead of "or1in! a!ainstt em.


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Principles of t e Son-RisePro!ram

oinin! in t e c ild5s repetiti#e andritualistic $e a#iors is considered t e 71eyto unloc1in! t e mystery of t ese

$e a#iors8, facilitatin! eye-contact, social$e a#iors and t e inclusion of ot ers in play.Utili%in! a c ild5s o"n moti#ations ad#anceslearnin! and $uilds t e foundation for

education and s1ill ac6uisition.Teac in! t rou! interacti#e play results ineFecti#e and meanin!ful sociali%ation andcommunication.


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T e pro!ram encoura!es pro#iders andparents to teac "it ent usiasm and toemploy a non-=ud!emental attitude.T is approac considers t e parent to $et e most important and $est resource. Itencoura!es t e creation of a distractionfree "or1 and play en#ironment tofacilitate optimal learnin!.

Principles of t e Son-RisePro!ram


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Inter#entionInter#ention is pro#ided t rou! parent-trainin! at one t e Autism TreatmentCenters of America.Parents are t e primary pro#iders,o"e#er t ey can include family and

friends in t e inter#ention process.T e Son-Rise Pro!ram com$ineseFecti#ely "it ot er complementaryt erapies *ie. 4iomedical inter#entions,sensory inte!ration, diet and AuditoryInte!ration t erapies .


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Pros and ConsT e cost in terms of 3nances and timere6uired for daily inter#ention may $epro i$iti#e for many parents.T e Son-Rise Pro!ram as come under3re for 7promotin!8 a cure for autism.It is interestin! to note t at t ispro!ram is not e#en listed in t e + ioParent5s Kuide to Autism SpectrumDisorders or on t e Autism Spea1s&e$site.""".autismtreatmentcenterofamerica.c


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The Role of other therapies in the

Son-Rise program


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ResourcesAutism Spea1s """.autismspea1s.com+ io Center for Autism and Lo" Incidence""".ocali.or!SLP-A4A ournal """.slp-a$a.net""".a$out.comGoe!el Autism Center

""".education.UCS4.edu(autism""".Joortime.or!""".stanley!reenspan.com


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Interdisciplinary Council on De#elopmental Learnin!Disorders """.icdl.com""".play-to-learn.com(dirJoortime. tm

Kreenspan,S.,? &eider, S. *) @ . 7T e C ild "itSpecial Heeds.8 Readin!, MA2 Addison-&esleyRelations ip De#elopment Inter#ention """.rdi.comTEACC """.teacc .comSCERTS """.scerts.comT e anen Approac """. anen.or!""".autismtreatmentcenterofamerica.com7American Ma%e8, Dale &il1ins. Used $y permission

():

Resources and Credits


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In SummaryT ere are many, many diFerentapproac es to treatin! Autism SpectrumDisorders.T is list is $y no means compre ensi#e.Parents and t erapists s ould en!a!e incareful researc $efore committin! toany speci3c pro!ram.


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T e End of t e Ma%eQQ

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