Transcript Treatments for Autism Spectrum Disorders

TREATMENT FOR
AUTISM SPECTRUM DISORDERS
Floor Time
 This approach is based on the Developmental
Individual Difference Model from Dr. Stanley
Greenspan.
 Floor Time is simply the idea that a child’s
communication skills can be improved by
building on his/her strengths while playing
together on the floor.
Floor Time:
 Six developmental milestones include:
 Self regulation and interest in the world
 Intimacy or a special love for others
 Two way communication
 Complex communication
 Emotional ideas
 Emotional thinking
Implementation
 The therapist enters the child’s activities and
follows the child’s leads in play and guides the
child in expanding his/her interactions.
 Parents are instructed on how to move the child
to more complicated interactions which are
referred to as “Opening and Closing
Communication Circles.
 Speech, motor, and cognitive skills are
addressed “Through a synthesized emphasis on
emotional development.
 Floor Time is sometimes used in conjuction with
ABA.
 Intervention is delivered in a low stimulus
environment from 2-5 hours per day with the
child’s family using the principles in daily life.
 Interdisciplinary Council on Developmental
Learning Disorders
 Greespan, S., & Weider, S. (1998). “The Child with
Special Needs”. Reading, MA: Addison-Wesley.
Floortime: Playtime
for the Clinician
 The principles of Floortime can easily be included
in the therapy techniques of Speech, OT and PT.
 Floortime allows for a fun, naturally reinforcing
therapy environment.
 SLP’s, OT’s, and PT’s already employ a variety of
play therapy techniques in their interventions.
FLOOR TIME VIDEO
 https://www.youtube.com/watch?v=vQW4TncfP7g&li
st=PL-41-jQ5lNtI6R0CVoi-ej0vYRkkAZ6YQ&index=4
II. TEACCH
raining and ducation of utistic and Related
ommuni ation for andicapped Children
(TEACCH)
 Developed by Eric Schopler, PhD of the
University of North Carolina
 This is a highly structured program based on the
“Culture of Autism”.
Culture of Autism
 This term refers to the “relative strengths and
difficulties shared by people with autism and that
are relevant to how they learn”.
Intervention
 In this approach, children are evaluated to
determine emergent skills and intervention is
designed to build on these skills.
 The intervention plan is developed for each
individual child to help plan activities and
experiences.
 The child refers to visual supports such as
picture schedules to help them predict and cope
with daily activities.
 The TEACCH program is for home or school
interventions.
 Training is available through TEACCH Centers in
North Carolina and by TEACCH trained
pshychologists, SPED Teachers and SLPS
 This program focuses on cultivation of the
child’s strengths and interests rather than
focusing on his/her deficits alone.
 The strengths of those with autism (visual skills,
recognizing details, and memory can become the
basis of successful adult functioning (Ohio’s
Parent Guide to Autism Spectrum Disorders –
Mesibov and Shea, 2006).
TEACCH and the Therapist
 SLPs, OTs, and PT’s can easily include TEACCH
procedures in their therapy sessions.
 Therapists can incorporate the use of schedules,
social stories and other techniques in their
therapy plans, encouraging skill generalization.
TEACCH VIDEO
 https://www.youtube.com/watch?v=uen98aGQO1A&i
ndex=1&list=PL4637CDA828AA3BD
PECS VIDEO
 https://www.youtube.com/watch?v=ZJiY59xcGEI&list
=PLFXMyvqb_n6d00Lb2jo8GRcp6KyTV0GQM&inde
x=4\
SCERTS
 Social Communication, Emotional Regulation,
and Transactional Support
 Developed by Barry Prizant, PhD., Amy
Wetherby, PhD, Emily Rubin and Amy Laurent
 SCERTS draws from other programs such as
ABA, Pivotal Response Treatment, TEACCH,
Floor Time and RDI.
SCERTS
 SCERTS encourages child initiated
communication in daily life.
 SCERTS aim is to help the child achieve
“Authentic Progress”, which is defined as the
ability to learn and spontaneously carry over
functional skills into various settings and with
many communication partners.
The Focal Aspects of SCERTS
 Social Communication: spontaneous
functional communication, emotional
expression and secure and trusting
relationships with others
 Emotional Regulation: the ability to maintain a
well-regulated emotional state and the ability to
cope with daily stresses.
 Transactional Support: development and
implementation of supports to assist
communication partners to adapt the
environment and provide the tools to enhance
learning(picture communication, written
schedules, sensory supports).
 Specific plans are developed to provide
education and emotional support for families
and to encourage teamwork among the
intervention team.
Intervention
 This program provides for children with Autism to
learn with and from other children who are good
social and language models
 Transitional supports (environmental
accommodations) and learning supports (picture
schedules or visual organizers)
 This program is usually provided in the school
settings by SCERTS trained professionals
Pros and Cons
 Unlike ABA, this program focuses on group
intervention rather than one on one treatment.
 Uses a multidisiciplinary team approach
 SCERTS is not an exclusive program and
accepts other educational models that the team
deems appropriate.
Therapist’s Perspective
 The SCERTS model is an interdisciplinary
approach. The model uses the knowledge base
and experience of general and special educators,
SLPs, OTs, PTs, and other professionals.
 Therapists should be familiar with SCERTS
principles and techniques and communication
with the SCERTS provider, parents other
members of the intervention team is critical to
the success of the program.
SCERTS VIDEO
 https://www.youtube.com/watch?v=WKVttP3Rfag
 https://www.youtube.com/watch?v=srJ2BnR-Qp8
The Hanen Approach
 This approach is based on the belief that parents
should be the child’s language teachers, because
they have the strongest bond and have many
opportunities to teach language in the natural
contexts of daily living.
 Parents are trained by Hanen certified SLPS.
The Hanen Approach
 Trained parents can then adapt the approach to
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meet the individual and unique needs of their child.
Programs for Parents include:
“It Takes Two To Talk”-Hanen program for parents.
“More Than Words”- Hanen program for parents of
children with Autism Spectrum Disorders
“Target Word” – Hanen program for parents of Late
Talkers.
The Hanen Approach
 The Hanen Centre has also developed supports
for teachers (Learning Language and Loving It –
A Guide to Promoting
Children’s Social, Language, and Literacy
Development second edition – Weitzman and
Greenber, 2002).
Pros and Cons
 Parents are to be the sole providers for this
approach.
 It is not intended to be a curriculum
 It does not exclude other educational models.
HANEN VIDEO
 https://www.youtube.com/watch?v=W-6frim4Ojc
 https://www.youtube.com/watch?v=SRDGOBTsJso
The Son-Rise Program
 The Son-Rise Program was developed by Barry
Neill Kaufman and his wife when their son Raun
was diagnosed as severely and incurably
autistic.
 The program is a system of treatment and
education focusing on joining children instead of
working against them.
Principles of the Son-Rise Program
 Joining in the child’s repetitive and ritualistic
behaviors is considered the “key to unlocking
the mystery of these behaviors”, facilitating eyecontact, social behaviors and the inclusion of
others in play.
 Utilizing a child’s own motivations advances
learning and builds the foundation for education
and skill acquisition.
 Teaching through interactive play results in
effective and meaningful socialization and
communication.
Principles of the Son-Rise Program
 The program encourages providers and parents
to teach with enthusiasm and to employ a nonjudgmental attitude.
 This approach considers the parent to be the
most important and best resource. It
encourages the creation of a distraction free
work and play environment to facilitate optimal
learning.
Intervention
 Intervention is provided through parent-training
at one the Autism Treatment Centers of America.
 Parents are the primary providers, however they
can include family and friends in the intervention
process.
 The Son-Rise Program combines effectively with
other complementary therapies (ie. Biomedical
interventions, sensory integration, diet and
Auditory Integration therapies).
 https://www.youtube.com/watch?v=SC3LeEg_8TQ
Applied Behavioral Analysis
 This treatment program (ABA) is based on the
principles of positive reinforcement of B.F.
Skinner.
 Simply, it is the repetitive use of positive
reinforcement to teach specific skills and
decrease inappropriate behaviors.
 What is occurring in the child’s environment to
cause negative behaviors?
ABA Three Step Procedure
 Antecedent: The verbal or physical stimulus
such as a command or request.
 Resulting Behavioral response to stimulus or a
lack of response
 Consequence: the positive reinforcement or no
response for inappropriate behavior
ABA Intervention
 ABA is not synonymous with Discrete Trial
Training. DTT was developed by Dr. O. Ivar
Lovass. DTT is a strategy used in ABA
 In ABA, skills are broken down into small,
discrete tasks which are taught using prompts,
which are faded out gradually as a skill is
mastered.
 Students are positively reinforced with either
verbal praise or something tangible that he/she
finds rewarding.
 ABA programs are carried out at school or in the
home with a one on one aide
 The goal is the carryover of the skills to other
environments.
 Facilitated play with peers is also part of this
program.
 The ABA provider is responsible for data
collection and analysis.
 Providers must be board certified behavior
analysts. The provider is responsible for
writing and managing the program. Individual
“Trainers”, who are not necessarily board
certified provide the daily intervention.
 Sessions last between 2-3 hours with 10-15
minute breaks at the end of each hour for
incidental teaching and play time.
 Intervention requires 35-40 hours per week
with families encouraged to use these
techniques daily.
 40 hours of intervention a week is often
considered to be just too much for many
families.
 The cost is prohibitive. While some schools will
provide ABA, few will pay the cost of 40 hours
per week of one on one intervention for “just”
one child.
 Critics suggest that ABA can create an
“emotionless, robotic” child who has difficulty
carrying over skills to a natural environment.
The Therapist’s Role in ABA
 ABA is usually paired with other therapies in
early intervention. The therapists should team.
 Speech Therapy, Occupational Therapy, and
Physical Therapy are often areas where the child
can generalize and practice skills with integrated
goals.
 Each discipline brings to the patients treatment
plan differing goals and objectives in terms of
communication modalities, positioning and
sensory needs.
Verbal Behavior
 This program uses Skinner’s analysis of
language as a system to teach language and
modify behaviors.
 It encourages the student to learn language by
developing a connection between a word and its
meaning.
 Verbal Behavior is based on the idea that the way
we talk influences how sensitive or aware we are
of changes to our environment.
 The intervention first focuses on using language
to request or “mands”.
 Then the focus turns to naming or labeling
referred to in the program as “Tact”
 Finally the focus of treatment moves to “IntraVerbal Communication” which includes
understanding and use of wh-questions and
conversation.
ABA VIDEO
 https://www.youtube.com/watch?v=SLBLnNxzftM