Transcript The Biology of Autism

Refrigerator mothers and beyond….
The aetiology of autism
Intervention
Intervention
Specific strategies
Triad of impairment
Evidence-based strategies
Five general strategies:
– Teach communicative and Social competence
– Use instructional strategies that maintain the natural flow
of classroom activities.
– Teach and provide opportunities for independence
– Proactively and systematically build a classroom
community that includes all children
– Promote generalization and maintenance of skills
Strategy 1: Teach communicative and Social
competence
• Use of the Picture Exchange Communication System (PECS) to teach an
effective mode of communication.
– children communicate using pictures and symbols, and focus on
initiations.
– Use of imitation to teach children with Autism to relate to others.
– Imitation is a critical tool.
– Children with Autism don’t know how to imitate others (actions, and
communication not words)
Strategy 2: Use Instructional Strategies that Maintain the
Natural Flow of Classroom Activities
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Teaching within context of developmentally appropriate activities and routines
Draw peers into the instructional situation
Teach using a variety of Naturalistic Teaching procedures including:
– Mend-Model procedures, time delay, incidental teaching, and interrupted
routines and behaviour chains
Characteristics of Naturalistic Teaching procedures:
– Teaching occurs in the natural environment
– Individual teaching interactions are brief and spaced over hours or days
– Typically child initiated
– Uses natural consequences –toys highly desired by the child
– Scaffolding is used in applying techniques different cues or prompts
– Only provide help required so that children do not become dependent on
prompts
Strategy 3: Teach and provide opportunities for
Independence
• 5 things that can help children with Autism have independence
– Give choices when possible, teach choice making when needed.
– Provide picture schedules and use timers to indicate duration of activities
– Make sure the day is filled with activities, and are conducted in the same way
and in the same sequence daily.
– Make a special effort to give all children frequent chances to respond to
teachers
– Maintain high expectations. Celebrate small victories and immediately
increase the expectations. Don’t say “he can’t; instead say How can we help
him to …?”
Strategy 4: Proactively and Systematically build
a classroom that includes all children
• Never question if a child “is ready” to participate, determine
what supports or accommodations are needed for the child to
be successful.
• Plan activities that engage children with a large range of
abilities.
• Plan activities that the child with the most significant
disabilities can do independently and are challenging for the
typically developing child.
Strategy 4: cont
• Group activities are important to create a classroom
community. Large Group activities and Small Group activities.
• Large Group activities include: opening circle, songs, stories,
and acting out plays
• Small Group activities include: games, art projects, preacademic activities
• Activities need to be short at the beginning of the year and
increase in length during the year.
Strategy 5: Promote Generalization and
Maintenance of Skills
• Unless skills are demonstrated in a variety of settings and maintained
throughout the year these skills will be used only in the setting where they
were learned.
• 4 strategies that promote generalization and maintenance are:
– Target skills that will be useful in each child’s life.
– Use prompts judiciously (use least directive and intrusive prompt) and fade
them rapidly
– Use naturally distributed trials – not all instruction is formally scheduled
– Use common material for instruction
Behavioural approaches
• Early intensive behavioural intervention seems to enable the development of
intelligence, communication, and adaptive function, and, to a lesser extent,
language, daily living skills, and socialisation. A shift from atypical to typical
neurophysiology has been reported after 2 years of intervention with the Early
Start Denver Model. However, too few randomised controlled trials have been
done. The second comprehensive approach, structured teaching, originates from
the TEACCH (Treatment and Education of Autistic and related Communicationhandicapped Children) model. It is widely used across a broad age range, but
little evidence is available
Targeted approaches
• Targeted approaches focus on specific cognitive behavioural domains. For non-verbal
individuals, the Picture Exchange Communication System could be helpful, at least in
the short term. Some evidence of effectiveness is available for models promoting
emotion recognition, theory of mind, imitation, and functional communication. Joint
attention or engagement training seems to be effective, and could be generalisable
to natural contexts and language development. A curriculum targeting socially
synchronous engagement for toddlers also seems to be effective. Social skill training
for older children, adolescents, and adults is also promising. Programmes
establishing independence are often used but still need systematic assessment.
Vocational intervention is important, especially for transition into adulthood.
Targeted behavioural intervention can also be beneficial by reducing anxiety and
aggression.
Parent-mediated intervention
• Parent-mediated intervention has the advantage of bringing treatment into home and community
settings to enable transfer of skills to real-life settings, an increasing parents’ and caregivers’ self-
confidence Programmes can be comprehensive (eg, parent delivery of the Early Start Denver Model) or
targeted (eg, at joint attention or communication).
• Sensory integration therapy—frequently used in occupational therapy—is sometimes offered as one
component of a comprehensive programme to address sensory-based problems. However, its
effectiveness is inconclusive
• Additionally, they emphasise that social-communication training (with a focus on social skills) should
be offered, and non-verbal individuals should have opportunities to use the Picture Exchange
Communication System (or alter native communication interventions if that is unsuccessful).
Approach
Target group
Effectiveness
Behavioural approaches
ABA intervention based
Young children usually aged < 5 years
Low to moderate
e.g. floortime, ESDM
Comprehensive structured teaching
TEACCH
Children, adolescents and adults
Low
Provides structures of the environment
and activities
Targeted skill-based intervention
PECS
Non-verbal individuals
Moderate
Teaches spontaneous socialcommunication skills
Targeted structured teaching
Joint attention, pretend play, theory of
mind, functional communication
Children
Not established, but potentially effective
Targets social cognitive abilities
fundamental to social-communication