Transcript Combining Treatment Approaches in Working with Children

Combining Treatment
Approaches in Working with
Children with Autism
By
Tracy Vail,MS,CCC/SLP
Letstalksls.com
Most Common Approaches Used
• Behavioral Approaches- ABA- Applied Behavior
Analysis and Applied Verbal Behavior,
TEACCH
• Developmental Approaches- SCERTS,
Floortime/DIR, RDI
Can We Combine Behavioral and
Developmental Approaches?
YES!!!
General Language Categories
• Language used to meet the needs of the
individual
• Language used for social interactions and
building relationships
• Language used for “learning” or academic
settings
Factors to Consider
• No single “program” works for all children to
address all their needs.
• Every human being’s learning ability is a
combination of internal and external factors.
• Motivation of the child is the most important
factor to consider when making treatment
decisions.
Relevant Information About
Learners with Autism
• They tend to have very analytical minds
• They tend to have unusual motivations and
consequently unusual reinforcers
• They tend to be “rule based” learners
• Their bodies experience the world in an unusual way
• Some are quite rigid and anxious
• They often have difficulty understanding the “rules” of
social interaction and communication
So what…..Now what?
Use Whatever Works to Teach
the Most Important Skills to each
Individual child at the Given
Time
So how do we know what’s most
important?
Ask and Observe
• Ask the parents! What are their priorities?
• Observe the child- What areas are causing the
child the most difficulty in life right now?
• Look at where the child is currently functioning
and determine the necessary component
behaviors/skills to meet the goals of the parents
and child.
• What are the goals of the family in 1 yr? 5 yrs?
10 yrs?
Developmental, Individual Differences,
Relationship Based Intervention,
DIR/Floortime
• A warm and intimate way of relating to a child. A floor
time philosophy means engaging, respecting and getting
in tune with the child in order to help the child
elaborate through gestures, words and pretend play
what is on the child’s mind. As a technique it is a
process that is used to support the emotional and social
development of the child. (Greenspan, 2002)
This model serves as the context or “container” of the therapy we do.
But what does it mean?
Hanen Method
• Teaching communication and play skills through
adult- child interactions. Parents/therapists are
to:
• Observe, Wait and Listen (OWL)
• This approach is very similar to DIR in that the
child leads and teaching is conducted based on
the interests of the child.
Relationship Development
Intervention
• A cognitive- developmental approach designed to
remediate Autism.
• Deals with autism as a neurologically based,
information processing disorder.
• Proposes to remediate the “Core Deficits” in Autism
including motivation, communication, emotional
regulation, episodic memory, rapid attention shifting,
self-awareness, appraisal, executive functioning, flexible
thinking, and creative problem solving.
Great stuff based on research by many in the field but what do these “core
deficits” mean? How do we know when these skills have improved? What
is the child doing? How can we measure it? AND, is it really necessary to
spend thousands of dollars being trained to address these issues?
Behavioral Approaches
• Scientifically validated based on many years of research.
• Based on measurable behaviors either internal or
observable.
• Based on the “laws of learning”
• Places the responsibility of learning on the “teacher”
rather than the student
• Many “faces” to behavioral interventions. Not all
programs look alike
• Data driven program decisions
Applied Verbal Behavior
• Based on the research of BF Skinner on “why” people
communicate
• Language is categorized into verbal operants or
functions
• Language is taught as a behavior with specific teaching
procedures used
• Both natural environment teaching and intensive
teaching are used based on the age and skills of the
child
• Resources: Educate Toward Recovery by Robert
Schramm, Assessment of Basic Language and Learning
by James Partington and Mark Sundberg.
TEACCH
• The long-term goals of the TEACCH approach are both skill development
and fulfillment of fundamental human needs such as dignity, engagement in
productive and personally meaningful activities, and feelings of security, selfefficacy, and self-confidence. To accomplish these goals, TEACCH
developed the intervention approach called “Structured Teaching.”
• The principles of Structured Teaching include:
– Understanding the culture of autism.
– Developing an individualized person- and family-centered plan for each
client or student, rather than using a standard curriculum.
– Structuring the physical environment.
– Using visual supports to make the sequence of daily activities predictable
and understandable .
– Using visual supports to make individual tasks understandable
(TEACCH Website)
The Language We Use
• Often it isn’t what we do but how we talk about what
we do that makes approaches seem so different.
• The language we use to talk about what we do should
be precise, agreed upon and based on “observable” or
“measurable” change.
• As SLPs we are charged to provide “evidenced based
practices”. Show me the data!!
Sam
What did you observe with Sam?
• He remained engaged with the
instructor for 3.5 minutes.
• He requested using gestures 4
times with no prompting.
• He imitated body movements twice
with no prompting.
• He looked at the instructor twice
and smiled.
• He laughed in response to the
instructors actions twice.
• He initiated a social game twice
with no prompting.
• He shared affect
• He shared attention
• He both opened and closed 5
circles of communication
• The instructor followed the child’s
lead
• He demonstrated a preference to
engage in a regulatory pattern with
ongoing variations
• He regulated his actions to
maintain social coordination
• He responded to guides role
actions to maintain the regulatory
status of the pair.
Children are Complete Human
Beings
• They have a right to communicate to get their needs
met
• They want and need successful relationships in their
lives
• While they have some similarities, they all have unique
needs that should be addressed
• Each family structure is different and has unique
priorities and needs
• Child and family needs will change over time and
programs need to reflect that
Early Learners
• Build trust/relationship by being predictable
• People are fun and “talking” is fun
• “Talking” is useful- I talk, I get
Use a combination of principles from DIR,
Floortime and VB
Build Context/Motivation to
Communicate
Communicating Before Talking
Use Music
Use Books
Shape Speech in the Context of
Requesting
Teach Them a Way to Communicate
Intermediate Learners
• Advance language and literacy skills
• Continue to include relationship development
• Include intensive teaching based on the needs of
the child
• Expand play skills
Teaching Mastered Skills in
Intensive Teaching
Expand Play Skills
Advanced Language Learners
•
•
•
•
Higher Level Language Skills
Continue to build relationships
Problem solving/negotiating
Foster success in academic and social settings
Advanced Pretend Play
Problem Solving and Story
Comprehension
Negotiating/Problem Solving
Thanks for All You Give to
Children!