Transcript Evidence Based Treatments for Autism Spectrum

Robert Jason Grant Ed.D, LPC, RPT-S
www.robertjasongrant.com
Autism Spectrum Disorders
 Autism
 Aspergers Syndrome
 Pervasive Developmental Disorder – Not Otherwise
Specified (PDD-NOS)
Pervasive Developmental Disorders
 Autism Spectrum Disorders
 Rhett’s Disorder
 Childhood Disintegrative Disorder
Pervasive Developmental Disorders
Science, Pseudoscience, and
Antiscience
 Science: strives to promote evidence based practices by
using time honored methods to put hypotheses to
logical and empirical tests
 Operational definitions
 Direct, reliable, and objective measurement
 Controlled experiments
 Reliance on objective data for making conclusions
 Independent verification of results
Science, Pseudoscience, and
Antiscience
 Pseudoscience: instead of objective measurements
from well controlled experiments and independent
verification from multiple research studies,
pseudoscience offers testimonials and unverified
personal reports to legitimatize claims
 Antiscience: a rejection of time tested methods of the
scientific approach as a means of proving results. An
extreme antiscience view would be that there are no
objective facts , only personal interpretations of
phenomena
Treatment Warning Signs
 High or universal “success” rates are claimed
 Rapid changes are promised
 The treatment promotes itself as a “cure” for autism
 The theory behind the treatment contradicts objective
knowledge
 The treatment is said to be easy to administer,
requiring no experience
 The treatment excludes other treatments and
emphasizes being administered exclusively
Treatment Warning Signs
 Promoters of the treatment are working outside their
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area of expertise
Promoters of the therapy do not have knowledge or
training in working with autism spectrum disorders
Little or no objective evidence is provided in support
of the treatment
Belief and faith are said to be necessary for the
treatment to work
Promoters are not open to independent evaluation of
the treatment approach
Selecting an Approach
 Three questions to consider when selecting a
treatment approach:
1. What are the anticipated outcomes that align with a
particular treatment, and are the outcomes in
harmony with the needs of the child
2. What are the potential risks associated with the
treatment
3. What are the most effective means of evaluating a
particular treatment
National Autism Center
National Standards Project, 2009
www.nationalautismcenter.org
Categories of Placement
 Evidence Based/Established Treatments
 Promising/Emerging Treatments
 Limited/Unestablished Treatments
 Not Recommended/Ineffective Treatments
Evidence Based/Established
 Several published, peer reviewed studies
 Interventions and treatments in this category have
undergone a substantial amount of research
 The evidence consistently provides results that prove
children with an ASD display a significant increase in
skill acquisition as a consequence of the treatment
Promising/Emerging
 Few published, peer reviewed studies
 Interventions and treatments in this category have
been widely used for several years without any or with
few adverse outcomes
 The research suggests that children and youth with an
ASD responded favorably from the intervention
Limited Support/Unestablished
 May or may not be based on research, if any research
base, it is very minimal
 May have high testimonial support but not
substantiated by research
 Interventions and treatments in this category have not
been widely utilized with children and youth with
ASD’s or reflect a range of results (poor to favorable)
when administered
Not Recommended/Ineffective
 Several published peer reviewed studies
 Interventions and treatments in this category have
been shown to not increase skill acquisition or produce
favorable results
 Some serious detrimental effects and outcomes have
been noted
Autism Treatment Chart
Applied Behavioral Analysis (ABA)
 Roots are in Behavior Theory www.bacb.com
 Functional Behavioral Analysis
 Emphasizes proactive antecedent (prevention)
approaches while also providing effective strategies for
intervening after a behavior has occurred
 Ongoing and comprehensive analysis of in individuals
environment
 Encompasses several behavioral approaches such as
prompting, fading, shaping, errorless learning,
extinction, and punishment
Lovaas Model
 Provides behavioral treatment utilizing the principles of applied behavior analysis.
 POSTIVE INTERACTIONS are first developed through the use of favorite activities and
responding to any attempts to communicate.
 MOTIVATION is encouraged through the use of familiar materials and child-specific
reinforces.
 SUCCESS is promoted through positive reinforcement of successive approximations and
prompting and fading procedures.
 PARENTAL INVOLVEMENT is critical. Parents are empowered through training and
collaboration to create an environment in which treatment is provided most of a child's
waking hours, at home, at school, and in the neighborhood.
 REQUESTING is developed as early as possible.
 Learning to talk and understand vocal LANGUAGE is considered a fundamental part of
social development. IMITATION is also crucial, allowing a child to learn by observing
other children learn.
 And finally, social interactions and cooperative PLAY are integral to treatment.
Facilitated play occurs first with siblings and then with peers during play dates and at
school.
 www.lovaas.com
Discrete Trial Training (DTT)
 Uses the principles of applied behavioral analysis (ABA)
 Example: the student is given a stimulus--a question, a set
of blocks and a pattern, a request to go ask Mom for a glass
of water--along with the correct response, or a strong 'hint'
at what the response should be. He is rewarded (an M&M,
a piggy-back ride, a happy "good job!") for repeating the
right answer; anything else is ignored or corrected very
neutrally. As his response becomes more reliable, the
'clues' are withdrawn until he can respond independently.
This is usually done one-on-one at a table (thus the term
table-top work), with detailed planning of the requests,
timing, wording, and the therapist's reaction to the
student's responses.
Pivotal Response Training (PRT)
 Uses the principles of applied behavioral analysis (ABA)
 Target behaviors are taught in natural environments using
items that are age appropriate and reinforcing to the child
 The parent or teacher presents to the child an instruction,
question, or other opportunity to respond. The child
responds. The parent or teacher provides some
consequence to the child depending on the child’s
response.
 Tasks should be chosen by the child as much as possible
 http://education.ucsb.edu/autism/
Comprehensive Behavioral
Treatment for Young Children
 Treatment that involves a combination of ABA
procedures, discrete trial, naturalistic teaching, etc.
 Example: Early intervention programs
Learning Experiences: An Alternative Program for
Preschoolers and Parents (LEAP)
 Uses applied behavior analysis (ABA) interventions
 Developed by Phil Strain [email protected]
 LEAP is a combination or peer-mediated instruction,
incidental teaching, self-management training,
prompting strategies, and systematic parent training
 A curriculum approach used by many special
education classrooms
Joint Attention Interventions
 Teaching a child to respond to the nonverbal social
bids of others or to initiate joint attention interactions
 Examples: pointing to objects, showing
items/activities to another person, and following eye
gaze
Modeling
 An adult or peer provides a demonstration of the target
behavior that should result in an imitation of the
target behavior by the individual with an ASD
 Can be simple or complex behaviors that are modeled
 Can be live modeling or video modeling
 Often combines with other strategies
Naturalistic Teaching Strategies
 Incidental Teaching, Milieu Teaching, Mand Model,
and Time Delay
 Uses strategies from the field of applied behavior
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analysis (ABA)
Is naturalistic, in that the child leads
Teacher or therapist may pre arrange environment
Lessons involve interactions in which the child expresses
interest and the adult responds with prompts and praise
A specific lesson can be repeated several times with the
adult removing the requested item and having the child
initiate interest again
Peer Related Interventions
 Teaching children without disabilities strategies for
facilitating play and social interactions with children
on the autism spectrum
 Peers can be classmates or siblings
 Examples include: integrated play groups, integrated
social skills groups, or peer mediated groups
www.autisminstitute.com
 These interventions may include components of other
treatments
Early Start Denver Model
 Developed by Sally Rogers and Geraldine Dawson.
 An "eclectic" autism intervention, combining ABA-
based with non-ABA-based approaches. The manual
specifies that ESDM "most closely resembles" RDI,
DIR/Floortime, and SCERTS. ESDM also "has clear ties
to" PRT, incidental teaching, and milieu teaching. And
ESDM "has in common" some elements of ABA-based
interventions as per Lovaas. Speech and occupational
therapy are also thrown in.
 www.ucdmc.ucdavis.edu/mindinstitute/research/esd
m/
Verbal Behavior Approach
 Guided by the principles of Applied Behavior Analysis
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(ABA). In addition to using ABA principles, a Verbal
Behavior (VB) practitioner also incorporates BF
Skinner's Analysis of Verbal Behavior.
looks first at what the child wants and then teaches
the child how to request.
Many VB consultants also recommend the use of sign
language for most non-vocal early learners.
VB is child-led.
www.verbalbehaviorapproach.com
Schedules
 The presentation of a task list that communicates a
series of activities or steps required to complete a
specific activity
 Schedules can be written words, pictures or
photographs, or work stations
 Often supplemented by other interventions
Self Management Interventions
 Promotes independence by teaching individuals with
ASD’s to regulate their behavior by recording the
occurrence/non-occurrence of the target behavior, and
securing reinforcement for doing so
 Reinforcement is usually a component of the
intervention
 Examples include: checklists (using checks,
smiling/frowning faces), counters, visual prompts, and
tokens
Story Based Interventions
 Social Stories
 Developed by Carol Gray www.thegraycenter.org
 A social story describes a situation, skill, or concept in terms of relevant
social cues, perspectives, and common responses in a specifically
defined style and format
 The four types of sentences:
 1. Descriptive – tells where situations occur, who is involved, what they
are doing, and why
 2. Perspective – describes the reactions and feelings of the student
and of other people
 3. Directive – tells student what to do
 4. Control – after the social story is read, the student writes sentences
to help her remember the information from the social story (often
considered optional)
 Other Resources: www.polyxo.com
Play Therapy Interventions
 The systematic use of a theoretical model to establish
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an interpersonal process wherein trained play
therapists use the therapeutic powers of play to help
clients prevent or resolve psychosocial difficulties and
achieve optimal growth and development.
AutPlay Therapy www.robertjasongrant.com
Filial Therapy www.play-therapy.com
Theraplay www.theraplay.org
Cognitive Behavioral Play Therapy
Association for Play Therapy www.a4pt.org
RePlays
 Developed by Dr. Karen Levine
 Pick an event that is troublesome for the child such as
sitting in their car seat or going to the doctor
 Re-enact the event using props, if child is just
beginning pretend play then the re-enactment needs
to be more concrete such as where the even acutely
occurs
 The re-enactment is done by the therapist and should
be short and quick at first and grab the child’s
attention.
 www.drkarenlevine.com
Floortime(DIR)/The Play Project
 Developed by Stanley Greenspan
 A specific technique to both follow the child’s natural
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emotional interests (lead) and at the same time
challenge the child towards greater and greater
mastery of the social, emotional and intellectual
capacities.
Play based
www.stanelygreenspan.com
www.icdl.com
www.playproject.org
Relationship Development
Intervention
 Developed by Dr. Steve Gutstein
 A parent-based intervention program where parents are
provided the tools to effectively teach Dynamic Intelligence
skills and motivation to their child
 Dynamic Intelligence skills consist of experience sharing,
dynamic analysis, flexible and creative problem-solving,
episodic memory and self-awareness, and resilience
 www.rdiconnect.com
Brain Gym (Brain Based Play)
 Refers to the original 26 Brain Gym movements, sometimes
abbreviated as the 26. These activities recall the movements
naturally done during the first years of life when learning to
coordinate the eyes, ears, hands, and whole body. The twenty-six
activities, along with a program for “learning through
movement” were developed by educator and reading specialist
Paul E. Dennison and his wife and colleague, Gail E. Dennison
 Claim dramatic improvements in areas such as: Concentration
and Focus, Memory, Academics: reading, writing, math, test
taking, Physical coordination, Relationships, Self-responsibility,
Organization skills, and Attitude
 www.braingym.com
 www.braingym.org
Autism Movement Therapy
 Developed by Joanne Lara
 An interhemispheric SENSORY INTEGRATION
technique incorporating movement and music in
collaboration with Positive Behavior Support (PBS)
strategies.
 Assists in meeting and achieving a child’s speech and
language, social and academic IEP goals.
 www.autismmovementtherapy.com
Theory of Mind Training
 Interventions are designed to teach individuals to
recognize and identify mental states in oneself or in
others and to be able to take the perspective of another
person in order to predict their actions
 Recognizing a persons thoughts, beliefs, intentions,
desires, and emotions.
TEACCH
 Treatment and Education of Autistic and related
Communication Handicapped Children.
 A state program originally developed in North
Carolina.
 A complete and comprehensive program of services for
autistic people which makes use of several techniques,
of several methods in various combination depending
upon the individual person's needs and emerging
capabilities.
 www.teacch.com
Music Therapy
 Teach individual skills or goals through music
 A targeting skill (counting, learning colors, taking
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turns, learning feelings) is first presented through
song or rhythmic cuing
Music is eventually faded
Make Sound and Move Around CD
www.musictherapy.org
www.jamminjenn.com
S.C.E.R.T.S
 Focuses on building competence in Social
Communication, Emotional Regulation and
Transactional Support.
 Families, educators and therapists work cooperatively
as a team.
 Includes a well-coordinated assessment process that
helps a team measure the child’s progress, and
determine the necessary supports to be used by the
child’s social partners (educators, peers and family
members).
 www.scerts.com
Rapid Prompting
 Developed by Soma Mukhopadhyay
 RPM uses a "Teach-Ask" paradigm for eliciting
responses through intensive verbal, auditory, visual
and/or tactile prompts.
 RPM uses prompting to initiate a student's
independent response, without physical support.
 (RPM) improves academic success and
communication.
 www.halo-soma.org
Massage/Touch Therapies
 Specific massage and touch protocols
 Typical results include improvement in behavior,
mood, sleep, and comfortableness with touch.
 Typical approaches include 15-minute sessions
conducted twice weekly or nightly 15-minute sessions
done at home by the parents before bedtime.
 www.amtamassage.org
Picture Exchange Communication
System (PECS)
 PECS was developed by Andrew S. Bondy & Lori Frost.
 A unique augmentative/alternative communication
intervention package.
 Based on B.F. Skinner’s book, Verbal Behavior
 PECS begins by teaching an individual to give a picture
of a desired item to a “communicative partner", who
immediately honors the exchange as a request,
individuals progressively moves through six phases.
 www.pecsusa.com
Augmentative and Alternative
Communication
 The term is applied to a variety of interventions that
are utilized to compensate for expressive
communication deficits.
 Augmentative refers to methods and devices that are
used as interventions to enhance an individuals
speech.
 Alternative refers to the use of techniques that are
used to replace speech for an individual who has not or
may not acquire spoken language.
Assistive Technology
 A broad term used to describe any aid that is used to
increase, maintain or improve the functional
capabilities of a child with Autism.
 Devices an be electronic or non electronic.
 Adapted utensils, talking calculators, ipads, voice
output devices, pencil grips, etc.
Art Therapy
 Art therapy is a form of expressive therapy that uses the
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creative process of making art to improve a person’s
physical, mental, and emotional well-being.
It can be used for counseling by therapists to promote
healing, treatment, rehabilitation, psychotherapy, and in
the broad sense of the term, art therapy can be used to
massage one’s inner-self in a way that may provide the
individual with a deeper understanding of him or herself.
www.arttherapy.org
www.arttherapyblog.com
www.arttherapytechniques.blogspot.com
Option Method (SonRise)
 Developed by Barry Neil Kaufman and Samahria Lyte
Kaufman.
 Basic components include: joining in a child's
repetitive and ritualistic behaviors, utilizing a child's
own motivation, teaching through interactive play,
using energy, excitement and enthusiasm, employing a
nonjudgmental and optimistic attitude, placing the
parent as the child's most important and lasting
resource, and creating a safe, distraction-free
work/play area.
 www.autismtreatmentcenter.org
Animal Assisted Therapies
 The Most common animal assisted therapies for
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Autism Disorders include: horses, dogs, cats, and
dolphins.
www.animalassistedtherapyprograms.com
www.equine-therapy-programs.com
www.dolphinassistedtherapy.com
www.autismassistancedog.com
www.autismservicedogsofamerica.com
www.iaath.com
Irlen Lenses
 A unique service for some children and adults identified
with reading and learning difficulties, low motivation,
attention deficit disorder, or discipline problems.
 The first testing session determines whether a person has
Irlen Syndrome (a problem with the brain's ability to
process visual information) and can be helped by the Irlen
Method’s color technology.
 The second testing session targets the precise wave lengths
of light causing problems by using a limitless number of
color filter combinations.
 www.irlen.com
Vision Therapy
 Various vision therapies and procedures designed to
correct or aid in vision problems.
 Not specific to or created for Autism Disorders.
 Typically done by a medical doctor training in vision
therapy and specifically in using vision therapy with
Autism disorders.
 Thought to be helpful for children with autism who
have vision problems and correction in vision
problems may help with behavior issues.
Aquatic Therapy
 Attempts to improve function through the application of
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aquatic therapeutic exercises.
Procedures require constant attendance of a therapist
educated in performing aquatic therapeutic exercises.
Aquatic therapy or pool therapy is physical therapy that is
performed in the water. Aquatic therapy use the resistance
of water instead of weights.
Helps with autism in calming the children, improving
movement, range of motion, improved body awareness,
increased balance, sensory integration, and mobility skills.
www.aquaticpt.org
www.atri.org
www.angelfishtherapy.com
Fast ForWord
 A family of educational software products intended to
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enhance cognitive skills of children, especially focused
on developing phonological awareness.
Typically used in school settings.
Promotes strengthening the skills of memory,
attention, processing rate, and sequencing for
children.
Participants spend 30 to 100 minutes a day, five days a
week, for four to 16 weeks using the products.
www.scilearn.com
MERIT Approach
 Mentalization Enhanced Remediation –an Integrated
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Treatment.
Mentalization describes the process in which we attend to
the thoughts and feelings of another.
Incorporates A.B.A. and other more developmentally based
approaches.
Provides metalizing experiences to forge a relationship
with the child, allowing mentalization to inform the
treatment on a regular basis, and remediating the socialemotional areas that prevent the child from progressing in
this area of development.
www.jeniferClark.com
Transcranial Magnetic Stimulation
 Scientists use a device to stimulate the brain non-
invasively in alert, awake patients.
 A simple procedure that lasts approximately 20
minutes. Regarded as being safe without any lasting
side effects.
 May reduce symptoms associated with Autism as brain
stimulation awakes and connects parts of the brain
that may be associated with creating Autism
symptoms.
Auditory Integration Training
 Created by Guy Bérard.
 Typically involves 20 half-hour sessions over 10 days
listening to specially filtered and modulated music.
 aims to address the sensory problems such as hearing
distortions and oversensitive hearing, which are said to
cause discomfort and confusion in persons suffering
from learning disabilities, including autism spectrum
disorders.
 www.aitinstitute.org
 Has not had favorable research.
The Davis Model of Sound
Intervention
 Created by Dorinne S. Davis
 Uses sound vibration with special equipment,
modified music, and/or specific tones/beats, the need
for which is identified with appropriate testing.
 Clients use headphones and sound proof rooms.
Treatment is 20 one-half hour listening sessions using
special listening devices. Sessions are twice a day for 10
days and must be separated by a minimum of three
hours and extend over a two week period which can be
separated by a weekend.
 www.thedaviscenter.com
Chelation Treatment
 The administration of chelating agents to remove
heavy metals from the body.
 Chelation therapy is used as a treatment for acute
mercury, iron, arsenic, lead, uranium, plutonium and
other forms of toxic metal poisoning. The chelating
agent may be administered intravenously,
intramuscularly, or orally, depending on the agent and
the type of poisoning.
 It has been suggested that Chelation therapy helps
reduce the symptoms of Autism.
Gentle Teaching
 Not a behavioral modification approach.
 Focuses on four primary goals: Teaching the person to
feel safe with us. Teaching the person to feel engaged.
Teaching the person to feel unconditionally valued.
Teaching the person to return unconditional valuing.
 Uses the relationship between the Individual and the
Caregiver as the foundation for teaching.
 Does not focus on compliance or obedience, but
focuses on teaching Individuals to feel safe with
others.
 www.gentleteaching.sharevision.ca
Van Dijk Approach
 A set of curriculum that can be taught to help improve
communication, socialization, and sensory deficits.
 The method involves several joint encounters where
both individuals (child and adult) experience events
together in an effort for the adult to better understand
the child.
 The child performs an action and the adult
immediately does the same action.
Gluten Free Diet
 A gluten free diet is a diet that excludes foods
containing gluten. Gluten is a protein found in wheat
(including kamut and spelt), barley, rye, malts and
triticale. It is used as a food additive in the form of a
flavoring, stabilizing or thickening agent, often as
"dextrin”.
 Autism claims include mild to dramatic improvements
in speech and/or behavior after these substances were
removed from their diet. Some also report that their
children have experienced fewer bouts of constipation
and diarrhea since starting a gluten-free diet.
Casein Free Diet
 Casein is a protein found in milk and foods containing
milk, such as cheese, cream, butter, yogurt, ice cream,
whey and even some brands of margarine. It also may
be added to non-milk products such as soy cheese and
hot dogs in the form of caseinate.
 Autism claims include mild to dramatic improvements
in speech and/or behavior after these substances were
removed from their diet. Some also report that their
children have experienced fewer bouts of constipation
and diarrhea since starting a casein-free diet.
Hyperbaric Oxygen Chamber
 The use of high pressure oxygen as a drug to treat Autism
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and basic pathophysiologic processes and their diseases.
HBOT is administered in a private setting in state-of-theart, monoplace chamber of clear acrylic.
There are basically two types of chambers: monoplace and
multiplace.
Monoplace chambers are designed to treat a single person
pressurized with 100% oxygen.
Multiplace chambers are designed to hold several people at
one time and oxygen is delivered through a mask or a hood.
www.hbot.com
Secretin Therapy
 Secretin is a gastrointestinal peptide (digestive system
hormone) used to treat peptive ulcers, typically given
orally.
 Autism related claims include improvement with
receptive and expressive language, gastrointestinal
symptoms, adaptive behaviors, cognitive functioning,
social skills, and fine motor skills.
 Research has not been able to show a clear benefit for
treating Autism.
Facilitated Communication
 A process by which a facilitator supports the hand or
arm of a communicatively impaired individual while
using a keyboard or other devices with the aim of
helping the individual to develop pointing skills and to
communicate.
Holding Therapies
 Also use the term attachment therapy.
 Procedure involves the parent intentionally agitating
the child, then holding the child down until the child
becomes calm, then talking to the child about what
needs to change, be changed.
 Can be done in a group format as well.
 www.marthawelch.com
References
 Association for Science in Autism Treatment
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www.asatonline.org
Autism Society of America www.autism-society.org
National Autism Center, National Standards Project, 2009.
www.nationalautismcenter.org
Simpson, R. (2004) Evidence-based practices and students
with Autism Spectrum Disorders. Focus on Autism and
Other Developmental Disabilities, 20, 140-149.
Simpson, R. (2005) Autism Spectrum Disorders:
Interventions and Treatments for Children and Youth.
Corwin Press: London
References
 Lyons, T. & Siri, K. (2010) Cutting Edge Therapies for
Autism. Skyhorse Publishing: New York.
 Exkorn, K. S. (2005) The Autism Sourcebook.
HarperCollins: New York.
THANK YOU!
Robert Jason Grant Ed.D, LPC, RPT-S
www.robertjasongrant.com