Introduction The diagnosis of an Autism Spectrum Disorder presents parents and clinicians with a...
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Introduction The diagnosis of an Autism Spectrum Disorder presents parents and clinicians with a veritable maze of programs and therapies. The diagnosis
Introduction The diagnosis of an Autism Spectrum Disorder
presents parents and clinicians with a veritable maze of programs
and therapies. The diagnosis of an Autism Spectrum Disorder
presents parents and clinicians with a veritable maze of programs
and therapies. What is out there? What is out there? Which programs
are best for my child/student? Which programs are best for my
child/student? What are the pros and cons? What are the pros and
cons?
Slide 3
1. What will the role of the clinician (OT, PT, SLP) be in
implementing this program or therapy? 2. For the next few minutes
we will look at an overview of the most standard and popular
treatment programs and therapies for individuals on the Autism
Spectrum.
Slide 4
Treatments for Core Symptoms Treatments for Autism Spectrum
Disorders can be divided into two categories: Treatments for Autism
Spectrum Disorders can be divided into two categories: Treatments
for Core Symptoms which address behavioral, developmental and
educational needs specific to autism. Treatments for Core Symptoms
which address behavioral, developmental and educational needs
specific to autism. Other therapies such as Occupational, Physical,
or Speech Therapy that while essential to the treatment of Autism
is not exclusive of other disorders such as developmental delays or
cerebral palsy. Other therapies such as Occupational, Physical, or
Speech Therapy that while essential to the treatment of Autism is
not exclusive of other disorders such as developmental delays or
cerebral palsy.
Slide 5
Applied Behavioral Analysis This treatment program (ABA) is
based on the principles of positive reinforcement of B.F. Skinner.
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. Simply, it is the repetitive use of
positive reinforcement to teach specific skills and decrease
inappropriate behaviors. What is occurring in the childs
environment to cause negative behaviors? What is occurring in the
childs environment to cause negative behaviors?
Slide 6
ABA Three Step Procedure Antecedent: The verbal or physical
stimulus such as a command or request. Antecedent: The verbal or
physical stimulus such as a command or request. Resulting
Behavioral response to stimulus or a lack of response Resulting
Behavioral response to stimulus or a lack of response Consequence:
the positive reinforcement or no response for inappropriate
behavior Consequence: the positive reinforcement or no response for
inappropriate behavior
Slide 7
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 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. 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. Students are positively
reinforced with either verbal praise or something tangible that
he/she finds rewarding.
Slide 8
ABA programs are carried out at school or in the home with a
one on one aide 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. The goal is the carryover of the skills to
other environments. Facilitated play with peers is also part of
this program. Facilitated play with peers is also part of this
program. The ABA provider is responsible for data collection and
analysis. The ABA provider is responsible for data collection and
analysis.
Slide 9
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. 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. 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. Intervention requires 35-40 hours per week with families
encouraged to use these techniques daily.
Slide 10
While punishments are not generally used, a therapist may
intervene if a child is hurting himself by non-injurious methods
such as a light spray of water in the face. While punishments are
not generally used, a therapist may intervene if a child is hurting
himself by non-injurious methods such as a light spray of water in
the face.
Slide 11
Slide 12
ABA is reputed by many to be the most successful therapy
available. ABA is reputed by many to be the most successful therapy
available. We found that 48% of all children showed rapid learning
and achieved average post-treatment scores, and at age 7 were
succeeding in regular classrooms.(Lovaas, 1987; McEachin, Smith and
Lovaas, 1993) We found that 48% of all children showed rapid
learning and achieved average post-treatment scores, and at age 7
were succeeding in regular classrooms.(Lovaas, 1987; McEachin,
Smith and Lovaas, 1993) The data collected on a daily basis allows
parents and team members to closely follow the students progress.
The data collected on a daily basis allows parents and team members
to closely follow the students progress.
Slide 13
40 hours of intervention a week is often considered to be just
too much for many families. 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. 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. Critics suggest that ABA can
create an emotionless, robotic child who has difficulty carrying
over skills to a natural environment.
Slide 14
The Therapists Role in ABA
Slide 15
Pivotal Response Treatment This program was developed at the
University of California at Santa Barbara by Dr. Robert Koegel, Dr.
Lynn Kern Koegel, and Dr. Laura Shrubman. This program was
developed at the University of California at Santa Barbara by Dr.
Robert Koegel, Dr. Lynn Kern Koegel, and Dr. Laura Shrubman. It is
also referred to as the Natural Language Paradigm and is based on
ABA principles. It is also referred to as the Natural Language
Paradigm and is based on ABA principles.
Slide 16
The goal of this intervention is to teach language, decrease
inappropriate behaviors, and increase social skills and academics.
The focus on intervention is on those skills pivotal to the normal
development of many other skills and behaviors. The goal of this
intervention is to teach language, decrease inappropriate
behaviors, and increase social skills and academics. The focus on
intervention is on those skills pivotal to the normal development
of many other skills and behaviors. Pivotal skills include:
communication skills, play, social skills, and the ability to
monitor ones own behavior. Pivotal skills include: communication
skills, play, social skills, and the ability to monitor ones own
behavior. Pivotal Response Treatment
Slide 17
Slide 18
Slide 19
PRT programs require at least 25 hours of intervention weekly.
PRT programs require at least 25 hours of intervention weekly. All
family members are encouraged to use PVT methods consistently with
the student. All family members are encouraged to use PVT methods
consistently with the student. Some disadvantages include:
financing, finding local providers and trying to live a normal
family life while constantly in therapy mode. Some disadvantages
include: financing, finding local providers and trying to live a
normal family life while constantly in therapy mode.
Slide 20
The Therapists Role in PRT As in ABA, the SLP, OT, and PT work
with the PRT provider in developing a treatment program. The PRT
provider should provide suggestions to other professionals on
targeting pivotal behaviors. Communication between therapists and
families is a must. As in ABA, the SLP, OT, and PT work with the
PRT provider in developing a treatment program. The PRT provider
should provide suggestions to other professionals on targeting
pivotal behaviors. Communication between therapists and families is
a must. All providers should focus on using the same prompting
strategies. All providers should focus on using the same prompting
strategies. PRT blends especially well with Speech Therapy as it
can be adapted to teach a variety of skills including symbolic and
sociodramatic play and joint attention. PRT blends especially well
with Speech Therapy as it can be adapted to teach a variety of
skills including symbolic and sociodramatic play and joint
attention.
Slide 21
Verbal Behavior This program uses Skinners analysis of language
as a system to teach language and modify behaviors. This program
uses Skinners 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. 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. Verbal Behavior is based on the idea
that the way we talk influences how sensitive or aware we are of
changes to our environment.
Slide 22
The intervention first focuses on using language to request or
mands. 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 Then the focus turns to naming or labeling
referred to in the program as Tact Finally the focus of treatment
moves to Intra- Verbal Communication which includes understanding
and use of wh-questions and conversation. Finally the focus of
treatment moves to Intra- Verbal Communication which includes
understanding and use of wh-questions and conversation.
Slide 23
Slide 24
Verbal Behavior and the Clinicians role
Slide 25
Floor Time This approach is based on the Developmental
Individual Difference Model from Dr. Stanley Greenspan. This
approach is based on the Developmental Individual Difference Model
from Dr. Stanley Greenspan. Floor Time is simply the idea that a
childs communication skills can be improved by building on his/her
strengths while playing together on the floor. Floor Time is simply
the idea that a childs communication skills can be improved by
building on his/her strengths while playing together on the
floor.
Slide 26
Floor Time: The overall goal Six developmental milestones Six
developmental milestones Self regulation and interest in the world
Self regulation and interest in the world Intimacy or a special
love for others Intimacy or a special love for others Two way
communication Two way communication Complex communication Complex
communication Emotional ideas Emotional ideas Emotional thinking
Emotional thinking
Slide 27
Implementation The therapist enters the childs activities and
follows the childs leads in play and guides the child in expanding
his/her interactions. The therapist enters the childs activities
and follows the childs 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. 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 emphases on emotional development.
Speech, motor, and cognitive skills are addressed Through a
synthesized emphases on emotional development.
Slide 28
Slide 29
Slide 30
Floortime: Playtime for the Clinician The principles of
Floortime can easily be included in the therapy techniques of
Speech, OT and PT. 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.
Floortime allows for a fun, naturally reinforcing therapy
environment. SLPs, OTs, and PTs already employ a variety of play
therapy techniques in their interventions. SLPs, OTs, and PTs
already employ a variety of play therapy techniques in their
interventions.
Slide 31
Relationship Development Intervention Developed by Dr. Steven
Gutstien Developed by Dr. Steven Gutstien It is a parent based
program using the following Dynamic Intelligence Objectives It is a
parent based program using the following Dynamic Intelligence
Objectives
Slide 32
Dynamic Intelligence Objectives Emotional Referencing: the use
of emotional feedback to learn from the experiences of others
Emotional Referencing: the use of emotional feedback to learn from
the experiences of others Social Coordination: the ability to
observe and continually regulate ones behavior in order to
participate in spontaneous relationships involving collaboration
and exchange of emotion. Social Coordination: the ability to
observe and continually regulate ones behavior in order to
participate in spontaneous relationships involving collaboration
and exchange of emotion.
Slide 33
Declarative Language: using language and non- verbal
communication to express curiosity and inviting others to interact
and share perceptions and feelings and to corridinate ones action
with others. Declarative Language: using language and non- verbal
communication to express curiosity and inviting others to interact
and share perceptions and feelings and to corridinate ones action
with others. Flexible Thinking: ability to adapt rapidly and change
strategies and alter plans based on changing circumstances.
Flexible Thinking: ability to adapt rapidly and change strategies
and alter plans based on changing circumstances. Dynamic
Intelligence Objectives
Slide 34
Relational Information Processing: the ability to obtain
meaning based on a larger context and solving problems that have no
clear right or wrong answers. Relational Information Processing:
the ability to obtain meaning based on a larger context and solving
problems that have no clear right or wrong answers. Foresight and
Hindsight: the ability to reflect on past experiences and
anticipate potential future scenarios. Foresight and Hindsight: the
ability to reflect on past experiences and anticipate potential
future scenarios. Dynamic Intelligence Objectives
Slide 35
Intervention In this program, the child begins working one on
one with the parent. Then another peer is added who is at a similar
level of relationship development. As the child progresses, other
children are added to the group and the environments are changed.
In this program, the child begins working one on one with the
parent. Then another peer is added who is at a similar level of
relationship development. As the child progresses, other children
are added to the group and the environments are changed. The
curriculum consists of six levels: Novice, Apprentice, Challenger,
Explorer, and Partner. The program guides the child to develop
friendships, and show empathy. The curriculum consists of six
levels: Novice, Apprentice, Challenger, Explorer, and Partner. The
program guides the child to develop friendships, and show
empathy.
Slide 36
Intervention
Slide 37
Pros and Cons RDI is not considered a complete treatment
program. RDI is not considered a complete treatment program. It is
a program designed specifically for parent implementation. It is a
program designed specifically for parent implementation.
Slide 38
RDI: A Therapists Perspective Since RDI is meant for
implementation by the parent only, it would be important for the
SLP, OT, and PT to be aware of the principles of RDI and the
progress of the student in this intervention. Since RDI is meant
for implementation by the parent only, it would be important for
the SLP, OT, and PT to be aware of the principles of RDI and the
progress of the student in this intervention. Communication with
parents and floor time intervention specialist is vital to the
development of a multi-disciplinary team approach. Communication
with parents and floor time intervention specialist is vital to the
development of a multi-disciplinary team approach.
Slide 39
TEACCH
Slide 40
Culture of Autism
Slide 41
Intervention In this approach, children are evaluated to
determine emergent skills and intervention is designed to build on
these skills. 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 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 child refers to visual supports such as picture
schedules to help them predict and cope with daily activities.
Slide 42
Slide 43
Pros and Cons This program focuses on cultivation of the childs
strengths and interests rather than focusing on his/her deficits
alone. This program focuses on cultivation of the childs 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
(Ohios Parent Guide to Autism Spectrum Disorders Mesibov and Shea,
2006). The strengths of those with autism (visual skills,
recognizing details, and memory can become the basis of successful
adult functioning (Ohios Parent Guide to Autism Spectrum Disorders
Mesibov and Shea, 2006).
Slide 44
TEACCH and the Therapist SLPs, OTs, and PTs can easily include
TEACCH procedures in their therapy sessions. SLPs, OTs, and PTs 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. Therapists can incorporate the use of schedules,
social stories and other techniques in their therapy plans,
encouraging skill generalization.
Slide 45
SCERTS Social Communication, Emotional Regulation, and
Transactional Support Social Communication, Emotional Regulation,
and Transactional Support Developed by Barry Prizant, PhD., Amy
Wetherby, PhD, Emily Rubin and Amy Laurent 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 draws from other
programs such as ABA, Pivotal Response Treatment, TEACCH, Floor
Time and RDI.
Slide 46
The main difference between SCERTS and ABA is that SCERTS
encourages child initiated communication in daily life. The main
difference between SCERTS and ABA is that 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. 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.
SCERTS
Slide 47
The Focal Aspects of SCERTS Social Communication: spontaneous
functional communication, emotional expression and secure and
trusting relationships with others 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. Emotional Regulation: the
ability to maintain a well-regulated emotional state and the
ability to cope with daily stresses.
Slide 48
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). 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. Specific plans are developed to provide
education and emotional support for families and to encourage
teamwork among the intervention team.
Slide 49
Intervention This program provides for children with Autism to
learn with and from other children who are good social and language
models 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) Transitional
supports (environmental accommodations) and learning supports
(picture schedules or visual organizers)
Slide 50
Slide 51
Pros and Cons Unlike ABA, this program focuses on group
intervention rather than one on one treatment. Unlike ABA, this
program focuses on group intervention rather than one on one
treatment. Uses a multidisiciplinary team approach Uses a
multidisiciplinary team approach SCERTS is not an exclusive program
and accepts other educational models that the team deems
appropriate. SCERTS is not an exclusive program and accepts other
educational models that the team deems appropriate.
Slide 52
Therapists 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. 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.
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.
Slide 53
The Hanen Approach This approach is based on the belief that
parents should be the childs language teachers, because they have
the strongest bond and have many opportunities to teach language in
the natural contexts of daily living. This approach is based on the
belief that parents should be the childs 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. Parents are trained by Hanen
certified SLPS.
Slide 54
Trained parents can then adapt the approach to meet the
individual and unique needs of their child. Trained parents can
then adapt the approach to meet the individual and unique needs of
their child. Programs for Parents include: Programs for Parents
include: It Takes Two To Talk-Hanen program for parents. It Takes
Two To Talk-Hanen program for parents. More Than Words- Hanen
program for parents of children with Autism Spectrum Disorders More
Than Words- Hanen program for parents of children with Autism
Spectrum Disorders Target Word Hanen program for parents of Late
Talkers. Target Word Hanen program for parents of Late Talkers. The
Hanen Approach
Slide 55
Slide 56
Pros and Cons Parents are to be the sole providers for this
approach. Parents are to be the sole providers for this approach.
It is not intended to be a curriculum It is not intended to be a
curriculum It does not exclude of other educational models. It does
not exclude of other educational models.
Slide 57
Integrated Play Groups
Slide 58
Slide 59
Pros and Cons
Slide 60
Play and Therapy!!
Slide 61
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 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. The program is a system of
treatment and education focusing on joining children instead of
working against them.
Slide 62
Principles of the Son-Rise Program Joining in the childs
repetitive and ritualistic behaviors is considered the key to
unlocking the mystery of these behaviors, facilitating eye-
contact, social behaviors and the inclusion of others in play.
Joining in the childs repetitive and ritualistic behaviors is
considered the key to unlocking the mystery of these behaviors,
facilitating eye- contact, social behaviors and the inclusion of
others in play. Utilizing a childs own motivations advances
learning and builds the foundation for education and skill
acquisition. Utilizing a childs 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. Teaching through
interactive play results in effective and meaningful socialization
and communication.
Slide 63
The program encourages providers and parents to teach with
enthusiasm and to employ a non- judgemental attitude. The program
encourages providers and parents to teach with enthusiasm and to
employ a non- judgemental 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. 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. Principles of the Son-Rise Program
Slide 64
Intervention Intervention is provided through parent-training
at one the Autism Treatment Centers of America. 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. 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). The Son-Rise Program combines effectively with other
complementary therapies (ie. Biomedical interventions, sensory
integration, diet and Auditory Integration therapies).
Slide 65
Pros and Cons The cost in terms of finances and time required
for daily intervention may be prohibitive for many parents. The
cost in terms of finances and time required for daily intervention
may be prohibitive for many parents. The Son-Rise Program has come
under fire for promoting a cure for autism. The Son-Rise Program
has come under fire for promoting a cure for autism. It is
interesting to note that this program is not even listed in the
Ohio Parents Guide to Autism Spectrum Disorders or on the Autism
Speaks Website. It is interesting to note that this program is not
even listed in the Ohio Parents Guide to Autism Spectrum Disorders
or on the Autism Speaks Website.
www.autismtreatmentcenterofamerica.com
www.autismtreatmentcenterofamerica.com
Slide 66
The Role of other therapies in the Son-Rise program
Slide 67
Resources
Slide 68
Resources and Credits
Slide 69
In Summary There are many, many different approaches to
treating Autism Spectrum Disorders. There are many, many different
approaches to treating Autism Spectrum Disorders. This list is by
no means comprehensive. This list is by no means comprehensive.
Parents and therapists should engage in careful research before
committing to any specific program. Parents and therapists should
engage in careful research before committing to any specific
program.