UNIT III: Approaches to Teaching
1. Behavioural Approach: - LOVAAS - Applied Behavioral Analysis - Discrete Trial Teaching - Verbal Behavior Analysis
2. Developmental Approach Floor time Montessori
3. Structure and visual Supports - TEACCH
4. Naturalistic Approaches - Pivotal Response Training
5. Considerations for eclectic approaches and cultural adaptations
1. Behavioural Approach: - LOVAAS - Applied Behavioral Analysis - Discrete Trial Teaching - Verbal Behavior Analysis
The Lovaas Approach is a form of Applied Behavioral Analysis that is used in early intervention programs for children who have developmental delays or who have been identified as autistic. The program, created by Ole Ivar Lovaas, is derived from work done by B.F. Skinner in the 1930s. The goal is to begin intervention with children as young as two to help them gain communication abilities and skills in education and activities of daily living. The intervention consists of breaking skills down into the simplest components and rewarding children positively and then “generalizing” the skills into a natural environment.
The first step is establishing a rapport with the children. The first skill is requesting, or asking for something. It is important for children to learn vocal language, if possible. Parental involvement is crucial for continuity of treatment at home. Another component of this approach is encouraging the child to imitate other children to develop social skills. The Lovaas approach of working with autistic and developmentally delayed children is based on scientific principles. Progress is continually measured and adapted as the children age. The motivating rewards differ with each child as does the program.
Who is the Lovaas Program for?
The Lovaas Program is used for autistic preschoolers. Children can take part in this therapy until they reach school age. The Program can be slightly modified for children who are already at school.
What is the Lovaas Program used for?
The Lovaas Program is used to teach and encourage appropriate behaviour, like language use and social skills. It can also help to reduce difficult behaviour.
Supporters of the Lovaas Program suggest that it results in:
Where does the Lovaas Program come from?
The Lovaas Program was developed in the early 1980s at the University of California in the United States as part of a research project focusing on young autistic people. It’s named after the researcher, Ivar Lovaas. It was originally known as the UCLA Young Autism Project model.
What is the idea behind the Lovaas Program?
The Lovaas Program is based on the principles of Applied Behaviour Analysis (ABA) and the idea that skills can be taught in a systematic way to improve children’s behaviour. As children get better at a skill, they feel encouraged and use the skill more often.
What does the Lovaas Program involve?
The Lovaas Program takes a lot of time and involves planned sessions where children are taught skills.
For the youngest children, the first year of the Lovaas Program involves therapists working with children at home for at least 40 hours per week. These sessions focus on teaching basic learning skills – for example, following simple instructions and imitation. They also focus on reducing behaviour that gets in the way of learning – for example, aggressive behaviour.
In later years children learn more complex skills, including verbal communication, interactive play and cooperation, reading and writing. They learn these skills in settings other than the home – for example, at preschool. The intensity of the Program is gradually reduced.
Each phase of the Program uses a range of teaching techniques, including Discrete Trial Training (DTT) and incidental teaching.
Costs depend on how the Lovaas Program is applied, and this can vary widely. The therapy team might include different kinds of people (professionals, paid aides, volunteers) working in many different settings. The Program also takes a lot of time and needs a lot of input from therapists and family members, which can increase costs.
There are forty years of research behind the Lovaas approach and more, if you include the research into Skinner’s theories, on which it is based. In all of the research into outcomes, the primary directive is that progress must be attributable to the program and not some other variable. Another study point is whether the intervention lasts as the child ages. In addition, other studies must be able to replicate the findings of the Lovaas research. One of the most satisfactory outcomes of the Lovaas approach is that, by age seven, many children are undistinguishable from their peers socially and have mainstreamed back into the regular classroom, where they perform at average levels on testing and assignments.
Children on the autism spectrum vary in the severity of the condition. The same can be said of developmental delays. The ability of the therapist to structure his intervention to the needs and abilities of the child is an important characteristic of the approach, but parental support and involvement is vital.
Applied Behavioral Analysis
Applied Behavior Analysis (ABA) is a type of therapy that focuses on improving specific behaviors, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. ABA is effective for children and adults with psychological disorders in a variety of settings, including schools, workplaces, homes, and clinics. It has also been shown that consistent ABA can significantly improve behaviors and skills and decrease the need for special services.
The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s.
Positive reinforcement is one of the main strategies used in ABA.
When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.
First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.
Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.
Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.
The following three steps – the “A-B-Cs” – help us teach and understand behavior:
1. An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
2. A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.
3. A consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.
Looking at A-B-Cs helps us understand:
1. Why a behavior may be happening
2. How different consequences could affect whether the behavior is likely to happen again
How could ABA help the student learn a more appropriate behavior in this situation?
With continued practice, the student will be able to replace the inappropriate behavior with one that is more helpful. This is an easier way for the student to get what she needs!
Discrete Trial Teaching
There is an increasing number of children who are diagnosed with autism, and Discrete Trial Teaching (DTT) is an important component of the interventions that doctors, therapists, and educators use with them. It is an important methodology that addresses the way these children learn new skills. What is DTT and how does it help children on the autism spectrum learn?
Discrete Trial Teaching is an intervention method utilizing applied behavioral analysis. Many children on the more severe side of the autistic spectrum have deficits in learning basic abilities. DTT teaches skills through a structured ladder of small, easily-taught components. The method began in the 1970s through the efforts of Doctor Ivar Lovaas. Through repetition of the DTT process, children can obtain mastery over necessary abilities. The skills taught are classified as “cognitive, communication, play, social and self-help.”
The basics of DTT are stated in five principles. First, skills are broken down into small bites. Instructions are given in the most concise manner possible. Instead of asking a child to show the teacher which card on a table is red, the instructor may say simply, “touch red.” In this way, students avoid confusion about what the practitioner is asking. Second, the educator teaches each “bite” until the student masters it before moving on to another skill. Third, each session is intensive. Fourth, teachers begin with prompts as needed and then decrease them. Fifth, learning must be reinforced by incentives. The offering of these incentives and the point at which they are offered must be consistent.
There are five steps of DTT:
The discriminative stimulus is a brief clear instruction alerting the child to the task at hand. This helps the student make a connection between a specific direction and an appropriate response. An example could be when a teacher says: “what is this?” before asking a child to identify an object.
A prompt is not always given but, for some children, it may be necessary to help them form the proper response. When provided, it is performed between the discriminative stimulus and the response. A prompt is when the teacher shows the child the correct response to guide their behavior. For example, using the above example, a trainer may tap the correct object if it appears the child is having difficulty.
The response is the behavior the child exhibits when presented with the discriminative stimulus. It is either going to be correct or incorrect. The target response is clearly defined ahead of time so the trainer knows exactly what behaviors are considered correct.
The consequence will vary according to the correctness of the response:
The inter-trial interval is the last step of DTT. It is the period of time that occurs after the consequence. It indicates the end of one trial and the impending start of another. It is usually no more than five seconds. The shortness of the interval contributes to the continuity of the learning process.
DTT is only one type of training that uses applied behavioral analysis. For instance, another teaching protocol, Incidental Teaching, focuses on naturally occurring events as teaching opportunities. The practitioner arranges an environment attractive to children and allows the child to prompt the teaching by showing interest in someone or something around him. The instructor then “elaborates” on the chosen item and elicits responses from the student. When the child reacts appropriately, he receives a “confirming response” or, in other words, a reward.
In Discrete Trial Teaching, however, the learning opportunity is engineered and structured by the practitioner. The process is as follows:
• Acquisition: the child accomplishes the initial lesson.
• Fluency: the child demonstrates the ability to repeat the skill and mastery of it.
• Maintenance: the student maintains the ability to perform the skill over time.
• Generalization: The child can apply the skill to a different environment or area.
Another difference between DTT and other types of ABA training is that sessions are more intensive than those in Incidental Teaching. This is because there are numerous quick sessions with very little lag time between trials. There is also the factor of social relevancy. Although a skill must be relevant for a child to want to learn it, DTT engineers sessions that teach skills that can be used in the environment whether or not they are needed in the instant. Incidental Teaching, in contrast, imparts skills as the need for them arises. In either method, the reward must be something which the child values, and it must be given immediately after the child learns the task.
As we learn more about autism, we will discover more and better ways to teach children how to communicate and interact in society to give them more normalcy in their lives. We now say that children “fall on the autism scale,” which is a way of saying that there are varying degrees of the condition. Any training method has to adapt to the level of cognition and communication the student possesses. Discrete Trial Teaching is an attempt to give children skills important to daily living that can be configured to the abilities of the student preparing them to have the fullest life possible.
In short, DTT is a concise step-by-step intervention tailored to improve a specific skill in the most efficient way possible. Its concentration on positivity and brevity allows for the productive shaping of important behavior in an easy-to-digest format. It has been a crucial intervention in assisting the autistic community for almost 50 years.
Verbal Behavior Analysis
Verbal Behavior (VB) therapy teaches communication and language. It is based on the principles of Applied Behavior Analysis and the theories of behaviorist B.F. Skinner.
This approach encourages people with autism to learn language by connecting words with their purposes. The student learns that words can help them get desired objects or results.
Verbal Behavior therapy does not focus on words as labels only (cat, car, etc.). Rather, it teaches why we use words and how they are useful in making requests and communicating ideas.
Language is classified into types, called “operants.” Each operant has a different function. Verbal Behavior therapy focuses on four word types:
VB and classic ABA use similar techniques to work with children. VB methods may be combined with an ABA program to work towards communication goals.
Verbal Behavior therapy begins by teaching mands (requests) as the most basic type of language. For example, the individual with autism learns that saying “cookie” can produce a cookie.
As soon as the student makes a request, the therapist repeats the word and presents the requested item. The therapist then uses the word again in the same context to reinforce the meaning.
The person does not have to say the actual word to receive the desired item. At first, he or she simply needs to make a request by any means (such as pointing). The person learns that communicating produces positive results.
The therapist then helps the student shape communication over time toward saying or signing the actual word.
In a typical session, the teacher asks a series of questions that combine easy and hard requests. This allows the student to be successful more often and reduces frustration. The teacher should vary the situations and instructions in ways that keep the student interested.
Verbal Behavior therapy uses a technique called “errorless learning.”
Errorless teaching means using immediate and frequent prompts to ensure the student provides the correct response each time. Over time, these prompts are reduced. Eventually the student no longer needs prompting to provide the correct response.
Step 1: The therapist holds a cookie in front of the student and says “cookie” to prompt a response from the child.
Step 2: The therapist holds the cookie and make a “c” sound to prompt the response.
Step 3: The therapist holds the cookie in the child’s line of sight and waits for the request with no cue.
The ultimate goal is for the child to say “cookie” when he or she wants a cookie – without any prompting.
Most programs involve at least one to three hours of therapy per week. More intensive programs can involve many more hours.
Instructors train parents and other caregivers to use verbal-behavior strategies in their daily life.
Verbal Behavior Therapy can help:
Verbal Behavior is a great approach that can be combined with other teaching methods such as Discrete Trial Training (DTT) or Natural Environment Training (NET). In fact, combining the total operants of Verbal Behavior across both DTT and NET may contribute to acquiring a more complete language repertoire (Sundberg & Michael, 2001). Children need the functional skills across the verbal operants to increase verbal behavior, particularly in environments with their peers (Sundberg & Michael, 2001). A child without strong intraverbal skills may not interact appropriately in response to their peers’ verbal behavior, which may weaken further interactions.
Verbal behavior also capitalizes on the child’s own motivation, teaching the child to communicate for what he desires. This ability to mand may reduce problematic behavior that functioned as a means for obtaining the desired item.
2. Developmental Approach Floor time Montessori
DIR is a developmental model which builds spontaneous communication and nurturing relationships. It is a model which takes into account different biological differences we all have, especially in terms of motor, sensory and language differences. DIR FLoortime is focused around the relationships children have in their lives wit parents, caregivers, friends, educators, therapists. The model is incredibly compatible with Montessori as the adult’s activity is based on observing the child and following their interests to achieve mastery of the developmental stage they are currently at. The focus is on the ‘play’ of a child, but as discussed in my piece on Play Therapy, the ‘play’ of DIR refers to the inherently motivated and joyful developmental activities Montessorian’s regard as ‘work’.
The stages of development can fit into Montessori’s planes of development, the way they can be understood is certainly similar. A child will typically acquire the stages spontaneously in order if given an appropriate environment, but a child with developmental difficulties will need additional support and encouragement to engage in sufficient repetition of activities associated with each stage. Children on the autistic spectrum may be reluctant to engage in sufficient attention to people (falling in love in DIR speech) or grace and courtesy (closing of circles in DIR). So additional help is needed. I think it is very important to have a clear model and guidance about how to help children who we are concerned about, because in our anxiety we might abandon the child to her own world or overwhelm the child with our demands to ‘normalise’. DIR Floortime gives a child-centred model we can feel confident about following and discuss with parents and professionals.
Stages of Development to observe and respond to;
It presents development as a model with six stages.
What is important is not so much the age at which a child masters each skill, but that each one is mastered, for each skill forms a foundation for the next. Each child can move up or down these steps depending on levels of comfort, stress, fatigue, change in routine and as a response to new events. For some activities they might be at a higher stage than other activities. As children are able to mater core deficits from earlier levels their process is evident in success in later levels. The six stages are;
Self-Regulation and Interest in
the World – shows interest in sensations, is calm and focus, can recover from
distress and is interested in people.
To develop this you can help him or her to look, listen, begin to move, and calm down. your child’s sense of security and awareness will help her understand more complex thoughts, help her brain develop, and lay the foundation for future learning.
2. Engagement & Relating or Falling in Love – responds to parents gestures and expressions with interest and wants to continue play
To develop this take time for love to blossom and be patient to the bumps along the way. What’s important is that your shared intimacy is gradually growing. You have plenty of time to cement a loving relationship with your child, as long as you stay emotionally involved. Observe your child’s individual preferences regarding what is enjoyable to her, and radiate excitement when you amplify pleasure.
3. Purposeful Communication – Opening and Closing Circles – responds to carers gestures, initiates interactions and demonstrates emotions; closeness, pleasure, curiosity, anger, fear and can recover from distress more quickly.
To develop this take note of the things your child is naturally interested in and then challenge him to express himself with feelings and actions in a purposeful way. In this way you will help him become a two-way communicator!
4. Complex Communication & Problem Solving – Using a series of interactive emotional signals or gestures to communicate while experiencing an emotion, imitates behaviour. Is able to sustain circles verbally or non-verbally. Begins to limit set with use of the word ‘no’ or a clear signal.
To develop this challenge your child to interact with you to solve problems- not only those that she wants to figure out on her own, but also those that you present. Exchange many gestures as the two of you problem-solve, include sounds or words and actions such as puling each other in various directions.
5. Creating Emotional Ideas – Using symbols or ideas to convey intentions or feelings, this maybe by playing games with a story or having a series of interactions with words, gestures or pictures to explain a present reality. Begins to use pretend play to recover from distress.
To develop this help the child tell you what he wants or thinks, and to become a partner in his emerging make-believe play.
6. Emotional and Logical Thinking, Communicating Reasoning, and Building Bridges Between Ideas – Building bridges between ideas. The child begins to build ideas, elaborations, invents a new games, can play a game by the rules, reflects on feelings, responds to open questions. The child has a sustained sense of self and expresses the full range of emotions.
To develop this challenge the child to connect ideas together by seeking her opinion, enjoying her debates, and enlarging her pretend dramas.
If the child is tapping a toy truck, the parent might tap a toy car in the same way. The parent might then put the car in front of the child’s truck or add language to the game. This encourages the child to respond and interact.
As children grow, therapists and parents match the strategies with their child’s developing interests. They encourage higher levels of interaction.
For example, instead of playing with toy trucks, parents can engage with model airplanes or even ideas and academic fields of special interest to their child.
Families are encouraged to use Floortime principals in their day-to-day lives.
Outcomes for DIR Floortime
DIR Floortime has been happening for decades and a great deal of research has been done. The icdl website has details and many studies and publications available.
A typical pathway for a child going through the model might be similar to this. Parents are shown how to play on the floor with their child by a DIR Floortime practitioner.The parents encouraging their child to close circles of communication they initiate. Their goal being to prevent the child withdrawing into themselves and tuning them out. Each time the child disengages the carers link the action, gesture or verbal comment to reality by joining them in their play. By helping close actions and verbal circles, they help the child share their world with them and they would help the child to share their world, rather than continue to live in their own. By joining the play the adults help the child to belong and help the child to adapt to her family and community. The practice here follows Montessori’s understanding of the needs and tendencies of each child.
As the child gains the foundations of the earlier stages the adults begin to try to help the child tie their own ideas to that of the adult, so that there would be a logical bridge between what the child creates and what someone else created. Teachers, therapists, siblings and other important people in the child’s life are similarly encouraged to help children to close their gestural and verbal circles. In addition to joining children in their games and communication adults do not give into demands which are not developmentally helpful, like tantrums, but are shown to hold children tightly to help to calm them down and then gradually help the child to resolve the difficulty through action or speech. Exercises from therapists are also used to help calm the child down and a greater understanding of the child’s individual motor and sensorial world can help in avoiding stressors and making the child more comfortable so they are less likely to be overwhelmed. As this process is repeated over weeks and months children have been able to form bridges between ideas, between the real world and play, stay involved in two-way communication, and to work out processing problems to a greater degree than thought possible.
3. Structure and visual Supports - TEACCH
Structured Teaching is a set of teaching techniques developed by Division TEACCH (Training and Education of Autistic and related Communication-handicapped Children), a state-wide program serving individuals with autism spectrum disorders (ASD) in North Carolina.
The TEACCH method was developed by researchers who wanted a more effective and integrated approach to helping individuals with autism spectrum disorders (ASD). TEACCH is an evidence-based academic program that is based on the idea that autistic individuals are visual learners, so teachers must correspondingly adapt their teaching style and intervention strategies.
Division TEACCH is a comprehensive treatment model that serves individuals with autism across the lifespan. Along with the structured teaching strategies, the model emphasizes an extensive understanding of autism, partnering with families, individualized assessment when developing and implementing strategies, and the development of skills across curriculum areas (with attention to the development of communication and social skills).
Structured teaching strategies can be implemented across settings and across curriculum area, as they serve as a vehicle to teach skills, and/or as a framework for a classroom setting.
These teaching strategies are based on an understanding of how autism impacts the thinking, learning, and behavior of an individual with ASD. Differences in auditory processing, imitation, motivation, and organization can hinder the educational success of students with ASD, as most traditional teaching strategies rely heavily on verbal instructions, demonstration, social reinforcement, and sequencing chunks of information or directives.
Structured Teaching strategies, however, capitalize on the strengths of students with ASD. These include providing predictable and meaningful routines through the use of structure, adding visual/structural supports to classroom instruction and activities to increase engagement and independence, and clearly organizing classroom spaces and teaching materials to reduce anxiety and increase appropriate behavior.
There are five elements of Structured Teaching that build on one another, and all emphasize the importance of predictability and flexible routines in the classroom setting. Division TEACCH developed a visual to illustrate the Structured Teaching components — the Structured Teaching pyramid:
TEACCH is centered on five basic principles. First, physical structure refers to individual’s immediate surroundings. Daily activities, such as playing and eating, work best when they are clearly defined by physical boundaries. Second, having a consistent schedule is possible through various mediums, such as drawings and photographs. Third, the work system establishes expectations and activity measurements that promote independence. Ideal work systems will communicate objectives with minimum written instructions. Fourth, routine is essential because the most important functional support for autistic individuals is consistency. Fifth, visual structure involves visually-based cues for reminders and instruction.
Although the TEACCH method is based on scientific research and documented studies, there are several potential limitations. The existing research studies of the TEACCH programs show that no harm is done, but struggle to isolate statistical correlations. That is, most studies have lacked control groups, failed to use double-blind methods and suffered from small sample sizes. Teachers and parents support TEACCH because most ASD students experience progress, but it is difficult to pinpoint how the positive changes are directly correlated to the program. Most researchers feel that while more research is needed, TEACCH is a widely successful program that offers potential benefits. Individuals with ASD may also benefit from comparative interventions, such as Applied Behavioral Analysis.
The TEACCH method is a structured program that helps individuals with ASD learn, function and reach their goals.
4. Naturalistic Approaches - Pivotal Response Training
One of the most proven behavioral approaches for treating children with autism spectrum disorders is pivotal response treatment, or PRT. Drawn from applied behavior analysis, PRT is a play-based method that targets improving “pivotal” development areas instead of individual behaviors. It’s based on the idea that changes in pivotal responses would spark widespread progress in other developmental areas. PRT was initially established in the 1970s by Dr. Robert Koegel and Dr. Lynn Kern Koegel at the University of California- Santa Barbara. First called pivotal response teaching, PRT combined several research-based interventions to improve autistic children’s social and communicative growth.
Pivotal Response Treatment, or PRT, is a behavioral treatment for autism. This therapy is play-based and initiated by the child. PRT is based on the principles of Applied Behavior Analysis (ABA).
Goals of this approach include:
The PRT therapist targets “pivotal” areas of a child’s development instead of working on one specific behavior. By focusing on pivotal areas, PRT produces improvements across other areas of social skills, communication, behavior and learning.
Pivotal areas include:
Motivation strategies are an important part of the PRT approach. These emphasize natural reinforcement.
For example, if a child makes a meaningful attempt to request a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward. Children are rewarded for making a good attempt, even if it is not perfect.
Each program is tailored to meet the goals and needs of the individual person and his or her everyday routines.
A session typically involves six segments. Language, play and social skills are targeted with both structured and unstructured interactions.
The focus of each session changes as the person makes progress, to accommodate more advanced goals and needs.
PRT programs usually involve 25 or more hours per week.
Everyone involved in the child’s life is encouraged to use PRT methods consistently in every part of his or her life. PRT has been described as a lifestyle adopted by the whole family.
PRT is considered a form of incidental or naturalistic teaching because it uses the child’s natural environment and interests to improve skills. As in the above example, communication skills are taught by encouraging the child to communicate for something that he or she truly wants, such as a favorite food or activity. PRT therapists carefully arrange a child’s environment to try and provide as many natural opportunities for communication (or other specific skills the child is working on) as possible. For example, the therapist may place a favorite toy out of reach from the child, but somewhere where he or she can still see it, so that the child is motivated to request the toy.
PRT is conducted in multiple settings, such as at home, school, or in the community.
5. Considerations for eclectic approaches and cultural adaptations
Eclectic interventions refer to the use of a combination of treatment strategies, which are sometimes drawn from different comprehensive intervention approaches and sometimes from a variety of single‐strategy approaches. A key aspect of exploring the impact of eclectic programmes is to consider their composition, in terms of their various components; that is, whether they include components of Applied Behaviour Analysis (ABA), Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), Speech and Language Therapy (SLT), Occupational Therapy (OT) or focus on communication and social behaviours.
Although there are many different approaches to helping autistic children, our autism curriculum at ABC parallels the core tenets of the ABA approach. Over the years, we have found that this curriculum helps children grow and learn the most effectively. A study conducted at the University of California recently compared the “eclectic” intervention approach to the ABA approach to determine which approach helped autistic children learn and grow the best. According to the Center for Autism, ABA “is the application of the principles of learning and motivation from Behavioral Analysis, and the procedures and technology derived from those principles, to the solution of the problems of social significance”. The “eclectic” approach involves multiple transitions per day from one activity or therapy to another. This study found that the children who received forms of intensive behavioral analytic treatment, like ABA, for 14 months vastly outperformed the children who received the “eclectic” approach of treatment in ever measure. This means that the children who received forms of treatment similar to ABA has large improvements in intellectual functioning, communication skills, and adaptive behavior.
Parents of children with autism, wanting to do everything possible for their sons and daughters, will often consider a variety of therapies and treatments. Although it may seem like a way to take advantage of the best aspects of every therapy, this “eclectic” treatment approach often assumes that all treatments for autism are equal. They are not.
Some school programs embrace this approach as well. When therapists and teachers talk about providing an eclectic program, they mean that they are using both proven and unproven treatments. An example of an eclectic program is when children spend a part of each day receiving different therapies, such as structured teaching using methods of applied behavior analysis (ABA), sensory integration and stimulation (brushing and swinging), floortime procedures, music sessions, and free play with typical peers.
ABA has more research support than any other treatment or therapy for this population. It incorporates proven strategies such as shaping, prompting, and positive reinforcement. Numerous task forces around the country have endorsed ABA as the preferred therapy for children with autism. There are hundreds of objective research studies that have shown ABA to be an effective method for teaching language, social, and independence skills, and for reducing problem behaviors. There are few, if any, research studies examining sensory integration, floor time, music therapy, and special diets.
When making decisions about their children’s treatment programs, parents should consider that, in addition to using up precious time and financial resources, unproven treatments might actually be counterproductive for children with autism. For example, therapists using a sensory integration approach will typically direct a child to a gross motor activity, such as swinging or jumping on a trampoline, when the child has a behavior problem, such as a tantrum. Although this approach may calm the child for the moment, the activity may act as a reward – and consequently make the problem worse.
Many unproven eclectic treatments fail to directly teach children important language, social, and independence skills. As a result, children do not learn appropriate functional behaviors. Finally, some eclectic dietary interventions restrict teachers and therapists from using the very food items that might offer them the best way to motivate the child.
There is an increasing need for culturally competent interventions for individuals with ASD. Given the dynamic relationship between culture and social behavior, the effectiveness of social skills interventions may be particularly influenced by the degree to which they are culturally appropriate. The extent to which ASD social skills intervention research has considered the role of culture (either through including diverse samples or by implementing cultural adaptations) is not well understood.