Lebanese Autism Society

Autism is a complex neurobiological disorder that typically lasts throughout a person's lifetime.

There is no single treatment protocol for all children with Autism, but most individuals with ASD respond best to highly structured Educational programs and Early Intervention.

Interventions for Autism

Some of the most common interventions are Applied Behavior Analysis (ABA), Floortime Therapy, Speech Therapy, Occupational Therapy, Sensory Integration Therapy, Relationship Development Intervention, Verbal Behavior Intervention, and the school-based TEACCH method.

Applied Behavioral Analysis (ABA)

Behavior analysis is a natural science of behavior that was originally described by B.F. Skinner in the 1930's. The principles and methods of behavior analysis have been applied effectively in many arenas. For example, methods that use the principle of positive reinforcement to strengthen a behavior by arranging for it to be followed by something of value have been used to develop a wide range of skills in learners with and without disabilities.

Since the early 1960's, hundreds of behavior analysts have used positive reinforcement and other principles to build communication, play, social, academic, self-care, work, and community living skills and to reduce problem behaviors in learners with autism of all ages. Some ABA techniques involve instruction that is directed by adults in highly structured fashion, while others make use of the learner¹s natural interests and follow his or her initiations. Still others teach skills in the context of ongoing activities. All skills are broken down into small steps or components, and learners are provided many repeated opportunities to learn and practice skills in a variety of settings, with abundant positive reinforcement. The goals of intervention as well as the specific types of instructions and reinforcers used are customized to the strengths and needs of the individual learner. Performance is measured continuously by direct observation, and intervention is modified if the data show that the learner is not making satisfactory progress.

Regardless of the age of the learner with autism, the goal of ABA intervention is to enable him or her to function as independently and successfully as possible in a variety of environments.
Floortime

Developed by child psychiatrist Stanley Greenspan, Floortime is a treatment method and a philosophy for interacting with autistic children. It is based on the premise that the child can increase and build a larger circle of interaction with an adult who meets the child at his current developmental level and who builds on the child's particular strengths.

The goal in Floortime is to move the child through the six basic developmental milestones that must be mastered for emotional and intellectual growth. Greenspan describes the six rungs on the developmental ladder as: self regulation and interest in the world; intimacy or a special love for the world of human relations; two-way communication; complex communication; emotional ideas; and emotional thinking. The autistic child is challenged in moving naturally through these milestones as a result of sensory over- or under-reactions, processing difficulties, and/or poor control of physical responses.

In Floortime, the parent engages the child at a level the child currently enjoys, enters the child's activities, and follows the child's lead. From a mutually shared engagement, the parent is instructed how to move the child toward more increasingly complex interactions, a process known as “opening and closing circles of communication.” Floortime does not separate and focus on speech, motor, or cognitive skills but rather addresses these areas through a synthesized emphasis on emotional development. The intervention is called Floortime because the parent gets down on the floor with the child to engage him at his level.
Occupational Therapy

Occupational Therapy can benefit a person with autism by attempting to improve the quality of life for the individual. The aim is to maintain, improve, or introduce skills that allow an individual to participate as independently as possible in meaningful life activities. Coping skills, fine motor skills, play skills, self help skills, and socialization are all targeted areas to be addressed.

Through occupational therapy methods, a person with autism can be aided both at home and within the school setting by teaching activities including dressing, feeding, toilet training, grooming, social skills, fine motor and visual skills that assist in writing and scissor use, gross motor coordination to help the individual ride a bike or walk properly, and visual perceptual skills needed for reading and writing.

Occupational therapy is usually part of a collaborative effort of medical and educational professionals, as well as parents and other family members. Through such collaboration a person with autism can move towards the appropriate social, play and learning skills needed to function successfully in everyday life.
Relationship Development Intervention (RDI)
Relationship Development Intervention (RDI) Based on the work of psychologist Steven Gutstein , Relationship Development Intervention (RDI) focuses on improving the long term quality of life for all individuals on the spectrum. The RDI program is a parent- based treatment that focuses on the core problems of gaining friendships , feeling empathy , expressing love and being able to share experiences with others. Dr's Gutstein program is said to be based on extensive research in typical development and translates research findings into a systematic clinical approach. His research found that individuals on the autism spectrum seemed to lack certain abilities necessary for success in managing the real life environments that are dynamic and changing. He calls these abilities dynamic intelligence and describes six aspects as follows:
- Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others.
- Social Coordination:The ability to observe and continually regulate one's behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions.
- Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.
- Flexible thinking: The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances.
- Relational Information Processing: The ability to obtain meaning based upon the larger context. Solving problems that have no "right-and-wrong" solutions.
- Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner
Dr Gutstein , who along with Dr. Rachelle Sheely , formed the Connections Center For Family and Personal Development based in Houston Texas in 1995, says, " We are challenging families and professionals to think beyond achieving mere functionality as a successful outcome for individuals with autism; our reference point for success in the RDI program is quality of life," The goal is social improvements as well as changes in flexible thinking, pragmatic communication, creative information processing and self- development. The program offers training workshops for parents as well as several books that offer step-by step exercises building motivation so that skills will be utilized and generalized. The program is said to be able to be started easily and implemented into regular, daily activities that enrich family life.
Sensory Integration Therapy

Sensory Integration is the process through which the brain organizes and interprets external stimuli such as movement, touch, smell, sight and sound. Autistic children often exhibit symptoms of Sensory Integration Dysfunction (SID) making it difficult for them to process information brought in through the senses. Children can have mild, moderate or severe SID deficits manifesting in either increased ( hypersensitivity )or decreased (hyposensitivity) to touch, sound, movement, etc. For example, a hypersensitive child may avoid being touched whereas a hyposensitive child will seek the stimulation of feeling objects and may enjoy being in tight places.

The goal of Sensory Integration Therapy is to facilitate the development of the nervous system's ability to process sensory input in a more typical way. Through integration the brain pulls together sensory messages and forms coherent information upon which to act . SIT uses neurosensory and neuromotor exercises to improve the brain's ability to repair itself. When successful, it can improve attention, concentration, listening, comprehension, balance, coordination and impulsivity control in some children.

The evaluation and treatment of basic sensory integrative processes in the autistic child are usually performed by an occupational and/or physical therapist. A specific program will be planned to provide sensory stimulation to the child, often in conjunction with purposeful muscle activities, to improve how the brain processes and organizes sensory information. The therapy often requires activities that consist of full body movements utilizing different types of equipment. It is believed that SIT does not teach higher-level skills, but enhances the sensory processing abilities thus allowing the child to acquire them.
Speech Therapy

The communications problems of autistic children vary to some degree and may depend on the intellectual and social development of the individual. Some may be completely unable to speak whereas others have well-developed vocabularies and can speak at length on topics that interest them. Any attempt at therapy must begin with an individual assessment of the child's language abilities by a trained speech and language pathologist.

Though some autistic children have little or no problem with the pronunciation of words, most have difficulty effectively using language. Even those children who have no articulation problems exhibit difficulties in the pragmatic use of language such as knowing what to say, how to say it, and when to say it as well as how to interact socially with people. Many who speak often say things that have no content or information. Others repeat verbatim what they have heard (echolalia) or repeat irrelevant scripts they have memorized. Some autistic children speak in a high-pitched voice or use robotic sounding speech.

Two pre skills for language development are joint attention and social initiation. Joint attention involves an eye gaze and referential gestures such as pointing, showing and giving. Children with autism lack social initiation such as questioning, make fewer utterance and fail to use language as a means of social initiation. Though no one treatment is found to successfully improve communication, the best treatment begins early during the preschool years, is individually tailored, and involves parents along with professionals. The goal is always to improve useful communication. For some verbal communication is realistic, for others gestured communication or communication through a symbol system such as picture boards can be attempted. Periodic evaluations must be made to find the best approaches and to reestablish goals for the individual child.
TEACCH

TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) is a special education program that is tailored to the autistic child's individual needs based on general guidelines. It dates back to the 1960's when doctors Eric Schopler, R.J. Reichler and Ms Margaret Lansing were working with children with autism and constructed a means to gain control of the teaching setup so that independence could be fostered in the children. What makes the TEACCH approach unique is that the focus is on the design of the physical, social and communicating environment. The environment is structured to accommodate the difficulties a child with autism has while training them to perform in acceptable and appropriate ways.

Building on the fact that autistic children are often visual learners, TEACCH brings visual clarity to the learning process in order to build receptiveness, understanding, organization and independence. The children work in a highly structured environment which may include physical organization of furniture, clearly delineated activity areas, picture-based schedules and work systems, and instructional clarity. The child is guided through a clear sequence of activities and thus aided to become more organized

It is believed that structure for autistic children provides a strong base and framework for learning. Though TEACCH does not specifically focus on social and communication skills as fully as other therapies it can be used along with such therapies to make them more effective.
Verbal Behavior Intervention

Verbal Behavior Intervention is often seen as an adjunct to Applied Behavioral Analysis (ABA). Though both are based on theories developed by Skinner there are differences in concept. In the late 1950s and early 60's when Dr. Ivar Lovaas was developing his ABA principles, Skinner published Verbal Behavior which detailed a functional analysis of language. He explained that language could be grouped into a set of units, with each operant serving a different function. The primary verbal operant are what Skinner termed echoic, mands, tacts, and intraverbals.

The function of a mand is to request or obtain what is wanted. For example, the child learns to say the word "cookie" when he is interested in obtaining a cookie. When given the cookie, the word is reinforced and will be used again in the same context. There is an emphasis on "function" of language(VB) as opposed to form (Lovaas-based). In a VB program the child is taught to ask for the cookie anyway he can( vocally, sign language, etc.) If the child can echo the word he will be motivated to do so to obtain the desired object. In a Lovaas-based ABA program the child might say the word cookie when seeing a picture and is thus labeling the item. This form of language is called a "tact." Critics of Lovaas say children are taught to label many words but often cannot use them in functional or spontaneous ways. Another operant, "intraverbals" describes verbal behavior that is under the control of other verbal behavior and is strengthened by social reinforcement. Intraverbals are the way people engage in conversational language. They are responses to the language of another person, usually answers to "wh-" questions.. If you say to the child "I'm baking..." and the child finishes the sentence with "Cookies," that's an intraverbal fill-in. Also, if you say, "What's something you bake?" (with no cookie present) and the child says, "Cookies," that's an intraverbal (wh- question). Intraverbals allow children to discuss stimuli that aren't present, which describes most conversation and is a goal of Verbal Behavior Intervention.

Both ABA and VB use similar formats to work with children. It is said that VB attempts to capture a child's motivation to develop a connection between the value of a word and the word itself. Many therapists are now using techniques of VB to bridge some of the gaps seen in ABA.

About Autism

Interventions for Autism