Understanding Autism

Autism is a complex neurobiological disorder that typically persists throughout a person's life. While there is no universal treatment protocol applicable to all individuals with Autism Spectrum Disorder (ASD), research indicates that most individuals respond best to highly structured educational programs and early intervention strategies.

Early Detection of Autism

If your child displays any of the following signs, there’s no need to be overly concerned, as these behaviors do not automatically indicate the presence of an autism spectrum disorder. Many infants exhibit some of these characteristics at various stages of their development and may still be developing typically. 

However, if you have any concerns, it’s important to consult your pediatrician.

Early Signs of Autism (After 1 Year Old):

• Absence of cooing, babbling, or pointing

• Poor eye contact

• Lack of response to their name

• Occasional indications of hearing impairment

• Limited gestures for communication

• Reduced desire to interact with others

• Ritualistic or repetitive play patterns, such as excessively lining up toys or objects

• Resistance to physical contact

• Loss of language or social skills (between 15-36 months)

• Research indicates that early diagnosis and intervention significantly improve outcomes for individuals with autism.

Interventions 

A variety of interventions can support individuals with ASD. Some of the most used approaches include:

Applied Behavior Analysis (ABA)

Behavior analysis is a scientific approach to understanding behavior, originally described by B.F. Skinner in the 1930s. Its principles and methods have been effectively applied in various fields. One key method involves positive reinforcement, which strengthens desired behaviors by providing something valuable afterward. This approach has been used to develop a wide range of skills in both learners with and without disabilities.

Since the early 1960s, many behavior analysts have employed positive reinforcement and other techniques to enhance communication, play, social skills, academics, self-care, work, and community living skills, while also reducing problematic behaviors in individuals with autism of all ages.

Some Applied Behavior Analysis (ABA) techniques involve structured instruction led by adults, while others focus on the learner's interests and follow their natural initiatives. Skills are often taught within the context of ongoing activities, and all skills are broken down into small, manageable steps. Learners receive numerous opportunities to practice these skills in various settings, accompanied by ample positive reinforcement.

The goals of intervention, along with the types of instruction and reinforcers used, are tailored to each learner’s unique strengths and needs. Performance is continuously monitored through direct observation, and interventions are adjusted if a learner isn’t making satisfactory progress. Ultimately, regardless of age, the aim of ABA intervention is to help individuals with autism function as independently and successfully as possible in different environments.

TEACCH Method

The TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) program is a specialized education initiative designed to meet the individual needs of people with Autism Spectrum Disorder, based on broad guidelines. Established in the 1960s by Dr. Eric Schopler, Dr. R.J. Reichler, and Ms. Margaret Lansing, the program was developed as a way to manage the educational environment in a manner that fosters independence in children with autism. What distinguishes the TEACCH approach is its emphasis on the physical, social, and communicative environment, structuring it to address the challenges faced by autistic individuals while simultaneously training them to engage in appropriate and acceptable behaviors.

Recognizing that many individuals with Autism Spectrum Disorder are strong visual learners, TEACCH integrates visual clarity into the learning process to enhance receptiveness, comprehension, organization, and independence. Children in this program operate within a highly structured environment, which may include the physical arrangement of furniture, clearly defined activity areas, picture-based schedules, work systems, and instructional clarity. The child is guided through a well-organized sequence of activities, promoting a sense of order and structure.

It is believed that structure for individuals with Autism Spectrum Disorder 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.

Floortime Therapy

Floortime, created by child psychiatrist Dr. Stanley Greenspan, is both a therapeutic method and a guiding philosophy for engaging with children on the autism spectrum. It is founded on the principle that children can expand their range of interactions when adults engage with them at their current developmental level, while building upon their individual strengths.

The central objective of Floortime is to support the child’s progression through six fundamental developmental milestones necessary for emotional and intellectual growth. Dr. Greenspan identifies these milestones as:

• Self-regulation and engagement with the environment

• Emotional connection with others

• Two-way communication

• Complex communication skills

• Emotional ideation

• Emotional reasoning

Floortime is a developmental intervention where the parent engages the child at their current level, following the child's lead. The goal is to promote emotional, social, and intellectual growth through shared activities. A key aspect is "opening and closing circles of communication," which involves back-and-forth exchanges between the parent and child. Rather than focusing on isolated skills, Floortime emphasizes emotional development to integrate speech, motor, and cognitive progress. The parent gets on the floor to meet the child at their level, fostering natural, emotional connections.

Speech and Language Therapy

The communication challenges faced by autistic individuals vary to some extent and are influenced by the individual's intellectual and social development. Some children may be completely non-verbal, while others possess well-developed vocabularies and can engage in extensive conversations on topics of interest to them. Any therapeutic intervention must begin with a comprehensive assessment of the child's language abilities, conducted by a trained speech and language pathologist.

Although some autistic individuals exhibit minimal or no difficulty with word pronunciation, the majority struggle with effectively utilizing language. Even those without articulation issues often encounter challenges in the pragmatic aspects of language, such as understanding what to say, how to say it, when to say it, and how to engage socially with others. Many children who speak do so in a manner that lacks meaningful content or information. Others engage in echolalia, repeating words or phrases they have heard, or recite irrelevant scripts they have memorized. Some may use a high-pitched or robotic-sounding tone of speech.

Two foundational skills for language development are joint attention and social initiation. Joint attention includes maintaining eye contact and using referential gestures such as pointing, showing, and giving. Autistic individuals often exhibit deficits in social initiation, such as asking questions, and they tend to make fewer verbalizations, failing to use language as a tool for social engagement. While no single treatment has proven universally successful in improving communication, the most effective interventions are those that begin early, during the preschool years, are tailored to the individual, and actively involve both parents and professionals. The primary objective is to enhance functional communication. For some children, verbal communication is a realistic goal, while for others, alternative methods such as gesture-based communication or the use of symbol systems like picture boards may be more appropriate. Regular evaluations are essential to determine the most effective approaches and to adjust goals as necessary for the individual child.

 Occupational Therapy

Occupational therapy offers significant benefits for individuals with autism by seeking to enhance their quality of life. The primary goal is to develop, maintain, or introduce skills that enable individuals to participate as independently as possible in meaningful daily activities. Key areas of focus include coping strategies, fine motor skills, play skills, self-care skills, and socialization.

Through occupational therapy techniques, individuals with autism can be supported both at home and in educational settings by learning essential activities such as dressing, feeding, toilet training, grooming, and social interaction. Additionally, the therapy targets fine motor and visual skills to assist with tasks like writing and using scissors, gross motor coordination for activities such as riding a bike or walking correctly, and visual perceptual skills necessary for reading and writing.

Occupational therapy is typically conducted as part of a collaborative approach involving medical and educational professionals, parents, and other family members. Through this coordinated effort, individuals with autism can develop the social, play, and learning skills necessary for successful functioning in everyday life.

Relationship Development Intervention (RDI)

Relationship Development Intervention (RDI), developed by psychologist Dr. Steven Gutstein, is a therapeutic approach aimed at enhancing the long-term quality of life for individuals with Autism Spectrum Disorder. RDI is a parent-based intervention that targets the core challenges of building friendships, developing empathy, expressing love, and sharing experiences with others. Dr. Gutstein’s program is grounded in extensive research on typical development and translates these findings into a structured clinical methodology. His research identified that individuals with Autism Spectrum Disorder often lack certain skills essential for navigating dynamic, real-life environments. He refers to these skills as "dynamic intelligence," which encompasses six key areas:

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

In 1995, Dr. Gutstein and Dr. Rachelle Sheely founded the Connections Center for Family and Personal Development in Houston, Texas. Dr. Gutstein emphasizes, “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 primary goal of RDI is to foster social improvement, as well as advancements in flexible thinking, pragmatic communication, creative problem-solving, and self-development.

The program provides training workshops for parents, along with a variety of books offering step-by-step exercises designed to build motivation, ensuring that skills are both utilized and generalized. RDI is known for being easy to initiate and seamlessly integrated into regular, daily activities, enriching family life.

Sensory Integration Therapy

Sensory Integration refers to the process by which the brain organizes and interprets external stimuli, including movement, touch, smell, sight, and sound. Individuals with Autism Spectrum Disorder often exhibit symptoms of Sensory Integration Dysfunction (SID), which can impede their ability to process sensory information effectively. The severity of SID can vary, presenting as mild, moderate, or severe deficits that may manifest as either hypersensitivity (increased sensitivity) or hyposensitivity (decreased sensitivity) to various stimuli. For instance, a hypersensitive child may actively avoid physical contact, whereas a hyposensitive child may seek out tactile stimulation and derive pleasure from being in confined spaces.

The primary objective of Sensory Integration Therapy (SIT) is to enhance the nervous system's capacity to process sensory input in a more typical manner. Through this integration, the brain consolidates sensory messages to create coherent information that guides behavior. SIT employs neurosensory and neuromotor exercises aimed at improving the brain's self-repair capabilities. When effective, this therapy may lead to improvements in attention, concentration, listening skills, comprehension, balance, coordination, and impulse control in some children.

The evaluation and treatment of fundamental sensory integrative processes in autistic children are typically conducted by occupational and/or physical therapists. A tailored program is developed to provide appropriate sensory stimulation, often in conjunction with targeted muscle activities, to enhance the brain's processing and organization of sensory information. Therapy frequently involves activities that promote full-body movement using various types of equipment. It is posited that SIT does not directly teach higher-level skills; rather, it enhances sensory processing abilities, thereby facilitating the acquisition of such skills.

Verbal Behavior Intervention (VBI)

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, tact, 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 "why” 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 (why- 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.

The Picture Exchange Communication System (PECS)

The Picture Exchange Communication System (PECS) is an augmentative and alternative communication (AAC) method designed to assist individuals with Autism Spectrum Disorder (ASD) in developing functional communication skills. Developed in the early 1990s, PECS focuses on teaching autistic individuals how to exchange pictures to express their needs, wants, and feelings. The system is structured into six phases, starting with the simple exchange of pictures and progressing to more complex sentence structures.

PECS is particularly beneficial for non-verbal or minimally verbal autistic individuals, as it provides a visual means of communication that may be more accessible than spoken language. Through the use of visual symbols, individuals learn to convey messages effectively, promoting engagement and reducing frustration associated with communication barriers. The approach encourages spontaneous communication, as users learn to select and exchange pictures to request items or express thoughts.

Implementation of PECS involves training for both the autistic individual and their communication partners, including parents, educators, and therapists. Regular practice and reinforcement are essential for successful integration into daily life. The ultimate goal of PECS is to enhance the communicative competence of individuals with ASD, thereby improving their ability to interact with others and participate in various social contexts.

Special Education Strategies

Special education strategies for individuals with Autism Spectrum Disorder (ASD) are tailored approaches designed to meet the unique learning needs of autistic individuals. These strategies emphasize individualized instruction, accommodating the diverse strengths and challenges associated with autism. Effective special education programs utilize evidence-based practices that promote engagement, communication, and social skills development.

Key strategies include structured teaching, visual supports, and the use of clear routines. Structured teaching helps create a predictable environment, allowing autistic individuals to understand expectations and transitions throughout the day. Visual supports, such as schedules, diagrams, and picture cues, enhance comprehension and provide clarity in the learning process. Additionally, incorporating social stories and role-playing can improve social understanding and interaction among peers.

Collaboration among educators, therapists, and families is essential to the success of special education strategies. By fostering a supportive learning environment and utilizing personalized interventions, educators can empower autistic individuals to develop essential skills, enhance their self-advocacy, and promote independence. Ultimately, these strategies aim to create inclusive educational settings that facilitate meaningful participation for individuals with Autism Spectrum Disorder.