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An Overview of Various Treatment Options

An Overview of Various Treatment Options. Mimi Lou, Ph.D. Clinical Director Children’s Hospital Autism Intervention (CHAI) Program. Psychoeducational Approaches in Autism/PDD. Developmental Models Behavioral Approaches Applied Behavioral Analysis (ABA) Discrete Trial – (Lovaas)

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An Overview of Various Treatment Options

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  1. An Overview of Various Treatment Options Mimi Lou, Ph.D. Clinical Director Children’s Hospital Autism Intervention (CHAI) Program

  2. Psychoeducational Approaches in Autism/PDD • Developmental Models • Behavioral Approaches • Applied Behavioral Analysis (ABA) • Discrete Trial – (Lovaas) • Contemporary ABA • Group/Classroom Instruction: TEACCH

  3. Developmental Models • DIR, Floortime (Greenspan & Wieder); SCERTS (Prizant & Wetherby); Hanen, More Than Words • Learning understood within context of developmental processes (typical child development) • Development proceeds from both external experience and internal, biological maturation • Different aspects/domains of development are interdependent • Child learns more than s/he is taught, or experience is more than instruction

  4. Developmental Models(cont.) • Use of interactive-facilitative (versus directive) strategies: • Child “leads”: active in selecting, directing own activities • Adult builds on child’s initiations; expands on child’s interests • Adult entices, actively engages child • Adult facilitates play by providing support and helping to structure experience and mediate the environment

  5. Developmental Models(cont.) • Naturally occurring and motivating contexts for learning • Central roles for play and functional learning; importance of affects, learning has meaning for child • Individual profile of sensory and motor processing

  6. Applied Behavioral Analysis(ABA) • Reinforce/reward appropriate behavior to teach new skills • Ignore/extinguish inappropriate behavior • Shape existing behaviors into new and useful ones • Functional Analysis: examine antecedents, behaviors, consequences for problem behaviors in order to correct

  7. Discrete Trial(Lovaas) • Direct instruction: verbal direction, prompting, reinforcement, with rapid repetition of short trials • Focus on 1 specific skill at a time • Highly structured context/setting • Adult control: determines activity, focus of attention, correctness of response • Child compliance • Prescribed sequenced curriculum

  8. Contemporary ABA • Natural Language paradigm, Pivotal Response Training(Koegels & Schreibman); Modified Discrete Trial (Leaf, McEachin); Incidental Learning (McGee); Picture Exchange Communication System (PECS) (Bondy & Frost) • More naturalistic instruction incorporating child’s choice/preference, naturally rewarding consequences

  9. Contemporary ABA(cont.) • Teaching in context of play and functional activities • Control of teaching interaction shared, with child initiating communicative exchanges more and adult responding

  10. Group/Classroom Instruction: TEACCH • Primary purpose: Improve each individual’s adaptation, level of skill • Modify, structure the environment to accommodate autism deficits • Aim to increase independent functioning (emphasis on visual components of structure) • Structured teaching = framework in which vocational, social, and living skills taught

  11. Group/Classroom Instruction: TEACCH (cont.) • 4 major components of structured teaching: • physical organization • schedules • work systems • task organization

  12. Characteristics of Effective Preschool Programs • Low adult:child ratio to teach core skills  • Highly structured, predictable classroom routines  • Functional approach to challenging behaviors  • Direct instruction in “survival skills” for transition  • Family involvement in intervention  • Intensity of intervention (15 – 40 hours/week)

  13. Characteristics of Effective Preschool Programs (cont.) • Curriculum Content (Direct instruction in core skills):  • Attention to environment, especially to people • Ability to imitate others • Ability to comprehend and use language • Ability to play appropriately with toys • Ability to socially interact with others

  14. Other Therapies • Complementary Medicine • Treatments specifically for sensory-motor issues • Auditory Processing • Treatments specifically for social relationships • Reading Intervention

  15. Complementary Medicine • Medications • Vitamins • Nutritional Supplements • Dietary Interventions • Immune System • Allergy treatment • Heavy Metals (Chelation)

  16. Treatments specifically for sensory-motor issues • Sensory Integration Therapy • Focuses on sensory processing issues and difficulties from poor integration of information from sensory systems, especially, proprioceptive, vestibular, and tactile; motor planning problems, regulatory issues of arousal • Through sensory stimulation and sensory-motor challenges

  17. Auditory Processing • Auditory Integration Therapy • Berard Tomatis, Others • Treatment for sound sensitivity; modulated music through headphones with filtering of certain sound frequencies • Processing Speed • FastForWord

  18. Treatments specifically for social relationships • Integrated Playgroups (Pamela Wolfberg) • Social Stories (Carol Gray) • Relationship Development Intervention (Steven Gutstein) •  Reading Intervention • Lindamood-Bell (Patricia Lindamood, Phyllis Lindamood, Nanci Bell)

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