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Interventions for
Autism Spectrum Disorders
Introduction
Identifying appropriate interventions can be an overwhelming and frustrating experience for parents. A recent Google search using the term “autism treatment” revealed over 750,000 results! Unfortunately, many of these “treatments” are costly, have limited scientific support, and may result in families failing to seek out interventions that are more likely to have beneficial effects. In 2009, the National Autism Center released The National Standards Report, a comprehensive review of the level of scientific evidence available to support applied treatments for individuals with ASDs. Based on a review of the research evidence, treatments were separated into three categories: (1) established, (2) emerging, and 3) not established. The authors of the report noted that the majority of the established treatments were developed in the field of Applied Behavior Analysis (ABA). The following is a brief overview of ABA treatments as well as information about selected other treatments for autism that have received support in the research literature.
Applied Behavior Analysis (ABA)
Within the field of autism, ABA programs typically focus on teaching new skills and generalizing the use of these skills across different settings, reinforcing desirable behaviors, and decreasing behaviors of concern. ABA procedures are used with children with ASDs to teach specific academic and vocational skills; to increase speech, social skills, and play skills; and to decrease problem behaviors. Multiple studies published over the past four decades have demonstrated that many children who receive intensive ABA interventions make substantial growth in their learning, adaptive skills, and behaviors. The specific approaches used in ABA programs vary. Some ABA programs focus on teaching specific skills through the use of massed learning trials, with trials conducted between a therapist and a child at a table. Recently, a greater emphasis has been placed on blending ABA principles into developmentally sequenced, play-based programs that are implemented in naturalistic settings. For challenging behaviors, the most common approach is to first conduct a functional analysis, an assessment of the environmental events that elicit and maintain problem behavior. After the function(s) for the problem behavior has been identified, the child is then taught to communicate for desired outcomes and to replace problem behavior with equivalent communications (e.g., to request a toy or a break from work).
Visual Supports
Other Therapies
Although many children with ASD have “sensory” issues that interfere with learning or social behavior, the theories behind sensory integration (SI) therapy for ASD lack scientific support. Despite this fact, some of the activities emphasized in “sensory” therapy may help children to become more physically active, to accept a wider range of sensory experiences, or to be more receptive to reinforcement for desired behavior when used as part of a comprehensive ASD intervention program.
Medical Treatment
Other medications are often prescribed on an “off-label” basis to target symptoms such as aggression, depression, anxiety, obsessive-compulsive tendencies, sleep difficulties, and attention deficits. Children with ASDs may not respond to medications in the same way as typically developing children. It is important for parents to work closely with a provider with expertise in the field of autism to closely monitor response to the medication. Additional medical care may be needed to manage problems with seizures, gastrointestinal problems, and dietary imbalances. Genetic testing using microarray analyses is also now being recommended for children with ASDs.
Complementary and Alternative Medicine (CAM) Treatments
General Intervention Guidelines
Key members of the assessment team often include a developmental pediatrician or other healthcare provider with expertise in autism, a speech and language pathologist, a psychologist, an educational consultant, and an occupational therapist. Results from the evaluation can be used by parents and the school team to develop a treatment program that is tailored to the child’s strengths and needs. As is true for any child with a serious neurodevelopmental disability, providing a “medical home” that can ensure care coordination, parent training, and family support is critically important to a comprehensive plan of care. For adolescents and adults with ASD, vocational training, job coaching, and interventions to improve social and behavioral adjustment are crucial to support independence in living and working in community settings. Although distinctions have been made between ASD services that are “habilitative” (building new skills) or “rehabilitative” (restoring lost skills), legal decisions have questioned the use of these distinctions. Current thinking supports the need for preventive, medical, and remedial services when these interventions have been recommended by a health care practitioner for the reduction of a physical or mental disability and for ensuring the best possible level of functioning. Whenever possible, recommended services should be based on proven interventions with a strong evidence base. Resources |
Winter 2011|
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