Resources

Intervention
and Therapies

Just decades ago, many people with Autism were placed in institutions. Professionals were less educated about Autism than they are today, and specific service and support were largely non-existent. The picture is much clearer now. With appropriate service and support, training and information, children who experience Autism will grow, learn, and flourish, even if at a different developmental rate than others.

While there is no known cure for Autism, there are treatment and education approaches that can address some of the challenges associated with the condition. Intervention can help to lessen disruptive behaviors, and education can teach self-help skills for greater independence. But just as there is no one symptom or behavior that identifies people with Autism, there is no single treatment that will

be effective for everyone who experiences Autism. Individuals can use the positive aspects of their condition to their benefit, but treatment must begin as early as possible and focus on the individual’s unique strengths, weaknesses, and needs.

Throughout the history of the Autism Society, parents and professionals have been cofounded by conflicting messages regarding which treatment options are appropriate for children and adults who experience Autism. As each person responds to treatment differently, we cannot endorse any one treatment or program. Families should educate themselves about all options and choose what they feel is in the best interest of their child and family, based on their experience and what resources are available.

Just decades ago, many people with Autism were placed in institutions. Professionals were less educated about Autism than they are today, and specific service and support were largely non-existent. The picture is much clearer now. With appropriate service and support, training and information, children who experience Autism will grow, learn, and flourish, even if at a different developmental rate than others.

While there is no known cure for Autism, there are treatment and education approaches that can address some of the challenges associated with the condition. Intervention can help to lessen disruptive behaviors, and education can teach self-help skills for greater independence. But just as there is no one symptom or behavior that identifies people with Autism, there is no single treatment that will be effective for everyone who experiences Autism. Individuals can use the positive aspects of their condition to their benefit, but treatment must begin as early as possible and focus on the individual’s unique strengths, weaknesses, and needs.

Throughout the history of the Autism Society, parents and professionals have been confounded by conflicting messages regarding which treatment options are appropriate for children and adults who experience Autism. As each person responds to treatment differently, we cannot endorse any one treatment or program. Families should educate themselves about all options and choose what they feel is in the best interest of their child and family, based on their experience and what resources are available.

This section provides an overview of many available approaches, not specific treatment recommendations.

Keep in mind that the word “treatment” is used in a very limited sense. While typically used for children under age three, the approaches described here can be included in an educational program for older children as well.

It is important to match a child’s potential and specific needs with treatments or strategies that are likely to help them reach established goals and greatest potential.

The Autism Society does not want to give the impression that parents, caregivers, or professionals will select just one treatment from a list. A search for appropriate treatment must be paired with the knowledge that all treatment approaches are not equal – what works for one will not work for all. The basis of a treatment plan should come from a thorough evaluation of the child’s strengths and weaknesses.

Nonmedical Interventions

The dramatic increase in the number of people identified with Autism spectrum disorder (ASD) has focused attention on the types of interventions that can lead to opportunities to live fully. These teaching strategies can introduce new behaviors or reduce inappropriate actions, often using the principles of behavior reinforcement. Nonmedical interventions frequently address one specific issue at a time – for example, teaching a student to focus on homework – and can yield results in those specific areas as well as more general improvement in functioning.

The Texas Statewide Leadership for Autism Training has compiled the Texas Autism Resource Guide for Effective Teaching (TARGET), which provides information on interventions for people with ASD. Recognizing the diversity of those with ASD, TARGET exercises a pragmatic approach to evidence-based practices (EBP):

The best measure of effectiveness of an intervention is whether it is effective for a particular individual. It is of utmost importance to collect and analyze data when using interventions with a student with Autism. If an intervention results in positive change for a particular student and you, as an educational professional, have data to support that, then the intervention is evidence-based for that student.

Interventions from TARGET

Activity-based intervention (ABI) provides a developmentally appropriate framework for incorporating several effective instructional strategies into a child’s daily activities. This approach is a promising way to utilize naturally occurring antecedents and consequences to teach children with Autism target skills.

Antecedent-based intervention (ABI) is an evidence-based practice used to address both interfering and on-task behaviors. This practice is most often used after a functional behavior assessment (FBA) has been conducted to identify the function of the interfering behavior.

Applied behavior analysis (ABA) has its roots in the philosophy of modern behaviorism pioneered by Skinner, who laid the foundation in the early 1900s. As such, it is the practical application of behavioral laws—laws of reinforcement—formulated by Skinner to solve behavior problems. ABA is defined as the process of systematically applying interventions based upon the principles of behavior theory to improve socially significant behaviors, including reading, academics, social skills, communication, and adaptive living skills, to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf, & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).

Assistive technology (AT) refers to equipment that is used by an individual with a disability to increase his or her functional capabilities. Many students with Autism require strategies, equipment, and/or support to reach their potential (Schlosser, Blischak, Belfiore, Bartley, & Barnett, 1998). Research has shown that one such means of support, assistive technology, is effective for students with Autism spectrum disorder.

Cognitive behavioral interventions (CBI) refer to a variety of related interventions that are used to alter behavior by teaching individuals to understand and change thoughts and behaviors.

Differential reinforcement of other behaviors means that reinforcement is provided for desired behaviors, while inappropriate behaviors are ignored. Differential reinforcement (DR) is a special application of reinforcement designed to reduce the occurrence of inappropriate or interfering behaviors (e.g., tantrums, aggression, self-injury, stereotypic behavior).

The Developmental, Individual-Difference, Relationship-Based (DIR) intervention model, also known as Floor Time™, is designed to help children work around processing difficulties to reestablish effective contact with caregivers or play partners and begin to master developmentally appropriate skills. It is designed to increase socialization, improve language, and decrease repetitive behaviors.

Discrete trial training (DTT) is a one-to-one instructional approach used to teach skills in a planned, controlled, and systematic manner. DTT is used when a learner needs to learn a skill best taught in small, repeated steps. In addition, DTT is often characterized by repeated, or massed, trials that have a definite beginning and end.

The Early Start Denver Model (ESDM) is a comprehensive behavioral early intervention approach for children with Autism, ages 12 to 48 months (one–four years). The program encompasses a developmental curriculum that defines the skills to be taught at any given time and a set of teaching procedures used to deliver this content.

Exercise (ECE) is a strategy that involves an increase in physical exertion as a means of reducing problem behaviors or increasing appropriate behavior while increasing physical fitness and motor skills.

Extinction refers to an applied behavior analysis (ABA) procedure whereby a behavior that was formerly reinforced is no longer reinforced.

Facilitated communication (FC) is a controversial technique in which a facilitator provides physical, communication, and emotional support to an individual with a communication disorder (the communicator).

Functional behavior assessment (FBA) is a systematic set of strategies used to determine the underlying function or purpose of a behavior so that an effective intervention plan can be developed.

Functional communication training (FCT) is a positive behavior support (PBS) intervention designed to reduce problem behaviors by replacing them with meaningful or functional communication, whether verbal or gestural. The emphasis of the communication is on functionality as opposed to form.

Modeling is the demonstration of a desired target behavior that results in imitation of the behavior by the learner and that leads to the acquisition of the imitated behavior. This EBP is often combined with other strategies such as prompting and reinforcement.

Naturalistic intervention (NI) is a collection of practices designed to encourage specific target behaviors based on learners’ interests. It occurs within the typical settings, activities, and/or routines in which the learner participates.

Parent-implemented Intervention (PII) entails parents directly using individualized intervention practices with their child to increase positive learning opportunities and acquisition of important skills. Parents learn to implement such practices in their home and/or community through a structured parent training program.

As a way to improve social reciprocity in more natural social contexts, peer-mediated interventions are used to provide social learning opportunities through peer interaction, peer modeling, and peer reinforcement.

As a way to improve social reciprocity in more natural social contexts, peer-mediated interventions are used to provide social learning opportunities through peer interaction, peer modeling, and peer reinforcement.

The Picture Exchange Communication System (PECS) is used to teach learners to communicate in a social context.

Pivotal Response Training (PRT) is a contemporary naturalistic-behavioral intervention that applies principles of applied behavior analysis (ABA) to build on learner initiative and interests, enhancing the pivotal learning variables: motivation, responding to multiple cues, self-management, and self-initiations of social interactions.

Prompting procedures (PP) include any help given to learners that assists them in using a specific skill.

The Rapid Prompting Method (RPM) was created by the parent of a child with Autism (AU) and popularized by the media.

Reinforcement (R+) is used to teach new skills and to increase behaviors. Reinforcement establishes the relationship between the learner’s behavior/use of skill and the consequence of that behavior/skill.

Response interruption/redirection (RIR) involves the introduction of a prompt, comment, or other distractors when an interfering behavior is occurring. The distractor is designed to divert the learner’s attention away from the interfering behavior and results in its reduction.

Scripting (SC) involves creating a verbal and/or written description about a specific skill or situation that serves as a model for the learner. Scripts are usually practiced repeatedly before the skill is used in the actual situation.

Self-management (SM) interventions help learners with Autism spectrum disorders (ASD) learn to independently regulate their own behaviors and act appropriately in a variety of home, school, and community-based situations.

SCERTS® is a comprehensive and multidisciplinary approach designed to improve communication and social-emotional functioning of young children with Autism. The areas emphasized include social communication (SC), emotional regulation (ER), and transactional support (TS).

Social narratives (SN) are interventions that describe social situations in some detail by highlighting relevant cues and offering examples of appropriate responses. They are aimed at helping learners adjust to changes in routine and adapt their behaviors based on the social and physical cues of a situation, or to teach specific social skills.

Social skills training (SST) is a form of group or individual instruction designed to teach learners with Autism spectrum disorders (ASD) ways to appropriately interact with peers, adults, and other individuals.

Social thinking is a type of group or individual instruction designed to improve social cognition, such as perspective taking. It emphasizes teaching children with Autism the foundation of social knowledge to develop successful social behaviors.

Structured play groups (SPG) involve small-group activities characterized by their occurrences in a defined area and with a defined activity; the specific selection of typically developing peers to be in the group; and a clear delineation of themes and roles by adult leading, prompting, or scaffolding as needed to support students’ performance related to the goals of the activity.

Task analysis (TA) is the process of breaking a skill into smaller, more manageable steps in order to teach the skill.

Technology-Aided Instruction and Innovation (TAII) involves instruction or interventions in which technology is the central feature supporting the acquisition of a goal for the learner.

Time delay (TD) is a practice that focuses on systematically fading the use of prompts during instructional activities.

Video modeling (VM) is a mode of teaching that uses video recording and display equipment to provide a visual model of the targeted behavior or skill.

Children with ASD often have superior visual-spatial skills and poor auditory memory skills. Visual support (VS) provides concrete support utilizing the strength in visual processing (Rollins, 2014).

A report for military families from the Ohio State University Project Team includes a comparison chart (created by Brenda Smith Myles, Ph.D.) outlining and describing the evidence-based practices developed by the Centers for Medicare & Medicaid Services, the National Autism Center and the National Professional Development Center on ASD.

For more information about interventions, try Autism Source, the Autism Society’s national contact center and database. Autism Source can connect you to service providers in your area and supply information to help you in choosing an intervention or therapy.

Evaluating Options

After identifying available treatments, interventions, therapies and other services, you’ll need to choose which ones are best for you or your child. Here are some considerations to help you make your decision:

  • What is the purpose of this theory/practice?
  • What do I have to do to benefit from the theory/practice, and what are its lasting effects?
  • For how long must my child be involved in this theory/practice to benefit from it?
  • Is there any physical or psychological harm this theory/practice could do to my child?
  • What are the personal costs of time and money that I will have to endure, and can I be reimbursed for these expenses?
  • How do I know that the costs of this theory/practice are fair and reasonable?
  • Are the theoreticians or practitioners competently and appropriately trained and prepared to implement the provisions of the theory or practice? How is their competence assured?
  • What steps will be taken to protect my privacy?
  • Are there any legal actions, current or past, against promoters, consumers or practitioners of the theory/practice?
  • How will the effects of this theory/practice be evaluated?
  • By choosing this theory/practice, what alternatives (proven or unproven) am I not pursuing?
  • Does this approach mesh with my child’s overall program?
  • Who has this theory positively benefited, and under what conditions?

The National Institute of Mental Health suggests the following list of questions to ask when planning a treatment program:

  • How successful has the program been for other children?
  • How many children have gone on to placement in a regular school and how have they performed?
  • Do staff members have training and experience in working with children with Autism?
  • How are activities planned and organized?
  • Are there predictable daily schedules and routines?
  • How much individual attention will my child receive?
  • How is progress measured? Will my child’s behavior be closely observed and recorded?
  • Will my child be given tasks and rewards that are personally motivating?
  • Is the environment designed to minimize distractions?
  • Will the program prepare me to continue the therapy at home?
  • What is the cost, time commitment, and location of the program?