Interventions for Children with Autism

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Interventions for Children with Autism

Individuals with autism demonstrate delays or deficits in social interaction and behaviours. Autism is apparent from early childhood, but can emerge in early adulthood. It is associated with a wide range of possible causes, but genetic factors are the main causes. Children with autism have impairments in cognition, language delays, and lack of or poor social interactions. Lack of communication may force these children to adopt repetitive behaviours such as self-inflicted injuries and violence. The teaching process requires interventions that address the repetitive behaviours, skill development, and play activities that promote communication and social interactions. Several authors have discussed different intervention models that are discussed in the sections below.

Rita Jordan-Behavioural and Communication Intervention

TEACCH Programme

The programme is community based and targets children and adults with autism and communication disabilities. TEACCH aims at developing communication skills among autistic children, and help them work and play independently of adults (Jordan, Jones and Murray, 1998). The development of communication skills is based on their understanding capability and their ability to express themselves. The programme teaches several ways of communication, such as the use of photographs and pictures, symbols and words, and objects of reference. The programmes assist children with autism in their childhood and provide them with support in their adulthood. The trainers focus on the strengths and interests displayed by the students and also address the emerging skills. Part of the training involves interacting and engaging in learning activities with normally developing children (Jordan, Jones and Murray, 1998). This interaction and reverse integration helps autistic children adjust to mainstream classes for normally developing children. The programme provides a prosthetic environment where difficulties experienced by autistic individuals can be circumvented in order to enable them to live and learn without unnecessary stress and anxiety (Jordan, Jones and Murray, 1998).

Trainers conduct an assessment that identifies the emerging skills and addresses them as the first teaching goals. Students begin by learning functional skills, and good work habits that enable them to function with little intervention provided they are within the TEACCH structure (Jordan, Jones and Murray, 1998). This is the most widely used approach for teaching autistic children. Visual information, predictability and structure help the children understand what they are supposed to do, where and when it should be done, and the order of doing the activity. Parents are also involved in the programme, and their work is to promote a feeling of competence and well-being among the children. They work as co-therapists and participate in home activities when TEACCH instructors make home visits (Jordan, Jones and Murray, 1998). Parents also provide home training for goals such as independent play, increasing communication, and toilet training. They are provided with parent support information that helps them learn strategies of effective training.

The TEACCH programme has advantages such as supporting autistic adults in the employment sector. There are employment support models that include individual placements, a dispersed enclave and a mobile crew model (Jordan, Jones and Murray, 1998). Therapists provide long-term support services to individuals and employers. Students in the TEACCH programmes attend mainstream or special schools, or remain at home with their parents and therapists make home visits and provide advice to the teaching staff. The visual learning activities help the student and adults perform most activities with little support from parents or trainers. This has helped adults receiving support participate in community activities with minimum assistance from supervisors. The main disadvantage of the programme is the lack of activities that address autism directly. The programme provides mechanisms of minimising the difficulties instead of addressing autism. Children within the programme may require other approaches to autism, but there is a likelihood of compromising the effectiveness of the programme or incorporated approaches (Jordan, Jones and Murray, 1998).

ABA (Applied Behaviour Analysis)

ABA provides behavioural approaches in the education process of children with autism and severe learning difficulties. It incorporates interventions such as applied behaviour analysis and discrete trial learning (Jordan, Jones and Murray, 1998). In applied behaviour analysis, a skill is analysed into steps, which are then used as a teaching programme for the student. The discrete trial learning process presents the steps with a clear goal and rewards are issued when the students completes the activities successfully. The behavioural approaches have incorporated developments such as ‘general case programming’ in place of ‘errorless discrimination learning.’ ‘Discrete trial learning’ has also been replaced with ‘ecologically valid task units’(Jordan, Jones and Murray, 1998). The general case programming gives the students experience of different exemplars of the concept to be learnt. On the other hand, errorless discrimination learning uses one correct exemplar at a time, and the task is structured to maximize the chances of success. Ecologically valid task units provide jargon of functional behavioural strings instead of breaking them into small steps used in discrete trial learning (Jordan, Jones and Murray, 1998).

ABA also addresses skill analysis and incorporates shaping procedures that teach new skills (Jordan, Jones and Murray, 1998). In this way, the behavioural techniques effect performance and help in skill acquisition. This intervention is based on the notion that human behaviour is learnt, and children can learn new skills through modification of stimuli. ABA also contains disadvantages since it is based on behavioural work instead of traditional approaches. It focuses on specific behaviours rather than addressing the diagnostic entity of autism. The main focus of ABA is on the immediate environment instead of the early history of the child (Jordan, Jones and Murray, 1998).

Patricia Howlin- Behavioural Therapy

ABC Approach

Howlin discusses traditional behavioural therapy using the ABC approach to analyse behavioural problems. This involves identifying the antecedents and consequences of behaviour modification (Howlin, 1998). The traditional approach does not lead to the most effective treatment and it may prove difficult to establish the antecedents or consequences of the learnt behaviour. The ABC approach contradicts the ABA model proposed by Jordan. ABA addresses the skills to be learnt, and learning steps are developed from the intended skill. On the other hand, ABC addresses the antecedents and consequences of acquiring certain behaviour. The ABC model may invoke unwanted consequences based on the present behavioural setting (Howlin, 1998). For example, a child might begin inflicting self-injuries since the present setting invokes previous distressing occurrences that ceased when self-injury commenced (Howlin, 1998). Recent interventions to the ABC model focus on the function of the behaviour instead on the consequences. This aims at establishing achievements associated with acquiring certain behaviour. Unlike ABA and TEACCH models discussed by Jordan, the ABC model does not encourage skill acquisition or development of new skills. The model only analyses behaviours that affect communicative functions.

Functional Analysis

The functional analysis of behaviour model focuses on aggressive, self-injurious, stereotyped, and other disruptive behaviours identified among autistic children (Howlin, 1998). The primary function of the behaviour has to be identified before the child can be provided with alternative means of achieving the same results. The strategy taught depends on the cognitive and linguistic abilities of the children (Howlin, 1998). The strategies may involve visual cues such as symbols and pictures similar to those discusses by Jordan in the TEACCH programme. However, the ABC model has additional cues such as pushing levers, switches, and buttons and using simple words and phrases. The main problem associated with this model is the change in factors that determine human behaviour (Howlin, 1998). These factors change from time to time, making it difficult to pinpoint the function underlying a particular challenging behaviour. Some behaviour is influenced by multiple factors, which makes it difficult to develop intervention strategies that address the behaviour (Howlin, 1998).

Scott McConnell: Social Interaction

Ecological Variations

Interventions based on ecological variations promote social interaction by manipulating or arranging the general features of the physical or social environment. This involves modifying the structure or schedule of activities, and nature and composition of peer groups (McConnell, 2002). Researchers have revealed a relationship between the characteristics of activities and social interaction among children with autism (McConnell, 2002). Preschool children engage in social interactions with activities they prefer or when activities and materials appear predictable. Periods of low environmental stimulation also help children with autism increase their rates of social participation and interaction. However, co-location of children with autism and competent peers without other forms of intervention does not sufficiently improve their interaction. This combination promotes social initiations among children with autism instead of promoting social interaction. On the other hand, access to integrated play groups promotes maintenance and generalization of social interaction (McConnell, 2002). Children with autism develop high rates of social interaction when they participate in developmentally integrated play groups.

Collateral skills interventions

Children with autism demonstrate increased social interaction by training in seemingly different skills (McConnell, 2002). This intervention increases social participation, academic responses, and socio-dramatic play. Teaching generalized play skills produces social interaction, especially in peer responses to initiations from children with autism. Participation in play activities and use of specific play skills acts as a necessary condition for improving social interaction among children with autism. Teaching these children social-dramatic play provides structured activities that improve their rates of interaction (McConnell, 2002). This involves the use of play scripts to coordinate the play activities. These play activities can involve the use of language that can help the children improve their interaction.

In conclusion, these interventions are not conclusive, and researchers have to develop new frameworks of assessing children with autism. In the TEACCH programme, controlled studies are necessary for comparing its performance against other programmes. This should involve evaluators without prior information regarding the purpose of the study. The ABA model should incorporate behavioural approaches that eliminate limited treatment gains and long-term regression. Some of the communication and behavioural responses may not work for children with high-functioning autism. This creates the need for interventions that can be applied to all cases of autism. The social interaction interventions should incorporate educational practices instead of overemphasizing peer intervention practices.

References

Howlin, P. (1998). Practitioner Review: Psychological and Educational Treatments for Autism. Journal of Child Psychology and Psychiatry, 39, 307-322.

Jordan,R., Jones, G., and Murray, D. (1998). Educational Interventions for Children with Autism: A Literature Review of Recent and Current Research. Norwich: Crown Publishers.

McConnell, S.R. (2002). Interventions to Facilitate Social Interaction for Young Children with Autism: Review of Available Research and Recommendations for Educational Intervention and Future Research. Journal of Autism and Developmental Disorders, 32, 351-371.