Autism Spectrum Disorder Interventions – Flashcards

Overarching goals: Maximize functioning Move toward independence Improve the quality of life for individual and family/caregiver Specific goals: Improve social functioning and play skills Improve communication skills (both functional and spontaneous) Improve adaptive skills Decrease nonfunctional or negative behaviors Promote academic functioning and cognition

Intensive Behavioral Interventions, TEACCH Method, Developmental and Relationship Models, Integrative Models, Comprehensive Integrative Models, Parental Role, and Interventions for Specific Behaviors

Seeks to target the defining symptoms of ASD and are based on principles of behavior modification. Intensive behavior programs may improve core symptoms of ASD and maladaptive behaviors but should not be expected to lead to typical function. To maximize success, intensive behavioral programs should have a low student-to-therapist ratio. They may be delivered in a variety of settings (eg, home, self-contained classroom, inclusive classroom, community). Examples of specific intensive behavior intervention programs include: ?Discrete trial training (DTT), which is the most structured form of intensive behavior therapy; it was developed by Ivar Lovaas. ?Contemporary ABA programs, which occur in more naturalistic settings; they include pivotal response training (PRT), language paradigms, and incidental teaching (teaching as events occur in the context of the natural environment). ?Early intensive behavioral intervention (EIBI). The studies revealing the most gains for intensive behavior programs included a high level of intervention (eg, 30 to 40 hours per week of intensive one-on-one services for two or more years and starting before the age of five years). However, the evidence is insufficient to provide a general recommendation that all children with ASD require this level of intervention. The most significant improvements generally are seen within the first 12 months of treatment. Pretreatment variables that are associated with improved outcomes include the presence of joint attention, functional play skills, higher cognitive abilities, and decreased severity of autism symptoms. Although research is ongoing, it is unclear whether one type of intensive behavioral intervention is better than another, how to determine which children with ASD will respond maximally to intensive behavioral interventions, and whether intensive behavior programs should be recommended over other types of treatment programs.

An intensive behavior intervention (seek to target the defining symptoms of ASD and are based on principles of behavior modification). ABA seeks to reinforce desirable behaviors and decrease undesirable behaviors. The goals of ABA are to teach new skills and generalize learned skills by breaking them down into their simplest elements. The skills are taught through repeated reward-based trials. Compared with other interventions - Although ABA methods appear to be efficacious when compared with control interventions (eg, special education), it is not clear that ABA is superior to other behavioral therapy methods. ABA for older children - There is some controversy about the use of ABA for older children, and there are few studies to guide recommendations for this age group. The studies tend to be smaller both in duration and in numbers. Children requiring ABA at an older age may be more impaired than children who no longer require ABA. In such children, ABA may be used to target specific needs, rather than broad deficits, limiting the generalizability of study results.

The TEACCH method uses Structured Teaching to help individuals overcome areas of weakness. The goal is to modify the environment and to improve skills. This model incorporates the therapist as generalist (meaning that the therapist understands the whole child and does not specialize in one developmental discipline), is individualized to the student, and includes family involvement. The TEACCH method focuses on: ?Understanding the culture of autism ?Using an individualized person and family-centered plan ?Organizing the physical environment ?A predictable sequence of activities ?Visual schedules ?Routines with flexibility ?Structured work/activity systems ?Visually structured activities Nonrandomized studies comparing TEACCH with no intervention have noted improvements in fine motor skills, gross motor skills, cognitive functioning, social adaptive functioning, and communication skills. The 2011 Agency for Healthcare Research and Quality (AHRQ) systematic review of four studies of TEACCH published after 2000 found some evidence of benefit in cognitive and motor function but that the body of evidence was insufficient to estimate the magnitude of the effect. This conclusion is similar to that of earlier systematic reviews, although one categorized TEACCH as "likely to be beneficial", based upon consensus

Developmental and relationship-based models focus on teaching skills that are essential to development (eg, social communication, emotional relationships, cognitive abilities) that were not learned adequately at the expected age. Developmental and relationship models include the Denver model; Developmental Individual Difference Relationship-based approach (DIR or Floortime); Relationship-Development Intervention (RDI): Reciprocal interaction; Incidental teaching; Pivotal Response Training (PRT); and Responsive Teaching (RT). Developmental therapies often are used in clinical practice. However, the current evidence is inconclusive. The variety of approaches to developmental therapies makes it difficult to interpret, compare, and generalize results. A 2008 systemic review found evidence of benefit for some developmental approaches, as illustrated below: ?Milieu therapy was associated with improvement in cognitive skills, overall course, and communication and play skills. ?Responsive teaching was associated with improvements in quality of social communication and expressive language. ?The More Than Words program was associated with positive outcomes in facilitative strategies and vocabulary, but failed to show gains in other areas.

Uses play, interpersonal relationships, and activities to remediate core deficits in imitation, emotion sharing, theory of mind, and social perception

Integrative program that uses a combination of developmental and relationship-based approaches and intensive applied behavior analytic (ABA) programming; includes parents as therapists

Focuses on "floor time" play sessions and other strategies to enhance relationships and social interactions to facilitate emotional and cognitive development; seeks to address deficits in auditory processing, language, motor planning and sequencing, sensory modulation, and visual-spatial processing

Focuses on teaching children new communication skills and behaviors in their natural environments

Family-focused program that provides parents with practical tools to help their child communicate

Focuses on activities that elicit interactive behaviors to engage the child in a social relationship; utilizes play-based scenarios that draw out social behaviors and secondarily motivate the child to be more social

Development curriculum implemented by parents during routine interactions in the child's natural environment to address cognitive, communication, and social needs

Many programs use an integrative approach that combines developmental and behavioral approaches in the natural environment. Joint Attention Symbolic Play Engagement and Regulation (JASPER) addresses development of joint attention and social communication

Comprehensive integrative models address multiple domains of function. The Social Communication/Emotional Regulation/Transactional Support (SCERTS) program is an example, although it is sometimes classified as a relationship-based model. The SCERTS program provides individualized, collaborative programming that addresses social communication deficits and interfering behaviors to help the child increase his or her competence and independence using various strategies supported in the literature.

Intensive Behavioral Interventions, TEACCH Method, Developmental and Relationship Models, Integrative Models, Comprehensive Integrative Models, Parental Role, and Interventions for Specific Behaviors

Seeks to target the defining symptoms of ASD and are based on principles of behavior modification. Intensive behavior programs may improve core symptoms of ASD and maladaptive behaviors but should not be expected to lead to typical function. To maximize success, intensive behavioral programs should have a low student-to-therapist ratio. They may be delivered in a variety of settings (eg, home, self-contained classroom, inclusive classroom, community). Examples of specific intensive behavior intervention programs include: ?Discrete trial training (DTT), which is the most structured form of intensive behavior therapy; it was developed by Ivar Lovaas. ?Contemporary ABA programs, which occur in more naturalistic settings; they include pivotal response training (PRT), language paradigms, and incidental teaching (teaching as events occur in the context of the natural environment). ?Early intensive behavioral intervention (EIBI). The studies revealing the most gains for intensive behavior programs included a high level of intervention (eg, 30 to 40 hours per week of intensive one-on-one services for two or more years and starting before the age of five years). However, the evidence is insufficient to provide a general recommendation that all children with ASD require this level of intervention. The most significant improvements generally are seen within the first 12 months of treatment. Pretreatment variables that are associated with improved outcomes include the presence of joint attention, functional play skills, higher cognitive abilities, and decreased severity of autism symptoms. Although research is ongoing, it is unclear whether one type of intensive behavioral intervention is better than another, how to determine which children with ASD will respond maximally to intensive behavioral interventions, and whether intensive behavior programs should be recommended over other types of treatment programs.

An intensive behavior intervention (seek to target the defining symptoms of ASD and are based on principles of behavior modification). ABA seeks to reinforce desirable behaviors and decrease undesirable behaviors. The goals of ABA are to teach new skills and generalize learned skills by breaking them down into their simplest elements. The skills are taught through repeated reward-based trials. Compared with other interventions - Although ABA methods appear to be efficacious when compared with control interventions (eg, special education), it is not clear that ABA is superior to other behavioral therapy methods. ABA for older children - There is some controversy about the use of ABA for older children, and there are few studies to guide recommendations for this age group. The studies tend to be smaller both in duration and in numbers. Children requiring ABA at an older age may be more impaired than children who no longer require ABA. In such children, ABA may be used to target specific needs, rather than broad deficits, limiting the generalizability of study results.

The TEACCH method uses Structured Teaching to help individuals overcome areas of weakness. The goal is to modify the environment and to improve skills. This model incorporates the therapist as generalist (meaning that the therapist understands the whole child and does not specialize in one developmental discipline), is individualized to the student, and includes family involvement. The TEACCH method focuses on: ?Understanding the culture of autism ?Using an individualized person and family-centered plan ?Organizing the physical environment ?A predictable sequence of activities ?Visual schedules ?Routines with flexibility ?Structured work/activity systems ?Visually structured activities Nonrandomized studies comparing TEACCH with no intervention have noted improvements in fine motor skills, gross motor skills, cognitive functioning, social adaptive functioning, and communication skills. The 2011 Agency for Healthcare Research and Quality (AHRQ) systematic review of four studies of TEACCH published after 2000 found some evidence of benefit in cognitive and motor function but that the body of evidence was insufficient to estimate the magnitude of the effect. This conclusion is similar to that of earlier systematic reviews, although one categorized TEACCH as "likely to be beneficial", based upon consensus

Developmental and relationship-based models focus on teaching skills that are essential to development (eg, social communication, emotional relationships, cognitive abilities) that were not learned adequately at the expected age. Developmental and relationship models include the Denver model; Developmental Individual Difference Relationship-based approach (DIR or Floortime); Relationship-Development Intervention (RDI): Reciprocal interaction; Incidental teaching; Pivotal Response Training (PRT); and Responsive Teaching (RT). Developmental therapies often are used in clinical practice. However, the current evidence is inconclusive. The variety of approaches to developmental therapies makes it difficult to interpret, compare, and generalize results. A 2008 systemic review found evidence of benefit for some developmental approaches, as illustrated below: ?Milieu therapy was associated with improvement in cognitive skills, overall course, and communication and play skills. ?Responsive teaching was associated with improvements in quality of social communication and expressive language. ?The More Than Words program was associated with positive outcomes in facilitative strategies and vocabulary, but failed to show gains in other areas.

Intensive Behavioral Interventions, TEACCH Method, Developmental and Relationship Models, Integrative Models, Comprehensive Integrative Models, Parental Role, and Interventions for Specific Behaviors

Seeks to target the defining symptoms of ASD and are based on principles of behavior modification. Intensive behavior programs may improve core symptoms of ASD and maladaptive behaviors but should not be expected to lead to typical function. To maximize success, intensive behavioral programs should have a low student-to-therapist ratio. They may be delivered in a variety of settings (eg, home, self-contained classroom, inclusive classroom, community). Examples of specific intensive behavior intervention programs include: ?Discrete trial training (DTT), which is the most structured form of intensive behavior therapy; it was developed by Ivar Lovaas. ?Contemporary ABA programs, which occur in more naturalistic settings; they include pivotal response training (PRT), language paradigms, and incidental teaching (teaching as events occur in the context of the natural environment). ?Early intensive behavioral intervention (EIBI). The studies revealing the most gains for intensive behavior programs included a high level of intervention (eg, 30 to 40 hours per week of intensive one-on-one services for two or more years and starting before the age of five years). However, the evidence is insufficient to provide a general recommendation that all children with ASD require this level of intervention. The most significant improvements generally are seen within the first 12 months of treatment. Pretreatment variables that are associated with improved outcomes include the presence of joint attention, functional play skills, higher cognitive abilities, and decreased severity of autism symptoms. Although research is ongoing, it is unclear whether one type of intensive behavioral intervention is better than another, how to determine which children with ASD will respond maximally to intensive behavioral interventions, and whether intensive behavior programs should be recommended over other types of treatment programs.

An intensive behavior intervention (seek to target the defining symptoms of ASD and are based on principles of behavior modification). ABA seeks to reinforce desirable behaviors and decrease undesirable behaviors. The goals of ABA are to teach new skills and generalize learned skills by breaking them down into their simplest elements. The skills are taught through repeated reward-based trials. Compared with other interventions - Although ABA methods appear to be efficacious when compared with control interventions (eg, special education), it is not clear that ABA is superior to other behavioral therapy methods. ABA for older children - There is some controversy about the use of ABA for older children, and there are few studies to guide recommendations for this age group. The studies tend to be smaller both in duration and in numbers. Children requiring ABA at an older age may be more impaired than children who no longer require ABA. In such children, ABA may be used to target specific needs, rather than broad deficits, limiting the generalizability of study results.

Intensive Behavioral Interventions, TEACCH Method, Developmental and Relationship Models, Integrative Models, Comprehensive Integrative Models, Parental Role, and Interventions for Specific Behaviors

Seeks to target the defining symptoms of ASD and are based on principles of behavior modification. Intensive behavior programs may improve core symptoms of ASD and maladaptive behaviors but should not be expected to lead to typical function. To maximize success, intensive behavioral programs should have a low student-to-therapist ratio. They may be delivered in a variety of settings (eg, home, self-contained classroom, inclusive classroom, community). Examples of specific intensive behavior intervention programs include: ?Discrete trial training (DTT), which is the most structured form of intensive behavior therapy; it was developed by Ivar Lovaas. ?Contemporary ABA programs, which occur in more naturalistic settings; they include pivotal response training (PRT), language paradigms, and incidental teaching (teaching as events occur in the context of the natural environment). ?Early intensive behavioral intervention (EIBI). The studies revealing the most gains for intensive behavior programs included a high level of intervention (eg, 30 to 40 hours per week of intensive one-on-one services for two or more years and starting before the age of five years). However, the evidence is insufficient to provide a general recommendation that all children with ASD require this level of intervention. The most significant improvements generally are seen within the first 12 months of treatment. Pretreatment variables that are associated with improved outcomes include the presence of joint attention, functional play skills, higher cognitive abilities, and decreased severity of autism symptoms. Although research is ongoing, it is unclear whether one type of intensive behavioral intervention is better than another, how to determine which children with ASD will respond maximally to intensive behavioral interventions, and whether intensive behavior programs should be recommended over other types of treatment programs.

Intensive Behavioral Interventions, TEACCH Method, Developmental and Relationship Models, Integrative Models, Comprehensive Integrative Models, Parental Role, and Interventions for Specific Behaviors