Combining Treatment Approaches in Working with Children with Autism

1. Combining Treatment Approaches in Working with Children with Autism By Tracy Vail,MS,CCC/SLP Letstalksls.com

2. Most Common Approaches Used • Behavioral Approaches- ABA- Applied Behavior Analysis and Applied Verbal Behavior, TEACCH • Developmental Approaches- SCERTS, Floortime/DIR, RDI

3. Can We Combine Behavioral and Developmental Approaches? YES!!!

4. General Language Categories • Language used to meet the needs of the individual • Language used for social interactions and building relationships • Language used for “learning” or academic settings

5. Factors to Consider • No single “program” works for all children to address all their needs. • Every human being’s learning ability is a combination of internal and external factors. • Motivation of the child is the most important factor to consider when making treatment decisions.

6. Relevant Information About Learners with Autism • They tend to have very analytical minds • They tend to have unusual motivations and consequently unusual reinforcers • They tend to be “rule based” learners • Their bodies experience the world in an unusual way • Some are quite rigid and anxious • They often have difficulty understanding the “rules” of social interaction and communication So what…..Now what?

7. Use Whatever Works to Teach the Most Important Skills to each Individual child at the Given Time So how do we know what’s most important?

8. Ask and Observe • Ask the parents! What are their priorities? • Observe the child- What areas are causing the child the most difficulty in life right now? • Look at where the child is currently functioning and determine the necessary component behaviors/skills to meet the goals of the parents and child. • What are the goals of the family in 1 yr? 5 yrs? 10 yrs?

9. Developmental, Individual Differences, Relationship Based Intervention, DIR/Floortime • A warm and intimate way of relating to a child. A floor time philosophy means engaging, respecting and getting in tune with the child in order to help the child elaborate through gestures, words and pretend play what is on the child’s mind. As a technique it is a process that is used to support the emotional and social development of the child. (Greenspan, 2002) This model serves as the context or “container” of the therapy we do. But what does it mean?

10. Hanen Method • Teaching communication and play skills through adult- child interactions. Parents/therapists are to: • Observe, Wait and Listen (OWL) • This approach is very similar to DIR in that the child leads and teaching is conducted based on the interests of the child.

11. Relationship Development Intervention • A cognitive- developmental approach designed to remediate Autism. • Deals with autism as a neurologically based, information processing disorder. • Proposes to remediate the “Core Deficits” in Autism including motivation, communication, emotional regulation, episodic memory, rapid attention shifting, self-awareness, appraisal, executive functioning, flexible thinking, and creative problem solving. Great stuff based on research by many in the field but what do these “core deficits” mean? How do we know when these skills have improved? What is the child doing? How can we measure it? AND, is it really necessary to spend thousands of dollars being trained to address these issues?

12. Behavioral Approaches • Scientifically validated based on many years of research. • Based on measurable behaviors either internal or observable. • Based on the “laws of learning” • Places the responsibility of learning on the “teacher” rather than the student • Many “faces” to behavioral interventions. Not all programs look alike • Data driven program decisions

13. Applied Verbal Behavior • Based on the research of BF Skinner on “why” people communicate • Language is categorized into verbal operants or functions • Language is taught as a behavior with specific teaching procedures used • Both natural environment teaching and intensive teaching are used based on the age and skills of the child • Resources: Educate Toward Recovery by Robert Schramm, Assessment of Basic Language and Learning by James Partington and Mark Sundberg.

14. TEACCH • The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence.  To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.”   • The principles of Structured Teaching include: • Understanding the culture of autism. • Developing an individualized person- and family-centered plan for each client or student, rather than using a standard curriculum. • Structuring the physical environment. • Using visual supports to make the sequence of daily activities predictable and understandable . • Using visual supports to make individual tasks understandable (TEACCH Website)

15. The Language We Use • Often it isn’t what we do but how we talk about what we do that makes approaches seem so different. • The language we use to talk about what we do should be precise, agreed upon and based on “observable” or “measurable” change. • As SLPs we are charged to provide “evidenced based practices”. Show me the data!!

16. Sam

17. He remained engaged with the instructor for 3.5 minutes. He requested using gestures 4 times with no prompting. He imitated body movements twice with no prompting. He looked at the instructor twice and smiled. He laughed in response to the instructors actions twice. He initiated a social game twice with no prompting. He shared affect He shared attention He both opened and closed 5 circles of communication The instructor followed the child’s lead He demonstrated a preference to engage in a regulatory pattern with ongoing variations He regulated his actions to maintain social coordination He responded to guides role actions to maintain the regulatory status of the pair. What did you observe with Sam?

18. Children are Complete Human Beings • They have a right to communicate to get their needs met • They want and need successful relationships in their lives • While they have some similarities, they all have unique needs that should be addressed • Each family structure is different and has unique priorities and needs • Child and family needs will change over time and programs need to reflect that

19. Early Learners • Build trust/relationship by being predictable • People are fun and “talking” is fun • “Talking” is useful- I talk, I get Use a combination of principles from DIR, Floortime and VB

20. Build Context/Motivation to Communicate

21. Communicating Before Talking

22. Use Music

23. Use Books

24. Shape Speech in the Context of Requesting

25. Teach Them a Way to Communicate

26. Intermediate Learners • Advance language and literacy skills • Continue to include relationship development • Include intensive teaching based on the needs of the child • Expand play skills

27. Teaching Mastered Skills in Intensive Teaching

28. Expand Play Skills

29. Advanced Language Learners • Higher Level Language Skills • Continue to build relationships • Problem solving/negotiating • Foster success in academic and social settings

30. Advanced Pretend Play

31. Problem Solving and Story Comprehension

32. Negotiating/Problem Solving

33. Thanks for All You Give to Children!