January 10, 2012

Beginning The Search For Best Practice Interventions For Individuals With ASD

The following is written by Sarah Kunkel, a Positive Behavior Support Trainer for the West Virginia Autism Training Center. Sarah provides a discussion on best practice interventions for individuals with autism spectrum disorders.

Many of the same questions are asked by parents soon after their child has received a diagnosis on the autism spectrum:

Where do we go from here?

What do I do next?

What is the best course of action for my child?

There are answers to those questions, although finding answers to fit the individual needs of a specific child isn’t always simple. The Internet can provide a plethora of information, suggestions, and potential answers. Google "autism therapy" and 32 million hits are found!

How can any one person or family sift through this sea of information?

Fortunately, there are specific therapies that are accepted as best practice for autism. Therapies with this label are considered the best of all available treatments to significantly make a difference. In addition, best practice methods are scientifically sound and empirically tested. Many different scientists, professors, therapists, and other professionals have proven through research that these therapies make a significant difference in the lives of individuals diagnosed with an autism spectrum disorder.

So, what are these best practice therapies? This article will cover some of the better known interventions.

The most well-known of these is Applied Behavior Analysis, or ABA. ABA is a systematic and scientific approach to understanding how behavior is affected by the environment. Through data collection, observation, and interviews of family and teachers, the ABA method allows for a hypothesize to be formed regarding the function of maladaptive behavior; then that hypothesis is used to create an intervention to reduce the challenging behavior. For instance, Sally may often scream out in class at what appears to be random times. After collecting data and observing Sally’s behavior, her teacher notices that the screaming occurs mostly during group instruction but not during one-on-one instruction. As a result, she decides to ignore Sally when she screams out but praise her when she raises her hand. Soon the teacher notices that Sally is hardly ever screaming out during group instruction.

ABA is sometime confused with Discrete Trial Therapy, or DTT. DTT is a type of ABA therapy and it is best associated with the research of Ivar Lovaas, who had success utilizing DTT interventions to teach skills to children diagnosed with autism. DTT can be utilized to teach a child each of the small steps involved in learning a skill in a systematic manner repeatedly to gain mastery. For instance, Billy is learning how to follow directions, so his teacher starts with one-step directions. While sitting at a table one-on-one working together, the teacher says “stand up,” and waits for Billy to respond. At first he needs some help with understanding her request, so she prompts him physically to stand up. After a few more attempts with this specific instruction, his teacher is able to fade the prompts to simply a gestural prompt. Eventually, Billy is able to follow the direction numerous times successfully with his teacher and mother. This skill is considered mastered and his teacher moves on to the next direction and eventually to two-step directions.

Because Billy’s teacher is very well educated about Autism and ABA, she also knows that she must utilize Natural Environment Training, or NET, to truly master this skill with Billy. NET is similar to DTT but takes place in a more unstructured fashion. This helps Billy generalize the skill he has learned across multiple environments (instead of just the table) and people. For instance, now that Billy has mastered the skill through DTT, his teacher may begin to give the direction in the lunchroom, at circle, and at other appropriate moments, or ask other adults at school to also give the direction to Billy in order to generalize this skill into real world situations.

Another best practice technique is Positive Behavior Support, or PBS. PBS grew out of ABA from a desire to be more person-centered and antecedent-focused. PBS utilizes the same behavioral principles established within ABA with the understanding that it is important to focus on improving the individual’s quality of life, creating interventions that mesh well with the family’s value system, and focus more on preventing the things that happen before the behavior (the antecedents) rather than using consequences to reduce the behavior. For instance, if Timmy has been hitting his classmates and a functional behavior assessment (FBA) revealed that he did this in order to get attention, PBS would focus more on teaching Timmy to request attention in a more functional manner, such as using verbal speech, PECS, or sign language instead of using a consequence strategy such as Timmy loses 5 minutes of recess every time he hits another student.

There are some other interventions and techniques that were not discussed within this article that are considered best practice,and perhaps we will cover them in a later article. However, it is very important to understand whether a proposed intervention or therapy is considered “best practice” before beginning treatment. This link leads to a document that includes an evaluation of many common interventions for individuals diagnosed on the autism spectrum. The National Professional Development Center On Autism Spectrum Disorders also provides detailed information on best practice methods and guidelines. That site can be accessed at this link.

It is  important to refer to guides such as these so that everyone can be a knowledgeable and responsible consumer. Additionally, it is important to ensure that a variety of the “best practice” techniques is utilized with each individual to ensure skills are learned and generalized across environments and that the individuals life is one of quality.

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