Early Intervention and Education for Autism Spectrum Disorder - A Closer Look
- What other services would you recommend?
- How often should Tim receive services?
- What key features should his program include?
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Possible medical causes/contributors to current functioning
- With his new diagnosis of ASD, Tim requires additional and more specialized services to support his acquisition of communication, social, play, learning, and self-help skills. Many different therapies are used in the treatment of ASD. A child’s individual needs, the family’s needs, and the availability of therapies in his or her geographic area may determine the choice of therapies.
- According to reports by the American Academy of Pediatrics (AAP) and the National Research Council (NRC), behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation.
- The earlier intervention can begin, the better for long-term outcomes. However, each child’s response to intervention may vary. It is never too late to begin teaching a child with autism new skills.
Applied Behavior Analysis (ABA)
A notable treatment approach for people with ASD is called applied behavior analysis (ABA). ABA has become widely accepted among health care professionals and is used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills. The child’s progress is tracked and measured.
There are several different interventions based on the principles of ABA. Some examples include Discrete Trial Training (DTT), Early Intensive Behavioral Intervention (EIBI), Pivotal Response Training (PRT), and Analysis of Verbal Behavior.
Several decades of research have demonstrated the effectiveness of ABA as an intervention to increase and decrease behaviors for children with ASD.
Types of ABA
There are different types of ABA. Following are some examples:
- Discrete Trial Training (DTT): DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored.
- Early Intensive Behavioral Intervention (EIBI): This is a type of ABA for very young children with ASD, usually younger than five, and often younger than three.
- Pivotal Response Training (PRT): PRT aims to increase a child’s motivation to learn, monitor his own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.
- Verbal Behavior Intervention (VBI): VBI is a type of ABA that focuses on teaching verbal skills.
TEACCH, a structured teaching method, uses visual cues to teach skills. For example, picture cards can help teach a child how to get dressed by breaking information down into small steps.
While fine and gross motor impairments are not universal or specific to ASD, the prevalence of such abnormalities in ASD is relatively high. Motor impairments have been found in skilled movement and eye-hand coordination, speed, praxis and imitation, gait, posture, and balance.
Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.
Sensory Integration (SI) Therapy
While sensory processing abnormalities are not universal or specific to ASD, the prevalence of such abnormalities in ASD is relatively high. Literature includes reports of both hypo- and hyperresponsiveness to sensory input.
SI therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.
This therapy is based on the supposition that children with ASD have difficulty processing external stimuli as demonstrated by symptoms such as hyperacusis, “tactile defensiveness,” or oral aversion due to the avoidance of foods because of smell, texture, or color. The goal of SI is to improve children’s ability to process and respond appropriately to sensory information. It is hoped that doing so may also improve overall balance, concentration, and control of impulses.
One of the core features of ASD is communication impairment. Children with ASD have deficits in their functional and social communication. They have difficulty using verbal and nonverbal means to meet their daily needs, such as making requests. They also have difficulty using language for social purposes.
Language abilities vary. Some children may be nonverbal, others may develop language that is highly idiosyncratic with echolalia, scripted speech, or unusual prosody (tone or inflection). In children with Asperger syndrome, for example, language skills, including articulation, vocabulary, and grammatical abilities, may be preserved. However, social or pragmatic aspects of language, such as the ability to engage in the give and take of social conversation, are impaired.
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.
Augmentative and alternative communication modalities may be used with children with ASD, such as sign language or the Picture Exchange Communication System (PECS). PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation.
There is some evidence to support the use of augmentative and alternative communication interventions.
PECS video icon
Social Skills Interventions
Social skills interventions may be beneficial for children with ASD. They can be incorporated into a child’s educational program in different ways. Examples include the use of social stories and participation in social skills groups and facilitated play groups, which are organized privately or through schools. When social skills instruction is provided, it should involve a curriculum-based program with measurable goals.
Social Stories™ provide a way of describing a particular scenario, such as a birthday party, to children with ASD. It breaks down the scenario step-by-step and emphasizes social cues, expectations, and appropriate responses to enhance understanding of the scenario.
Although there is some evidence to support the use of social skills instruction, it is primarily descriptive in nature. Research is ongoing in this area.
Developmental, Individual Differences, Relationship-Based Approach (DIR, also called “Floortime”)
Floortime focuses on emotional and relational development (feelings, relationship with caregivers)external icon. It also focuses on how the child deals with sights, sounds, and smells.
The idea behind Floortime is that an adult can help a child communicate better by meeting him at his developmental level and focusing on his strengths. Therapy is often built into play activities children are doing on the floor. Floortime therapists work on needs in areas such as speech and cognitive skills through an emphasis on emotional development. It is considered an alternative to behavioral therapies and is sometimes delivered in conjunction with them.
The 2001 National Research Council (NRC) reportEducating Children with Autism recommended children with ASD receive a minimum of 25 hours of intervention per week, 12 months a year. Available research suggests children with ASD require a certain intensity of services to ensure their continued development and progress. However, resources to provide such services vary within regions and from state to state. Therefore, children with ASD living in different geographic areas may have differing educational programs in terms of the hours of services per week they receive.
In Educating Children with Autism, the NRC identifies the following key features of effective intervention programs for children with ASD:
- Early entry
- Full-day, 5 days/week, full-year (12 month) program of intensive services
- “Use of planned teaching opportunities, organized around relatively brief periods of time for the youngest children (e.g., 15-20 minute intervals)”
- “Sufficient amount of adult attention in one-to-one or very small group instruction” (often with a student-teacher ratio of no larger than 2:1)
Note: This level of services is often not available and/or affordable for families, therefore creativity in a child’s program planning is important.
Given Tim’s age, less than three years, he continues to receive services through his local Early Intervention program. He must have an individualized family service plan (IFSP) if he is receiving services through the local early intervention program.
Federally Mandated Services:
The Individuals with Disabilities Education Act (IDEA) is a federal law that requires each state to ensure a free, appropriate public education is available in the least restrictive environment to all eligible children with disabilities residing in that state, thereby encouraging inclusive education.
- Part C: Early Intervention (EI) services for children birth to 2 years, 11 months
- Part B: special education and related services for children 3 through 21 years
Services covered under Part C are administered by the Department of Health or the Department of Education (depending on the state), while those covered under Part B are administered by the Department of Education.
Individualized Family Service Plan (IFSP)
For children birth to 3 years old, who are determined eligible for Early Intervention Services, an IFSP will be created. In developing the IFSP, the family’s needed services and supports are determined on an individual basis.
Under Part C, an IFSP is created for each child. This document outlines the Early Intervention goals and services for the family and child. The role of the child’s family in his development and service delivery plan constitutes a large part of the IFSP.
Components of IFSP
The role of the child’s family in his development and service delivery plan constitute a large part of the IFSP. An IFSP must contain information about:
- The infant’s or toddler’s present levels of physical, cognitive, communication, social or emotional, and adaptive development
- The family’s resources, priorities, and concerns relating to enhancing the development of the infant or toddler
- The major outcomes expected for the infant or toddler and his or her family, as well as criteria for determining progress made toward such outcomes; any revisions of either outcomes or services to achieve them must also be included
- The specific early intervention services necessary to meet the unique needs of the infant or toddler and the family, including the frequency, intensity, and method of delivery
- The natural environments in which the early intervention services will be provided, including a justification of the extent, if any, to which the services will not be provided
- The date the services will begin and their anticipated duration
- The identification of the service coordinator, from the profession most immediately relevant to the infant’s or toddler’s family’s needs, who will be responsible for the coordination and implementation of the plan with the other agencies and persons
- The steps to be taken to support the transition of the toddler with a disability to preschool or other appropriate services
The plan is developed in partnership among the parents, early intervention staff, and others who might be involved in the early intervention process.
It is important for Tim’s parents to know their rights under IDEA. IDEA requires these rights to be given to them at the first and any subsequent IFSP meetings.
Parents are an integral part of the IFSP development. They must be provided with the results of the early intervention team’s evaluation. They must agree to and sign the IFSP before services are implemented for their child. In addition, they have the right to disagree with the content of the IFSP and to discuss their concerns with other members of the IFSP team. If an agreement cannot be reached, Tim’s parents may ask for mediation or the early intervention agency may offer it.
Role of Parents
Parents of children with disabilities can and should be thoroughly involved in the development of the IFSP.
IFSP plans, requirements, and support resources vary by state.
Before Attending an IFSP Meeting
- Parents should make a list of things for the child to learn to do. Take notes about aspects of the child’s behavior that could interfere with the learning process. Describe the methods that have been found to be successful in dealing with these behaviors.
- Parents should gather any information the team may not already have. Examples include copies of medical records, past preschool records, or test or evaluation results. Add real-life examples to demonstrate the child’s ability in certain areas; reports do not say all there is to say about a child.
- Parents should plan to bring a family member or friend for support.
At the IFSP Meeting
- Parents should find out what related services are being provided and ask each professional to describe the kind of service he or she will be providing and what improvement might be expected as a result of these services.
- Parents should ask what can be done at home to support the program, such as applying skills learned at school to activities at home.
- Parents should discuss methods for handling behavior problems that are effective with the child.