by: Sabrina Riera and Suzi Naguib, Psy.D. March 2013
Has your child just been diagnosed with an Autism Spectrum Disorder (ASD)? You are not alone in feeling emotional, overwhelmed, or just plain confused on what to do next. What services are out there? What are the best treatments? Which ones will deliver the best outcomes? There are many misconceptions regarding the effectiveness of ASD therapies and treatments. Below you will find an overview of comprehensive treatment models (CTM) and information about focused intervention practices that are currently found to be most effective in early autism.
Earlier is better!
Studies have shown a number of benefits to early intervention for children with autism, including decreases in ASD related symptoms and problem behaviors, as well as improvements in development 12.
Choosing the right treatment
There are plenty of up-and-coming treatments for autism that show promise, but do not necessarily have sufficient research to back them up. When considering the best treatment for your child, it is important to keep in mind the potential risks that come with choosing a treatment that has not been tested effectively, especially when it may be taking the place of a treatment that would be beneficial for your child 11. Comprehensive Treatment Models (CTMs) are all encompassing, aiming to treat multiple ASD symptoms, including deficits in language, cognitive, social and play development. A team of multidisciplinary professionals provides intense intervention, typically 25 hours or more a week for several years, with the goal of not only improving behaviors, but also reducing the severity of the disability in the long-term 7, 8, 11, 12. The following is a review of CTMs:
I. Skills-Based Applied Behavior Analysis – Comprehensive Treatment Models:
Lovaas’ Applied Behavior Analysis (ABA) – The goal of ABA therapy is to essentially teach children how to learn. What does this mean? ABA therapists help children develop skills to improve IQ, expressive language, language comprehension, school functioning, and adaptive and social skills1. There have been numerous trials testing this treatment which show promising results, making it a well-established and effective treatment option 12, 11. However, like most therapies, there are some limitations. For example, because it focuses primarily on a behavioral approach, it may ignore the neurological or emotional aspects of ASD. It can also be very expensive, potentially costing a family up to $50,000 a year 1. Some insurance companies in Michigan and Medicaid programs do cover the cost ABA therapy for those who qualify, so make sure to talk to your insurance company regarding coverage.
Pivotal Response Treatment (PRT) – Pivotal Response Treatment (PRT) is a play-based therapy that is derived from ABA. It targets core areas of a child’s development, including motivation, initiation of social interactions, self-management, and response to various cues. The idea is that by targeting these key areas, other areas will improve, such as communication, social skills, and academic skills 14. Studies assessing PRT have found improvements in communication, language, play and imitation skills, in children who underwent treatment 12, 6,13. While there have been studies showing that this treatment does have promise, more research needs to be done to be sure how effective it is 12.
Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH) – The aim of the TEACCH approach is to help those with ASD gain the skills they need to lead independent lives. This treatment provides support from early childhood to adulthood, emphasizing the development of functional skills. Reports for TEACCH show promise: in addition to improving functional and adaptive skills, North Carolina reports high successful employment rates for participants. It is also compatible with a number of other ASD therapies, including Occupational Therapy (OT), Physical Therapy (PT), Picture Exchange Communication System (PECS), and Floortime. One of the downfalls to this approach, however, is the program’s lack of emphasis on developing social and communication skills 1. While the TEACCH model is considered a well-respected program, more research is still needed to determine its effectiveness 11.
Walden Early Childhood Program – Unlike other ABA interventions that use parent education programs, the Walden Early Childhood Program was created with the family’s specific lifestyle and routine in mind. This approach is called “incidental teaching,” which allows teaching and learning to occur constantly throughout the child’s day. Designed for toddlers and preschoolers with ASD, Walden supports peer engagement and family collaboration through play activities that promote social, language, and daily living skills. Parents are heavily involved in the treatment, playing a key role in teaching their child these skills and creating new intervention goals 15.
Learning Experiences: An Alternative Program for Preschoolers and Parents (LEAP) – LEAP allows preschoolers with ASD to participate in a program with typically developing peers12, 15. The program uses an individualized approach, tailoring its curriculum to meet the needs of each child and modifies specific teaching efforts depending on what works. The idea is to allow peers to promote social interactions and allow for natural teaching opportunities. LEAP also provides extensive training for parents 15. While current studies for this treatment show promise, more research needs to be done to determine just how effective it is 11, 15.
II. Developmental Relationship-Based Approaches – Comprehensive Treatment Models:
Developmental relationship-based approaches identify teaching goals based on assessments of a child’s developmental skills, creating individually tailored interventions for each area that is affected by ASD. These interventions are created by looking at the child’s current developmental profile across a number of areas, including communication, social, and cognitive skills 15. The following are several treatments that follow a developmental relationship-based approach:
Denver Model and the Early Start Denver Model (ESDM) – The Early Start Denver Model is a comprehensive early intervention program for toddlers with ASD. The treatment uses several approaches, specifically integrating ABA with developmental and relationship-based approaches 2. The Denver Model’s approach involves teaching during everyday family routines, like bathing, meals, and playtime, and targets all areas of development that are affected by ASD 15. Studies show very promising results: children who received this treatment had increases in IQ and improved language and adaptive behavior 2, 15.
Responsive Teaching – Responsive Teaching educates parents on how to use responsive interaction strategies, a set of procedures that encourage conversation between the child and the adult 15, 9. These strategies are catered specifically to address a child’s unique developmental needs, particularly in the following areas: social-emotional functioning, motivation, cognition, and communication 15.
Developmental Individual-Difference Model (DIR) also referred to as Floortime – Unlike some other ASD therapies,the DIR model does not treat specific ASD symptoms; instead, it uses personal interactions as a way of helping a child improve their developmental skills. This treatment also teaches parents how to engage with their children in happier and more relaxed ways by using a play-based approach that encourages parents to get on their child’s level 1. The goal of Floortime is to help children understand how they can intentionally interact with others and to build language, cognitive, and social skills. They use various activities, including spontaneous child-initiated play, problem-solving and motor tasks as well as sensory play. There isn’t a lot of research done on this treatment yet, so it is difficult to say how effective it is 15.
Early Social Interaction Project (ESI) – SCERTS – The Early Social Interaction (ESI) project is a parent-implemented treatment approach for young children with autism that integrates principles of ABA with developmental and relationship-based approaches. ESI uses a community based model teaching parents strategies to help their child develop communication, social and play based skills. They also provide parents with plenty of support and resources to teach and guide them in their child’s development 3. A multi-site study evaluating the effectiveness of this intervention was conducted at the University of Michigan Autism and Communication Disorders Center (UMAAC) and Florida State University (FSU) and data is currently being analyzed.
Unlike CTMs, focused interventions target specific behaviors and skills that are associated with autism, such as sleep challenges, play and social skills, tantrums, and aggression 7, 11. Some of these strategies are based on principles of applied behavior analysis (ABA) and positive behavior supports (PBS) 7, 11. The National Professional Development Center (NPDC) on Autism has identified many of these as evidence-based practices according to specific research criteria 8. For more information about evidence-based practices, including step-by-step guidelines and corresponding implementation checklists please follow this link to the NPDC website.
1Autism Treatments: Current Interventions in Autism- A Brief Analysis. Retrieved from www.theautismprogram.org
2Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A. & Varley, J. (2010). Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics, 125, 17-23.
3Early Social Interaction Project- About ESI. (2012). Retrieved from http://esi.fsu.edu/
4Laugeson, E. (2013, March 6). PEERS for Adolescents. Retrieved from http://www.semel.ucla.edu/peers/teens
5Lerna, A., Esposito, D., Conson, M., Russo, L. & Massagli, A. (2012). Social communicative effects of the Picture Exchange Communication System (PECS) in Autism Spectrum Disorders. International Journal of Language and Communication Disorders, 47, 609-617.
6Minjarez, M.B., Williams, S.E., Mercier, E.M., & Hardan, A.Y. (2011). Pivotal Response Group Treatment Program for Parents of Children with Autism. Journal of Autism and Developmental Disorders, 41, 92-101.
7 Odom, S. L., Boyd, B. A., Hall, L. J. & Hume, K. (2009). Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. Journal of Autism & Developmental Disorders, 40, 425-436.
8 Odom, S.E., Collet-Klingenberg, L., Rogers, S. J. & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure, 54 (4), 275-282.
9 Odom, S.L., Horner, R.H., Snell, M.E., & Blacher, J. (Eds.). (2007). Interventions for Preschoolers. Handbook of Developmental Disabilities (191). New York, NY: The Guilford Press.
10 Pivotal Response Treatment (PRT). Retrieved from http://www.autismspeaks.org/what-autism/treatment/pivotal-responsetherapy-prt
11 Rogers, S. J. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27(2), 168-179.
12 Rogers, S. J. & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37 (1), 8-38.
13 Stahmer, A.C. (1999). Using pivotal response training to facilitate appropriate play in children with autistic spectrum disorders. Child Language Teaching andTherapy, 15, 29-40.
14 Sussman, F. More Than Words: The Hanen Program for Parents of Children with Autism Spectrum Disorder. Retrieved from http://www.hanen.org/Helpful Info/Research-Summaries/More-Than-Words-Research-Summary.aspx
15 Vismara, L.S. & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorders: What do we know? Annual Review of Clinical Psychology 6, 447-68.