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behavioral article

Behavioral Article

by Denise Spainhower

One child in every 166 children will be diagnosed as autistic.  Behavior teaching for Autistic children in early childhood is worth the cost and effort.  The only documented way for children with autism to become indistinguishable from their peers (parents call their children cured) is with the use of behavior teaching methods.  These children need to be diagnosed early and receive intensive intervention in a quality individualized multidisciplinary behavior program.  Even if a child or adult does not receive the proper services early there are still numerous benefits.  So why aren’t children immediately put into one of these programs after diagnosis?

There are many reasons that more quality behavior programs have not been introduced.  Some of these reasons include the many controversies around autism, the difficulty in getting a diagnosis, parents not knowing about behavioral methods, the cost, and the lack of programs.  Most public school programs are watered down versions of what is necessary.  They are portrayed to parents as a wonderful thing that they are giving to the child.  Unfortunately, they give parents a false sense of security that they are providing the necessary services for the child. 

Autism has been the subject of controversy for many years for various reasons.  The first controversy had to with a theory that was soon proven wrong that cold mothers with no attachment to their children made them autistic.  Although this theory wasn’t around long, it negatively impacted families already dealing with a difficult situation and influenced the thinking of many people.  The next controversy had to do with Applied Behavior Analysis and that instructors used subversives (hit the child’s leg) when the child did not respond with the correct answer.  Now there is the mercury controversy.  Many parents believe their children are suffering from mercury poisoning from government-required vaccinations.  Many natural alternatives (vitamins and herbs) are also controversial in traditional doctor and drug company’s opinions.  Also, it is debated between parents and the government whether the number of children who have autism has truly skyrocketed or if doctors are now doing a better job at diagnosing the disorder.  Another highly disputed area is whether the children are “cured” or if they are “unidentifiable from their peers.”

 Define Autism

“There are difficulties in defining autism as a syndrome, because of other developmental problems that often accompany it” (Jordan & Powell, 1996).  Autism is a neurological disorder where developmental problems can be seen soon after birth and many other children do not have problems until about 18 months of age, which is late-onset autism.  According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) by the American Psychiatric Association (1994), in order to be diagnosed with autism he or she must exhibit or have exhibited a specified number of problems in social interaction, in communication and in imaginative play, as well as unusual behaviors and restricted interests and activities by age 3.  Since autism has so many different aspects it is sometimes hard to get a proper diagnosis and receive early intervention.  It affects more boys than girls.  Professionals are now calling it autism spectrum disorder with several specific disorders within it such as Asperger’s Disorder, Pervasive Development Disorder (PDD), Pervasive Development Disorder Not Otherwise Specified (PDD-NOS), Rett’s Disorder, and Childhood Disintegrative Disorder to name the most popular. 

Most parents are given little hope once they receive a diagnosis and many are happy just to receive a diagnosis.  Parents are told that their child has a lifelong disability.  They are not told that there are ways to improve their child’s quality of life or perhaps cure them.  If parents were armed with at least some positive information they would spend what it takes to help their child.  Unfortunately, they do not receive this information and may go into denial or depression as a result.  This further delays their child from receiving early intensive intervention.

What are the costs:  Individualized multidisciplinary education is expensive.  Multidisciplinary teams can include:  an autism consultant, a special education teacher, speech therapist, physical therapist, occupational therapist, psychologist, social worker, student advocate, attorneys, parents, and a school administrator.  While most of these people will work with more than one child, it is labor intensive if done correct.  The teams spends time individually and collaboratively conducting initial and then periodic evaluations, team meetings, continually updating goals and objectives, working with the student or students as well as highly trained personnel to work with each child individually and prepare new materials.  Most programs do not have adequate autism consultant time which should lead the team, design the curriculum, train the team as well as paraprofessionals and suggest changes in methods.  This may require direct teaching time and observation.  The better the consultant and teachers know the child the better the services will be. 

Define Behavior Teaching:  Various Models

Behavior teaching also goes by many names and there are different versions.  A good program will use various characteristics of these programs that are individually suited to the child.  They must find the strengths of the child. 

Behavioral therapy is my favorite therapy so far because it can be used for a wide variety of behaviors and skills.  Behavioral Therapy is an autism teaching strategy to correct a child's behavior (rather it's throwing a tantrum, getting eye contact or teaching social skills) and includes these techniques:

Discrete trials include mass and expanded trials.

  • breakdown of tasks into small units
  • systematic use of reinforcement (food, praise or toy)
  • verbally simple using clear and straightforward language

Receptive language (understanding of language)

Expressive language (spoken use of language)

Action on object command ("Put the toy on the chair.")

Errorless teaching with most-to-least prompting.

Prompting:  positional, physical, gestural, verbal, and visual.  

Assists with focus and student being able to sit still.

ABA therapy is sometimes also called “discreet trial training” or the Lovaas Method. Pioneered by Dr. O. Ivaar Lovaas, professor emeritus at the University of California at Los Angeles, it is an early intervention program for children as young as 2 or 3 years old. ABA therapy refers to a wide variety of techniques that use rewards to develop new skills or reduce unwanted behaviors, like aggression or self-injury. Skills, such as learning to make eye contact, are developed one at a time. ABA is a highly structured, adult-led program (the adult directs the activity while the child follows along) intended to prepare a child to enter kindergarten by age 5 or 6. It involves intensive one-on-one instruction between the child and a therapist or parent. The therapy takes place in the home or school for as many as 20 to 40 hours per week.

ABA is backed by the strongest scientific support of any autism treatment, mostly based on Lovaas’s original 1987 study in which he cited a 47 percent recovery rate. However, no other study has replicated Lovaas’s results. ABA is recognized for its effectiveness in helping children learn language and cognitive skills, but critics charge that the rigid structure does not build social skills and that children tend to become more robotic in their responses and less spontaneous in adapting to real-world situations.

Pivotal Response Training or PRT is an approach based on the ABA method but is considered to be more naturalistic, meaning that instruction takes place in a relaxed environment and the teaching is child-centered, or guided by the child’s interests, motivations and favorite activities. Researchers believe that “pivotal behaviors” affect a range of responses in children with autism. Because these behaviors influence a diverse area of functions, positive changes can have a ripple effect on other behaviors. In PRT therapy, instructions and rewards are more varied than with traditional ABA. PRT is offered through clinics and school programs. 

Floortime was developed by Drs. Stanley Greenspan and Serena Wieder.  It is an alternative behavorial approach focused on helping children build fundamental skills needed for communication and relationships. It is primarily a home-based technique that enlists professional helpers to work alongside parents and their children. The adults get down on the floor with the child and follow the child’s natural interests.

Some critics say there is not enough scientific research supporting the effectiveness of DIR Floortime and that children with more severe autism may not be well-served by such a child-centered program. However, the Floortime Foundation claims that in a review of 200 children diagnosed with autistic spectrum disorders who were treated intensively with DIR Floortime for up to six years, more than 50 percent have "become warm, engaged and loving."

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is an approach developed in 1964 at the University of North Carolina at Chapel Hill. The classroom-based program evolved from the theory that children with autism have strong visual skills and respond well to visual cues and symbols. Instead of using rewards for behavior modification, TEACCH emphasizes picture systems to develop organizational skills and help children better understand what is expected of them. TEACCH is based on brain research that suggests people with autism have more difficulty switching their attention from one task to another. The approach focuses on helping children transition more smoothly from one activity to the next. 

Parent Involvement

Why early in Childhood

Benefits: 

Children such as Catherine Maurice’s, who wrote Let Me Hear Your Voice, have become indistinguishable to even an expert.  She recovered two of her children from autism several years ago and has worked hard to let other families know there is a possible cure.  Her children require no additional support in school.  She set-up her own program in their home.  She was smart enough to say that she knew she could help her children.  It was expensive, but compared to the alternative of having two children to support for the rest of their life was the alternative. 

A functioning human being in society perhaps without any government support in childhood and/or adulthood.

More direct teaching time with an experienced expert...  Not only does it assist the teachers, but also the children.  The current statistic is 1 in 166 children are in the autism spectrum. 

An autism consultant assists the teachers by:

  • Having specialized training in a field with a lot of unknowns and diversity of challenges
  • Keeping up with literature
  • Training teachers
  • Acting as a support person (cheerleader)
  • Someone to go to for problem solving
  • Understanding that many of these children do have bright futures!

These factors will in turn assist with special education teacher attrition.  We are very lucky to have such great teachers and should try to keep them.

As you can tell, this is an extremely important subject to me.  I heard a parent last week talk about how many of the public school programs had the placebo effect on autistic children (as well as parents!).  That statement brought tears to my eyes.  That is exactly what happened to Allen in the Early Childhood Program!  I was led to believe that the preschool was the only option for him.  Allen was in preschool for over a year and was slipping away from us right before our eyes.  After I requested (which I should NOT have had to do!!!) ABA-type services, he gained eye contact and his personality!  The changes were positive, finally!  He is far from recovered, but the significant changes in him are apparent today.  The School District has and will save enormous amounts of money on services for him due to this early intervention.  There is documented evidence that intensive work with a child early can RECOVER a child from autism.  Just think, he may not have needed any special services now and in the future if he had he received the intensive intervention much earlier when he should have.  We lost an entire year!

Sadly, most parents didn’t know that we had an Autism Consultant or what a valuable resource it is.  I feel guilty not letting them know about this resource because I was afraid it would take away the little bit of valuable time that Allen was receiving.  I should not have to feel that way.  I know that having an Autism Consultant is expensive, but the payoff not only for the schools, teachers and families is enormous!!!!  I can tell when Tracy has “consulted” with him.  He is more talkative, happy, plays with his toys.  It helps him in numerous ways.  It is an effective treatment.  I have seen it before my own eyes!

The Service Center needs to hire additional experienced people to do quality work with these children.  Again, the payoff can’t even be described.

One thing that experts and parents agree on is that behavioral therapy produces results that have been documented.  The problem with the use of it has many facets as well.  There are various types of behavior programs available.  Quality programs are expensive to run.  The behavior program must be individualized for each child and normally consists of a multidisciplinary team.  Also there are few people who know how to properly set-up programs for students.  None of this can happen until the child has been properly diagnosed. 

The bottom line is that the government must require those who are diagnosing children to give them adequate information and perhaps even more importantly referral to the school so that proper arrangements can be made to start  intensive intervention immediately.


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