Evaluation of a Multi-Pronged Intervention with an Autistic Child: A Grounded Action Research

An action research was conducted to develop an intensive multi-pronged individualized therapeutic plan for an autistic child (Asad*). The plan was based on humanistic and behavioral approaches. Mixed method approach was adopted in order to evaluate the progress of the interventions. The quantitative evaluation of the improvement was done using The Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1980) and subjective ratings. Qualitative analysis was conducted using grounded theory on reflective journals, which was also used to build theoretical model of therapeutic process. This cyclic process of continuous reflection, action and then again reflection created a prominent change in the child's daily functioning including social interaction, compliance, self help, concentration, on-seat behavior, and multiple verbal and non-verbal behaviors.Keywords: autism, child, multi-pronged, intervention, action research. * Asad is a pseudonym given to the child in the present study.Autism first appeared as an identified disorder of children in the 1930s and has been increasing in incidence ever since, to the point that in 2002, nearly 120,000 children with autism were being served under the Individual with Disabilities Education Act (IDEA) - an increase of 500 percent over the previous decade. In the United States, Centre for Disease Control and Prevention has estimated that one in 1 10 children have autism (Estepp, 2009). One recent study, conducted by Suhail and Zafar (2008), shown that the prevalence of autism in Lahore, Pakistan, is 6.31%. Results further elaborated that the equally more common characteristics of autism in these children were "relating to people", "emotional responses" and "visual responses". Autism is quite prevalent in Pakistan but there is a huge gap of research in this field. The statistics about its prevalence is almost non-existent. According to Azeem (2009) the number of people falling in autism spectrum disorders is a minimum of 3,45,600 out of 172,800,048 population of Pakistan. He further argues that this figure is not accurate because of factors like misdiagnosis, social stigma and underreporting of the disorder. Not much work has been done on the development of individually tailored interventions for autistic children.Although assessment case studies have been conducted (Sahu, 2006) but very little work has been done on evaluating the efficacy of different intervention models with autism through the use of case studies. There have been many studies conducted on the efficacy of doing intensive behavioral therapy with autistic children. These studies have shown that implementing behavior therapy intensively on autistic children is mostly fruitful, especially if started at an early age. Outcomes of the intensive Behavioral intervention at the age of 35-41 months (Lovaas, 1987) and 6 year old autistic children (Conner, 1998) suggested that intensive behavioral approach couldachieve positive outcomes especially if implemented at an early pre-school age. Thus, intensive intervention plan started at an early age can bring drastic improvements in autistic children. These intensive programs are mostly based on the behavioral approaches that have often proved effective while working with autistic children. Behavior intervention is considered more satisfying by parents (Runco&Schieberman, 1983), improves behavioral problems (Campbell, 2003) and also demonstrates greater improvements in IQ, visual spatial skills, and language skills (Smith, Groen, & Wynn, 2000). In the present study, we have also used humanistic interventions including play therapy, speech therapy, art therapy and music therapy. As children with autism have poor or no communication skills and social interaction and furthermore, they are not much expressive and receptive, parents usually communicate and interact with them less frequently than their other kids. Therefore in this study we used a humanistic approach i. …