children with autism Behavioural Interventions Focus on application of learning theory and skill development. Use of Applied Behaviour Analysis (ABA). Example: Pivotal Response Training (PRT) Developmental Interventions Focus on development of social emotional capacities. Example: Relationship Development Intervention (RDI) Therapy Based Interventions Focus on communication and social development or sensory motor development. Usually designed for use with other interventions. Example: Picture Exchange Communication System (PECS). Combined Interventions Incorporate behavioural and developmental strategies. Often include sensory issues. Focus on working with and managing the characteristics of autism. Examples: TEACCH (Treatment and Education of Autistic and Communication Handicapped Children, Early Start Denver Model (ESDM) Family Based Interventions Focus on working with families to develop skills in working with their children. Example: The Hanen Program Other Interventions Example: Music Therapy
Research Evidence for Autism Specific Early Intervention Evidence from high quality intervention trials is somewhat inconsistent. There are also few studies which are able to show whether real improvements have been made as a direct result of the interventions carried out. There is little well documented information about potential adverse treatment outcomes, and few studies that rigorously assess cost benefit of treatments. High intensity interventions which address the child and family’s clearly documented needs, using behavioural, educational and/or developmental approaches have been shown to be the best of currently available early interventions. Research has consistently shown good outcomes for intensive ABA programs and there is growing evidence that intensive developmental and combined programs are also effective. Some interventions have been proven to be ineffective and should be avoided. Reviewers of programs remain cautious in their conclusions about longer term outcomes for children with autism, in social, adaptive or vocational areas, or greater independence in adulthood. There are too few well controlled studies to allow for confident claims about what types of intervention are best for improving long term learning and adaptive functioning. We can define key elements which are necessary for effective intervention. An autism specific curriculum content focusing on attention, compliance, imitation, language, and social skills. Highly supportive teaching environments which deal with
the need for predictability and routine, and with challenging behaviours, obsessions, and ritual behaviours. Support for children in their transition from the preschool classroom. Support for family members via partnership with professionals involved in treatments. Amount, timing and duration of treatment The amount of intervention is usually described as number of hours of treatment per week. Fifteen to twenty-five hours per week is generally recommended for autism early intervention in the research literature (Roberts & Prior, 2006) with some programs recommending as much as 40 hours per week. Quality of intervention is as important as quantity. Intervention should start as soon as characteristics of ASD are noted and continue for as long as required. Characteristics of autism are lifelong, however the need for support varies among individuals and according to their age and stage. Intensity, timing and duration of intervention should be based on individual needs. Individual variation It is important to account for the whole spectrum of autism disorders and to recognise that no one child with autism will have the same pattern of strengths and needs as another. In addition, families differ in their goals, strengths, and needs. Hence, no one program will suit all children with autism and their families. There are benefits from early, intensive, family-based treatment programs, so long as these are adapted to the child’s pattern of strengths and weaknesses and take account of family circumstances.