Can
Social Skills and Behavior Be Improved?
A
number of treatment approaches have
evolved in the decades since autism
was first identified. Some therapeutic
programs focus on developing skills
and replacing dysfunctional behaviors
with more appropriate ones. Others
focus on creating a stimulating learning
environment tailored to the unique
needs of children
with autism.
Researchers
have begun to identify factors
that make certain treatment programs
more effective in reducing- or reversing-the
limitations imposed by autism. Treatment
programs that build on the child's
interests, offer a predictable schedule,
teach tasks as a series of simple
steps, actively engage the child's
attention in highly structured activities,
and provide regular reinforcement
of behavior, seem to produce the greatest
gains.
Parent
involvement has also emerged as a
major factor in treatment success.
Parents work with teachers and therapists
to identify the behaviors to be changed
and the skills to be taught. Recognizing
that parents are the child's earliest
teachers, more programs are beginning
to train parents to continue the therapy
at home. Research is beginning to
suggest that mothers and fathers who
are trained to work with their child
can be as effective as professional
teachers and therapists.
Developmental approaches
Professionals
have found that many children with
autism learn best in an environment
that builds on their skills and interests
while accommodating their special
needs. Programs employing a developmental
approach provide consistency and structure
along with appropriate levels of stimulation.
For example, a predictable schedule
of activities each day helps children
with autism plan and organize their
experiences. Using a certain area
of the classroom for each activity
helps students know what they are
expected to do. For those with sensory
problems, activities that sensitize
or desensitize the child to certain
kinds of stimulation may be especially
helpful.
In one developmental preschool classroom,
a typical session starts with a physical
activity to help develop balance,
coordination, and body awareness.
Children string beads, piece puzzles
together, paint and participate in
other structured activities. At snack
time, the teacher encourages social
interaction and models how to use
language to ask for more juice. Later,
the teacher stimulates creative play
by prompting the children to pretend
being a train. As in any classroom,
the children learn by doing.
Although
higher-functioning children may be
able to handle academic work, they
too need help to organize the task
and avoid distractions. A student
with autism might be assigned the
same addition problems as her classmates.
But instead of assigning several pages
in the textbook, the teacher might
give her one page at a time or make
a list of specific tasks to be checked
off as each is done.
Behaviorist approaches
When
people are rewarded for a certain
behavior, they are more likely to
repeat or continue that behavior.
Behaviorist training approaches are
based on this principle. When children
with autism are rewarded each time
they attempt or perform a new skill,
they are likely to perform it more
often. With enough practice, they
eventually acquire the skill. For
example, a child who is rewarded whenever
she looks at the therapist may gradually
learn to make eye contact on her own.
Dr.
O. Ivar Lovaas pioneered the use of
behaviorist methods for children with
autism more than 25 years ago. His
methods involve time-intensive, highly
structured, repetitive sequences in
which a child is given a command and
rewarded each time he responds correctly.
For example, in teaching a young boy
to sit still, a therapist might place
him in front of chair and tell him
to sit. If the child doesn't respond,
the therapist nudges him into the
chair. Once seated, the child is immediately
rewarded in some way. A reward might
be a bit of chocolate, a sip of juice,
a hug, or applause-whatever the child
enjoys. The process is repeated many
times over a period of up to two hours.
Eventually, the child begins to respond
without being nudged and sits for
longer periods of time. Learning to
sit still and follow directions then
provides a foundation for learning
more complex behaviors. Using this
approach for up to 40 hours a week,
some children may be brought to the
point of near-normal behavior. Others
are much less responsive to the treatment.
However,
some researchers and therapists believe
that less intensive treatments, particularly
those begun early in a child's life,
may be more efficient and just as
effective. So, over the years, researchers
sponsored by NIMH and other agencies
have continued to study and modify
the behaviorist approach. Today, some
of these behaviorist treatment programs
are more individualized and built
around the child's own interests and
capabilities. Many programs also involve
parents or other non-autistic children
in teaching the child. Instruction
is no longer limited to a controlled
environment, but takes place in natural,
everyday settings. Thus, a trip to
the supermarket may be an opportunity
to practice using words for size and
shape. Although rewarding desired
behavior is still a key element, the
rewards are varied and appropriate
to the situation. A child who makes
eye contact may be rewarded with a
smile, rather than candy. NIMH is
funding several types of behaviorist
treatment approaches to help determine
the best time for treatment to start,
the optimum treatment intensity and
duration, and the most effective methods
to reach both high- and low-functioning
children.
Nonstandard approaches
In
trying to do everything possible to
help their children, many parents
are quick to try new treatments. Some
treatments are developed by reputable
therapists or by parents of a child
with autism, yet when tested scientifically,
cannot be proven to help. Before spending
time and money and possibly slowing
their child's progress, the family
should talk with experts and evaluate
the findings of objective reviewers.
Following are some of the approaches
that have not been shown to be effective
in treating the majority of children
with autism:
- Facilitated
Communication,
which assumes that by supporting
a nonverbal child's arms and fingers
so that he can type on a keyboard,
the child will be able to type out
his inner thoughts. Several scientific
studies have shown that the typed
messages actually reflect the thoughts
of the person providing the support.
- Holding
Therapy, in which the parent
hugs the child for long periods
of time, even if the child resists.
Those who use this technique contend
that it forges a bond between the
parent and child. Some claim that
it helps stimulate parts of the
brain as the child senses the boundaries
of her own body. There is no scientific
evidence, however, to support these
claims.
-
Auditory Integration Training,
in which the child listens to a
variety of sounds with the goal
of improving language comprehension.
Advocates of this method suggest
that it helps people with autism
receive more balanced sensory input
from their environment. When tested
using scientific procedures, the
method was shown to be no more effective
than listening to music.
- Dolman/Delcato
Method, in which people are
made to crawl and move as they did
at each stage of early development,
in an attempt to learn missing skills.
Again, no scientific studies support
the effectiveness of the method.
It is critical that parents obtain
reliable, objective information
before enrolling their child in
any treatment program. Programs
that are not based on sound principles
and tested through solid research
can do more harm than good. They
may frustrate the child and cause
the family to lose money, time,
and hope.
Selecting a treatment program
Parents
are often disappointed to learn that
there is no single best treatment
for all children with autism; possibly
not even for a specific child.
Even
after a child
has been thoroughly tested and
formally diagnosed, there is no clear
"right" course of action.
The diagnostic team may suggest treatment
methods and service providers, but
ultimately it is up to the parents
to consider their child's unique needs,
research the various options, and
decide.
Above
all, parents should consider their
own sense of what will work for their
child. Keeping in mind that autism
takes many forms, parents need
to consider whether a specific program
has helped children like their own.
Here
is a list of books
and associations that provide
more detailed information about each
form of therapy and other resources.
Exploring
Treatment Options
Parents
may find these questions helpful as
they consider various treatment programs:
- How
successful has the program been
for other children?
- How
many children have gone on to placement
in a regular school and how have
they performed?
- Do
staff members have training and
experience in working with children
and adolescents with autism?
- How
are activities planned and organized?
- Are
there predictable daily schedules
and routines?
- How
much individual attention will my
child receive?
- How
is progress measured? Will my child's
behavior be closely observed and
recorded?
- Will
my child be given tasks and rewards
that are personally motivating?
Is
the environment designed to minimize
distractions?
- Will
the program prepare me to continue
the therapy at home?
- What
is the cost, time commitment, and
location of the program?
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