The National Institute of Mental Health
Treatments Options
There is no
single best treatment package for all children with ASD. One point
that most professionals agree on is that early intervention is
important; another is that most individuals with ASD respond well to
highly structured, specialized programs.
Before you make
decisions on your child's treatment, you will want to gather
information about the various options available. Learn as much as
you can, look at all the options, and make your decision on your
child's treatment based on your child's needs. You may want to visit
public schools in your area to see the type of program they offer to
special needs children.
Guidelines used
by the Autism Society of America include the following questions
parents can ask about potential treatments:
- Will the
treatment result in harm to my child?
- How will
failure of the treatment affect my child and family?
- Has the
treatment been validated scientifically?
- Are there
assessment procedures specified?
- How will
the treatment be integrated into my child's current program? Do
not become so infatuated with a given treatment that functional
curriculum, vocational life, and social skills are ignored.
The National
Institute of Mental Health suggests a list of questions parents can
ask when planning for their child:
- 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?
Among the many
methods available for treatment and education of people with autism,
applied behavior analysis (
ABA)
has become widely accepted as an effective treatment.
Mental
Health: A Report of the Surgeon General states,“Thirty years of
research demonstrated the efficacy of applied behavioral methods in
reducing inappropriate behavior and in increasing communication,
learning, and appropriate social behavior”
20 The basic
research done by Ivar Lovaas and his colleagues at the University of
California, Los Angeles, calling for an intensive, one-on-one
child-teacher interaction for 40 hours a week, laid a foundation for
other educators and researchers in the search for further effective
early interventions to help those with ASD attain their potential.
The goal of behavioral management is to reinforce desirable
behaviors and reduce undesirable ones.
21, 22
An effective
treatment program will 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. Parental
involvement has 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.
As soon as a
child's disability has been identified, instruction should begin.
Effective programs will teach early communication and social
interaction skills. In children younger than 3 years, appropriate
interventions usually take place in the home or a child care center.
These interventions target specific deficits in learning, language,
imitation, attention, motivation, compliance, and initiative of
interaction. Included are behavioral methods, communication,
occupational and physical therapy along with social play
interventions. Often the day will begin with a physical activity to
help develop coordination and body awareness; children string beads,
piece puzzles together, paint, and participate in other motor skills
activities. At snack time the teacher encourages social interaction
and models how to use language to ask for more juice. The children
learn by doing. Working with the children are students, behavioral
therapists, and parents who have received extensive training. In
teaching the children, positive reinforcement is used.
23
Children older
than 3 years usually have school-based, individualized, special
education. The child may be in a segregated class with other
autistic children or in an integrated class with children without
disabilities for at least part of the day. Different localities may
use differing methods but all should provide a structure that will
help the children learn social skills and functional communication.
In these programs, teachers often involve the parents, giving useful
advice in how to help their child use the skills or behaviors
learned at school when they are at home.
24
In elementary
school, the child should receive help in any skill area that is
delayed and, at the same time, be encouraged to grow in his or her
areas of strength. Ideally, the curriculum should be adapted to the
individual child's needs. Many schools today have an inclusion
program in which the child is in a regular classroom for most of the
day, with special instruction for a part of the day. This
instruction should include such skills as learning how to act in
social situations and in making friends. Although higher-functioning
children may be able to handle academic work, they too need help to
organize tasks and avoid distractions.
During middle
and high school years, instruction will begin to address such
practical matters as work, community living, and recreational
activities. This should include work experience, using public
transportation, and learning skills that will be important in
community living.
25
All through your
child's school years, you will want to be an active participant in
his or her education program. Collaboration between parents and
educators is essential in evaluating your child's progress.