Facts about Autism
Did you know…
- 1 in 150 children is diagnosed with autism
- 1 in 94 boys is on the autism spectrum
- 67 children are diagnosed per day
- A new case is diagnosed almost every 20 minutes
- More children will be diagnosed with autism this year than with AIDS, diabetes & cancer combined
- Autism is the fastest-growing serious developmental disability in the U.S.
- Autism costs the nation over $35 billion per year, a figure expected to significantly increase in the next decade
- Autism receives less than 5% of the research funding of many less prevalent childhood diseases
- Boys are four times more likely than girls to have autism
- There is no medical detection
- This material is copyright
Learn the Signs – Watch for the Red Flags of Autism
(The following red flags may indicate a child is at risk for atypical development, and is in need of an immediate evaluation.)
In clinical terms, there are a few “absolute indicators,” often referred to as “red flags,” that indicate that a child should be evaluated. For a parent, these are the “red flags” that your child should be screened to ensure that he/she is on the right developmental path. If your baby shows any of these signs, please ask your pediatrician or family practitioner for an immediate evaluation:
- No big smiles or other warm, joyful expressions by six months or thereafter
- No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
- No babbling by 12 months
- No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
- No words by 16 months
- No two-word meaningful phrases (without imitating or repeating) by 24 months
- Any loss of speech or babbling or social skills at any age
Learn the Signs – Milestones
Milestones enable parents and physicians to monitor a baby’s learning, behavior, and development. While each child develops differently, some differences may indicate a slight delay and others may be a cause for greater concern. The following milestones provide important guidelines for tracking healthy development from four months to three years of age.
Before your child’s next visit to the physician, please take the time to see if your child has met his/her key milestones. These milestones should not be used in place of a screening, but should be used as discussion points between parents and physicians at each well visit. If a child does not have the skills listed—or if there is a loss of any skill at any age—be sure to let your physician know.
Check to see if your child is achieving these typical milestones at each age level:
By 3-4 months
Watches faces with interest and follows moving objects
Recognizes familiar objects and people; smiles at the sound of your voice
Begins to develop a social smile
Turns head toward sounds
By 7 Months
Responds to other people’s emotions
Enjoys face-to-face play; can find partially hidden objects
Explores with hands and mouth; struggles for out of reach objects
Responds to own name
Uses voice to express joy and displeasure; babbles chains of sounds
By 12 Months/1 Year
Enjoys imitating people; tries to imitate sounds
Enjoys simple social games, such as “gonna get you!”
Explores objects; finds hidden objects
Responds to “no;” uses simple gestures, such as pointing to an object
Babbles with changes in tone; may use single words (“dada,”“mama,” “Uh-oh!”)
Turns to person speaking when his/her name is called.
By 24 Months/2 Years
Imitates behavior of others; is excited about company of other children
Understands several words
Finds deeply hidden objects; points to named pictures and objects
Begins to sort by shapes and colors; begins simple make-believe play
Recognizes names of familiar people and objects; follows simple instructions
Combines two words to communicate with others, such as “more cookie?”
By 36Months/3 Years
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Expresses affection openly and has a wide range of emotions
Makes mechanical toys work; plays make-believe
Sorts objects by shape and color, matches objects to pictures
Follows a 2- or 3-part command; uses simple phrases to communicate with others, such as “go outside, swing?”
Uses pronouns (I, you, me) and some plurals (cars, dogs)
By 48 Months/4 Years
Cooperates with other children; is increasingly inventive in fantasy play
Names some colors; understands concepts of counting and time
Speaks in sentences of five to six words
Tells stories; speaks clearly enough for strangers to understand
Follows three-part commands; understands “same” and “different”
By 60 Months/5 Years
Wants to be like his/her friends; likes to sing, dance, and act
Is able to distinguish fantasy from reality
Shows increased independence
Can count 10 or more objects and correctly name at least four colors
Speaks in sentences of more than five words; tells longer stories
Parents are often the first to notice that something is not right with their child. A child may be unresponsive from birth, cry excessively, not make eye contact, or focus obsessively on an object for a long period of time. Some children who seemed to be developing normally suddenly stop babbling, become indifferent to others, lose imaginative play skills, do not respond to their name, and become uninterested in playing with other children.
In evaluating a child, doctors rely on these behavioral characteristics to make a diagnosis. A well-child checkup should include observational data and a developmental screening. Parents’ observations are essential in a proper screening. In addition, several tools are commonly used to screen for autism, including the Checklist of Autism in Toddlers (CHAT) and the Comprehensive Autism Ratings Scale (CARS). These basic screening tools do not provide a diagnosis, but rather indicate whether a child should be referred for further evaluation.
Usually, a team of specialists is involved in the diagnosis. The team may include a neurologist, psychiatrist, developmental pediatrician, psychologist, gastroenterologist, audiologist, speech therapist, occupational therapist, and other professionals. Because there is no medical test or biomarker for autism, diagnosis is based on observation of the child’s behavior, educational and psychological testing, and parent reporting. Usually the team members evaluate the child, assessing his or her strengths and weaknesses, and then explain the test results to parents.
The moment when parents learn that their child is autistic is devastating, even if they suspected something was wrong. Unlike other diseases, autism carries no defined treatment protocol. Unfortunately, all too often parents are on their own and must begin navigating the complex web of treatments, interventions, and therapies to determine which intervention approach might be best for their child. Gaining as much information as possible is critical to becoming an effective advocate for your child.
It’s not easy to hear the news that your child has autism, and realize that your life will be utterly different than you had expected it to be. Daily life with a special-needs child presents many unique challenges. How do you come to terms with the fact that your child has autism? How do you cope once you get over the initial shock? We aim to help you by providing regular features on topics ranging from how autism affects your family to dayto day survival strategies. Please be sure to check in with us often.
Read the first installment in our series of coping strategies about coming to terms with your child’s diagnosis of autism. We would like to hearyour story about what you experienced when you first heard that your child was diagnosed with autism. What did you go through? What helped you cope? Do you have any advice that might help someone going through this right now? Please send your stories to email@example.com
Coming to Terms with the Diagnosis
No matter how well-prepared you thought you were after months spent worrying about your child’s development, and seemingly endless visits withspecialists, hearing that your child has autism is usually devastating. Many parents and psychologists describe the diagnosis as a kind of “death.”
As Sharon Rosenbloom writes in Souls: Beneath and Beyond Autism, “With the diagnosis of autism, the dream dies.” While of course your child is very much alive, the feeling of loss is nonetheless very real for most parents and families. In many ways, the diagnosis of autism represents the death of both your idealized child and your life as you imagined it would be, full of soccer games and school plays, ballet classes and sleepovers.
The diagnosis leaves you facing something entirely new and unknown, and it can feel very scary indeed.
What to Expect
You will most likely experience a wide range of emotions. These may range from shock, anger, and resentment, to fear, worry, and profound sadness. Some parents may feel guilt, while others may actually feel some relief at finally having a diagnosis. One minute you may feel like screaming, and the next minute all you want to do is cry. Each person displays his or her own range and intensity of emotions. Still, you may go through something similar to that of others who suffer a great loss:
Shock: You may feel confused or frightened, or you may find yourself in denial, questioning the diagnosis or searching for another doctor who will tell you something different.
Profound sadness or grief: As the shock subsides, these feelings may engulf you as you mourn the loss of your idealized baby.
Anger: With time, your grief may turn into anger toward your child, your spouse, or whoever may be close at hand. You may also feel resentment toward other parents with healthy children.
Acceptance: Ultimately, you begin to accept your child’s diagnosis and the changes that living with autism brings.
This can be a very challenging time. The main thing to remember is that all of these emotions you’re feeling are normal. Be patient with yourself. It can be a long time before you are able to feel a sense of acceptance about your child’s disability. But most parents who have been through this already will assure you that eventually that time does come.
Help Yourself Adjust
In the meantime, there are some strategies that can help you. Psychologist Judith Grossman, of the Ackerman Institute in New York City, recommends a preventionist approach. In other words, don’t let yourself fall apart. While you may be on an emotional roller-coaster ride, your child needs you now more than ever. Give yourself time to heal. You may need to take time off from work while you are grieving. Let yourself cry, scream, or anything else that
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Write in a journal. Louise DeSalvo, in Writing as a Way of Healing, notes that studies have shown that “writing that describes traumatic events and our deepest thoughts and feelings about them . . . is linked with improved immune function, improved emotional and physical health,” and positive behavioral changes.
Begin treatment for your child immediately. Bryna Siegel, in The World of the Autistic Child, writes that “starting with treatment is the best way to work through the acceptance of the diagnosis. . . . The sooner the treatment begins, the sooner there will be some positive change in the child and the parents can begin to see that the child’s situation is not hopeless.”
Talk about your feelings. Discussions with someone you trust, whether a partner, friend, family member, or religious leader, can be a tremendous relief.
Learn facts about autism. With information, you will feel more capable to make the right decisions for your child. Take care not to become overwhelmed, though. You don’t need to solve all your child’s problems at once.
Maintain daily routines. Routines bring order to family life at a time when it may feel chaotic and overwhelming.
Join a support group. Find other parents who understand what you’re going through and can give you advice and direct you to resources.
Don’t let yourself become isolated.
Do something for yourself every day. Gardening, exercise, art, prayer, anything that makes you feel good.
Don’t forget to appreciate your child’s gifts. Don’t let the word “autism” cloud your feelings toward your child. This is the same little person you loved and appreciated before the diagnosis
Get help when necessary. Following the above strategies should help keep you from falling apart. However, if you do find yourself so overwhelmed that you are unable to function or care for your child or children, consider seeing a trained psychotherapist who can help you work through your difficult emotions.
TREATMENTS FOR AUTISM
There is no single treatment protocol for all children with autism, but most individuals respond best to highly structured behavioral programs. The National Institute of Child Health and Human Development lists Applied Behavior Analysis among the recommended treatment methods for autism spectrum disorders. Some of the most common interventions are Applied Behavior Analysis (ABA), Floortime Therapy, Gluten Free, Casein Free Diet (GFCF). Speech Therapy, Occupational Therapy, PECS, SCERTS, Sensory Integration Therapy, Relationship Development Intervention, Verbal Behavior Intervention, and the school-based TEAACH method.
Gluten Free, Casein Free Diet (GFCF)
Relationship Development Intervention
Sensory Integration Therapy
TEACCHVerbal Behavior Intervention
Applied Behavioral Analysis (ABA)
Behavior analysis is a natural science of behavior that was originally described by B.F. Skinner in the 1930’s. The principles and methods of behavior analysis have been applied effectively in many arenas. For example, methods that use the principle of positive reinforcement to strengthen a behavior by arranging for it to be followed by something of value have been used to develop a wide range of skills in learners with and without disabilities.
Since the early 1960’s, hundreds of behavior analysts have used positive reinforcement and other principles to build communication, play, social, academic, self-care, work, and community living skills and to reduce problem behaviors in learners with autism of all ages. Some ABA techniques involve instruction that is directed by adults in highly structured fashion, while others make use of the learner¹s natural interests and follow his or her initiations. Still others teach skills in the context of ongoing activities. All skills are broken down into small steps or components, and learners are provided many repeated opportunities to learn and practice skills in a variety of settings, with abundant positive reinforcement. The goals of intervention as well as the specific types of instructions and reinforcers used are customized to the strengths and needs of the individual learner. Performance is measured continuously by direct observation, and intervention is modified if the data show that the learner is not making satisfactory progress.
Regardless of the age of the learner with autism, the goal of ABA intervention is to enable him or her to function as independently and successfully as possible in a variety of environments.
Developed by child psychiatrist Stanley Greenspan, Floortime is a treatment method and a philosophy for interacting with autistic children. It is based on the premise that the child can increase and build a larger circle of interaction with an adult who meets the child at his current Welcome to the Hellenic website about Autism and Pervasive Developmental Disorders Autism Diagnosis Strategies Navigating the spectrum Your child’s rights Useful links e-library Home Day Care Centre Be Informed CDC’s Act Early Resources Approaches to Autism NGO Autism–Asperger Hellas developmental level and who builds on the child’s particular strengths.
The goal in Floortime is to move the child through the six basic developmental milestones that must be mastered for emotional and intellectual growth. Greenspan describes the six rungs on the developmental ladder as: self regulation and interest in the world; intimacy or a special love for
the world of human relations; two-way communication; complex communication; emotional ideas; and emotional thinking. The autistic child is challenged in moving naturally through these milestones as a result of sensory over- or under-reactions, processing difficulties, and/or poor control of physical responses.
In Floortime, the parent engages the child at a level the child currently enjoys, enters the child’s activities, and follows the child’s lead. From a mutually shared engagement, the parent is instructed how to move the child toward more increasingly complex interactions, a process known as “opening and closing circles of communication.” Floortime does not separate and focus on speech, motor, or cognitive skills but rather addresses these areas through a synthesized emphasis on emotional development. The intervention is called Floortime because the parent gets down on the floor with the child to engage him at his level.
Gluten Free, Casein Free Diet (GFCF)
Many families of children with autism spectrum disorders are interested in dietary and nutritional interventions that might help some of their children’s symptoms. Removal of gluten (a protein found in barley, rye, oats, and wheat) and casein (a protein found in dairy products), in what is
known as a Gluten Free, Casein Free diet, or GFCF, is a popular dietary treatment for symptoms of autism. It is based on the hypothesis that these proteins are absorbed differently in children with autism spectrum disorders and act like false opiate-like chemicals in the brain. The hypothesis is
not based on an allergic response. Neither the hypothesis nor the effectiveness of this dietary intervention has been demonstrated in scientific studies to date. Studies are ongoing in a number of centers. However, many families report that dietary elimination of gluten and casein has helped
regulate bowel habits, sleep, activity, habitual behaviors and enhance overall progress in their individual child. No specific laboratory tests can predict which children might be observed by their families to have a positive response to dietary intervention. For that reason, many families elect a trial of dietary restriction with careful observation by the family and intervention team.
A trial of dietary restriction requires attention to basic nutritional guidelines. Dairy products are the most common source of calcium and vitamin D in young children in the U.S. Many young children depend on dairy products for a balanced protein intake. Alternative sources of these nutrients
require substitution of other food and beverage products with attention to nutritional content rather than solely as a milk substitute beverage. Substitution of gluten free products requires attention to the overall fiber and vitamin content of a child’s diet. Vitamin and supplement use may
have both positive effects and side effects. Consultation with a dietitian or physician should be considered and can be helpful to families in the determination of healthy application of a GFCF diet. This may be especially true for children who are picky eaters.
Occupational Therapy can benefit a person with autism by attempting to improve the quality of life for the individual. The aim is to maintain, improve, or introduce skills that allow an individual to participate as independently as possible in meaningful life activities. Coping skills, fine motor
skills, play skills, self help skills, and socialization are all targeted areas to be addressed.
Through occupational therapy methods, a person with autism can be aided both at home and within the school setting by teaching activities including dressing, feeding, toilet training, grooming, social skills, fine motor and visual skills that assist in writing and scissor use, gross motor coordination to help the individual ride a bike or walk properly, and visual perceptual skills needed for reading and writing.
Occupational therapy is usually part of a collaborative effort of medical and educational professionals, as well as parents and other family members. Through such collaboration a person with autism can move towards the appropriate social, play and learning skills needed to function successfully in everyday life.
PECS is a type of augmentative and alternative communication technique where individuals with little or no verbal ability learn to communicate using picture cards. Children use these pictures to “vocalize” a desire, observation, or feeling. These pictures can be purchased in a manualized book, or they can be made at home using images from newspapers, magazines or other books. Since some people with autism tend to learn visually, this type of communication technique has been shown to be effective at improving independent communication skills, leading in some cases to gains in spoken language.
A formalized training program is offered through a company called Pyramid Products, and this program takes the caregiver and child through different phases. However, this manual is not the only source of training and resources. Images may be obtained through magazines, photos, or other media. In Phase one, a communication trainer works with the child and their caregivers to help decide which images would be most motivating. For example, images food may elicit the strongest response. Cards are then created (or provided through a pre-made book) with those images, and the trainer and the caregiver work with the child to help him or her discover that, by handing over the card, they can get the desired object. In Phase two, the caregiver then moves farther away from the child when showing the picture, so that the child must actually come over and hand over the card to receive the food reward. This process engages the child’s ability to seek and obtain another person’s attention. In this way, a full vocabulary and methods for using these new words are taught to the affected individual.
In later phases, children are given more than one image so that they must decide which to use when requesting an item, and throughout the process the number of cards grows and thus the child’s ‘vocabulary’ also increases. Over time, the child may develop the ability to use sentences,
including phrases like “I want” to start off the sentence, and even use descriptors like “large” or “red”. Throughout the process, which may take weeks, months or years, the caregiver gives constant feedback to the child. It is thought that by allowing children to express themselves nonverbally,
the children are less frustrated and non-desirable behavior including tantrums is reduced.
Relationship Development Intervention (RDI)
Relationship Development Intervention (RDI) Based on the work of psychologist Steven Gutstein , Relationship Development Intervention (RDI) focuses on improving the long term quality of life for all individuals on the spectrum. The RDI program is a parent- based treatment that focuses on the core problems of gaining friendships, feeling empathy , expressing love and being able to share experiences with others. Dr’s Gutstein program is said to be based on extensive research in typical development and translates research findings into a systematic clinical approach. His research found that individuals on the autism spectrum seemed to lack certain abilities necessary for success in managing the real life environments that are dynamic and changing. He calls these abilities dynamic intelligence and describes six aspects as follows:
- Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others.
- Social Coordination: The ability to observe and continually regulate one’s behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions.
- Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.
- Flexible thinking: The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances.
- Relational Information Processing: The ability to obtain meaning based upon the larger context. Solving problems that have no “right-and-wrong” solutions.
- Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner. Dr Gutstein, who along with Dr. Rachelle Sheely , formed the Connections Center For Family and Personal Development based in Houston Texas in 1995, says, ” We are challenging families and professionals to think beyond achieving mere functionality as a successful outcome for individuals with autism; our reference point for success in the RDI program is quality of life,” The goal is social improvements as well as changes in flexible thinking, pragmatic communication, creative information processing and self development. The program offers training workshops for parents as well as several books that offer step-by step exercises building motivation so that skills will be utilized and generalized. The program is said to be able to be started easily and implemented into regular, daily activities that enrich family life.
The SCERTS® Model
(Prizant, Wetherby, Rubin, Rydell & Laurent, 2006)
The SCERTS® Model is a comprehensive, team-based, multidisciplinary model for enhancing abilities in Social Communication and Emotional Regulation, and implementing Transactional Supports for children and older individuals with autism spectrum disorders (ASD) and their families. SCERTS is not an exclusive approach, in that it provides a framework in which practices and strategies from other approaches may be integrated, such as Positive Behavioral Supports (ABA), visual supports, sensory supports, augmentative and alternative communication (AAC), and Social Stories® . The SCERTS model can be used with individuals across a wide range of ages and developmental abilities. It was developed by Barry Prizant, Amy Wetherby, Emily Rubin, Amy Laurent and Patrick Rydell, a multidisciplinary team of clinicians, researchers, and educators who have more than 100 years experience, and have published extensively in the field of autism.
The focus on Social Communication involves developing spontaneous, functional communication and secure, trusting relationships with children and adults. Emotional Regulation involves enhancing the ability to maintain a well-regulated emotional state to be most available for learning and
interacting. Transactional Support includes supporting children, their families, and professionals to maximize learning, positive relationships and successful social experiences across home, school and community settings. The SCERTS Model, emphasizes the importance of child initiated
communication in natural as well as semi-structured activities for a broad range of purposes such as requesting, greeting, expressing emotions and protesting/refusing. Objectives for the child are developmentally appropriate and may target both verbal and non-verbal forms of
communication. SCERTS is a collaborative educational model in that families and educators work together to identify and develop strategies to successfully engage the child in meaningful daily activities.
SCERTS differs from the focus of “traditional” ABA that typically targets children’s responses in adult directed discrete trials with the use of behavioral techniques to teach language. In contrast, the focus of the SCERTS model is on promoting child-initiated communication in everyday
activities. In philosophy and practice, SCERTS is closer to “contemporary” ABA practices such as Pivotal Response Training and Incidental Teaching, which use natural activities in a variety of social situations, as well as semi-structured teaching in social routines. In contrast to most
ABA practices, SCERTS relies extensively on visual supports (e.g., photos, picture symbols) for supporting Social Communication and Emotional Regulation. SCERTS is based on child development research and research on the core challenges in autism, in a manner similar to Floortime and RDI.
The SCERTS Model is most concerned with helping persons with autism to achieve “Authentic Progress”, which is defined as the ability to learn and apply functional skills in a variety of settings and with a variety of partners. All of a child’s partners, including educators, therapists, parents, siblings and peers potentially play an important role in a SCERTS Model Program, because activities in which goals and objectives are addressed include daily routines at home and school, as well as special therapies and activities that have the potential to enhance abilities in independent and self-help skills, with a particular emphasis on social communication and emotional regulation. For example, mealtimes across home and school settings may have the same objectives that include using pictures, words and/or gestures to select food items, to observe and imitate partners in order to benefit from their social models, and to respond to a partners’ attempts to support a good emotional state that results in sustained attention and active participation. Objectives in play and social skills may also be identified and targeted at school with classmates, as well as at home with siblings or cousins. A plan to support a child’s emotional regulation across each day is also developed based on a child’s needs. The plan may include regularly scheduled exercise and “regulating” breaks, opportunities for sensory and motor activities, and a plan used by all partners to modify learning environments. Partners also become expert at reading a child’s signals of emotional dysregulation and responding with appropriate support as needed to maximize attention and learning and to prevent escalation into more problematic behavior (e.g., offering deep pressure, simplifying difficult tasks. clarifying tasks through the use of visuals – e.g., “2 more then we are all done”).
When observing activities in the SCERTS Model, there is always a high priority placed on:
- children initiating as well as responding to partner’s verbal and nonverbal communication;
- children actively participating in activities with adults and peers, with an emphasis on joyful, shared positive emotional experience, and the development of trusting relationships,
- partners implementing a range of interpersonal and learning supports to help a child be most available for learning and engaging,
- partners being highly responsive and supportive in a flexible manner that depends on the child’s emotional state, distractions in the setting, the
- child’s success in the activity and the need for appropriate levels of support to actively participate.
- In SCERTS, there is a great emphasis on child initiation in natural as well as semi-structured activities for a very broad range of communicative
functions (e.g., greeting, requesting comfort, protesting/refusing, calling). Objectives are developmentally sequenced, including nonverbal (e.g., gestures) as well as verbal communication and are selected based on a child’s functional needs in daily activities as determined by the child’s
team. Thus, the focus of the SCERTS model on promoting child-initiated communication in everyday activities differs from the focus of “traditional” ABA, that typically targets children’s responses in adult directed Discrete Trials with the use of behavioral techniques to teach language. In
Philosophy and practice, SCERTS is closer to “contemporary” ABA practices such as Pivotal Response Training and Incidental Teaching, which use natural activities in a variety of social situations with a variety of partners (peers and different adults), as well as semi-structured teaching in social routines. SCERTS also relies on visual supports (e.g., photos, picture symbols) extensively for supporting Social Communication and Emotional Regulation to a greater extent than ABA, and is based on child development research and research on the core challenges in autism, in a manner similar to Floortime and RDI. For further information, including a detailed list of FAQ’s and research support for the SCERTS Model, go to www.SCERTS.com.
Sensory Integration Therapy
Sensory Integration is the process through which the brain organizes and interprets external stimuli such as movement, touch, smell, sight and sound. Autistic children often exhibit symptoms of Sensory Integration Dysfunction (SID) making it difficult for them to process information brought
in through the senses. Children can have mild, moderate or severe SID deficits manifesting in either increased (hypersensitivity) or decreased (hyposensitivity) to touch, sound, movement, etc. For example, a hypersensitive child may avoid being touched whereas a hyposensitive child will
seek the stimulation of feeling objects and may enjoy being in tight places.
The goal of Sensory Integration Therapy is to facilitate the development of the nervous system’s ability to process sensory input in a more typical way. Through integration the brain pulls together sensory messages and forms coherent information upon which to act . SIT uses neurosensory and neuromotor exercises to improve the brain’s ability to repair itself. When successful, it can improve attention, concentration, listening, comprehension, balance, coordination and impulsivity control in some children. The evaluation and treatment of basic sensory integrative processes in the autistic child are usually performed by an occupational and/or physical therapist. A specific program will be planned to provide sensory stimulation to the child, often in conjunction with purposeful muscle activities, to improve how the brain processes and organizes sensory information. The therapy often requires activities that consist of full body movements utilizing different types of equipment. It is believed that SIT does not teach higher-level skills, but enhances the sensory processing abilities thus allowing the child to acquire them.
The communications problems of autistic children vary to some degree and may depend on the intellectual and social development of the individual. Some may be completely unable to speak whereas others have well-developed vocabularies and can speak at length on topics that interest them. Any attempt at therapy must begin with an individual assessment of the child’s language abilities by a trained speech and language pathologist.
Though some autistic children have little or no problem with the pronunciation of words, most have difficulty effectively using language. Even those children who have no articulation problems exhibit difficulties in the pragmatic use of language such as knowing what to say, how to say it, and
when to say it as well as how to interact socially with people. Many who speak often say things that have no content or information. Others repeat verbatim what they have heard (echolalia) or repeat irrelevant scripts they have memorized. Some autistic children speak in a high-pitched voice or
use robotic sounding speech.
Two pre skills for language development are joint attention and social initiation. Joint attention involves an eye gaze and referential gestures such as pointing, showing and giving. Children with autism lack social initiation such as questioning, make fewer utterance and fail to use language as a means of social initiation. Though no one treatment is found to successfully improve communication, the best treatment begins early during the preschool years, is individually tailored, and involves parents along with professionals. The goal is always to improve useful communication. For some verbal communication is realistic, for others gestured communication or communication through a symbol system such as picture boards can be attempted. Periodic evaluations must be made to find the best approaches and to reestablish goals for the individual child.
TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) is a special education program that is tailored to the autistic child’s individual needs based on general guidelines. It dates back to the 1960’s when doctors Eric Schopler, R.J. Reichler and Ms
Margaret Lansing were working with children with autism and constructed a means to gain control of the teaching setup so that independence could be fostered in the children. What makes the TEACCH approach unique is that the focus is on the design of the physical, social and
communicating environment. The environment is structured to accommodate the difficulties a child with autism has while training them to perform in acceptable and appropriate ways.
Building on the fact that autistic children are often visual learners, TEACCH brings visual clarity to the learning process in order to build receptiveness, understanding, organization and independence. The children work in a highly structured environment which may include physical organization of furniture, clearly delineated activity areas, picture-based schedules and work systems, and instructional clarity. The child is guided through a clear sequence of activities and thus aided to become more organized. It is believed that structure for autistic children provides a strong base and framework for learning. Though TEACCH does not specifically focus on social and communication skills as fully as other therapies it can be used along with such therapies to make them more effective.
Verbal Behavior Intervention
Verbal Behavior Intervention is often seen as an adjunct to Applied Behavioral Analysis (ABA). Though both are based on theories developed by Skinner there are differences in concept. In the late 1950s and early 60’s when Dr. Ivar Lovaas was developing his ABA principles, Skinner published Verbal Behavior which detailed a functional analysis of language. He explained that language could be grouped into a set of units, with each operant serving a different function. The primary verbal operants are what Skinner termed echoics, mands, tacts, and intraverbals.
The function of a mand is to request or obtain what is wanted. For example, the child learns to say the word “cookie” when he is interested in obtaining a cookie. When given the cookie, the word is reinforced and will be used again in the same context. There is an emphasis on “function” of language(VB) as opposed to form (Lovaas-based). In a VB program the child is taught to ask for the cookie anyway he can( vocally, sign language, etc.) If the child can echo the word he will be motivated to do so to obtain the desired object. In a Lovaas-based ABA program the child might say the word cookie when seeing a picture and is thus labeling the item. This form of language is called a “tact.” Critics of Lovaas say children are taught to label many words but often cannot use them in functional or spontaneous ways. Another operant, “intraverbals” describes verbal behavior that is under the control of other verbal behavior and is strengthened by social reinforcement. Intraverbals are the way people engage in conversational language. They are responses to the language of another person, usually answers to “wh-” questions.. If you say to the child “I’m baking…” and the child finishes the sentence with “Cookies,” that’s an intraverbal fill-in. Also, if you say, “What’s something you bake?” (with no cookie present) and the child says, “Cookies,” that’s an intraverbal (wh- question). Intraverbals allow children to discuss stimuli that aren’t present, which describes most conversation and is a goal of Verbal Behavior Intervention. Both ABA and VB use similar formats to work with children. It is said that VB attempts to capture a child’s motivation to develop a connection between the value of a word and the word itself. Many therapists are now using techniques of VB to bridge some of the gaps seen in ABA.