5 Science, Pseudoscience, and Antiscience Science: strives to promote evidence based practices by using time honored methods to put hypotheses to logical and empirical testsOperational definitionsDirect, reliable, and objective measurementControlled experimentsReliance on objective data for making conclusionsIndependent verification of results
6 Science, Pseudoscience, and Antiscience Pseudoscience: instead of objective measurements from well controlled experiments and independent verification from multiple research studies, pseudoscience offers testimonials and unverified personal reports to legitimatize claimsAntiscience: a rejection of time tested methods of the scientific approach as a means of proving results. An extreme antiscience view would be that there are no objective facts , only personal interpretations of phenomena
7 Treatment Warning Signs High or universal “success” rates are claimedRapid changes are promisedThe treatment promotes itself as a “cure” for autismThe theory behind the treatment contradicts objective knowledgeThe treatment is said to be easy to administer, requiring no experienceThe treatment excludes other treatments and emphasizes being administered exclusively
8 Treatment Warning Signs Promoters of the treatment are working outside their area of expertisePromoters of the therapy do not have knowledge or training in working with autism spectrum disordersLittle or no objective evidence is provided in support of the treatmentBelief and faith are said to be necessary for the treatment to workPromoters are not open to independent evaluation of the treatment approach
9 Selecting an ApproachThree questions to consider when selecting a treatment approach:What are the anticipated outcomes that align with a particular treatment, and are the outcomes in harmony with the needs of the childWhat are the potential risks associated with the treatmentWhat are the most effective means of evaluating a particular treatment
10 National Autism Center National Standards Project, 2009
12 Evidence Based/Established Several published, peer reviewed studiesInterventions and treatments in this category have undergone a substantial amount of researchThe evidence consistently provides results that prove children with an ASD display a significant increase in skill acquisition as a consequence of the treatment
13 Promising/Emerging Few published, peer reviewed studies Interventions and treatments in this category have been widely used for several years without any or with few adverse outcomesThe research suggests that children and youth with an ASD responded favorably from the intervention
14 Limited Support/Unestablished May or may not be based on research, if any research base, it is very minimalMay have high testimonial support but not substantiated by researchInterventions and treatments in this category have not been widely utilized with children and youth with ASD’s or reflect a range of results (poor to favorable) when administered
15 Not Recommended/Ineffective Several published peer reviewed studiesInterventions and treatments in this category have been shown to not increase skill acquisition or produce favorable resultsSome serious detrimental effects and outcomes have been noted
17 Applied Behavioral Analysis (ABA) Roots are in Behavior TheoryFunctional Behavioral AnalysisEmphasizes proactive antecedent (prevention) approaches while also providing effective strategies for intervening after a behavior has occurredOngoing and comprehensive analysis of in individuals environmentEncompasses several behavioral approaches such as prompting, fading, shaping, errorless learning, extinction, and punishment
18 Lovaas ModelProvides behavioral treatment utilizing the principles of applied behavior analysis.POSTIVE INTERACTIONS are first developed through the use of favorite activities and responding to any attempts to communicate.MOTIVATION is encouraged through the use of familiar materials and child-specific reinforces.SUCCESS is promoted through positive reinforcement of successive approximations and prompting and fading procedures.PARENTAL INVOLVEMENT is critical. Parents are empowered through training and collaboration to create an environment in which treatment is provided most of a child's waking hours, at home, at school, and in the neighborhood.REQUESTING is developed as early as possible.Learning to talk and understand vocal LANGUAGE is considered a fundamental part of social development. IMITATION is also crucial, allowing a child to learn by observing other children learn.And finally, social interactions and cooperative PLAY are integral to treatment. Facilitated play occurs first with siblings and then with peers during play dates and at school.
19 Discrete Trial Training (DTT) Uses the principles of applied behavioral analysis (ABA)Example: the student is given a stimulus--a question, a set of blocks and a pattern, a request to go ask Mom for a glass of water--along with the correct response, or a strong 'hint' at what the response should be. He is rewarded (an M&M, a piggy-back ride, a happy "good job!") for repeating the right answer; anything else is ignored or corrected very neutrally. As his response becomes more reliable, the 'clues' are withdrawn until he can respond independently. This is usually done one-on-one at a table (thus the term table-top work), with detailed planning of the requests, timing, wording, and the therapist's reaction to the student's responses.
20 Pivotal Response Training (PRT) Uses the principles of applied behavioral analysis (ABA)Target behaviors are taught in natural environments using items that are age appropriate and reinforcing to the childThe parent or teacher presents to the child an instruction, question, or other opportunity to respond. The child responds. The parent or teacher provides some consequence to the child depending on the child’s response.Tasks should be chosen by the child as much as possible
21 Comprehensive Behavioral Treatment for Young Children Treatment that involves a combination of ABA procedures, discrete trial, naturalistic teaching, etc.Example: Early intervention programs
22 Learning Experiences: An Alternative Program for Preschoolers and Parents (LEAP) Uses applied behavior analysis (ABA) interventionsDeveloped by Phil StrainLEAP is a combination or peer-mediated instruction, incidental teaching, self-management training, prompting strategies, and systematic parent trainingA curriculum approach used by many special education classrooms
23 Joint Attention Interventions Teaching a child to respond to the nonverbal social bids of others or to initiate joint attention interactionsExamples: pointing to objects, showing items/activities to another person, and following eye gaze
24 ModelingAn adult or peer provides a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with an ASDCan be simple or complex behaviors that are modeledCan be live modeling or video modelingOften combines with other strategies
25 Naturalistic Teaching Strategies Incidental Teaching, Milieu Teaching, Mand Model, and Time DelayUses strategies from the field of applied behavior analysis (ABA)Is naturalistic, in that the child leadsTeacher or therapist may pre arrange environmentLessons involve interactions in which the child expresses interest and the adult responds with prompts and praiseA specific lesson can be repeated several times with the adult removing the requested item and having the child initiate interest again
26 Peer Related Interventions Teaching children without disabilities strategies for facilitating play and social interactions with children on the autism spectrumPeers can be classmates or siblingsExamples include: integrated play groups, integrated social skills groups, or peer mediated groupsThese interventions may include components of other treatments
27 Early Start Denver Model Developed by Sally Rogers and Geraldine Dawson.An "eclectic" autism intervention, combining ABA-based with non-ABA-based approaches. The manual specifies that ESDM "most closely resembles" RDI, DIR/Floortime, and SCERTS. ESDM also "has clear ties to" PRT, incidental teaching, and milieu teaching. And ESDM "has in common" some elements of ABA-based interventions as per Lovaas. Speech and occupational therapy are also thrown in.
28 Verbal Behavior Approach Guided by the principles of Applied Behavior Analysis (ABA). In addition to using ABA principles, a Verbal Behavior (VB) practitioner also incorporates BF Skinner's Analysis of Verbal Behavior.looks first at what the child wants and then teaches the child how to request.Many VB consultants also recommend the use of sign language for most non-vocal early learners.VB is child-led.
29 SchedulesThe presentation of a task list that communicates a series of activities or steps required to complete a specific activitySchedules can be written words, pictures or photographs, or work stationsOften supplemented by other interventions
30 Self Management Interventions Promotes independence by teaching individuals with ASD’s to regulate their behavior by recording the occurrence/non-occurrence of the target behavior, and securing reinforcement for doing soReinforcement is usually a component of the interventionExamples include: checklists (using checks, smiling/frowning faces), counters, visual prompts, and tokens
31 Story Based Interventions Social StoriesDeveloped by Carol GrayA social story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and formatThe four types of sentences:1. Descriptive – tells where situations occur, who is involved, what they are doing, and why2. Perspective – describes the reactions and feelings of the student and of other people3. Directive – tells student what to do4. Control – after the social story is read, the student writes sentences to help her remember the information from the social story (often considered optional)Other Resources:
32 Play Therapy Interventions The systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.AutPlay TherapyFilial TherapyTheraplayCognitive Behavioral Play TherapyAssociation for Play Therapy
33 RePlays Developed by Dr. Karen Levine Pick an event that is troublesome for the child such as sitting in their car seat or going to the doctorRe-enact the event using props, if child is just beginning pretend play then the re-enactment needs to be more concrete such as where the even acutely occursThe re-enactment is done by the therapist and should be short and quick at first and grab the child’s attention.
34 Floortime(DIR)/The Play Project Developed by Stanley GreenspanA specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities. Play based
35 Relationship Development Intervention Developed by Dr. Steve GutsteinA parent-based intervention program where parents are provided the tools to effectively teach Dynamic Intelligence skills and motivation to their childDynamic Intelligence skills consist of experience sharing, dynamic analysis, flexible and creative problem-solving, episodic memory and self-awareness, and resilience
36 Brain Gym (Brain Based Play) Refers to the original 26 Brain Gym movements, sometimes abbreviated as the 26. These activities recall the movements naturally done during the first years of life when learning to coordinate the eyes, ears, hands, and whole body. The twenty-six activities, along with a program for “learning through movement” were developed by educator and reading specialist Paul E. Dennison and his wife and colleague, Gail E. DennisonClaim dramatic improvements in areas such as: Concentration and Focus, Memory, Academics: reading, writing, math, test taking, Physical coordination, Relationships, Self-responsibility, Organization skills, and Attitude
37 Autism Movement Therapy Developed by Joanne LaraAn interhemispheric SENSORY INTEGRATION technique incorporating movement and music in collaboration with Positive Behavior Support (PBS) strategies.Assists in meeting and achieving a child’s speech and language, social and academic IEP goals.
38 Theory of Mind Training Interventions are designed to teach individuals to recognize and identify mental states in oneself or in others and to be able to take the perspective of another person in order to predict their actionsRecognizing a persons thoughts, beliefs, intentions, desires, and emotions.
39 TEACCHTreatment and Education of Autistic and related Communication Handicapped Children.A state program originally developed in North Carolina.A complete and comprehensive program of services for autistic people which makes use of several techniques, of several methods in various combination depending upon the individual person's needs and emerging capabilities.
40 Music Therapy Teach individual skills or goals through music A targeting skill (counting, learning colors, taking turns, learning feelings) is first presented through song or rhythmic cuingMusic is eventually fadedMake Sound and Move Around CD
41 S.C.E.R.T.SFocuses on building competence in Social Communication, Emotional Regulation and Transactional Support.Families, educators and therapists work cooperatively as a team.Includes a well-coordinated assessment process that helps a team measure the child’s progress, and determine the necessary supports to be used by the child’s social partners (educators, peers and family members).
42 Rapid Prompting Developed by Soma Mukhopadhyay RPM uses a "Teach-Ask" paradigm for eliciting responses through intensive verbal, auditory, visual and/or tactile prompts.RPM uses prompting to initiate a student's independent response, without physical support.(RPM) improves academic success and communication.
43 Massage/Touch Therapies Specific massage and touch protocolsTypical results include improvement in behavior, mood, sleep, and comfortableness with touch.Typical approaches include 15-minute sessions conducted twice weekly or nightly 15-minute sessions done at home by the parents before bedtime.
44 Picture Exchange Communication System (PECS) PECS was developed by Andrew S. Bondy & Lori Frost.A unique augmentative/alternative communication intervention package.Based on B.F. Skinner’s book, Verbal BehaviorPECS begins by teaching an individual to give a picture of a desired item to a “communicative partner", who immediately honors the exchange as a request, individuals progressively moves through six phases.
45 Augmentative and Alternative Communication The term is applied to a variety of interventions that are utilized to compensate for expressive communication deficits.Augmentative refers to methods and devices that are used as interventions to enhance an individuals speech.Alternative refers to the use of techniques that are used to replace speech for an individual who has not or may not acquire spoken language.
46 Assistive TechnologyA broad term used to describe any aid that is used to increase, maintain or improve the functional capabilities of a child with Autism.Devices an be electronic or non electronic.Adapted utensils, talking calculators, ipads, voice output devices, pencil grips, etc.
47 Art TherapyArt therapy is a form of expressive therapy that uses the creative process of making art to improve a person’s physical, mental, and emotional well-being.It can be used for counseling by therapists to promote healing, treatment, rehabilitation, psychotherapy, and in the broad sense of the term, art therapy can be used to massage one’s inner-self in a way that may provide the individual with a deeper understanding of him or herself.
48 Option Method (SonRise) Developed by Barry Neil Kaufman and Samahria Lyte Kaufman.Basic components include: joining in a child's repetitive and ritualistic behaviors, utilizing a child's own motivation, teaching through interactive play, using energy, excitement and enthusiasm, employing a nonjudgmental and optimistic attitude, placing the parent as the child's most important and lasting resource, and creating a safe, distraction-free work/play area.
49 Animal Assisted Therapies The Most common animal assisted therapies for Autism Disorders include: horses, dogs, cats, and dolphins.
50 Irlen LensesA unique service for some children and adults identified with reading and learning difficulties, low motivation, attention deficit disorder, or discipline problems.The first testing session determines whether a person has Irlen Syndrome (a problem with the brain's ability to process visual information) and can be helped by the Irlen Method’s color technology.The second testing session targets the precise wave lengths of light causing problems by using a limitless number of color filter combinations.
51 Vision TherapyVarious vision therapies and procedures designed to correct or aid in vision problems.Not specific to or created for Autism Disorders.Typically done by a medical doctor training in vision therapy and specifically in using vision therapy with Autism disorders.Thought to be helpful for children with autism who have vision problems and correction in vision problems may help with behavior issues.
52 Aquatic TherapyAttempts to improve function through the application of aquatic therapeutic exercises.Procedures require constant attendance of a therapist educated in performing aquatic therapeutic exercises.Aquatic therapy or pool therapy is physical therapy that is performed in the water. Aquatic therapy use the resistance of water instead of weights.Helps with autism in calming the children, improving movement, range of motion, improved body awareness, increased balance, sensory integration, and mobility skills.
53 Fast ForWordA family of educational software products intended to enhance cognitive skills of children, especially focused on developing phonological awareness.Typically used in school settings.Promotes strengthening the skills of memory, attention, processing rate, and sequencing for children.Participants spend 30 to 100 minutes a day, five days a week, for four to 16 weeks using the products.
54 MERIT ApproachMentalization Enhanced Remediation –an Integrated Treatment. Mentalization describes the process in which we attend to the thoughts and feelings of another.Incorporates A.B.A. and other more developmentally based approaches.Provides metalizing experiences to forge a relationship with the child, allowing mentalization to inform the treatment on a regular basis, and remediating the social-emotional areas that prevent the child from progressing in this area of development.
55 Transcranial Magnetic Stimulation Scientists use a device to stimulate the brain non-invasively in alert, awake patients.A simple procedure that lasts approximately 20 minutes. Regarded as being safe without any lasting side effects.May reduce symptoms associated with Autism as brain stimulation awakes and connects parts of the brain that may be associated with creating Autism symptoms.
56 Auditory Integration Training Created by Guy Bérard.Typically involves 20 half-hour sessions over 10 days listening to specially filtered and modulated music.aims to address the sensory problems such as hearing distortions and oversensitive hearing, which are said to cause discomfort and confusion in persons suffering from learning disabilities, including autism spectrum disorders.Has not had favorable research.
57 The Davis Model of Sound Intervention Created by Dorinne S. DavisUses sound vibration with special equipment, modified music, and/or specific tones/beats, the need for which is identified with appropriate testing.Clients use headphones and sound proof rooms. Treatment is 20 one-half hour listening sessions using special listening devices. Sessions are twice a day for 10 days and must be separated by a minimum of three hours and extend over a two week period which can be separated by a weekend.
58 Chelation TreatmentThe administration of chelating agents to remove heavy metals from the body.Chelation therapy is used as a treatment for acute mercury, iron, arsenic, lead, uranium, plutonium and other forms of toxic metal poisoning. The chelating agent may be administered intravenously, intramuscularly, or orally, depending on the agent and the type of poisoning.It has been suggested that Chelation therapy helps reduce the symptoms of Autism.
59 Gentle Teaching Not a behavioral modification approach. Focuses on four primary goals: Teaching the person to feel safe with us. Teaching the person to feel engaged. Teaching the person to feel unconditionally valued. Teaching the person to return unconditional valuing.Uses the relationship between the Individual and the Caregiver as the foundation for teaching.Does not focus on compliance or obedience, but focuses on teaching Individuals to feel safe with others.
60 Van Dijk ApproachA set of curriculum that can be taught to help improve communication, socialization, and sensory deficits.The method involves several joint encounters where both individuals (child and adult) experience events together in an effort for the adult to better understand the child.The child performs an action and the adult immediately does the same action.
61 Gluten Free DietA gluten free diet is a diet that excludes foods containing gluten. Gluten is a protein found in wheat (including kamut and spelt), barley, rye, malts and triticale. It is used as a food additive in the form of a flavoring, stabilizing or thickening agent, often as "dextrin”.Autism claims include mild to dramatic improvements in speech and/or behavior after these substances were removed from their diet. Some also report that their children have experienced fewer bouts of constipation and diarrhea since starting a gluten-free diet.
62 Casein Free DietCasein is a protein found in milk and foods containing milk, such as cheese, cream, butter, yogurt, ice cream, whey and even some brands of margarine. It also may be added to non-milk products such as soy cheese and hot dogs in the form of caseinate.Autism claims include mild to dramatic improvements in speech and/or behavior after these substances were removed from their diet. Some also report that their children have experienced fewer bouts of constipation and diarrhea since starting a casein-free diet.
63 Hyperbaric Oxygen Chamber The use of high pressure oxygen as a drug to treat Autism and basic pathophysiologic processes and their diseases.HBOT is administered in a private setting in state-of-the-art, monoplace chamber of clear acrylic.There are basically two types of chambers: monoplace and multiplace.Monoplace chambers are designed to treat a single person pressurized with 100% oxygen.Multiplace chambers are designed to hold several people at one time and oxygen is delivered through a mask or a hood.
64 Secretin TherapySecretin is a gastrointestinal peptide (digestive system hormone) used to treat peptive ulcers, typically given orally.Autism related claims include improvement with receptive and expressive language, gastrointestinal symptoms, adaptive behaviors, cognitive functioning, social skills, and fine motor skills.Research has not been able to show a clear benefit for treating Autism.
65 Facilitated Communication A process by which a facilitator supports the hand or arm of a communicatively impaired individual while using a keyboard or other devices with the aim of helping the individual to develop pointing skills and to communicate.
66 Holding Therapies Also use the term attachment therapy. Procedure involves the parent intentionally agitating the child, then holding the child down until the child becomes calm, then talking to the child about what needs to change, be changed.Can be done in a group format as well.
67 ReferencesAssociation for Science in Autism TreatmentAutism Society of AmericaNational Autism Center, National Standards Project,Simpson, R. (2004) Evidence-based practices and students with Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 20,Simpson, R. (2005) Autism Spectrum Disorders: Interventions and Treatments for Children and Youth. Corwin Press: London
68 ReferencesLyons, T. & Siri, K. (2010) Cutting Edge Therapies for Autism. Skyhorse Publishing: New York.Exkorn, K. S. (2005) The Autism Sourcebook. HarperCollins: New York.
69 THANK YOU! www.robertjasongrant.com Robert Jason Grant Ed.D, LPC, RPT-S