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Resource Guide: POSSIBLE INTERVENTION TECHNIQUES FOR PERSONS WITH AUTISM SPECTRUM DISORDERS Sincere appreciation to the following people for their input and support in the development of this guide: Doreen Garten, Maru Hartman, Wendy Kalberg, Pat Osbourn, Kathleen "Mo" Taylor and Karen Wright. It is recommended that caregivers carefully review the research available and make informed choices about which interventions to implement. Due to the fact that intervention information in Autism Spectrum Disorders (ASD) changes rapidly, please understand that the information presented was compiled according to knowledge obtained at its publication. It is the responsibility of the reader to insure that the information is current. It is widely acknowledged that ASD are developmental disabilities with multiple areas of impairment. There is no evidence that any one treatment will address all areas of need for the individual.
There is no one intervention which is equally effective for every individual with Autism Spectrum Disorders (ASD). There is research to support the usefulness of some interventions, while others lack research support. Even for those with "scientific proof", we recommend the family or caregiver read the research information offered and look for replication studies done by other professionals that report similar findings. Even if there is research, it may not have been done for persons with ASD. Several of the treatments listed have been proven effective for some individuals, but have not been proven effective for those with ASD. Thus, it is important to review the research on all intervention strategies. When deciding whether or not to proceed with an intervention technique, some things that families and professionals may want to consider, include:
The following interventions are listed alphabetically. For additional information on interventions, and ideas on evaluating their use, please contact the Autism Society of America at 1-800-3AUTISM ext. 150.
One form of yeast, candida albicans, has been reported to exacerbate behavior and health problems in persons with autism. Repeated exposure to antibiotics may kill the bacteria that keep the growth of candida suppressed; when the yeast multiplies it may release substances and lead to an overgrowth of the yeast causing an impairment of the central nervous system and the immune system. Some of the behavior problems which may be linked to an overgrowth of candida albicans include: confusion, hyperactivity, short attention span, lethargy, irritability, and aggressiveness. Health problems may include headaches, stomach aches, constipation, gas pains, fatigue and depression. For more information on the internet, contact the Autism-PDD Network For additional information, contact Dr. William Shaw, Great Plains Laboratory, 9335 West 75th Street, Overland Park, Kansas, 66204.
The AZ method uses video to develop language skills in people with ASD. The video technique illustrates everyday objects and uses voice-over to identify each. Each video stresses different things, including concepts. Life skills and facial expressions used to describe emotions are also taught through the use of videos. For additional information on the internet, contact: Fern Zihni, PO Box 32, Shrewsbury, Shropshire, SY3 OWB England, UK. Bridges for Children with Autism has been developed by Educational Models, Inc. to assist parents and professionals in learning about Applied Behavioral Analysis (ABA) and how it applies to children with Autism Spectrum Disorders and related disabilities, as well as in beginning their own program using ABA. This series of videotapes guides parents and professionals through the process of establishing an ABA program for children with ASD. Chelatin Therapy is provided to lessen the amount of mild or mixed substance in the body (e.g., lead, mercury, copper, aluminum, etc.). It is a treatment by which a man-made amino acid called ethylene diamine tetracetic (EDTA) is administered by a properly trained physician to a patient, intravenously. The EDTA in solutions bonds with metals in the body and carries them away in the urine. Treatments take 3-4 hours and participants receive an average of 30 treatments. Chelatin Therapy may be used for persons with ASD concerned with heavy metal toxicity affecting biological and behavioral aspects of their lives. For additional information on the internet, contact The Edelson Center. Craniosacral Therapy uses light hand contact to subtly affect the natural rhythmic movement of the skull bones and the sacrum. It causes an unwinding of areas of tension or restriction throughout the body, leading to a feeling of deep relaxation and general well-being. Dr. Stanley Greenspan is the major influence behind the Developmental Approach. This approach places an emphasis on what happens during specific periods of development. Then it tries, as Greenspan (1992) notes "to re-establish the developmental sequence which went awry. Following the child’s lead and supporting spontaneity, internal motivation, affective expression in free play, and unstructured interactions as the vehicles for accomplishing developmental sequence". Dr. Greenspan has developed the Developmental, Individual-Difference, Relationship-Based Model or DIR. There are several dietary concerns that families have had regarding food allergies for people with ASD. One way to find a reaction to a particular food is to remove the food from the person’s diet. Families seem to have most concern with the following: milk, sugar, wheat, preservatives, and red dye. For additional information on the internet, contact the Center for the Study of Autism
Several educational facilities have been developed which use dolphins as a therapeutic tool for persons with autism. The multi-sensory stimulation which occurs in the dolphin environment may allow for increased communication, social, and sensory improvements as well as boosting immune systems for persons with ASD. Other than the obvious benefits of exercise, several research studies have shown that vigorous or strenuous exercise is often associated with decreases in self-stimulatory behaviors, hyperactivity, aggression, self-injury, and destructiveness. Exercise through school or community programs is helpful as well as through the development of an individual exercise program. For additional information, contact the Center for the Study of Autism. It is now known that much learning occurs in the very earliest days and months of a child’s life. Early Intervention programs are designed to meet not only educational, intellectual and social needs, but a variety of the child’s therapeutic and medical needs as well as the needs of the family. Early Intervention services are defined differently in each state. In New Mexico, persons are eligible if they:
A number of "early intervention" services are available for the individual and family, and services vary from state to state. For information on the internet about services in New Mexico, contact Early Childhood NET.
Education can occur in a variety of ways. Some of the possibilities are through the public education system, public special education services, in a private school of choice (Montessori, parochial, etc.), or through home schooling. For additional information contact your local schools and home school organizations, or contact the Autism-PDD Network, select special education. Facilitated Communication is a technique by which a trained professional, a facilitator, supports the hand, arm or shoulder of an individual with communication impairments so that the person with the impairment can either point to or press the keys of a communication device. If successful, the individual who was previously unable to communicate can do so through typing or spelling out words. For additional information on the internet, contact the Autism Society. This technique was pioneered by Dr. Kiyo Kitawa at the Higashi School in Japan and provides education and emphasizes greatly vigorous physical education and the arts. For more information on the internet, contact the Boston Higashi School.
The benefits of Therapeutic Horseback Riding for persons with ASD are many. Therapy builds upon the psychosocial benefits of riding a horse, and adds improvements in physical components as well. The motion and heat of the horse not only aid a rider’s blood circulation and reflexes, but also gently exercise the rider’s spinal column, providing a combination of sensory and neurological input that can be used to address a variety of disabilities, including ASD. Horses provide a motivating, rich therapeutic environment—combining fresh air and the outdoors with the emotional contact and movements of a horse. For persons with ASD, significant gains in communication and social skills have been noted, often the result of relationships formed between riders and "their" horses. Other benefits may include assistance with balance, assuming of responsibility, increasing attention span, and decreasing negative behaviors. For additional information contact: North American Riding for the Handicapped Association (NARHA) This therapy involves the forced holding of a child experiencing a tantrum, through theoretical phases of acceptance, resistance, and acquiescence. The rationale for this therapy is that a bond was not established with the affected child, perhaps because of problems with social reciprocity, and thus the child withdraws to defend himself against the perceived rejection. For information on the internet, contact the Autism-PDD Network. For additional information, read: The World of the Autistic Child, by Bryna Siegel, Ph.D., Oxford University Press, 1996.
Scotopic Sensitivity/Irlen Syndrome is a visual-perceptual problem which occurs in some people with learning/reading disorders, ASD, and other developmental disorders. People with Scotopic Sensitivity/Irlen Syndrome experience perceptual stress which can lead to a variety of perceptual distortions when reading and/or viewing their environment. As a result, the person may experience:
Helen Irlen has developed two methods to treat Scotopic Sensitivity: 1) the use of colored transparencies or overlays to improve reading; and 2) tinted glasses to improve one’s visual perception of his/her environment. For additional information, contact: Irlen_Institute@compuserve.com Dr. Ivar Lovaas directs the Lovaas Institute for Early Intervention, or LIFE, which is a small research-based psychology clinic in the Los Angeles area that specializes in developing and implementing behavior modification treatment programs for children with ASD. The program uses traditional ABA therapy, which was described earlier. Contracting through the Lovaas Institute, families or programs can receive an intensive 40-hour per-week program which uses a "Lovaas" trained consultant to teach, and then requires families or school districts to hire one or more additional "behavior therapists" to implement the program. Since the diagnosis of ASD is based on a grouping of symptoms and behaviors, no medications have been found to be effective in the treatment of ASD specifically. Most medications used to treat ASD were developed primarily to treat other disorders, and then tried on persons with ASD because of the overlap in the symptoms. Most physicians will recommend behavioral and educational interventions prior to trying medication. Putting a person with ASD on medication should always be considered an experiment. Therefore, there should be a plan for objectively evaluating whether or not the medication is alleviating the symptoms for which it was prescribed. There are a number of drugs that have been prescribed for persons with ASD. A qualified physician, with experience with persons with ASD, should be secured to prescribe and monitor medications. For additional information, contact the Autism-PDD Network, select drug treatments For additional information on specific medication recommendations, review the chapter, "Psychoactive Medications" in the book, The World of the Autistic Child, by Bryna Siegel, Oxford University Press, 1996. Music Therapy is the application of music to enhance personal lives by creating positive changes in human behavior. Music is used as a tool to encourage development in social/emotional, cognitive/learning, and perceptual-motor areas. A trained music therapist delivers the therapy which is particularly useful with ASD, in part, due to the nonverbal, nonthreatening nature of the music. For additional information contact Center for the Study of Autism Neuro-Linguistic Programming is the relationship between neurology, linguistics, and observable patterns of behavior, to help build self-confidence and capability. One example of its use is through pacing. Pacing implies an absence of any pressure and is the first stage of building rapportmodeling a person’s way of being. By pacing and matching language, emotional state, breathing, body language, and thinking speed, it helps to build a strong, mutually respectful relationship. For general information about Neuro-Linguistic Programming, not specific to ASD, contact ANLP The Association for Neuro-Linguistic Programming For additional information, contact Bibi at 108 Wellfield Road, Streatham, London, SW 16 2BU, tel/fax 0181 677-6550. Melatonin is a hormone which acts as a natural sleep aid and is naturally produced within the pineal gland, a glandular organ nestled between the cerebral hemispheres. It is usually released into the body when illumination diminishes. It is believed that for some persons with ASD, too little melatonin is released, causing sleep difficulties. It is believed that by adding melatonin to the body, the sleep disorders will lessen. It is presently available over-the-counter at many health food stores. It is important to follow certain guidelines in its use as a sleep promoting agent for persons with ASD and to confer with a doctor if the person takes other medications. Very little research has been conducted on the effectiveness of melatonin for treating sleep disorders in individuals with ASD. For additional information about melatonin and its use, contact Center for the Study of Autism. Mind mapping is a graphic technique which has been found to be helpful for more able persons with ASD. Instead of note-taking, mind mapping uses a graphic "map" which has a central point or main subject and then branches out with additional key information/themes surrounding it visually. There are smaller branches linked to the main ones, and all form a connected structure. This visual depiction of an idea may assist persons with ASD who respond well to visual learning. For additional information at Linguarama: Postscript Magazine - Mind mapping Occupational Therapy is the therapeutic use of self-care, work, and play activities to increase independent function, enhance development, and prevent disability. It may include adaptation of task or environment to achieve maximum independence and to enhance quality of life. Occupational Therapy serves those who are recovering from illness or injury, and others who because of age, poverty, cultural difference, or psychological, physical, and social disability, have difficulty coping with the tasks of living. For ASD, an occupational therapist may use a variety of strategies: sensory integration addressing developmental, gross & fine motor needs; visual structuring; movement therapy to address motor needs; listening therapy; and provide combination therapy with speech/language pathologists. For additional information contact AOTA - American Occupational Therapy Association
Founded by Barry and Samahria Kaufman, the Option Institute provides intensive personal growth seminars for adults. The SonRise Program offers specific training to families with children with ASD. The program recognizes that parents are a child’s most valuable resource, and trains parents to learn about the child and how to involve the child as the guide in learning about themselves. The participant is taught the process of "going with" the child through exploration.
The Picture Exchange Communication System (PECS) is an augmentative communication training package that allows children and adults with ASD, who comprehend relate to pictures, to initiate communication. PECS begins with teaching a student to exchange a picture of a desired item with a teacher, who immediately honors the request. The system goes on to teach discrimination of symbols and then puts these together in simple sentences. The system was developed by Lori Frost and Dr. Andrew Bondy. The PECS Training Manual is available commercially. Picture rehearsal is an instructional strategy that uses repeated practice of a sequence of behaviors by presenting the sequence to the individual in the form of pictures and accompanying script. The spontaneous, less-structured nature of play and recreation may be difficult for people with autism to comprehend and follow. Persons with ASD must be taught to play and to socialize. Recreation therapy provides a structured way to learn how to play. A program developed by Edmund Jacobson, the relaxation program involves teaching individuals how to discriminate between tense muscles and relaxed muscles. The person learns to tighten and relax the arms, hands, and legs, and to do deep breathing in a sitting position. The child or adult is then taught relaxing without tensing. Finally, the person is taught to tighten and relax all remaining muscle groups of the body. Work is then done to identify stressful situations. Once the stressful situations have been pinpointed, coping strategies of visual imagery or relaxation can be used. For additional information read an Interview with June Groden, Ph.D. Secretin is a hormone that is found in the pancreas, liver, and upper intestinal tract. Secretin stimulates the pancreas to release bicarbonate and digestive enzymes into the intestinal tract, and stimulates the liver to excrete bile and the stomach to produce pepsin. Secretin is also found in the brain and stimulates the production of serotonin. Some families have found that if their child had digestive tract difficulties in the past, and had injections of Secretin, their digestive difficulties improved, along with some of their autistic behaviors. Research on the efficacy of Secretin is just beginning, and will continue. Self-Management refers to the individual achieving personal autonomy. The goal for the person with ASD is to shift super-vision and control from a parent, caregiver, job coach, or employer to the person himself/herself. For more information, read Self-Management, written by Stephen M. Edelson, Ph.D. Sensory Integration Theory was developed by A. Jean Ayres, Ph.D., OTR/L. Sensory integration refers to the organization of our senses to give us an understanding of ourselves and what is going on in the world around us. Our perceptions of taste, touch, smell, hearing, vision, balance, movement, body awareness, etc., are combined and organized by our brain to give us a clear "picture". Each of our different senses provides us with a piece of the puzzle that combines to form a picture. There are three major sensory systems with receptors in different places in our body that provide our brain with information: tactile system includes receptors in our skin that give the brain information about touch, temperature, pressure, and pain; the vestibular system includes receptors in the inner ear that tell our brain about movement and balance as well as arousal levels; and the proprioceptive system which includes receptors in muscles and joints that tell our brain about what position our body is in. When these systems do not work in harmony in a person, a trained therapist, usually an occupational therapist, will attempt to provide activities which help to organize the senses. For additional information read an Interview with Lorna Jean King, OTR, FAOTA.
Teaching sign language and speech at the same time is often referred to as Signed Speech or Simultaneous Communication. Although this form of communication is not universally understood and used by others, it is one form of communication that may be considered when teaching communication to persons with ASD. A social encyclopedia is a social map of a person’s life, a journal of personal experiences that are organized into categories to teach social understanding. The encyclopedia includes experiences journal, feelings journal, and social maps. For more information read about DO-WATCH-LISTEN-SAY Social and Communication Intervention for Children with Autism online or review pages 160-162, Do-Watch-Listen-Say, by Kathleen Ann Quill, Brookes Publishing Co., 2000. Many persons with ASD have deficits in social cognition, the ability to think in ways necessary for appropriate social interaction. This can be addressed through a technique which is used to help individuals with ASD "read" and understand social situations. This technique, called "social stories" presents appropriate social behaviors in the form of a story. Once read by the student (or read to) the person then takes the information and uses it to change social behavior accordingly. The technique was developed by Carol Gray and seeks to include answers to questions that persons with ASD need to know to interact appropriately with others. Other interventions to teach social understanding developed by Carol Gray include: Comic Strip Conversations; The Topic Box; Pictures of Me; and the Sixth Sense. There are a number of books, manuals, and videos, which describe the technique in detail. Speech/language therapy is a service provided when a person’s speech or language is markedly different from that of others of the same age, sex, or ethnic group; when a person’s speech or language is difficult to understand; when a person is overly concerned about his or her own speech; or when a person frequently avoids communicating with others. Difficulties may involve articulation, voice, stuttering or language, including semantics, syntax and pragmatics. Although individuals with ASD may evidence a variety of speech and language difficulties, their primary deficit appears to be in the area of pragmatics or social communication. For additional information on the internet, contact the American Language-Speech-Hearing Association. The "Squeeze Machine" or "Hug Box" was developed by Temple Grandin. It is made of two padded side-boards which are hinged near the bottom to form a V-shape. The user lies down or squats inside the V. By using a lever, the user engages an air cylinder, which pushes the side-boards together. This action provides the deep pressure stimulation evenly across the lateral parts of the body, which some persons with ASD crave. Some persons prefer long squeezes while others prefer a short one.
The TEACCH program takes a developmental approach by recognizing differences in rate and nature of development within and between people. TEACCH advocates emphasize that goals for treatment include both the person and family members. Objectives include changing the behavior and skill level of the person as well as developing an environment that matches the person’s needs. TEACCH’s structured approach caters to the person’s visual processing strengths by organizing the physical structure of the room and providing visual schedules to supply information about activities. Other visual cues are developed for all aspects of the person’s day at school or home. Areas of emphasis include assessment, physical structure, routines, scheduling, work systems, and task organization. Some persons with ASD have vision dysfunction of a variety of sorts, which may include:
Since vision development follows predictable stages, it is a pro-cess that can respond to training if disruption occurs. Vision Therapy is a process of retraining the visual perceptual system so that it functions with optimal efficiency. The process follows a sequence of steps aimed at improving the visual system. Therefore, it is a procedure with therapy activities prescribed by the vision therapist which are carried out in the practitioner’s office, and frequently reinforced with home activities. Vision training is available through Behavioral Optometrists who have received postdoctoral training in this specific field. Visual imagery focuses on stressful events that are known to trigger problem behaviors and supports a person with ASD in learning alternative self-control strategies. For more information read an Interview with June Groden, Ph.D.
About the Model
For web site information contact roseh@unm.edu
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