Written by Sudha Ramaswamy, PhD, BCBA-D, LBA
Medical professionals and therapists concur that the earlier in life a child receives early intervention services the better the child’s prognosis. All children with autism can benefit from early intervention and there is abundant evidence that early intervention for at least two years prior to the start of school can result in significant improvements for children with autism spectrum disorders (ASD). As soon as autism is diagnosed, early intervention instruction should begin. Effective programs focus on developing communication, social, and cognitive skills. Early diagnosis coupled with immediate and effective intervention, is paramount to achieving the best possible prognosis for the child. Even at ages as young as six months, a diagnosis of ASD is possible. Regular screenings by pediatric psychiatrists are recommended by the Centers for Disease Control and Prevention (CDC).
Occupational therapy can help improve their motor, cognitive, sensory processing, communication, and play skills. In early intervention, occupational therapists promote participation of children and their families in everyday routines by addressing activities of daily living, rest and sleep, play, education, and social participation. OTs enhance a family’s ability to care for their child and promote his or her development and participation in natural environments where the child and family live, work, and play. The goals that families have for their children often drives the work of OTs in early intervention settings. OT evaluate the child and then identifies activities that parents and caregivers can do throughout the day to reinforce a skill and improve sensory processing or enable new learning. For example, parents might be concerned that their child cannot pick up her food to finger feed. An occupational therapist can work with the family to identify times during the day that the child can practice skills related to finger feeding food, such as isolating her index finger and grasping small things. The Occupational Therapist and parents might then develop strategies to adapt meal times with larger bits of food for easier grasping or work on pointing to pictures during the bedtime story routine at night. A premise of OT is that because children learn skills within the context that they will be used on a daily or frequent basis. This is in contrast to ABA, which tends to program for generalization by teaching skills in one setting and systematically generalize skills to other settings and people over time.
Physical Therapists can help improve overall gross motor development through strength, function, and mobility training. Like OTs, a PT in Early Intervention, engages families in how they can incorporate exercises and strategies into their everyday routines. They assist children in meeting developmental milestones such as sitting, crawling, and walking. They also improve age appropriate strength, balance, and coordination. PTs manage range of motion due to muscle restrictions. They also evaluate the need for orthotics or other supportive equipment and evaluate children for appropriate seating and mobility options. Like Occupational therapists, PTs ensure that the focus is on helping the child be an active part of the family and finding opportunities to interact with their peers despite developmental delays.
Speech and Language therapy involves a developmental approach that addresses challenges with language and communication. It can help children with autism improve their verbal, nonverbal, and social communication. The overall goal is to help the child communicate in more useful and functional ways. Communication and speech-related challenges vary from person to person. Some individuals on the autism spectrum are not able to speak. Others can talk, but have difficulty holding a conversation or understanding body language and facial expressions when talking with others. A speech therapy program begins with an evaluation by a speech-language pathologist (SLP) to assess the person’s communication strengths and challenges. From this evaluation, the SLP creates individual goals for therapy. Goals may include improving spoken language, learning nonverbal skills such as signs or gestures, or learning to communicate using an alternative method such as pictures. Speech therapists commonly use a variety of strategies including picture cues and tactile prompts, to develop and strengthen communication skills. ABA and speech therapy are similar in that they can be used to treat individuals with speech and language difficulties. They also have similar goals of helping children become independent and successful with communication outside of therapy. They differ, however, in that ABA uses a substantial evidence base of behavioral tactics to enhance a specific behavior, and can be used to develop any behavioral, motor, or learning skill. Speech therapy focuses specifically on language and communication skills. ABA uses observation and measurement to track progress, and speech pathologists frequently monitor progress with tallies or rubrics. Whereas Speech Therapy sessions are often two to three times per week for thirty to forty-five minutes, ABA intervention is much more frequent and intensive – often up to 30 hours per week.
Applied Behavior Analysis
Behavior Analysts develop “applied” skills that are socially significant and meaningful for children. During ABA therapy, treatment is individualized and targets a range of difficulties that children with ASD experience to help them participate meaningfully at home, school, and social settings. Behavior analysts work on communication skills, daily living skills, imitation skills, play and social skills, cognitive skills, gross and fine motor skills, behavioral and safety skills. Due to skill deficits demonstrated by children with Autism, behavior analysts use behavior analytic principles to teach socially significant behaviors such as language and communication. Their philosophical approach termed “verbal behavior” assumes that language has function. In practice, that means behavior analysts teach children with autism to learn language by connecting words with their purpose or function. Verbal Behavior does not focus on words as labels only (cat, car, etc.). Rather, it teaches why words are used and how they are useful in making requests and communicating ideas. Second, the term “behavior” in “applied behavior analysis” refers to the child’s responses that therapists observe and measure over time. Behavior analysts are able to monitor a child’s progress on skills by observing and measuring concrete behaviors. Some examples of these types of behaviors include imitating actions, greeting classmates by name or asking for a preferred snack as well as maladaptive behaviors such as hitting or crying. Finally, “analysis” refers to a behavior analyst’s ability to look at the effect of environmental conditions that occur around a particular skill; then being able to modify the conditions to increase learning opportunities and skill acquisition. This involves data collection and modification of skills and strategies for instruction. When it comes to problem behavior a child may have, the function of that behavior is identified and addressed through behavior intervention plans.
There are a number of benefits that OTs, PTs, SLPs and Behavior Analysts gain by being a part of each other’s early intervention team. Children with autism have a spectrum of needs and as such require a spectrum of interventions. Within the collaboration process, it is essential that consultation time is spent discussing goals, progress, instructing and guiding providers so that deficits are targeted appropriately.
There are hundreds of therapies that incorporate the practices of evidence-based approaches to improve symptoms of ASD and parents should be mindful of what constitutes evidence-based practice when searching for effective therapies. Applied Behavior Analysis (ABA) is the leading, research-based methodology proven to bring about positive, meaningful change in behavior in individuals with autism and related developmental disabilities. ABA has been endorsed by state and federal agencies, including the U.S. Surgeon General. Effective ABA programs address a number developmental areas that enable successful, productive lives. In the last twenty years there has been a dramatic increase in the use of ABA for not only autism, but also a wide variety of other developmental, learning and behavioral challenges in individuals of all ages