Autism (cont.)

Other Therapy

Behavioral therapies

Behavioral therapy is the foundation for most treatment programs for children with autism. More than 30 years of research has shown the benefit of applied behavioral methods in improving communication, learning, adaptive behavior, and appropriate social behavior while reducing inappropriate behavior in children with autism. There is strong evidence that these interventions are most effective when started early, typically in the preschool years. A range of scientifically proven behavioral treatment has been developed for children with autism. These are mainly based on the principles of applied behavior analysis.

Applied behavior analysis (ABA) is designed to both correct behavior and teach skills for dealing with specific situations. It is based on the principle of reinforcement: that behavior can be changed by rewarding desired behavior and removing reinforcement for unwanted behavior. The person will naturally repeat behaviors for which he or she is rewarded. This principle is applied in many different ways, such as discrete trial training, incidental teaching, errorless learning, and shaping and fading. Most treatment programs include a number of ABA therapies.

These comprehensive treatment approaches differ in their specifics but are highly structured, intensive programs in which the child spends a large amount of time (15-40+ hours per week), usually in one-to-one activities with a therapist, to change behaviors. Behavioral therapists typically collaborate with parents, school personnel, and community professionals in providing a comprehensive treatment program that is individualized to meet each child's specific needs.

Positive behavioral interventions and support are designed to replace problem behaviors with positive behaviors and improve the person's quality of life. Like other approaches, this approach requires examination of the individual's unique strengths and problems and development of strategies to improve his or her quality of life overall.

Education

The main principle of education is that each person with autism has his or her own strengths, abilities, and functional level and that his or her education should be tailored to meet his or her individual requirements. This is not only desirable for the child, it is required by federal law. The Individuals with Disabilities Education Act (IDEA; P.L.101-476) guarantees free and appropriate public education for every child with a disability. This law specifies that a written and explicit education plan (the Individualized Education Plan, or IEP) be prepared by the local education authority in consultation with the child's parents. When all parties agree on the plan, the plan must be put into place and the child's progress documented. Preparation of the plan includes a comprehensive assessment of the child's needs.

Many different options are available for educating children with autism. The basic assumption is that, whenever possible, children with disabilities should be educated with their nondisabled peers, who serve as models for appropriate language, social, and behavioral skills. Thus, some children with autism are educated in mainstream classrooms, others in special education classes within mainstream public schools, and others in specialized programs separate from mainstream public schools. Parents wanting to find the best possible program for their child are advised to work with the local education authority; full cooperation and communication are essential for meeting this goal.

The following specific programs have been developed for persons with autism:

• TEACCH is a program developed in North Carolina and is used statewide for people with autism. It encompasses many different theories and techniques to develop an individualized program for each person with autism. The underlying principle is that the environment should be adapted for the person with autism, not the other way around. This program focuses less on changing specific behaviors and more on providing the child with the skills needed to understand his or her environment and communicate his or her needs.
  
  
• Floor time is an approach that helps the child with autism progress on the natural developmental ladder. It is based on the theory that children cannot progress to advanced learning until they have completed all the required steps of this ladder, and that children with autism have not completed the ladder.
  
  
• Social stories is an approach that uses stories to teach children social skills. In each story, a person is faced with a situation or event; the story is intended to help the child with autism understand the thoughts and emotions of the person in the story. This helps the child develop an understanding of the appropriate or expected response to the situation. The stories are tailored to the individual and often include music and illustrations.

It is important that skills learned at school are generalized outside the classroom setting. Thus, programs for children with autism must include the family and be coordinated across the child's home and community.

Complementary therapies

Complementary therapies include art therapy, music therapy, animal therapy, and sensory integration therapy. These are not behavioral or educational approaches per se, but they provide another opportunity for the child to develop social and communication skills. Although there is little scientific evidence that these therapies increase skills, many parents and therapists describe noticeable improvements in a child's behavior and communication abilities, as well as a sense of enjoyment.

Complementary therapies are typically used in addition to behavioral and educational approaches.

• Art therapy offers the child a nonverbal way to express his or her feelings.
  
  
• Music therapy involving singing helps develop the child's speech and language skills.
  
  
• Animal therapy, such as horseback riding and swimming with dolphins, improves the child's motor skills while increasing self-confidence.
  
  
• Sensory integration focuses on normalizing extreme reactions to sensory input. It tries to help the child reorganize and integrate his or her sensory information so he or she can better understand the external world.