The following methods, tools and interventions contain elements that set them apart from behaviour-based treatment programs but many of them do have behavioural components. In addition, components of some of these methods and interventions are integrated into many ABA-based programs.
TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children)
TEACCH was developed at the School of Medicine at the University of North Carolina in the 1970s. It is a structured teaching approach (usually used within a classroom or care centre setting) based on the premise that the learning environment should be tailored to accommodate the student with autism who often does not adapt easily to a regular “fluid” environment. It is an attempt to meet the student in their own reality using careful individualized assessment and capitalizing on their unique interests and motivations. The idea is not to impose a model of “normal” behaviour but rather to help the student develop skills to function more independently using their unique skills and strengths in the “normal” world.
TEACCH is not a specific technique, but rather a program developed for the child's functioning level. Learning abilities are assessed through the Psycho Educational Profile (PEP) and teaching strategies are designed to develop communication, social and coping skills and more independent functioning. Sometimes TEACCH methods are used along with more behavior-based therapies to make them more effective.
There is strong focus on the functional design of the physical and social environment which is highly organized with separate areas for each activity. Clear expectations, detailed instructions, work systems, picture cues and visual schedules provide highly structured teaching to accommodate the individual challenges of the student.
TEACCH is not so much focused on specific life skills and behaviours, rather it aims to provide the child with the tools and strategies he/she needs to understand and cope with his or her world and other people's expectations. TEACCH validates the cause of a child's behaviours and then helps the child to learn how to cope in constructive ways, using instructional clarity and various communication skills.
Floortime/The Greenspan Method/DIR®/Floortime™
Foortime was developed by child psychiatrist, Dr. Stanley Greenspan, Clinical Professor of Psychiatry, Behavioral Science and Pediatrics, George Washington University. In contrast to other approaches which tend to focus on cognitive, verbal/speech and motor development, Floortime focuses on the importance of interaction in cognitive and emotional growth. The therapy helps a child to meet key developmental milestones which will form a foundation for emotional and intellectual gains in all areas of life. The six rungs on the developmental ladder are:
- self regulation and ability to focus attention (interest in the world)
- intimacy (emotional connection)
- two-way communication (gesturing or vocalizing back and forth)
- complex social communication and problem solving
- pretend/creative play
- emotional thinking (logic, abstract and sequential thinking)
After assessing and developing a profile of a child’s core challenges with communication, sensory and processing difficulties and/or poor control of physical responses, the families are taught to fully engage the child at their level (on the floor) in play sessions and take the lead from their activities and interests. For example, if the child wants to line up blocks, the parent or care giver tries to create some interaction by playing with the blocks as well, making sounds and gestures to gain the child’s attention within the play session. The theory is that biological processing difficulties are the core problem in ASDs and the symptoms of autism are somewhat secondary. Interrupting and changing up the way child is processing information (making contact - breaking through) will lead to positive changes in the ability to catch up on missing developmental stages which affect the ability to relate and communicate.
Floortime is a family-focused therapy sometimes used for a child's playtime at home, at school and often in conjunction with other methods such as OT, speech and language therapy, ABA programs, etc. It is also called the Developmental, Individual Difference, Relationship (DIR) model.
Autism: How to Help your Child Reach Out Socially and Emotionally. John Hoffman, Today's Parent, September 2012 (Print Edition): Canadian autism researchers have discovered a way to help children with autism reach out. Here’s more about DIR/Floortime therapy.
The SCERTS®ModelDeveloped by Dr. Barry M. Prizant, Amy Wetherby, Emily Rubin, Amy Laurent and Patrick Rydell, with a multidisciplinary group of clinicians, researchers, and educators, SCERTS, (Social Communication and Emotional Regulation, and implementing Transactional Supports) is a team-based approach used for enhancing communication and socio-emotional abilities for individuals with ASD across a wide range of age and ability.
SCERTS focuses on building social communication, regulating emotions and providing transactional support, offering a collaborative framework to address the core challenges experienced by individuals with ASD. The SCERTS framework is meant to be used with other practices and strategies such as behaviour-based programs, augmentative and alternative communication, Social Stories® and others.
The SCERTS Model, emphasizes:
- child-initiated communication in everyday activities
- teaching developmentally appropriate functional and self-help skills
- both verbal and non-verbal forms of communication
- extensive use of visual supports in all settings (home, school, play, etc)
- stepped supports to prevent escalating problematic behaviour
- individual, family and educator collaboration
SCERTS Model website: Created by Carol Gray, describes the model and SCERTS philosophy in one of her Journals published in 2002.
Gray Center for Social Learning & Understanding: Non-profit site including Carol Gray's social stories, and other information and ideas.
Social and Play-related Tools and Interventions
People with ASDs may also need extra training in functional living skills from the earliest possible age. Critical skills for children such as crossing a street safely, going to the store or asking for directions or other help may be challenging. For youths and adults, navigating the outside world and being able to function in new and changing situations will also be important. A child, youth or adult may need this extra help to develop the skills that foster greater independence in matters of daily living.
Social Stories were developed in 1991 by Carol Gray as a tool for teaching social skills to individuals with ASDs. They are often used for those on the spectrum who are higher-functioning and usually focus on developing the ability to recognize the feelings, points of view or plans of others. Short stories or cartoons are developed to meet the child's individual needs based on their anxieties, their fears or the difficulty of particular situations. The stories help people with ASDs to develop appropriate responses to real life emotions and situations.
Polyxo.com: Teaching Children with Autism, a resource by Jason M. Wallin
This approach uses social strategies to increase participation and integration with peers and may include:
- participation in social skills/play groups
- peer networks
- "class buddies" systems
- peer tutoring
- cooperative learning
- modified curriculum
In this approach, teachers in regular and special education programs are trained to choose program participants and the parents receive support in planning and provide recommendations for their children with yearly progress reports.
Theory of Mind Training
Theory of mind training focuses on promoting social communication abilities in young children with autism by:
- increasing a person's abilities to understand that others have their own thoughts and feelings
- teaching a person to imagine or predict what others are thinking/feeling, based on understanding of a particular circumstance or situation
- helping a person with an ASD to distinguish between lies and jokes or sarcasm
- helping a person to understand how personality influences communication and intentions and to be able to better evaluate a person's intentions
Ability to learn "theory of mind" is influenced by language skills and by cognitive development.
Relationship Development Intervention (RDI)
Based on the work of psychologist Steven Gutstein, this is also a method for teaching children with autism conditions “dynamic intelligence” – how to develop relationships, first with their parents and later with their peers. A family-focused treatment meant to be integrated into daily life, it is intended to provide tools that address the core challenges of developing social skills and friendships. The approach addresses: motivation, mindful social communication, emotional and behavioural self-awareness and regulation, episodic memory, rapid attention shifting, understanding the emotional feedback of others, executive functioning, flexible thinking, and creative problem solving.
The Miller Method®
Developed by Arnold Miller, Ph.D., and Eileen Eller-Miller, M.A., CCC, Sp/L, of the Language and Cognitive Development Center of Boston who founded the Language and Cognitive Development Center (LCDC) in Boston, in 1965.
The Miller Method is used in clinical and classroom setting and focuses on:
- The Umwelt Assessment to understand how the child perceives reality and racts to situations
- Transforming the child’s “autistic” systems or behaviours such as lining up blocks, hand flapping, etc. into functional behaviors
- Repeated exposure to new activities that fill developmental gaps and lags
- Use of elevated structures to increase focus
The Miller Method in intended to expand and change the limited reality systems of children with autism and enrich their range of skills and ability to deal with various life situations.
The Son-Rise Program®
The Son-Rise Program® was developed by Barry and Samahria Kaufman, whose son Raun was diagnosed with autism. The program is based on intensive stimulation provided with an attitude of unconditional acceptance and enthusiasm. Program fcuses is on:
- Personal Optiva Dialogue sessions to explore parent attitudes and develop a loving approach
- Full acceptance and respect
- Child-led high energy play and activities
- Exposure to new stimuli
- Breaking down skills to manageable parts
- Family and volunteer training
Complementary InterventionsSee also: Communication Systems and Resources and Links: Treatment and Education
Some parents and educators feel that in addition to more standard methods and treatments, complementary therapies can be useful tools to improve communication and reduce some of the behavioural symptoms and sensitivities associated with autism.
Complementary therapies including art, music and animal assisted therapy are sometimes used as part of another treatment program or on their own as additional activities for an individual.
These complementary activities are thought to help in developing self-esteem and in building social and communication skills. They are also sometimes used to build trust in a therapy relationship.
Brain-based complementary therapies:
The Alert Program is used to help teach self-regulation awareness. The program supports children, teachers, parents and therapists to choose appropriate strategies to change or maintain states of alertness.
Patterning is also known as the Doman-Delacato Treatment. This approach was developed during the 1950s and is offered at the Institutes for the Achievement of Human Potential (IAHP) in Philadelphia, Pennsylvania, among other locations. Patterning is a neurological development technique which provides sensory input and stimulation to the brain in an effort to reprogram proper operation of a deficient functional area. The philosophy behind patterning is that in order to help a child overcome their disability, one must deal directly where problem lies, which is in the brain. Participants crawl and move as they did at each stage of early development, in an attempt to learn missing skills.
Neurodevelopmental Therapy was developed by Svea J. Gold, MLS. A functional therapeutic whole brain technique for teachers and parents.
Cranio-sacral Therapy (CST) is a hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.
Art and music therapies:
Art and music can provide tactile, visual and auditory stimulation. Music, especially song, can be a tool for speech development and language comprehension as well as to treat behavioural problems and improve cognitive, physical, sensory and motor functioning. Painting, art and craft therapy may offer an important means of expression, especially for a non-verbal child with autism.
The American Music Therapy Association.Autism Spectrum Disorders: Music Therapy Research and Evidence-Based Practice Support (An annotated bibliography).
See also ASD Arts!
Animal Assisted Therapies:
- Therapeutic horseback riding is said to improve coordination and motor development while creating a sense of well-being and increasing self-confidence.
- Trained autism assist dogs are being used more frequently to help children and adults reduce isolation, develop social confidence, relate to others, and communicate.