TIPS FOR SELECTING SUITABLE INTERVENTION

by Barry K. Morris B.ScWk

Early interventions for Autism Spectrum Disorders are continually developing, and can present a bewildering array of approaches, costs, benefits and waiting lists to parents who may still be reeling from the impact of their child being diagnosed. Although parents may feel a sense of urgency to find therapies quickly, in the long term it is advisable to put time, research and discussion into your choice.

Intervention should be Autism-specific

The therapy should be designed for children with Autism Spectrum Disorders. If it focuses specifically on your child's particular condition (ie. Autism or Asperger's) so much the better. The therapists should also take time to observe and assess your child, then discuss the theory behind the therapy, how it is works, and its suitability in your child's case.

An experienced therapist will acknowledge and respect your role as a parent. You know your child best and your involvement should be emphasized. The therapy should also provide parents with strategies to implement in the home environment. Ideally a therapy should give you practical approaches to use in general life situations.

common elements of effective interventions

There is a broad range of interventions styles available, so a number of studies have looked for the common elements in these interventions regardless of the particular style chosen (Dawson and Osterling 1997). The effectiveness of interventions does not seem to rely so much on the particular styles chosen, but how well they are adapted to suit the needs and strengths of the child and family as a whole.

The most effective interventions address the following issues:

• Attention and concentration

• Appropriate social interaction

• Ability to imitate other people

• Language skills

• Appropriate play.

Multidisciplinary approach

As Autism Spectrum Disorders affect a child in many ways, effective interventions usually have a stress on a multidisciplinary approach, with the possible involvement of occupational therapists, speech therapists, teachers, psychologists, physiotherapists, and of course, the parents. In the same spirit, a variety of interventions may be used together to better address the needs of the individual child.

Parents are actively involved

The most effective interventions involve the parents heavily in learning to consistently apply the intervention in their child' life. Experienced therapists should be aware of the difficulties faced by parents and be able to support them as issues arise.

Intensive supportive and structured teaching environment

The teaching environment focuses on the need for routine and enabling the child to predict what will happen next. The environment is also highly supportive and aims to generalize strategies learnt from one context to another. The number of hours devoted each week to interventions are important too. This can vary from a suggested minimum of 15 hours per week (Dawson and Osterling 1997) to the 40 hours per week or more of intensive Applied Behavior Analysis.

Proactive approach to challenging behaviors

There is a proactive approach to challenging behaviors by identifying and minimizing the triggers for behavior, and looking for what the child is trying to communicate through the behavior. There is also an emphasis on a structured environment, holding the child's interest and using positive reinforcement to encourage appropriate behavior.

Child-focused intervention

The most effective interventions are increasingly stressing the need to encourage choice, independence and a focus on the child's control of what happens during intervention.

Support for transition to school

The start of schooling is a difficult time for children on the autism spectrum and the most effective interventions encourage independence in a child that makes this transition easier. Extra support is provided during this transition and the intervention therapists should work with parents to find the most suitable school available for their child.

Visual cues for communication

A common characteristic of children on the autism spectrum is a difficulty with verbal language. Augmentative communication uses strategies such as the Picture Exchange Communication System, interactive story boards and social stories to develop communication skills.

Encourage interaction with other children

Effective interventions stress the need for a child on the autism spectrum to engage in social interaction and play with other children to develop appropriate communication and play skills.

Self-stimulating behaviors, rituals and obsessions

An emphasis is needed on why these behaviors occur. Interventions should seek to minimize these behaviors when inappropriate, but at the same time realize that as pleasurable activities they can be used as positive reinforcement and managing stressful situations.

be skeptical

Some people claim miraculous benefits or cures for children on the autism spectrum. Remember that each child has a diverse range of issues from being on the autism spectrum and will respond to various interventions in various ways. There are also less reputable services providing 'cures' on the Internet that seek to exploit every parents desire to see their child develop as normally as possible.

Some children improve substantially even without therapy, so it is very difficult to know when therapy has definitely made the difference. In other cases, a therapy may work so well for one child it will appear as if it has 'cured' the Autism, but may only have moderate to little effect for most other children.

An evidence-based approach uses objective rigorous testing to look at large groups of children under a therapy, and have a 'control group' of children not under the therapy. Unfortunately this approach has not been applied to many new therapies so far. The next best option is to look for general agreement on an intervention's effectiveness from Autism associations, researchers, journals and respected books on the autism spectrum. When a therapy is quite new, you may need to rely on anecdotal evidence from wide range of parents who have used the therapy. Try not to be swayed by one or two parents who had huge success. You are looking for a substantial number of parents who consistently report benefits. Talk to parents in support groups, get into autism forums and talk with Autism associations about your findings.

In your research, ask when the intervention style was developed, how widely it is used and its evaluation from autism specialists. Unfortunately, therapies are often very expensive. Some parents look at creating their own home-based budget intervention program. Your local Autism association should be able to inform you on subsidies, government treatments and other options available.

where to start?

Given the controversies, debates, lack of research and variations on the autism spectrum, making general suggestions on choosing interventions is difficult. However, there is a fairly broad consensus that the first step is assessment by an experienced pediatrician or team to see in which areas your child needs support.

In most cases, the next step is implementing a behavioral program such as Applied Behavior Analysis which is the most rigorously tested intervention method to date. When there are sensory problems, some form of sensory integration therapy will prove useful. Communication issues can be dealt with using a variety of interventions, some of which include Applied Behavior Analysis and Social Stories.

Finally, many parents look at biomedical interventions such as restrictive diets and vitamins, although evidence for these is still mostly anecdotal in nature with little evidence-based research done to date. There is no one approach here that helps all children across the autism spectrum - however some parents find that a particular biomedical intervention can have a positive effect. When this occurs, there is usually debate over whether the biomedical intervention is actually treating the Autism Spectrum Disorder, or simply one of the many comorbid disorders.

Click here to read a fact sheet about avoiding exploitation by less ethical intervention services.

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