Combining Treatment Approaches in Working with Children with Autism By Tracy Vail,MS,CCC/SLP Letstalksls.com

Most Common Approaches Used Behavioral Approaches- ABA- Applied Behavior Analysis and Applied Verbal Behavior, TEACCHBehavioral Approaches- ABA- Applied Behavior Analysis and Applied Verbal Behavior, TEACCH Developmental Approaches- SCERTS, Floortime/DIR, RDIDevelopmental Approaches- SCERTS, Floortime/DIR, RDI

Can We Combine Behavioral and Developmental Approaches? YES!!!

General Language Categories Language used to meet the needs of the individualLanguage used to meet the needs of the individual Language used for social interactions and building relationshipsLanguage used for social interactions and building relationships Language used for learning or academic settingsLanguage used for learning or academic settings

Factors to Consider No single program works for all children to address all their needs.No single program works for all children to address all their needs. Every human beings learning ability is a combination of internal and external factors.Every human beings learning ability is a combination of internal and external factors. Motivation of the child is the most important factor to consider when making treatment decisions.Motivation of the child is the most important factor to consider when making treatment decisions.

Relevant Information About Learners with Autism They tend to have very analytical mindsThey tend to have very analytical minds They tend to have unusual motivations and consequently unusual reinforcersThey tend to have unusual motivations and consequently unusual reinforcers They tend to be rule based learnersThey tend to be rule based learners Their bodies experience the world in an unusual wayTheir bodies experience the world in an unusual way Some are quite rigid and anxiousSome are quite rigid and anxious They often have difficulty understanding the rules of social interaction and communicationThey often have difficulty understanding the rules of social interaction and communication So what…..Now what?

Use Whatever Works to Teach the Most Important Skills to each Individual child at the Given Time Use Whatever Works to Teach the Most Important Skills to each Individual child at the Given Time So how do we know whats most important?

Ask and Observe Ask the parents! What are their priorities?Ask the parents! What are their priorities? Observe the child- What areas are causing the child the most difficulty in life right now?Observe the child- What areas are causing the child the most difficulty in life right now? Look at where the child is currently functioning and determine the necessary component behaviors/skills to meet the goals of the parents and child.Look at where the child is currently functioning and determine the necessary component behaviors/skills to meet the goals of the parents and child. What are the goals of the family in 1 yr? 5 yrs? 10 yrs?What are the goals of the family in 1 yr? 5 yrs? 10 yrs?

Developmental, Individual Differences, Relationship Based Intervention, DIR/Floortime A warm and intimate way of relating to a child. A floor time philosophy means engaging, respecting and getting in tune with the child in order to help the child elaborate through gestures, words and pretend play what is on the childs mind. As a technique it is a process that is used to support the emotional and social development of the child. (Greenspan, 2002)A warm and intimate way of relating to a child. A floor time philosophy means engaging, respecting and getting in tune with the child in order to help the child elaborate through gestures, words and pretend play what is on the childs mind. As a technique it is a process that is used to support the emotional and social development of the child. (Greenspan, 2002) This model serves as the context or container of the therapy we do. But what does it mean?

Hanen Method Teaching communication and play skills through adult- child interactions. Parents/therapists are to:Teaching communication and play skills through adult- child interactions. Parents/therapists are to: Observe, Wait and Listen (OWL)Observe, Wait and Listen (OWL) This approach is very similar to DIR in that the child leads and teaching is conducted based on the interests of the child.This approach is very similar to DIR in that the child leads and teaching is conducted based on the interests of the child.

Relationship Development Intervention A cognitive- developmental approach designed to remediate Autism.A cognitive- developmental approach designed to remediate Autism. Deals with autism as a neurologically based, information processing disorder.Deals with autism as a neurologically based, information processing disorder. Proposes to remediate the Core Deficits in Autism including motivation, communication, emotional regulation, episodic memory, rapid attention shifting, self-awareness, appraisal, executive functioning, flexible thinking, and creative problem solving.Proposes to remediate the Core Deficits in Autism including motivation, communication, emotional regulation, episodic memory, rapid attention shifting, self-awareness, appraisal, executive functioning, flexible thinking, and creative problem solving. Great stuff based on research by many in the field but what do these core deficits mean? How do we know when these skills have improved? What is the child doing? How can we measure it? AND, is it really necessary to spend thousands of dollars being trained to address these issues?

Behavioral Approaches Scientifically validated based on many years of research.Scientifically validated based on many years of research. Based on measurable behaviors either internal or observable.Based on measurable behaviors either internal or observable. Based on the laws of learningBased on the laws of learning Places the responsibility of learning on the teacher rather than the studentPlaces the responsibility of learning on the teacher rather than the student Many faces to behavioral interventions. Not all programs look alikeMany faces to behavioral interventions. Not all programs look alike Data driven program decisionsData driven program decisions

Applied Verbal Behavior Based on the research of BF Skinner on why people communicateBased on the research of BF Skinner on why people communicate Language is categorized into verbal operants or functionsLanguage is categorized into verbal operants or functions Language is taught as a behavior with specific teaching procedures usedLanguage is taught as a behavior with specific teaching procedures used Both natural environment teaching and intensive teaching are used based on the age and skills of the childBoth natural environment teaching and intensive teaching are used based on the age and skills of the child Resources: Educate Toward Recovery by Robert Schramm, Assessment of Basic Language and Learning by James Partington and Mark Sundberg.Resources: Educate Toward Recovery by Robert Schramm, Assessment of Basic Language and Learning by James Partington and Mark Sundberg.

TEACCH The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self- efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called Structured Teaching.The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self- efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called Structured Teaching. The principles of Structured Teaching include:The principles of Structured Teaching include: –Understanding the culture of autism. –Developing an individualized person- and family-centered plan for each client or student, rather than using a standard curriculum. –Structuring the physical environment. –Using visual supports to make the sequence of daily activities predictable and understandable. –Using visual supports to make individual tasks understandable (TEACCH Website)

The Language We Use Often it isnt what we do but how we talk about what we do that makes approaches seem so different.Often it isnt what we do but how we talk about what we do that makes approaches seem so different. The language we use to talk about what we do should be precise, agreed upon and based on observable or measurable change.The language we use to talk about what we do should be precise, agreed upon and based on observable or measurable change. As SLPs we are charged to provide evidenced based practices. Show me the data!!As SLPs we are charged to provide evidenced based practices. Show me the data!!

Sam

What did you observe with Sam? He remained engaged with the instructor for 3.5 minutes.He remained engaged with the instructor for 3.5 minutes. He requested using gestures 4 times with no prompting.He requested using gestures 4 times with no prompting. He imitated body movements twice with no prompting.He imitated body movements twice with no prompting. He looked at the instructor twice and smiled.He looked at the instructor twice and smiled. He laughed in response to the instructors actions twice.He laughed in response to the instructors actions twice. He initiated a social game twice with no prompting.He initiated a social game twice with no prompting. He shared affect He shared attention He both opened and closed 5 circles of communication The instructor followed the childs lead He demonstrated a preference to engage in a regulatory pattern with ongoing variations He regulated his actions to maintain social coordination He responded to guides role actions to maintain the regulatory status of the pair.

Children are Complete Human Beings They have a right to communicate to get their needs metThey have a right to communicate to get their needs met They want and need successful relationships in their livesThey want and need successful relationships in their lives While they have some similarities, they all have unique needs that should be addressedWhile they have some similarities, they all have unique needs that should be addressed Each family structure is different and has unique priorities and needsEach family structure is different and has unique priorities and needs Child and family needs will change over time and programs need to reflect thatChild and family needs will change over time and programs need to reflect that

Early Learners Build trust/relationship by being predictableBuild trust/relationship by being predictable People are fun and talking is funPeople are fun and talking is fun Talking is useful- I talk, I getTalking is useful- I talk, I get Use a combination of principles from DIR, Floortime and VB

Build Context/Motivation to Communicate

Communicating Before Talking

Use Music

Use Books

Shape Speech in the Context of Requesting

Teach Them a Way to Communicate

Intermediate Learners Advance language and literacy skillsAdvance language and literacy skills Continue to include relationship developmentContinue to include relationship development Include intensive teaching based on the needs of the childInclude intensive teaching based on the needs of the child Expand play skillsExpand play skills

Teaching Mastered Skills in Intensive Teaching

Expand Play Skills

Advanced Language Learners Higher Level Language SkillsHigher Level Language Skills Continue to build relationshipsContinue to build relationships Problem solving/negotiatingProblem solving/negotiating Foster success in academic and social settingsFoster success in academic and social settings

Advanced Pretend Play

Problem Solving and Story Comprehension

Negotiating/Problem Solving

Thanks for All You Give to Children!