Types of Autism Behavior Interventions
What is an intervention?
Intervention for autism involves taking action, often with outside help, to improve a specific condition or behavior. A successful intervention requires the cooperation of the child, parent, and therapist. With consistent practice and teamwork, interventions can make a difference.
There are many interventions that address the many challenges parents encounter when raising a child with autism. Some intervention strategies can be a one-time event, while others require regular sessions for a long time.
When to use autism intervention strategies
The effects of autism vary from one child to another. Parents, family members, and caregivers are the ones who can determine if a child with autism needs undergo treatment to resolve harmful and unacceptable behavior.
Some challenging autism behavior can include
- Refusing or ignoring requests
- Socially unacceptable behavior (banging utensils on the dinner table, hurting people, etc.)
- Repetitive behavior (stimming)
- Hurting oneself or others
There are several reasons why children with autism act out in surprising or unexpected ways. Some of these reasons are:
- Difficulty understanding verbal or non-verbal language, including gestures, tone of voice, and contextual meanings
- Communication challenges (some children with autism are non-verbal) that can lead to frustration
- Sensitivity to sights, sounds, and smells
- Aggressive behavior
- Dislike for a break in routine
It is important parents and primary caregivers of children with autism understand the triggers of challenging autism behaviors and respond appropriately. Typical punishment such as a time-out may not resolve unwanted behavior.
Creating a plan to start and implement intervention
The first step towards an intervention is deciding on the right method. Consult with your child’s doctor to learn more about the different types of appropriate interventions. Your doctor should also be able to assess your child’s needs and recommend the right treatment plan.
Today, there are a handful of treatments and techniques for autism behavior issues.
ABA therapy interventions have been tested and proven to have a positive impact on children on the spectrum.
Treatments or behavioral techniques for autism can be focused or comprehensive. Focused interventions have single strategies used alone or in combination with others to improve a specific behavior or skill. Comprehensive interventions, on the other hand, employ multiple strategies that target a broad range of behaviors.
Applied Behavior Analysis
ABA aims to build a positive change in behavior using the premise people improve their behavior when given positive consequences or rewards. It is a variety of techniques used to teach people with autism a new skill or to lessen undesirable behavior.
A clinical psychologist and professor at the University of California, Dr. Ole Lovaas, pioneered ABA and was the first to prove the method effective in modifying autism behavior in children.
In his study, “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children,” 19 children with autism received 40 hours of ABA per week for two years. At the end of two years, 9 out of the 19 children in the ABA group achieved cognitive functioning and performed in school with minimal help.
ABA therapy focuses more on rewarding good behavior. When children with autism behave a certain way with the promise of a reward, they are more likely to repeat the behavior in the future.
ABA uses an observation tool called the ABCs.
A: Antecedent: the events, actions, or circumstances that happen before a behavior
B: Behavior: the behavior that results from the antecedent
C: Consequences: the action or response that follows the behavior
An example of this in an everyday setting is:
A: A parent asks the child to stop playing and eat dinner
B: The child refuses and throws a fit when asked several times
C: A parent leaves the child alone, and the child goes back to playing
In an ABA setting, therapists modify antecedents to achieve the target behavior (positive) and the desired consequence.
Discrete Trial Training
Discrete Trial Training is a teaching method used in tandem with other intervention techniques. DTT is often used in ABA-based sessions. It is ideally for autistic children ages 2–6 years.
DTT makes learning easier for children on the spectrum by breaking down a task into its most basic components. A task like tooth brushing can be broken down into steps, so it’s easy to follow. Most DTT methods rely on repetition until the child learns the skill or behavior.
As the child completes each step in the task, he/she is given a reward or motivator such as being told “Great job!” or receiving a star stamped at the back of the child’s hand.
The five steps of DTT are:
1. Antecedent (usually instructions or requests given by the therapist)
2. Prompt (any gesture that helps guide the child to what he/she needs to do)
3. Response (the target behavior)
4. Consequence for correct response (reinforcement/praise)
5. Consequence of incorrect response (correction)
6. Inter-trial interval (a break in between tasks or learning points)
DTT is effective for children with autism because it is easier for them to learn with this technique. In DTT, each activity is kept short to ensure maximum attention. It also helps that this approach is given in a one-on-one session, so tasks are tailored according to the child’s needs.
Early Intensive Behavioral Interventions
Early Intensive Behavioral Intervention (EIBI) is under the umbrella of ABA. This method is for children with autism ages five and under. A successful EIBI treatment requires the child to undergo 20–40 hours of sessions in a week.
Just like ABA, EIBI uses positive reinforcement to achieve a target autism behavior. It is also used for curbing harmful and destructive behavior such as self-harm, hurting others, aggression, and irrational tantrums.
A research study conducted in 2014 concluded EIBI was successful in improving behavior in children, specifically those who started the treatment before two years old.
More importantly, the study suggests EIBI is one of the most effective evidence-based behavioral interventions for repetitive autism behaviors. The study concluded: “Increases were seen on direct measures of JA [joint attention], play, imitation, and language while decreases were seen in stereotypy regardless of level of performance at entry into EIBI.”
Incidental teaching is a naturalistic teaching method that is part of ABA. It is used to improve the communication skills of children with autism. Incidental teaching is advisable for children ages 2–9, but it works with any age.
The process for incidental teaching involves the following:
1. Prepare a room that is inviting for a child—for example, a play area with his/her favorite toys and games.
2. Limit access to a desirable object or toy by making it visible, but somewhere the child cannot reach.
3. Wait for the child to ask for the toy or point to it.
4. Ask the child, “Which toy animal do you want?”
5. Wait for the child’s answer—for instance, “Horse.”
6. Give the toy horse as a reward.
Unlike a structured setting such as a clinic, incidental teaching is done in a casual environment where the child takes the lead. Research has shown this arrangement can help the child apply what he/she has learned and use it in different situations.
Milieu teaching is a method of behavioral intervention done in a natural environment (home, playground, park) and aims to improve language skills for children with autism.
The teaching opportunities happen within the child’s everyday routine such as eating breakfast, getting ready for school, playing at the park, etc. The teacher, usually a parent or primary caregiver, waits for the child to show interest in doing something such as playing in the slide or getting a snack. The child is then encouraged to use his/her communication skills to make a request, provide more information, and respond to questions appropriately.
Milieu teaching has three teaching procedures:
1. Model: The teacher demonstrates the target language so the child can imitate it.
2. Mand: The teacher asks the child a question such as “What do you want?” or “Tell me what you want.”
3. Time delay: The teacher waits and prompts a response with non-verbal gestures like raising eyebrows to let the child know his/her response is needed.
Enhanced Milieu Teaching (EMT)
Enhanced Milieu Teaching (EMT) is an extended version of Milieu Teaching. EMT is usually done by parents who are trained in this method.
EMT not only aims to improve communication skills but to manage challenging behavior. Some strategies for preventing unwanted behavior are:
- Using a timer for smoother transitions (the child should stop what he’s/she’s doing when the timer stops)
- Using a visual schedule (pictures that show a child’s expected activities for the day)
- Offering choices (gives the child a feeling of control)
A 1994 study of parents practicing EMT with their children at home saw positive results. Children who were given the treatment improved their communication skills and their relationship with their parents.
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Pivotal Response Treatment
Pivotal Response Treatment (PRT) is another naturalistic form of ABA, similar to EIBI and Incidental Teaching. PRT uses play as an environment for children with autism to improve social, communication, and play skills. PRT lessons usually include imitation, socialization, taking turns, and joint attention.
PRT’s theory states there are four areas of child development “pivotal” for later development:
- Motivation: a child’s desire to learn and try new things
- Self-initiation: eagerly answering the child’s questions when he/she shows interest in a subject
- Self-management: helping a child be independent and learn on his/her own
- Responsiveness to multiple cues: teaching children to respond to different prompts that might mean the same thing (“Comb your hair,” “Fix your hair,” “Please use the comb for your hair”).
A PRT session usually involves the following:
- Identify a goal for the child, such as saying “please” or “thank you.”
- Find an item the child likes and use it as a point of interest and an opportunity to reach the goal.
- Praise and/or reward the child each time he/she makes an effort to reach the goal.
In PRT, the child does not have to hit a goal before he is rewarded. The attempt itself is enough to warrant a reward.
Positive Behavior Support
Positive Behavior Support is a comprehensive intervention where triggers for unwanted behavior are removed or reduced and an acceptable behavior is taught to the child to replace difficult or undesirable behavior.
PBS is based on the Human Rights Act which states all children have the right to be treated with dignity and have an opportunity to get a good education.
The treatment strategy of PBS focuses on how the child can communicate effectively to get what he/she wants, so he/she does not have to resort to behaving inappropriately. In cases where a child displays challenging behavior, the teacher or therapist will attempt to replace the behavior with one that is appropriate.
Other strategies used in PBS are:
- Changing the environment or routine
- Tactical ignoring of the behavior (pretending to not recognize the behavior)
- Rewarding good behavior
- Adjusting expectations from the child
- Modification methods such as desensitization
- Teaching other people how to react around the child
- Time out
PBS does not resort to punishment or correction when a child behaves unexpectedly. When this happens, the right thing to do would be to calmly give the child choices.
For example, if a child is loud, you don’t just say, “Stop it!” Instead, you present a choice, “You can play quietly or leave the room.”
This is in line with the philosophy that the child should always be treated with respect and that resorting to coercion or punishment violates the child’s rights.
UCLA Young Autism Project
The University of California at Los Angeles Young Autism Project (also known as the Lovaas Program) is a structured, comprehensive intervention made to help young children with autism.
This method aims to teach young children self-help, communication, thinking, and social skills. As children learn the lessons, they are rewarded. Challenging behavior, however, is ignored.
The UCLA YAP model uses several methods, including Discrete Trial Training, Discrimination Training, and Incidental Teaching. It is an intensive training that requires 40 hours per week and is mostly done by parents with the help of a specialist.
Verbal Behavior Approach
Verbal Behavior Approach, also called Verbal Behavior Therapy, is based on theories of ABA. The approach encourages children with autism to connect their words to what they want to do. With this method, children on the spectrum learn speaking or using words can help them get what they want.
There are four types of “operants” or languages in this technique:
1. Mand – a request such as saying, “Water,” to ask for water.
2. Tact – A comment used to share an experience or get attention. For instance, pointing to the sink and saying, “sink.”
3. Intraverbal – Using words to respond or answer a question
4. Echoic – Words that are repeated or echoed
Verbal Behavior Approach uses errorless learning, the use of prompts to encourage a child to respond. This process is repeated until the child no longer requires prompts to accomplish a task.
Choosing the best behavior intervention for your child is not a light decision to make. With the help of your child’s doctor and/or a behavior analyst, you should be able to develop an excellent treatment plan and be on your way to seeing improved behavior in your child.
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