Expert: James Michael Roan - 3/2/2006

Question
Hello,
I am writing an article on autism for Our Kids magazine (part of United Parenting Publications) in San Antonio. My focus is on treatments and early detection.  Can you talk a little about popular treatments now? Some of the experts here advocate ABA.

Thanks so much.
Laurie Kaiser
Editor, Our Kids

Answer
Hi Laurie;

This is a daunting task indeed! In my view there are really to categories in which I place all interventions and/or therapies: 1. Those that are empirically validated in the research, and 2. Those that are not.  Unfortunately, as with any need that has not been adequately filled, there are a number of unscrupulous individuals and organizations that prey on vulnerable parents who are searching for something, anything that can help their child. Autism, I am sorry to say, is becoming the next gold rush for purveyors of “snake oil,” or quick fixes and they are selling them at astronomical prices. The problem with interventions that are not strongly supported in the research is that while a child is involved in one of these programs that may or may not produce positive results, they are losing valuable time, time that might be better spent on empirically validated interventions. It is a gamble and the stakes are quite high: a child.

With that in mind, I will address interventions that are supported through direct research or group studies. Applied Behavior Analysis or ABA as it is more commonly known has it's benefits and its limitations. In my experience, it is best suited for teaching basic skills that are either not present or very weakly present in a child's behavioral repertoire. ABA is useful for developing and shaping speech sounds, for adding words to pointing behaviors, or learning to use a Picture Exchange Communication System (PECS) program. It is limited in that skills learned through ABA rarely, if ever, generalize to dissimilar environments rendering any gains as questionable in terms of their value.

Other programs such that are naturalistic in nature and incorporate incidental learning outcomes have a much better likelihood for generalization. The most well known by most parents would be Stanley Greenspan's Floortime Model (Greenspan & Wieder, 1998). Simply put,  joint attention is established between the caregiver and child by first engaging in the autistic individual's behavior of choice, which is usually their repetitive and stereotypic behaviors, and then slowly shifting joint attention to more socially adaptable interests. Pivotal response techniques accomplish very similar results.

I have provided a list of programs other than behavioral ones that were reviewed by The National Research Council [NRC] (2001) and found to produce a variety of positive results:

Denver Model at the University of Colorado Health Sciences Center, which uses a developmental approach using play as the mechanism for learning a variety of developmental skills.

Developmental Intervention Model at The George Washington University School of Medicine, a relationship based approach using the floortime model (Greenspan & Wieder, 1998).

Pivotal Response Model at the University of California at Santa Barbara, which uses the pivotal-response method for establishing joint attention and thus communication.

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) at the University of North Carolina School of Medicine at Chapel Hill. This program effectively blends behavioral and naturalistic teaching techniques in their teaching strategies.

Walden Early Childhood Programs at the Emory University School of Medicine uses incidental teaching strategies.

This list is hardly exhaustive but provides a good starting point for researching an appropriate program for any child on the autism spectrum.


References

Greenspan, S. I., & Weider, S. (1998). The child with special needs: Encouraging
intellectual and emotional growth. Reading, MA: Addison-Wesley.


National Research Council (2001). Educating children with autism. Committee on Educational
Interventions for Children with Autism. Division of Behavioral and Social Sciences and Education. Catherine Lord and James P. McGee, eds. Division of Education and Social Sciences and Education. Washington, DC: National Academy Press.

I hope that helps you a bit in your research. Let me know if you need more clarification and/or detail.

Please end me a copy of your article if you don't mind.

Kind Regards,
James Roan