V.2 #4 Early Intervention - Autism Spectrum Disorder and Early Intervention: A Summary of Approaches
Autism Spectrum Disorder (ASD) refers to a group of developmental disabilities whose most common characteristics include impaired verbal and non verbal communication, social skills, and restrictive, repetitive, or stereotyped patterns of behavior (See, for example www.autismspeaks.org). The Center for Disease Control and Prevention estimates the prevalence rate for children to be about 1 in 150 and estimates that 35,111 children between the ages of 3 to 5 were served under the autism classification for special education services in 2006 (See http://www.cdc.gov/). Given rising prevalence rates of ASD in recent years and the provisions for children with disabilities (including ASD) available under the Individual with Disabilities Education Act of 2004, it has become an increasing priority to find effective early intervention programs for children with ASD.
One of the fundamental abilities that all young children come to develop over the early years of life is the ability to communicate with others in their community. Because children with ASD have impaired communication skills, many interventions focus specifically on this area. These interventions are not all alike—they vary in the kinds of approaches they take to improve aspects of young children’s communication skills. In a review of interventions, Goldstein (2002) describes several such approaches, including the use of sign language, discrete—trial training, milieu teaching procedures, replacing challenging behaviors, and promoting social and scripted interventions. Some highlights from Goldstein’s review of about 60 peer reviewed research studies follow:
Interventions using sign language. Interventions that couple sign with speech have been found to be positively associated with vocabulary development. Children with poor verbal imitation skills and more limited communication abilities overall appear to benefit from interventions incorporating sign to a greater degree than children who have stronger verbal imitation skills.
Interventions using discrete-trial training. Interventions using discrete-trial training prompt or guide children to use certain communicative behaviors (e.g., asking “what” versus “who”), and provide reinforcement (e.g., praise, a reward) when children respond appropriately to prompts. The goal of discrete-trial training is to have children learn to produce appropriate communicative responses on their own, without reinforcement, and in a variety of contexts that call for the particular communicative behavior they have learned. Recent interventions using discrete-trial training have found that children can learn how to use more sophisticated communication behaviors than was previously thought to be possible, for example by combining multiple words into sentences or by using multiple sentence responses.
Interventions using milieu teaching procedures. Milieu teaching procedures are those designed to encourage children to satisfy their own communication needs (e.g., requesting, commenting), as they occur in everyday settings, such as in the home, at school, and in the community. Some communicative behaviors that children have learned to use successfully through milieu teaching procedures include requesting a desired object, making eye contact with other speakers, using polite terms such as "excuse me, please, thank you, you're welcome," and engaging in positive interactions with peers.
Interventions designed to reduce challenging behaviors. Children with ASD may engage in challenging forms of behavior, including aggression, tantrums, or property destruction, in certain situations. Interventions designed to reduce challenging behaviors must first identify the triggers or situations prompting children’s challenging behavior, and then teach children how to replace their challenging behavior by communicating with others. For example, if a child exhibits aggression in school each time he doesn’t understand a teacher’s request, he might be taught to replace his challenging behavior (aggression) with a communicative behavior that will help to satisfy his needs (e.g., “I don’t understand” or “Please help me”). Interventions designed to reduce challenging behaviors have been successful at both identifying common variables that prompt challenging behaviors and identifying the kinds of communicative functions children can use to replace challenging behaviors to satisfy their needs.
Interventions to promote social and scripted interactions. Because social skills tend to be impaired in children with ASD, teaching children how to interact and communicate in socially appropriate ways is very important. Some interventions have successfully taught children without ASD how to share and give play directions to their peers with ASD, which seems to be associated with increased social and communicative interactions during play. Other interventions have successfully taught children with ASD how to initiate social interactions with their peers, and how to use “scripted interactions” in play situations (for example, in a play situation taking place in a restaurant, scripts might involve “what would you like to eat?, what would you like to drink?, would you like any dessert?”). Interventions promoting social and scripted interactions have been found to be successful at promoting both communicative behavior and social interactions with peers.
Interventions that use a variety of approaches for improving communication are available to professionals providing early intervention services to children with ASD. Although many interventions have been found to have promising effects, it is important that early intervention providers select interventions that work best with the objectives of the children and families they serve and that maximize the potential that children’s newly learned communication behaviors will be extended to a variety of naturally occurring contexts and experiences.
Goldstein, H. (2002). Communication intervention for children with Autism: A review of treatment efficacy. Journal of Autism and Developmental Disorders, 32, 373-396.
Khara Pence Turnbull, Ph.D. is editor of Assessment in Emergent Literacy (Plural Publishing) and author of Language Development from Theory to Practice (Merrill/Prentice Hall).