Thereputic programmes for autism

In behaviour modification, small sections of behaviour are modelled, shaped and positively reinforced. One popular behavioural approach for treatment of autism is applied behavioural analysis (ABA.) ABA uses the principles of learning theory to improve selected behaviours in children. ABA is objective and improvement is measurable and it often results in positive behavioural changes.

One type of ABA was pioneered by Lovass in 1987 and this was called Discrete trial training (DTT.)

AIM - carried out a case study of a young boy who had problems with verbal and social behaviour, and engaged in self destructive head banging behaviour

METHOD- the researchers monitored and documented the boys progress as he underwent a behaviour shaping programme. He refused to wear glassses, a problem as his sight would not develop normally. The behaviour programme consisted of giving him a sweet as a reward, first for inspection of the glasses. Each time the child held the frames nearer to the face for the reward and finally, only rewarded when the frames were on his head.

RESULT- though rewarded for successive approximations to desired behaviour, the child eventually learns to wear his glasses

CONCLUSION- operant conditioning techniques in the form of behaviour shaping can be used to successfully condition desired behaviour into autistic children

In DTT, skills are broken down to their most basic components and positive reinforcement is used to reward performance of each component. The tasks are broken down into short, simple trials and repeated lessons are taught one on one. Each trial consists of:

o Antecedent- a request for the individual to perform an action

o Behaviour - a response from that person

o Consequence - a reaction from the therapist

It is the consequence that is positively reinforcing and this may be combined with a biscuit or an extrinsic reward.a choice such as 'what do you want to draw?' has also been found to be importanant for successful outcome (Koegal et al 1996.) positive reinforcers are selected to the child's preference. DTT has been found to be one of the most effective treatments for long term, and children effectively improve IQ, language and cognitive skills (mceachin et al, 1993)

Another ABA approach is PRT which is able to increase motivation in children, via letting them make choices and is sometimes regarded better than DTT.

The Lovaas technique is also a well known behaviour modification procedure used to elicit communication or language through operant conditioning. Lovaas (1967) used behaviour aping principles, rewarding successive approximations to desired language in children with autism. Using food as reinforcement, the child would be rewarded for making eye contact, speech sound, particular vowels or constants and then a desired word or phrase.

o most people consider behaviour modification unethical and involve control and manipulation

o Gross (2001) points out that children treated by these methods aren't magically transformed into 'normal' children and their behaviour can regress when treatment stops

o Behavioural treatments might help autistic children live easier lives

o Alrhough popular with parents, there is controversy surrounding the use of intensive therapy. Critics state that children may produce appropriate behaviours without understanding why these actions may be appropriate

o Kendall suggests that progress is often slow, not always successful and the greatest improvements occur when treatment is intensive and involves the parents

Some autistic symptoms are aggressive behaviour, anxiety and hyperactivity. These can be treated with drugs.

Haloperidol (or haldol) is a drug that reduces social withdrawal, stereotyped motor behaviour and aggression. Many children don't respond to this drug, however, and it has no effect in their symptoms. There are also potentially dangerous side effects, like 1/3 develop involuntary body movements.

Fenfluarmime lowers serotonin levels and there is some evidence of Improvent in beHaviour and thought processes. There is no consistent effect been found on language or cognitive levels and the effects are often subtle.

o No drug has yet been developed that reduces enough of the autistic symptoms to warrant long term use

o Medication would usually be needed to be combined with other interventions

o Side effects of the drugs often outweigh any gains

o many drugs haven't been tested on children

o medication can provide relief for specific symptoms and therefore relieve some stress on the carers

o Parental involvement has been shown to be paramount in educational improvement with autistic children. Where ever possible, it is suggested parents should be involved in the treatment.

o one reason suggested for this is that parents can help autistic children generalise behaviours. Especially if parents are present at a variety of sessions that take part in different places.

o Treatment contracts are set up with parents, where they specify which behaviours they want to change. The parents are usually asked to reinforce desirable behaviours and withhold reinforcement for undesirable behaviours

o this is a time consuming and lengthy programme so parents have to be prepared for this

o Koegel et al 1982 showed that 30 hours of parent training was effective as 200 of clinical treatment In improving autistic children's behaviour
o Koegel et al (1996) found most benefit occurred when parents concentrated on improving their autistic children's motivation and responsiveness rather than targeting specific problem areas. If the child was allowed to choose the teaching materials and positive reinforcers,then family interactions and positive communication improved greatly
o Lovaas found that parental involvement vastly improved his ABA therapy. He stated training only really works if you involve parents. In follow up studies he found those who remained in insituitions regressed, where as those who went back to their parents and continued development made strong gains
o This concept of family involvement puts families under alot of pressure and the training is very expensive and intense. It also takes alot of time, efforts and expense and some families may struggle to afford it and may feel under pressure and stress which can affect other family members
o not all autistic children are treated at home. Some are severely disturbed and cared for best by a mental health proffesional in a hospital or care house setting.