Education Methods


The Treatment of Autism Spectrum Disorder (ASD)

The types of training, therapies and treatments that are available for ASD are very varied and new ones are being added to the list with each passing day. The Tohum Autism Foundation website has information on some of the most current and widely used methods and techniques.

The benefits of any training, therapy or treatment must be established through scientifically verifiable results. However, the fact that research exists on a given method does not necessarily prove the efficacy of said method. For research results to evince the effects of a method such research should adhere to two standards:

  1. The research must be empirical,*
  2. The research must be published in a peer-reviewed, scientific publication.**

The training, therapy or treatments that have been presented in the Tohum Foundation Website have been judged on the above two standards as follows:

* Empirical research is conducted using control groups and depends on establishing cause and effect.

** Peer-reviewed publications are those which every article has been peer-reviewed by more than one specialist in the particular area.

Good: There are numerous experimental research studies which show that the method has had a positive outcome on children with autism.

Average: There is only limited experimental research showing that this method has had a positive outcome on children with autism.

Poor: There is no experimental research showing the positive effects of this technique on children with autism or the research which has been done shows no positive effect on children with autism.


Applied Behavioral Analysis

Applied Behavioral Analysis (“ABA”) is also known as the Behavioral Method. This method is based on an objective analysis of the individuals behavior as well as the associated environmental factors. It is thought that such behavior is either rewarded or punished in some manner by the environment. So, by using various reward mechanisms and -where absolutely necessary – dis-incentivizing mechanisms (for example, the child loses points) the method aims to increase appropriate behavior and reduce inappropriate behavior. Some of the behaviors that are sought to be increased in children with autism are: mimicry, playing, social skills, communication skills, self-care skills, and those which that are sought to be reduced are: temper tantrums and self-stimulation (stereotypic, i.e. repetitive, rhythmic, purposeless movements) behaviors.

In ABA, the individual’s desired or unwanted behaviors are determined through systemic observation and recorded concurrently. Thereafter, these behaviors are intervened and the results are similarly observed and recorded for the determination of efficacy. Children who show typical development can usually apply learned behavior to more than one situation (‘generalize’), whereas children with ASD need to be taught to generalize learned skills. In other words, they are taught to become able to apply a skill in different situations.

In ABA, special programs are prepared in order to reduce the problem behavior detected in children with ASD. In this method, the reason for behavior is sought not in the individual but in the individual’s interaction with his/her environment. Thus, whilst working to reduce the problem behavior, priority is given to observing the environment prior, during and after the particular behavior. Afterwards, the triggers for the behavior are removed, the behavior is disregarded or actively dis-incentivised (i.e. the child loses points), and the alternatives to the problem behavior -which ABA seeks to increase- are rewarded effectively.

For children with autism, ABA applies to:

  • Every moment the child is awake,
  • Every behavior,
  • Every environment in which the child functions,
  • Every person in the child’s life.

On top of these, 20-40 hours of weekly training that begins as early as possible is prioritized.

ABA’s final goal is to bring children with autism to a level where they can continue to integrated schooling with their peers.

ABA stands out amongst all the other methods as the only one with a success rate that is scientifically proven through experimental research. For example, experimental work completed by Lovaas et al. over a 2 year period of Applied Behavioral Analysis implemented on children demonstrated that close to 90% of children showed substantial mental and social progress. More strikingly, roughly half of these children had progressed to intellectual and adaptive levels that are quite close to typically developing children’s. Furthermore, the progress continued throughout puberty. None of the control group children, who were similar in their characteristics, were able to show any progress at all.

Applied Behavioral Analysis comprises various techniques that have numerous uses in autism education. Moreover, these techniques have been brought together in different ways to develop further relevant applications.


Sources:

LOVAAS, O. I. (1987) Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

MCEACHIN, J. J., SMITH, T. & LOVAAS, O.l. (1993) Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), 359-372

Discrete Trial Teaching

Known also as the Lovaas Method, Discrete Trial Teaching (“DTT”) comprises a one-on-one teaching session during which numerous teaching aids are presented in succession. During these presentations, the child is asked a question, given a command or given an object and in return they are expected to respond; correct responses are rewarded, inappropriate responses are corrected. Through this system, children can acquire developmental skills in all areas.

A more systematized version of DTT is error-free learning where various clues are utilized for responses. Thus, the probability of the child making an error is minimized. Aided by the clues, the child will get accustomed to responding with certain behaviors and slowly the clues will be removed.

DTT has also been proven useful in helping children with autism to gain critical skills in mimicry, mapping, language acquisition, playing, self-care, etc. in various experimental research.


Sources:

NAC (2009). National Standards Report. USA: NAC.


Evaluating this Method:

iyiGood: There are numerous experimental research papers which show that this method has had a positive outcome on children with autism.

Early Intensive Behavioral Intervention

Early Intensive Behavioral Intervention (“EIBI”) is a technique pioneered by Lovaas over 40 years ago at UCLA (University of California in Los Angeles, USA), which is supported by diverse experimental research work. This technique is applied as early as possible and on a one-on-one education program of 20-40 hours per week. Beginning at first with Discrete Trial Teaching, as progress is made other techniques and group teaching is introduced. Teaching mostly takes place at the child’s own home. Moreover, the syllabus followed will include all areas of development.

Research has shown that this model has resulted in almost half of the children achieving enormous progress and completing the rest of their education with their peers.


Sources:

NAC (2009). National Standards Report. USA: NAC. Peters-Scheffer, N. et al., (20u). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with ASD. Research in ASD, 5, 60-69.


Evaluating this Method:

iyiGood: There are numerous experimental research papers which show that this method has had a positive outcome on children with autism.

Teaching Through Activity Schedules

In Teaching Through Activity Schedules, tasks are divided into small steps and an activity schedule showing these steps (for example a notebook with photos) is prepared. Afterwards, the child is assisted in completing the steps by following the activity schedule (e.g. by turning the pages of the notebook). Physical help is provided to assist the child to complete the steps. For example, the teacher will stand behind the child holding his/her hand to help turn the pages and to help them hold the tool in the way shown in each photograph. The clues are provided in a systematic way and their elimination is achieved through the error-free learning technique.

Teaching Through Activity Schedules is very effective in helping children with ASD to master various skills needed for independence such as self-care, daily life routines and free time abilities. Depending on each child’s needs, the schedule can be one or more pages long with written commands or photos, it can also be provided on a computer or other technology.


Sources:

  1. a) NAC (2009). National Standarts Report. ABD :NAC
  2. b) McClannahan, L.E. and Krantz, P.J. (2010). Activity schedules for children with autism: teaching independent behavior. USA: NAC.

Evaluating this Method:

iyiGood: There are numerous experimental research papers which show that this method has had a positive outcome on children with autism.

Teaching Through Script and Script Fading

Teaching Through Script and Script Fading technique is used to teach children to initiate interactions, and start and maintain conversations. This technique seeks to do more than just directing children by giving clues to speak or respond to questions. For example, a Script may consist of a question requiring a child to ask a friend sitting next to him/her at lunch what the friend did that morning; or another one could necessitate saying ‘see you later’ when leaving. Verbal or written script models are removed in time.


Sources:

  1. McClannahan, L.E. and Krantz, P.J. (2010). Activity schedules for children with autism: teaching independent behavior. USA: NAC.
  2. ncbi.nlm.nih.gov/pmc/articles/PMC2741063/pdf/
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251297/pdf/jaba-44-04- 943. pdfjaba-42-03-659.pdf
  4. pubmedcentral.nih.gov/picrender.fcgi?artid=1284111&blobtype=pdf

Evaluating this Method:

ortaAverage: There is only limited experimental research showing that this method has had a positive outcome on children with autism.

Video Modelling

The Video Modelling (“VM”) is a mode of teaching that uses video recording and display equipment to demonstrate how a function is performed. The video can be of another child, an adult or the child herself. The child watches the targeted skill or behavior: for example playing behavior with imaginary farm animals. While watching, child is given the same tools that are in the video. Without disrupting the child’s field of vision, the teacher physically intervenes to ensure the child is performing the same movements in the video recording. For example, child’s hands are held from above and assisted to make jumping movements in sync with the animals in the recording. This physical assistance is removed systematically and various reward mechanisms are used during sessions.

There are numerous experimental research papers which document that VM is effective in acquiring social, communication, play, self-care, and daily routine skills.


Sources:

National Standards Report. USA: NAC


Evaluating this Method:

iyiGood: There are numerous experimental research papers which show that this method has had a positive outcome on children with autism.

Incidental Teaching

Incidental Teaching (“IT”) is a technique used to develop communication skills. To apply IT techniques, an environment that will encourage the child to initiate communication is set. For example, a well-loved toy is placed in a spot which is visible to the child but out of reach. When the child reaches for the toy, the teacher will encourage them to request the toy verbally or with gestures. The child’s communication efforts will be rewarded by giving them the object they requested. As time goes on, more sophisticated communicative behavior is expected of the child and when necessary, the therapist will be the model for the child.

Experimental research on incidental teaching has shown its effectiveness especially in early childhood years and showed that the communication skills gained are likely to be generalized.

Pivotal Response Training or PRT is also an application of incidental training and is widely used in the education of children with autism.


Sources:

National Standards Report. USA: NAC


Evaluating this Method:

iyiGood: There are numerous experimental research papers which show that this method has had a positive outcome on children with autism.

Functional Assessment and Analysis

Functional Assessment and Analysis was developed as an alternative to traditional Applied Behavioral Therapy techniques. This technique aims to identify the functions of problem behavior in order to beget the appropriate behavior to the same functions. The main reasons of behavior problems are assumed to be attention seeking, demand for an object or an activity, evasion from unwanted activity or the need for emotional pleasure. Research indicates that temper tantrums, which children with ASD are often prone to, serve the first three purposes; and that the self-stimulatory behavior is primarily aimed at obtaining emotional pleasure. To teach children to adopt appropriate behavior, behavioral strategies (such as shaping or chaining) among which reward mechanisms are prioritized, are applied.

There are various experimental research papers which show the effectiveness of this application.


Sources:

Tiger, J.H. et al. (2008). Functional communication training Behavior Analysis in Practice, 1, 10-23.


Evaluating this Method:

iyiGood: There are numerous experimental research papers which show that this method has had a positive outcome on children with autism.

- PECS

PECS (Picture Exchange Communication System) was developed as an alternative communication system by Andy Bond and speech therapist Lori Frost. In using PECS, the child is taught to give the picture of a desired object or activity to the person in charge. PECS can be taught to all children with ASD who can’t talk or who can’t use speech to communicate.

PECS teaching is in 6 stages. The child who at first, could communicate his/her needs through only one picture, in time is taught to differentiate between different pictures and to form sentences with those images. Pictures and sentences are placed into a portable separable folder. This is to allow the child to form new sentences whenever the child wants to communicate, in new environments.

Research shows that an important percentage of children who learn PECS can communicate functionally; some of these children also show speech development alongside the picture based communication, and behavioral problems are reduced. On the other hand, there are children who get stuck on one of the stages of PECS or who are unable to benefit from it at all.


Sources:

National Standards Report. USA: NAC


Evaluating this Method:

ortaAverage: There is only very limited experimental research showing that this method has had a positive outcome on children with autism.

Applied Verbal Behavior

The Verbal Behavior or Applied Verbal Behavior (VB/AVB) method, is derived from a book written by Skinner in 1957 titled Verbal Behavior that deals with language development, and proposes ways to help children with autism to gain communication skills. In this technique, various behavioral applications are made in order to help children gain communication skills. In these applications firstly the communication of desire (mand) and the identification and portrayal (tact) skills are taught. Afterwards, further planning is put forward so as to gain more sophisticated communication skills.

Without waiting for language acquisition to reach a certain level, the VB technique immediately focuses on the portrayal skills. For this method, functionality is more important than the shape it takes. So for example in the first stage of teaching to communicate a desire, the child can speak, gesture or use any other means to communicate and acquire what’s wanted. This method is followed by other language skill techniques.

In VB, for each concept the following sequence of skills are attempted to be taught:

  • When the child wants a drink of water to ask for water
  • When asked to point to water
  • When asked what the child is drinking to be able to say ‘water’
  • Respond with ‘water’ when asked ‘what do you wash your hands with?’

Even though this method appears to be rather reasonable and is recommended by important specialists in the field, there is limited scientific research on its effectiveness for autism. Moreover, there are views that this is not a discrete technique and that it is a re-hash of methods that belong to applied behavioral analysis.


Sources:

LeBlanc, LA. et al. (2006). Behavioral language interventions for children with autism. The Analysis of Verbal Behavior, 22, 49-60.


Evaluating this Method:

ortaAverage: There is only very limited experimental research showing that this method has had a positive outcome on children with autism.

Peer Mediated Applications

In Peer Mediated Applications peers take on the role of instructive, communicating or facilitating sustainment. These applications can be carried out in two forms: (a) peer modeling and (b) peer teaching. In peer modeling, the peer of the child with autism becomes a model of demonstrating a certain skill to the child and the child is aimed to exhibit this behavior by taking a model. In peer teaching, the instructive peer is aimed to teach his peer with autism spectrum disorder. Instructive peers are trained by the teacher or practitioner on how to do the teaching. In this process, the instructive peer learns how to present instructions, clues, reinforcements and provides systematic learning to his peer. When peer teaching will be planned, it should be paid attention that the peers who teach are selected among the children who do not have continuation problems, who volunteer for this process and who have positive interpersonal relations in general. The entire process throughout peer teaching should be followed by a teacher’s supervision and counseling. Peer modeling and peer teaching can be done by children at the same age or planned among children at different ages. It can be used effectively, especially in inclusion environments. In addition, siblings, cousins can also do peer modeling or teaching.

It is used successfully in the teaching of language and communication skills, academic skills and social skills.


Examples of Resources:

  1. a) www.asatonline.org/treatment/procedures/peer.htm
  2. b) autismpdc.fpg.unc.edu/content/peer-mediated-instruction-and-intervention

Assessment of The Method:

iyiGood: There are numerous experimental research studies which show that the method has had a positive outcome on children with autism.

TEACCH

TEACHH is short for the “Treatment and Education of Autistic and Related Communication Handicapped Children.” The approach is a special education program designed in 1966 under the leadership of Eric Schopler at the University of North Carolina. In this program, the child is not expected to adapt to the environment, instead the environment is adapted to suit the child. Accordingly, physical environment and work areas are structured especially for the child. Children follow their visual plans in their own work areas to complete various tasks. This method attempts to reduce their dependence on others.

Despite its wide application in Turkey and all over the world, much of the research on the effects of TEACCH on children with ASD are only descriptive in nature and do not exhibit scientific features. Therefore, a comparison of the effectiveness of TEACCH with other methods is needed.


Sources:

National Standards Report. USA: NAC (2009)


Evaluating this Method:

ortaAverage: There is only very limited experimental research showing that this method has had a positive outcome on children with autism.

Relationship-Based Methods

Relationship-based methods prioritize emotional development and attachment of children. The most popular amongst these methods is ‘Floortime’ (DIR) and RDI. Key to these techniques is to raise the child’s social interactions during play time. Accordingly, the aim is to develop the child’s social interaction skills and to ensure their enjoyment of these abilities. During these interactions, the child takes the lead and each activity is deemed to have a deep meaning. Thus, the child’s activities are not prevented or interrupted; on the contrary the child is imitated in his/her actions to initiate interaction. In contrast to ‘Floortime’, RDI is thought to contain activities which help develop the brain’s dynamic intelligence. However, there is no research data that sets forth how this happens in practice.

Since lack of social interaction constitutes one of the most basic deficiencies associated with autism, Relationship-based methods can be attractive to both practitioners and families. However, these techniques have not progressed beyond particular cases or descriptive applications. For as long as the outcomes are not proven through experiments, it is impossible to accept these techniques as having any basis in science.


Sources:

National Standards Report. USA: NAC (2009)


Evaluating this Method:

ortaAverage: There is only very limited experimental research showing that this method has had a positive outcome on children with autism.

Social Stories

Social Stories was developed by an education professional named Carol Gray in 1991 for children’s training. Social Stories is for literate children using simple phrases and for those who can’t yet read or write, through the use of pictures to create stories. These stories are about how children should behave in social situations. Children who use Social Stories to acquire specific social skills have to have ownership of the story; in other words the story must be written for them.

These stories mostly deal with the ‘how’ and sometimes the ‘why’ of social behavior. Each story begins with extensive detail on the situation which the child is having difficulty understanding. Next, the story will go on to include the play the story unfolds, who else is in the story, the nature of the difficulty and what this means in real life. Rather than using very precise language, ‘in general’, ‘I will try to do’ type of phrases are preferred. This allows for mistakes or exceptions. The reason for this is that children with autism find it very difficult to amend or modify a behavior once it has been learned.

Social Stories has shown its effects on children’s behavior and the research data on this is sufficient.


Sources:

National Standards Report. USA: NAC (2009)


Evaluating this Method:

ortaAverage: There is only very limited experimental research showing that this method has had a positive outcome on children with autism.

Facilitated Communication

Facilitated Communication (also known as supported communication) is a form of alternative communication for children with ASD who can’t verbally communicate. This technique helps the child to prepare his/her message in written form by means of physical support. The helper holds the child’s hand or wrist over the keyboard to help the child type. In some systems, the child’s expression becomes verbal. In order for this technique to be used, the child must be literate. Since the helper is in direct contact with the child, without meaning to, they can affect the communication and steer the child. This has led to severe criticisms of this technique. Research has shown that meaningful sentences are not formed when the helper does not know the child. Therefore it is thought that much of the message belongs to the helper rather than the child.

In 1994 the American Association of Psychologists opined that this technique was not scientific. Today, it is generally accepted that no further research is needed on this technique as the data suggests that the technique is ineffective.


Sources:

National Standards Report. USA: NAC (2009)


Evaluating this Method:

zayifPoor: There is no experimental research showing positive effects of this technique on children with autism or the research which has been done shows no positive effect on children with autism.