MORE ABOUT TREATING AUTISM
More on Applied Behavior Analysis
ABA targets the learning of skills and the reduction of challenging behaviors. Most ABA programs are highly structured. Targeted skills and behaviors are based on an established curriculum. ABA therapists break down each skill into small steps and teach them using prompts that are gradually eliminated as the steps are mastered. They give the child repeated opportunities to learn and practice each step in a variety of settings. Each time the child achieves the desired result, they get positive reinforcement, such as verbal praise or something else that is motivating. The therapist then builds on these skills so that the child learns how to learn in a natural environment.
ABA programs often include support for the child in a school setting with a one-on-one aide. Therapists measure success by direct observation and data collection and analysis – all critical components of ABA.
Effective ABA for autism is not a “one size fits all” approach and is not a “canned” set of programs or drills. Instead, a skilled therapist customizes the intervention to each child’s skills, needs, interests, preferences and family situation. So an ABA program for one learner looks different than a program for another learner. ABA changes as the needs of the learner change. Families can use ABA principles in their daily lives. Below are three distinct types of ABA therapy.
Discrete Trial Training (DTT)
Discrete Trial Training (DTT) is the most traditional ABA technique. It involves teaching individual skills one at a time using several repeated teaching trials and reinforcements that may or may not be related to the skill that is being taught. DTT is also called the Lovaas method after its founder, Dr. Ivar Lovaas.
A board-certified behavior analyst (BCBA) specializing in autism writes, implements and monitors the child’s individualized program. Therapists (often called trainers) will work directly with the child on a day-to-day basis. Trainers don’t have to be board-certified.
DTT sessions are often two to three hours long and include short periods of structured time (three to five minutes) focused on a task. Short breaks are often taken during and at the end of therapy sessions. Free play and breaks are used for incidental teaching or practicing skills in new environments. Most DTT programs consist of 25 or more hours per week of therapy.
The principles and technologies of ABA can also be provided in a naturalistic fashion that is child-led and uses natural reinforcement opportunities. Two examples are Pivotal Response Treatment and Early Start Denver Model.
Pivotal Response Treatment (PRT)
Pivotal Response Treatment (PRT) was developed by Dr. Robert L. Koegel and Dr. Lynn Kern Koegel of Stanford University. It was previously called the Natural Language Paradigm (NLP). This approach has been used since the 1970s. It is a behavioral intervention model based on the principles of ABA.
PRT is one of the best studied and validated behavioral treatments for autism. It is play-based and child-initiated. Its goals include development of communication, language and positive social behaviors and relief from disruptive self-stimulatory behaviors.
Rather than target individual behaviors, the PRT therapist targets “pivotal” areas of a child’s development. These include:
- Response to multiple cues
- Initiation of social interactions
By targeting these critical areas, PRT produces improvements across other areas of sociability, communication, behavior and academic skill building. Motivation strategies are an important part of PRT. These emphasize “natural” reinforcement. For example, if a child makes a meaningful attempt to request a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward.
Professionals specifically trained in PRT might include:
- Special education teachers
- Board-certified behavior analysts
- Speech therapists
- Other providers
Each program is tailored to meet the goals and needs of the individual learner and the school and home routines. A session typically involves six segments during which language, play and social skills are targeted with both structured and unstructured interactions. As the child progresses, the focus of each session changes to meet more advanced goals and needs.
PRT programs usually involve 25 or more hours per week. Therapists encourage everyone involved in the child’s life to use PRT methods consistently in every part of the child’s life. Many families have described PRT as an adopted lifestyle for their family.
Early Start Denver Model (ESDM)
Early Start Denver Model (ESDM) is another naturalistic form of ABA. It is a behavioral early intervention approach for children with autism, ages 12 to 48 months. The program uses a curriculum that defines the skills to be taught and methods used to teach these skills. Therapy teams and/or parents can deliver both group programs and individual therapy sessions in either a clinic setting or the child’s home.
ESDM was developed by psychologists Sally Rogers, Ph.D., and Geraldine Dawson, Ph.D. in 2010. The focus of ESDM is parents and therapists using play to build positive and fun relationships. Through play and joint activities, the child is encouraged to boost language, social and cognitive skills. Its core features include:
- Understanding of normal toddler learning and development
- Focus on building positive relationships
- Teaching during natural play and everyday activities
- Using play to encourage interaction and communication
An ESDM therapist might be a:
- Behavioral therapist
- Occupational therapist
- Speech and language pathologist
- Early intervention specialist
- Developmental pediatrician
What’s important is that the provider has ESDM training and certification. Parents are a crucial part of ESDM programs. If your child is receiving ESDM therapy, the instructor can explain and model the strategies for you and your family to use at home.
ESDM programs usually involve 20-25 or more hours per week of scheduled therapy. ESDM is designed to be highly engaging and enjoyable for the child. Instructors teach skills within a naturalistic, play-based interaction. They teach some skills on the floor during interactive play and others at the table, focusing on more structured activities. As the child develops social skills, peers or siblings are included in the therapy session to promote peer relationships.
For other types of early intervention programs and other treatment modalities, visit autismspeaks.org/treatments.
Medication for autism
There is no medication specifically to treat autism. Rather, medications can be used to treat some symptoms of autism. These medicines are most effective when used with behavioral therapies, such as ABA. Ideally, medicines are a complement to other treatment strategies.
Medicines for treating the two core symptoms of autism – social communication/interaction and restricted and repetitive behaviors – have long been a huge area of unmet need. Unfortunately, there are no drugs on the market today that effectively relieve these symptoms.
Today, most medicines prescribed to ease the symptoms of autism are used “off label,” meaning that their FDA approval is for other sometimes-related conditions such as attention deficit hyperactivity disorder (ADHD), sleep disturbances or depression. Speak to your child’s health care provider about medications that might help your child.
Autism Speaks ATN has developed two tool kits that can help you learn more: Autism and Medication: Safe and Careful Use and a Medication Decision Aid. Both can be found at autismspeaks.org/tool-kit.