Therapies
Therapies - My Personal Experience
My grandson started with a private speech therapist a full half year before he was diagnosed. It made sense to us: if he wasn't speaking, then he would need speech therapy, regardless of the diagnosis. So why wait?
After he was diagnosed with autism, he was enrolled in private therapies while we waited for him to come to the top of the waiting list for IBI therapy through CHEO.
We also had a biomedical analysis done and found it to be helpful.
Each child is unique and you will have to decide which therapies you feel will work best for your child.
Getting Started Services are provided free of charge and begin pre-diagnosis. Attending the Getting Started Services does not mean your child will be diagnosed with autism.
Types of Therapies
Many parents use a combination of therapies and interventions.
This site is intended to provide information for parents and families and does not endorse one therapy over another. That choice is solely for the parent(s) to decide.
The following is a list of some therapies
Early Start Denver Model
A study released in November 2010 shows that early intervention in toddlers with the Early Start Denver Model (ESDM) showed significant results.
The Early Start Denver Model brings together the teaching of behavioral analysis with approaches based on developmental relationships, such as parent-child and teacher-pupil.
The model is new because it blends the discipline of behavior analysis with play-based routines as a way to build a relationship with the child with autism. The approach can start with children as young as 12 months old.
A small US study involving toddlers diagnosed with autism, some as as young as 18 months old, showed that intensive early intervention delivered by trained specialists and parents was very effective and improved IQ, social interaction and language ability. Read more.
Applied Behavioural Analysis (ABA)
Behaviour analysis is a natural science of behaviour that was originally described by B.F. Skinner in the 1930s. The principles and methods of behaviour analysis have been applied effectively in many arenas. For example, methods that use the principle of positive reinforcement to strengthen a particular behaviour by arranging for it to be followed by something of value have been used to develop a wide range of skills in learners with and without disabilities.
Since the early 1960s, hundreds of behaviour analysts have used positive reinforcement and other principles to build communication, play, social, academic, self-care, work, and community living skills and to reduce problem behaviours in learners with autism of all ages. Some ABA techniques involve instruction that is directed by adults in a highly structured fashion, while others make use of the learner's natural interests and follow his or her initiations. Still others teach skills in the context of ongoing activities. All skills are broken down into small steps or components, and learners are provided many repeat opportunities to learn and practice skills in a variety of settings, with abundant positive reinforcement. The goals of intervention as well as the specific types of instructions and reinforcers used are customized to the strengths and needs of the individual learner. Performance is measured continuously by direct observation, and intervention is modified if the data shows that the learner is not making satisfactory progress.
Regardless of the age of the learner with autism, the goal of ABA intervention is to enable him to function as independently and successfully as possible in a variety of environments.
Floortime Therapy
Developed by child psychiatrist Stanley Greenspan, Floortime is a treatment method and a philosophy for interacting with autistic children. It is based on the premise that the child can increase and build a larger circle of interaction with an adult who meets the child at his current developmental level and who builds on the child's particular strengths.
The goal in Floortime is to move the child through the six basic developmental milestones that must be mastered for emotional and intellectual growth. Greenspan describes the six rungs on the developmental ladder as: self-regulation and interest in the world; intimacy or a special love for the world of human relations; two-way communication; complex communication; emotional ideas; and emotional thinking. The autistic child is challenged in moving naturally through these milestones as a result of sensory over- or under-reactions, processing difficulties, and/or poor control of physical responses.
In Floortime, the parent engages the child at a level the child currently enjoys, enters the child's activities, and follows the child's lead. From a shared engagement, the parent is instructed on how to move the child toward increasingly complex interactions, a process known as "opening and closing circles of communication." Floortime does not separate and focus on speech, motor, or cognitive skills but rather addresses these areas through a synthesized emphasis on emotional development. The intervention is called Floortime because the parent gets down on the floor with the child to engage him at his level.
Gluten-free/Casein-free Diet (GFCF)
Many families of children with autism spectrum disorders are interested in dietary and nutritional interventions that might help lessen some of the symptoms of the disorders. The removal of gluten (a protein found in barley, rye, oats, and wheat) and casein (a protein found in dairy products) from the diet, also known as the Gluten-free/Casein-free diet or GFCF, is a popular dietary treatment for symptoms of autism. It is based on the hypothesis that these proteins are absorbed differently in children with autism spectrum disorders and act like false opiate-like chemicals in the brain. The hypothesis is not based on an allergic response. To date, neither the hypothesis nor the effectiveness of this dietary intervention has been demonstrated in scientific studies. Studies are ongoing in a number of centres. However, many families report that the elimination of gluten and casein from their child's diet has helped regulate bowel habits, sleep, activity, and habitual behaviours and enhanced overall progress in the child's development. No specific laboratory tests can predict which children might be observed to have a positive response to dietary intervention. For that reason, many families elect a trial of dietary restrictions with careful observation by the family and intervention team.
A trial of dietary restrictions requires attention to basic nutritional guidelines. Dairy products are the most common source of calcium and vitamin D in young children in the U.S. Many young children depend on dairy products for a balanced protein intake. Finding alternative sources of these nutrients requires substitution with other food and beverage products, paying close attention to nutritional content rather than solely looking for a milk-substitute beverage. Substitution with gluten-free products requires attention to the overall fibre and vitamin content of a child's diet. Vitamin and supplement use may have both positive effects and side effects. Consultation with a dietician or physician should be considered and can be helpful to families in the healthy application of a GFCF diet. This may be especially true for children who are picky eaters.
Occupational Therapy
Occupational therapy can benefit a person with autism by attempting to improve the quality of life for the individual. The aim is to maintain, improve, or introduce skills that allow an individual to participate as independently as possible in meaningful life activities. Coping skills, fine motor skills, play skills, self-help skills, and socialization are all targeted areas to be addressed.
Through occupational therapy methods, a person with autism can be aided both at home and within the school setting by teaching and reinforcing the following: activities including dressing, feeding, toilet training, grooming, social skills; fine motor and visual skills that assist in writing and scissor use; gross motor coordination to help the individual ride a bike or walk properly, and; visual-perceptual skills needed for reading and writing.
Occupational therapy is usually part of a collaborative effort of medical and educational professionals as well as parents and other family members. Through such collaboration, a person with autism can move towards the appropriate social, play and learning skills needed to function successfully in everyday life.
PECS
PECS is a type of augmentative and alternative communication technique where individuals with little or no verbal ability learn to communicate using picture cards. Children use these pictures to "vocalize" a desire, observation, or feeling. Since some people with autism tend to learn visually, this type of communication technique has been shown to be effective at improving independent communication skills leading, in some cases, to gains in spoken language.
In Phase One, a communication trainer works with the child and his or her caregivers to help decide which images would be most motivating. For example, images of food may elicit the strongest response. Cards are then created (or provided through a pre-made book) with those images, and the trainer and the caregiver work with the child to help him or her discover that, by handing over the card, they can get the desired object. In Phase Two, the caregiver then moves farther away from the child when showing the picture so that the child must actually come over and hand over the card to receive the food reward. This process engages the child's ability to seek and obtain another person's attention. In this way, a full vocabulary and methods for using these new words are taught to the affected individual.
In later phases, children are given more than one image so that they must decide which ones to use when requesting an item. Throughout the process the number of cards grows, and consequently, the child's "vocabulary" also increases. Over time, the child may develop the ability to use sentences, including phrases like "I want" to start off the sentence and even use descriptors like "large" or "red." Throughout the process, which may take weeks, months or years, the caregiver gives constant feedback to the child. It is thought that by allowing children to express themselves non-verbally, the children are less frustrated and non-desirable behaviour, including tantrums, is reduced.
If your child is on the waiting list for the Autism Intervention Program (IBI) then there are workshops that you can attend, including one on PECS. www.cheo.on.ca/english/8000_autism.shtml
Relationship Development Intervention (RDI)
Relationship Development Intervention (RDI) is based on the work of psychologist Steven Gutstein. RDI focuses on improving the long-term quality of life for all individuals on the spectrum. The RDI program is a parent-based treatment that focuses on the core problems of gaining friendships, feeling empathy, expressing love and being able to share experiences with others. Dr. Gutstein's program is said to be based on extensive research in typical development and translates research findings into a systematic clinical approach. His research found that individuals on the autism spectrum seemed to lack certain abilities necessary for success in managing the real-life environments that are dynamic and changing. He calls these abilities dynamic intelligence and describes six aspects as follows:
1) Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others
2) Social Coordination: The ability to observe and continually regulate one's behaviour in order to participate in spontaneous relationships involving collaboration and exchange of emotions
3) Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others
4) Flexible Thinking: The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances
5) Relational Information Processing: The ability to obtain meaning based upon the larger context. Solving problems that have no "right-and-wrong" solutions
6) Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner
Dr. Gutstein, who along with Dr. Rachelle Sheely, formed the Connections Center For Family and Personal Development based in Houston, Texas in 1995, says, "We are challenging families and professionals to think beyond achieving mere functionality as a successful outcome for individuals with autism; our reference point for success in the RDI program is quality of life". The goal is social improvements as well as changes in flexible thinking, pragmatic communication, creative information processing and self-development. The program offers training workshops for parents as well as several books that offer step-by-step exercises building motivation so that skills will be utilized and generalized. The program is said to be started easily and implemented into regular, daily activities that enrich family life.
The SCERTS® Model
(Prizant, Wetherby, Rubin, Rydell & Laurent, 2006)
The SCERTS® Model is a comprehensive, team-based, multidisciplinary model for enhancing abilities in Social Communication and Emotional Regulation, and implementing Transactional Supports for children and older individuals with autism spectrum disorders (ASD) and their families. SCERTS is not an exclusive approach, in that it provides a framework in which practices and strategies from other approaches may be integrated, such as positive behavioural supports (e.g., ABA), visual supports, sensory supports, augmentative and alternative communication (AAC), and social stories. The SCERTS model can be used with individuals across a wide range of ages and developmental abilities.
Sensory Integration Therapy (SIT)
Sensory integration is the process through which the brain organizes and interprets external stimuli such as movement, touch, smell, sight and sound. Autistic children often exhibit symptoms of Sensory Integration Dysfunction (SID) making it difficult for them to process information brought in through the senses. Children can have mild, moderate or severe SID deficits manifesting in either increased (hypersensitivity) or decreased (hyposensitivity) sensitivity to touch, sound, movement, etc. For example, a hypersensitive child may avoid being touched whereas a hyposensitive child will seek the stimulation of feeling objects and may enjoy being in tight places.
The goal of Sensory Integration Therapy (SIT) is to facilitate the development of the nervous system's ability to process sensory input in a more typical way. Through integration the brain pulls together sensory messages and forms coherent information upon which to act. SIT uses neurosensory and neuromotor exercises to improve the brain's ability to repair itself. When successful, it can improve attention, concentration, listening, comprehension, balance, coordination and impulsivity control in some children.
The evaluation and treatment of basic sensory integrative processes in the autistic child are usually performed by an occupational and/or physical therapist. A specific program will be planned to provide sensory stimulation to the child, often in conjunction with purposeful muscle activities, to improve how the brain processes and organizes sensory information. The therapy often requires activities that consist of full-body movements utilizing different types of equipment. It is believed that SIT does not teach higher-level skills, but enhances the sensory processing abilities thus allowing the child to acquire them.
Speech Therapy
The communication problems of autistic children vary to some degree and may depend on the intellectual and social development of the individual. Some may be completely unable to speak, whereas others have well-developed vocabularies and can speak at length on topics that interest them. Any attempt at therapy must begin with an individual assessment of the child's language abilities by a trained speech and language pathologist.
Though some autistic children have little or no problem with the pronunciation of words, most have difficulty effectively using language. Even those children who have no articulation problems exhibit difficulties in the pragmatic use of language such as knowing what to say it, how to say it, and when to say it as well as how to interact socially with people. Many who speak often say things that have no content or information. Others repeat verbatim what they have heard (echolalia) or repeat irrelevant scripts they have memorized. Some autistic children speak in a high-pitched voice or use robotic-sounding speech.
Two pre-skills for language development are joint attention and social initiation. Joint attention involves an eye gaze and referential gestures such as pointing, showing and giving. Children with autism lack social initiation such as questioning, make fewer utterance and fail to use language as a means of social initiation. Though no one treatment is found to successfully improve communication, the best treatment begins early during the preschool years, is individually tailored, and involves parents along with professionals. The goal is always to improve useful communication. For some, verbal communication is realistic. For others, gestured communication or communication through a symbol system such as picture boards can be attempted. Periodic evaluations must be made to find the best approaches and to re-establish goals for the individual child.
Verbal Behaviour Intervention
Verbal Behaviour Intervention is often seen as an adjunct to Applied Behavioural Analysis (ABA). Though both are based on theories developed by Skinner, there are differences in concept. In the late 1950s and early 1960s when Dr. Ivar Lovaas was developing his ABA principles, Skinner published Verbal Behaviour, which detailed a functional analysis of language. He explained that language could be grouped into a set of units, with each operant serving a different function. The primary verbal operants are what Skinner termed echoics, mands, tacts, and intraverbals.
The function of a mand is to request or obtain what is wanted. For example, the child learns to say the word "cookie" when he is interested in obtaining a cookie. When given the cookie, the word is reinforced and will be used again in the same context. There is an emphasis on "function" of language (VB) as opposed to form (Lovaas-based). In a VB program the child is taught to ask for the cookie anyway he can (vocally, sign language, etc.) If the child can echo the word he will be motivated to do so to obtain the desired object. In a Lovaas-based ABA program the child might say the word cookie when seeing a picture and is thus labelling the item. This form of language is called a "tact." Critics of Lovaas say children are taught to label many words but often cannot use them in functional or spontaneous ways. Another operant, "intraverbals" describes verbal behaviour that is under the control of other verbal behaviour and is strengthened by social reinforcement. Intraverbals are the way people engage in conversational language. They are responses to the language of another person, usually answers to "wh-" questions. If you say to the child "I'm baking..." and the child finishes the sentence with "Cookies," that's an intraverbal fill-in. Also, if you say, "What's something you bake?" (with no cookie present) and the child says, "Cookies," that's an intraverbal (wh- question). Intraverbals allow children to discuss stimuli that aren't present, which describes most conversation and is a goal of Verbal Behaviour Intervention.
Both ABA and VB use similar formats to work with children. It is said that VB attempts to capture a child's motivation to develop a connection between the value of a word and the word itself. Many therapists are now using techniques of VB to bridge some of the gaps seen in ABA.
Biomedical
From Jenny McCarthy site Generation Rescue
Childhood Neurological Disorders (NDs) are typically diagnosed by professionals with psychology and psychiatry backgrounds. Parents are often told that their children's diagnosis is the result of genes and is psychological in nature. Typical "psychological" manifestations of these NDs in children may include delayed speech, lack of eye contact, impaired or non-present social skills, shyness, perseverative behavior (doing the same thing repeatedly), delayed gross or fine motor skills, sensory integration issues (sound and touch sensitivity, etc.), not responding to one's name, inflexibility with transitions, and major, often unexplained, changes in mood.
Yet, the physical or medical issues that our children often share are rarely noted or discussed. Typical physical manifestations of children with NDs may include food allergies and eczema, general gastrointestinal distress, constipation and diarrhea, yeast overgrowth, immune system disregulation, and sleep disturbances. Typically, proper testing would also reveal high levels of environmental toxins relative to neurotypical children.
Biomedical intervention for NDs is based on the belief that the psychological symptoms of NDs are a product of the physical issues the child is experiencing and that addressing the physical issues will lead to an improvement in those psychological symptoms.
It is important that your find a qualified physician to help you treat your child.
The ultimate goal of biomedical treatment is to remove environmental toxins from your child's body and repair the damage that has been done.
