Autism Spectrum Disorder

Treatments

Assessment of mental flexibility.

Treatment Summary: The participants had in front of them a keyboard and a computer screen. They were directed to match the four “key cards,” symbols which appeared on the screen to those printed on the keyboard. The symbols on the cards were identical to those appearing on the computer screen. After they had successfully matched the symbols a high-pitch beep sound would go off. If they were unsuccessful in matching the symbols a buzzer would go off. The computerized version of the Wisconsin Card Sorting Test (WCST) included four “key cards,” and 128 responds cards.

• Reference: Kaland, N., Smith, L. & Mortensen, E. L. (2007). Brief report: Cognitive flexibility and focused attention in children and adolescents high-functioning autism as measured on the computerized version of the Wisconsin card sorting test. Journal of Autism Developmental Disorders, 38:1161-1165. Retrieved September 13, 2009, Proguest Psychology Journal.
• Submitter: Ella Adams

Assessment of neuromotor development

Treatment Summary: The treatment was design to measure the flexibility of children between the ages of 4-12 years. To assess the neuromotor development of the children they were administered the Zurich Neuromotor Assessment (ZNA) test. The test consisted of observing the children as they sat or stood. Their ability to repeat several different motor skill. First they would motor them as they perform repetitive toe tapping. Then they would be monitored while performing a heel- toe-alternation exercise. Afterwards, the children would be monitor as they attempted to snap their fingers. Other balancing techniques were perform, such as they placed pegs into a board, walked on their toes, heels, and inner and outer sole of their feet.

• Reference: Freitag, C. M., Klesier, C., Schneider, M., and Gontard, A. (2006). Quantitative Assessment of Neuromotor Function in Adolescents with High Functioning Autism and Asperger Syndrome. Department of Child and Adolescent Psychiatry. 37:948-959. Retrieved September 13, 2009,
• Submitter: Ella Adams

Social and Behavioral Issues

Treatment Summary: Giving positive reinforcement will increase the child’s desire to inter-act with peers. The use of story boards where social skills are acted out by dolls are puppets will go along way in reinforcing those desire social skills. To teach speaking rules repeat the same things more than once. Always change the emphasis on each word. Use different voice inflections when attempting this treatment. Respond only to those infractions that may cause misunderstanding between the child and a peer. Teach metaphors and idioms by keeping a list of phrases in a notebook near the child desk. List phrases that the child did not understand in it. Review the list with the child at least once a week.

• Reference: Bellando, J. *+& Pulliam, E. (2009). Helping the Student with Asperger’s Disorder with Social and Behavioral Issues in the School: Nursing Psychology, and Educators Working in Unison: Journal from Specialists in Pediatric Nursing, 14(3) 210-4
• Submitter: Ella Adams

Size Sequencing

Treatment Summary: Using a touch screen monitor the child would sequence objects that are in the shape of stars. The stars would be of various sizes and colors. The test is comprised of 12 levels. The child would have to place the objects in either ascending or descending order by there and color and sizes. As the child successfully masters a level the next level would immediately appear on the screen. A correct response by the child would be rewarded by a smiling animated figure briefly dancing on the screen.

• Reference: McGonigle-Chalmers, M., Bodner, K., Fox-Pitt, & Nicholson, L. (2007). Size Sequencing as a Window on Executive Control in Children with Autism and Asperger’s Syndrome. Department of Psychology, School of Philosophy, Psychology and Language Sciences, PPLS. 39:1382-1390 http://search.ebscohost.com, doi:10.1002/mpr.24
• Submitter: Ella Adams

Antecedent-Behavior Models of Functional Analysis. This form of treatment is also sometimes referred to as Structured Descriptive Assessment

Treatment Summary: This treatment involves manipulating the antecedent of a behavior. An antecedent is a preceding event. In other words, if one notices that a certain event causes disruptive behavior then he or she would alter the circumstances of the event that leads to such behavior. This is accomplished by exposing individuals to various types of antecedents. Examples of types of antecedents might include restricting a child’s access to certain toys or activities. The behavior that occurs is then observed. Then the clinician compares the happening of problem behavior to a controlled condition. Once a desired behavior and antecedent are observed this ultimately allows parents and caregivers to reinforce positive behaviors over negative ones.

• Reference: Manente, C., Maraventano, J., LaRue, R., Delmolino, L., & Sloan, D. (2010). Effective Behavioral Intervention for Adults on the Autism Spectrum: Best Practices in Functional Assessment and Treatment Development. Behavior Analyst Today, 11(1), 36-48.
• Submitter: Sarah Delozier

Cognitive Behaviour Drama (CBD)

Treatment Summary: Children with Asperger’s syndrome typically are plagued with irrational fears. Cognitive Behaviour Drama can be used to desensitize the client from his or her fear in an indirect manner. A scenario is created by the facilitator which will eventually lead to defeating the object of the child’s fear. The child plays a role (not himself or herself) that confronts the feared object. The facilitator orchestrates the eventual defeat by giving the object another persona. For example, a hand dryer is called a fire breathing dragon which the hero has to go through several levels before reaching. The child is not forced to confront the object of his or her fear but confronts the feared object as a natural progression of the story which unfolds.

• Reference: Karnezi, H., Tierney, K., (2009). A novel intervention to address fears in children with Asperger syndrome: A pilot study of the cognitive behaviour drama (CBD) model. Behaviour Change, 26(4), 271-282.
• Submitter: Sue Dolifka

Virtual reality Environment

Treatment Summary: With the treatment virtual reality environment (VRE), patients were exposed to their fear or phobia in a controlled environment under trained supervision. Being that fears and phobias stemming from anxiety is a condition associated with ASD, this treatment plan tackles this problem by placing the patients in an actual setting that causes them anxiety or fear. In virtual reality environment, the patients were put in a blue room that had the environment of the client that caused them to have fear/phobia. The sessions would start off short in length, then expand the length or the amount of exposure. The clinician ensured the patient that the blue room was safe and if at any time the patient wanted to stop the session they could. Patients would go through a brief session first on how to deal with anxiety using different techniques and only done in the blue room. The patients then received a break while the blue rooms were set up for each child depending on their VRE scene. Once set up, they participated in 20-30 minutes of the session four times for two half days. To start each session off there was soothing music being played and the parents had the capability to watch their child in the room. After practicing the relaxation techniques, the psychologist began the virtual scene when the child was ready. By doing the treatment this way it allowed the child to control their own environment and gradually overcome their fear/phobia by the repetitive interactions of the scene via the VRE.

• Reference: Maskey, M., Lowry, J., Rodgers, J., McConachie, H., & Parr, J. R. (2014, July). Reducing specific phobia/fear in young people with Autism Spectrum Disorders (ASD) through a virtual reality environment intervention. PLOS ONE, 9(7). http://dx.doi.org/10.1371/journal.pone.0100374
• Submitter: Kevin Wilburn

Low-Intensity Behavioral Treatment

Treatment Summary: Children with Autism work with therapists who are trained on the low-intensity behavioral model, one on one a few hours a day in the classroom. The therapists implement specific behavioral interventions such as teaching peer interactions sills, providing instruction of self help skills, and conducting incidental teaching to name a few. In short, the treatment begins with helping the child establish basic tasks, such as simply responding to adults’ request, imitation of gross motor behaviors, identify matching of objects and teaching simply toy play, like completing puzzles. Once these tasks are mastered the child moves on to more complex skills, such as imitation of fine motor and oral motor behaviors. After the child had acquired vocal imitation of words and basic receptive language skills, he/she was taught how to name objects and actions. As the child progressed through each stage, the stages began to include more abstract and discriminative learning/thinking, and finally making friends with peers. Making the child capable of learning in natural settings the same way that typical children learned was the ultimate of goal for this intervention.

• Reference: Eldevik, S.,Eikeseth, S., Jahr, E., & Smith, T. (2006). Effects of low-intensity behavioral treatment for children with autism and mental retardation. Autism and Development Disorders, 36, (2)
• Submitter: N/A

Early Intensive Behavioral Intervention (EIBI)

Treatment Summary: EIBI is a highly structured treatment for children with Autism. Spending as much as 40 hours a week for up to three years, autistic children are taught simple concepts initially, like imitation of instructors’ actions. Then the process becomes more complex as the process continues, with the next step as matching identical items on to gradually more difficult tasks. This treatment is known for the structure of the program and the reward system. At the first stage of imitation, as soon as the child can imitate their instructor they are rewarded. The rewarding of correct behavior is part of the success of the program, along with the strong desire to help the children not withdraw socially. EIBI was developed in the mid 1970’s and has proven to be one of the more successful treatments for helping children develop normal intelligence and function ability in the educational format.

• Reference: Reichow, B., and Wolery,M.(2008). Comprehensive Synthesis of Early Intensive Behavioral Interventions for Young Children with Autism Based on the UCLA Young Autism Project Model. Journal of Autism and Developmental Disorders, 39:23-41
• Submitter: N/A

Gluten-Free Diet

Treatment Summary: The gluten-free diet, or casein free diet has proven to be helpful to some, but not all, cases of Asperger’s syndrome. Gluten is a casein-like substance that is found in the seeds of various cereal plants, such as; wheat, oat, rye, and barley. Casein is also the principal protein in milk. Since gluten and milk are found in many of the foods we eat, following a gluten-free, casein-free diet is difficult.

• Reference: Strock, M. (2007). Autism spectrum disorders. National Institute of Mental Health, 30, 1-41.
• Submitter: Anna Vazquez

Narrative Therapy

Treatment Summary: Asperger’s disorder is a developmental disorder that affects a child’s ability to socially interact and communicate with others. Feeling uncomfortable in society is typically seen in children with Asperger’s syndrome. Although Narrative therapy is linguistically based, noting Asperger’s syndrome is more visually than linguistically expressed, it is considered a possible treatment for this condition. A child with Asperger’s syndrome most likely has problems with social skills and communication, and typically exhibit social awkwardness and an all-absorbing interest in certain topics. Often when these children are placed in a social setting, such as school, where this environment requires a lot of social interaction and constant change of activities throughout the day, the child with Asperger’s syndrome may display signs of anxiety or depression.Thus, helping the child re-story his/her environment can help him/her examine and edit the story he/she tells himself/herself about the world to promote social adaptation while working on particular problems of daily living. Narrative therapy helps the child re-story and externalize what he/she sees as a problem when exposed to novel situations. For example, Sarah a 13 year-old girl with Asperger’s syndrome is in school, a social environment. Sarah is exposed to a situation where before she would have typically felt uncomfortable, a group of girls come up to her asking her questions. Instead of becoming anxious, uneasy or nervous, seeing this as a problem, she becomes empowered.With NT, she is taught to externalize the problem, the problem is the problem, and she is not the problem

• Reference: Cashin, A. (2008). Narrative therapy: A psychotherapeutic approach in the treatment of adolescents with asperger’s disorder. Journal of Child and Adolescent Psychiatric Nursing, 21 (1), 48-56.
• Submitter: N/A

Early Intensive Behavioral Intervention (EIBI)

Treatment Summary: EIBI is a highly structured treatment for children with Asperger’s and Autism. Spending as much as 40 hours a week for up to three years, these children are taught simple concepts initially, like imitation of instructors’ actions. Then the process becomes more complex as the process continues, with the next step as matching identical items on to gradually more difficult tasks. This treatment is known for the structure of the program and the reward system. At the first stage of imitation, as soon as the child can imitate their instructor they are rewarded. The rewarding of correct behavior is part of the success of the program, along with the strong desire to help the children not withdraw socially. EIBI was developed in the mid 1970’s and has proven to be one of the more successful treatments for helping children develop normal intelligence and function ability in the educational format.

• Reference: Reichow, B., and Wolery,M.(2008). Comprehensive Synthesis of Early Intensive Behavioral Interventions for Young Children with Autism Based on the UCLA Young Autism Project Model. Journal of Autism and Developmental Disorders, 39:23-41
• Submitter: N/A

Differential reinforcement of other behaviors (DRO), functional communication training (FCT), compliance training, and extinction.

Treatment Summary: A completed assessment and evaluation led to the treatment plan to improve behavior. To begin, compliance training is used to help combat a failure to comply with a demand given by an authoritative figure. A three-step process used included verbal, gestural, and physical cues to remediate. A positive reinforcement system of praise was initiated for periods of non-disruptive behavior displaying DRO techniques. The timeframe for reinforcements average 30 min. to one hour. For compliance training the individual was given a reminder cards that allowed them to ask for assistance or to remind them when a specific action, such as waiting, were indicated. A five-week training course was provided for the parent to assist in having the same expectations of the individual whether at home or in the clinical setting. By using the behavioral techniques listed above, the chance of extinction of maladaptive behavior increases. The treatment plan timeline is determined by the individual’s improvement rather than a specific time goal model.

• Reference: Matson, J.,LoVullo, S.,Boisjoli, J., & Gonzalez, M. (2008). The behavior treatment of an 11-year-old girl with autism and aggressive behaviors. Clinical Case Studies, 7(4), 313 – 326.
• Submitter: Kelli A. Friddle

Social Stories

Treatment Summary: Once the target social skill has been identified, a short social story containing details specific to the individual and situation will be written in the first person. It will contain descriptions of the situation and provide precise behavioral responses to that situation. These short stories will be reviewed with the individual on a daily basis and will provide the social “rules” that an individual with Asperger Disorder often is unaware of.

• Reference: Powell-Smith, K., Sansosti, F., (2006). Using social stories to improve the social behavior of children with Asperger Syndrome. Journal of Positive Behavior Interventions, 8(1), 43-57.
• Submitter: Ilana Rivera

Video Self-Modeling

Summary of Treatment: In the study reference below, the authors examine the effects of video self-modeling on individuals with autism spectrum disorders.  Video self-modeling is believed to be an effective way to help individuals with ASD develop communication and language skill, social skill, modify behavior, and teach functional skills.   During video self-modeling the individual is recorded performing the desired behavior.  The video is then edited to eliminate the negative behaviors and any errors.  Therefore, when the individual watches the video they only see them performing the behavior at a mastery level.  This technique is believed to be effective because people respond to models that are similar to them.  Using the individual as the model increases the chances that the modeled behavior will stick.

• Reference: Anderson, C., Gelbar, N. W., McCarthy, S.  (2012). Video self-modeling as an intervention strategy for individuals with autism spectrum disorders.  Psychology in      Schools, 49(1), 15-22.

• Submitted by: Erica Copeland

Narrative Therapy

Summary of Treatment: In the study referenced below, narrative therapy were practiced by nurses when they were working with adolescents who had trouble with social interactions and were either tense or not reactive during those social situations. The basic realm of narrative therapy is that adolescents with Asperger’s disorder will tell stories about their life, and edit them and speak them out loud to the nurses and keep telling stories until there is some sort of ease within the mind of the adolescent. These stories are complex and specific to their situations and the child can re-live certain situations that are troublesome for them. The purpose for this story-telling type of therapy is for the child to construct some sort of meaning within the brain, and how the information is processed and stored. Therefore, training the child for appropriate reactions towards specific situations, in which they would otherwise have no clue how to react, if they react at all

• Reference: Cashin, A. (2008). Narrative Therapy: A Psychotherapeutic Approach in the Treatment of Adolescents With Asperger’s Disorder. Journal of Child and Adolescent Psychiatric Nursing, 21(1), 48-56. doi: 10.1111/j.1744-6171.2008.00128.x

• Submitted by: Gabriela Rosas

Social Story Intervention

Summary of Treatment: In the study referenced below, the practice of using social stories as an intervention treatment to improve the social skills in children with Asperger’s disorder is visited via a study done with three school aged boys.

Social stories help children understand certain social situations.  The stories work by individualizing a story to address a certain skill or situation that the individual is struggling with in a social context.  The goal of social stories is to give the individual a better understanding of appropriate ways to respond to a situation. The story is presented in a written format that the child is instructed to read x number of times per day.  The stories may deal with sportsmanship, participation in social groups, or even just talking to another child. The child reads the story and rehearses the appropriate responses to a certain situation.

By utilizing a written format for the social stories, the typically anti-social child, will be able to learn better because the learning is not as imposing as a typical social skills instruction would be.  The stories describe specific situations with appropriate responses and characters in order to mimic a realistic setting.  Ina addition, social stories will have pictures incorporated into it for a better understanding. Furthermore, the study suggests that the rules that social stories impress on a child with Asperger’s disorder, will work well due to how they adhere closely to rules.

• Reference: Sansosti, F. J., & Powell-Smith, K. A. (2006). Using Social Stories to Improve the Social Behavior of Children with Asperger Syndrome. Journal Of Positive Behavior Interventions, 8(1), 43-57.
• Submitted by: Belinda Winn

Applied Behavioral Analysis (ABA)

Summary of Treatment: In the study referenced below, the practice of applied behavior analysis (ABA) is considered to be one of the most effective treatments in decreasing unwanted behaviors, and developing behaviors that are deemed appropriate for the individual’s developmental stage.  In order to allow children to reach a high level of functioning and their own potential, wanted behaviors need to be taught and reinforced utilizing a reward system.

The article specifically names the discrete trial instruction. This type of instruction consists of one-on-one drilling with an ABA specialist.  They are small steps or skills that are being prompted and reinforced to get to desired behavioral skills.  Skills that are taught include communication, learning, and social skills.  Each trial teaches a new skill that serves as a stepping stone towards the desired behavior that is individualized to the autistic child.  ABA is a long process that may take as many as 40 hours per week between a trained specialist and the child.  It is all about instruction, practice, and reinforcement.

ABA works as a collective effort between specialists, parents, and other caregivers that interact with the child on a daily basis.  The ultimate goal is to have the child executing desired behaviors independently. In order to do this, he/she must have the support of his/her parents at home, and also with the other care givers he/she interacts with.  Training parents and caregivers to continue reinforcing wanted behaviors outside of the one-on-one therapy is key to helping the child reach his/her potential. This boils down to practicing the skill sets learned in the child’s natural settings.

• Reference Jensen, V., & Sinclair, L. (2002). Treatment of autism in young children: behavioral intervention and applied behavior analysis. Infants & Young Children: An Interdisciplinary Journal of Special Care Practices, 14(4), 42-52.
• Submitted by: Belinda Winn

Applied Behavioral Analysis (ABA)

Summary of Treatment: The ABA is a behavioral approach that focuses on changing the understanding of what happens before and after the behavior. ABA encourage desired behaviors and discourages undesired behaviors to improve a variety of skills. The process must be tracked and measured precisely. There are two ABA teaching styles that are called discreate trial training (DTT) and pivotal response training (PRT). First go over DTT this uses step by step instructions to teach a desired behavior or response. In regards, the lessons must be broken down into simple parts. The desired answer and behaviors are followed through with a reward. If the undesired answers occur and behaviors are ignored. The second PRT takes part in a natural setting rather than a clinic. The goals for PRT to help improve pivotal skills such as a person to learn many other skills. The one example provided pivotal skill is to be able to learn how to communication with others.

• Reference: Centers for Disease Control and Prevention. (n.d.-c). Treatment and intervention for autism spectrum disorder. Centers for Disease Control and Prevention. https://www.cdc.gov/autism/treatment/index.html#:~:text=Complementary%20and%20alternative-,Behavioral%20approaches,-Behavioral%20approaches%20focus
• Submitted By: Ambrosia Moore