An overview of various treatment options
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An Overview of Various Treatment Options. Mimi Lou, Ph.D. Clinical Director Children’s Hospital Autism Intervention (CHAI) Program. Psychoeducational Approaches in Autism/PDD. Developmental Models Behavioral Approaches Applied Behavioral Analysis (ABA) Discrete Trial – (Lovaas)

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An Overview of Various Treatment Options

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An Overview of Various Treatment Options

Mimi Lou, Ph.D.

Clinical Director

Children’s Hospital Autism Intervention

(CHAI) Program

Psychoeducational Approaches in Autism/PDD

  • Developmental Models

  • Behavioral Approaches

    • Applied Behavioral Analysis (ABA)

    • Discrete Trial – (Lovaas)

    • Contemporary ABA

  • Group/Classroom Instruction: TEACCH

Developmental Models

  • DIR, Floortime (Greenspan & Wieder); SCERTS (Prizant & Wetherby); Hanen, More Than Words

  • Learning understood within context of developmental processes (typical child development)

    • Development proceeds from both external experience and internal, biological maturation

    • Different aspects/domains of development are interdependent

    • Child learns more than s/he is taught, or experience is more than instruction

Developmental Models(cont.)

  • Use of interactive-facilitative (versus directive) strategies:

  • Child “leads”: active in selecting, directing own activities

  • Adult builds on child’s initiations; expands on child’s interests

  • Adult entices, actively engages child

  • Adult facilitates play by providing support and helping to structure experience and mediate the environment

Developmental Models(cont.)

  • Naturally occurring and motivating contexts for learning

  • Central roles for play and functional learning; importance of affects, learning has meaning for child

  • Individual profile of sensory and motor processing

Applied Behavioral Analysis(ABA)

  • Reinforce/reward appropriate behavior to teach new skills

  • Ignore/extinguish inappropriate behavior

  • Shape existing behaviors into new and useful ones

  • Functional Analysis: examine antecedents, behaviors, consequences for problem behaviors in order to correct

Discrete Trial(Lovaas)

  • Direct instruction: verbal direction, prompting, reinforcement, with rapid repetition of short trials

  • Focus on 1 specific skill at a time

  • Highly structured context/setting

  • Adult control: determines activity, focus of attention, correctness of response

  • Child compliance

  • Prescribed sequenced curriculum

Contemporary ABA

  • Natural Language paradigm, Pivotal Response Training(Koegels & Schreibman); Modified Discrete Trial (Leaf, McEachin); Incidental Learning (McGee); Picture Exchange Communication System (PECS) (Bondy & Frost)

  • More naturalistic instruction incorporating child’s choice/preference, naturally rewarding consequences

Contemporary ABA(cont.)

  • Teaching in context of play and functional activities

  • Control of teaching interaction shared, with child initiating communicative exchanges more and adult responding

Group/Classroom Instruction: TEACCH

  • Primary purpose: Improve each individual’s adaptation, level of skill

  • Modify, structure the environment to accommodate autism deficits

  • Aim to increase independent functioning (emphasis on visual components of structure)

  • Structured teaching = framework in which vocational, social, and living skills taught

Group/Classroom Instruction: TEACCH (cont.)

  • 4 major components of structured teaching:

    • physical organization

    • schedules

    • work systems

    • task organization

Characteristics of Effective Preschool Programs

  • Low adult:child ratio to teach core skills 

  • Highly structured, predictable classroom routines 

  • Functional approach to challenging behaviors 

  • Direct instruction in “survival skills” for transition 

  • Family involvement in intervention 

  • Intensity of intervention (15 – 40 hours/week)

Characteristics of Effective Preschool Programs (cont.)

  • Curriculum Content (Direct instruction in core skills): 

    • Attention to environment, especially to people

    • Ability to imitate others

    • Ability to comprehend and use language

    • Ability to play appropriately with toys

    • Ability to socially interact with others

Other Therapies

  • Complementary Medicine

  • Treatments specifically for sensory-motor issues

  • Auditory Processing

  • Treatments specifically for social relationships

  • Reading Intervention

Complementary Medicine

  • Medications

  • Vitamins

  • Nutritional Supplements

  • Dietary Interventions

  • Immune System

  • Allergy treatment

  • Heavy Metals (Chelation)

Treatments specifically for sensory-motor issues

  • Sensory Integration Therapy

    • Focuses on sensory processing issues and difficulties from poor integration of information from sensory systems, especially, proprioceptive, vestibular, and tactile; motor planning problems, regulatory issues of arousal

    • Through sensory stimulation and sensory-motor challenges

Auditory Processing

  • Auditory Integration Therapy

    • Berard Tomatis, Others

    • Treatment for sound sensitivity; modulated music through headphones with filtering of certain sound frequencies

  • Processing Speed

    • FastForWord

Treatments specifically for social relationships

  • Integrated Playgroups (Pamela Wolfberg)

  • Social Stories (Carol Gray)

  • Relationship Development Intervention (Steven Gutstein)

  •  Reading Intervention

    • Lindamood-Bell (Patricia Lindamood, Phyllis Lindamood, Nanci Bell)

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