Wednesday, 7 September 2011

What treatments are available for ASD? Positive approaches and interventions


In these days of 'I'll just google it....' we can all access a wealth of information and advice. However, as with anything you come across, the information must be viewed with a  great deal of caution. This is especially true with anything that involves children and particularly pertinent when it comes to ASD. If a parent has just received a diagnosis or maybe just suspects that their child may not be developing language or social skills as they should, the desire to search the web for information is compelling. There are two points I would like to make: 1. There is a dearth of utter rubbish about ASD and intervention and 2. The quote I really like is 'when you have met one person with autism....... you have met one person with autism'. This means that one size does not fit all in the world of ASD therapy/approaches.
With this in mind, I was delighted to read the Options Group's latest newsletter in which their expert Geoff Evans gives an overview of some of the more reliable ones. I have permission to show it here:
A quick search of the internet will produce a vast array of approaches and interventions many of them promising to almost work miracles. Deciding whether to use an approach or which will be most appropriate can be very difficult. It is important to consider the impacts on the individual with autism as it may cause high levels of anxiety and stress.
In this article I present a few thoughts for your consideration and references to more detailed information.
Inclusion of any specific approach does not mean that either I or Options Group approves of it but it is included to represent the variety of approaches available to parents and professionals.
I have placed approaches and interventions under a number of loose headings, these include:
Approaches and Intervention
Behaviour based
ABA (Applied Behaviour Analysis)
This approach uses observation and measurement of behaviour to understand individual’s behaviour and how they learn. This is used to promote learning and development. Information can be found atwww.iaba.com.
TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children)
This provides a framework for understanding autism and enabling independence through its emphasis upon structured teaching. For further information on this approach refer to www.autism.org/teacch.
Interaction based approaches
There are a number of approaches that are based around interaction. In general terms they include, in their aims, creating an enjoyable none threatening communication environment in which individuals learn to accept the presence of others and share personal space, pay attention, take turns in communication and begin to use and appreciate the benefits of communication. One of the key features of these approaches is that they take their lead from the individual with autism.
As an introduction the following books and articles may be of interest,
"Finding you finding me, using interaction to get in touch with people with severe disabilities combined with autistic spectrum disorders" by Phoebe Caldwell.
"A practical guide to intensive interaction" by Melanie Nind and David Hewitt
"A good introduction to the floor time which is a developmental interaction approach developed" by Stanely Greenspan, which can be found at http://wwwpolyxo.com/floortime/buildingplaypartners .html
Sensory based
Whilst there are a number of approaches that are predominately about understanding and meeting sensory differences, many approaches such as TEACCH and SPELL have recognition of the importance of meeting sensory needs and integrating them within their framework.
Sensory Perception Issues in Autism by Olga Bogdashina is a great reference point which looks into the sensory and autism world.
Another informative book is "Living Sensationally" by Winni Dunn. This is not autism specific but provides good understanding of the senses.
Whilst these books do not advocate a specific approach they provide a good starting place for further research.
Communication based
Many approaches and interventions in autism are based around meeting the communication needs of individuals with autism. These include well established approaches such as PECS (www.pecs.pecs.org.uk). For further information on communication and autism based approaches visit www.icommunicatetherapy.com.
The aid of visual supports which are used to communicate is widely accepted. A great information source can be found on the NAS website in the living with autism section, www.autism.org.
IT based
Framework Approaches
Many organisations including Options Group work to a framework approach rather than implementing a single approach. Implementing such an approach allows us to respond to uniqueness and individual needs and requirements. Furthermore utilising such an approach will assist in responding to innovation. The NAS - SPELL framework is a widely recognised approach,
Structure
Positive approaches and expectations
Empathy
Low arousal
Links
SPELL can be easily adapted to suit various provisions, for homes, schools or even residential provisions. When looking at any intervention or approach it is important to look at the values underpinning it. As a minimum I believe they should include recognising individuality, a commitment to working with the person with autism, based on honesty, integrity, equality, openness and underpinned by sound independent evaluation and research.
Final thoughts
My personal view of what contributes to successful approaches and interventions
(1) Centralise the individual with autism and actively engage them in decisions. This often means putting extra effort into understanding their perspective and wishes, particularly with those who struggle to make their own decisions. Within the SPELL approach this is addressed through the empathy component.
(2) The approach enables you to get a wider understanding of autism through various perspectives. This understanding is based upon current research whenever possible.
(3) 
Structure is a key component of such approaches as TEACCH. The following website has examples of using structure to address such needs as toilet training and provides a good example of how structure is used. http://www.teacch.com 
(4) Emphasis upon the individual’s preferred form of communication needs. There is a variety of communication support available to parents and professionals, for example Picture Exchange Communication Systems (PECS) and a number of symbols based products.
As mentioned above, recently a number of IT based systems have become widely available. A good example of this is touch phones and easy downloadable apps. If considering this type of communication support it is well worth considering the different ranges of apps available. Organisations such as Autism and Computing at http://www.autismandcomputing.org.uk/about.en,htmlcan offer useful advice not only about technology and communication but also about their use in terms of structure and other benefits.
(5) Be very clear about what you want from the intervention or approach.
We would all like an approach that solved all the difficulties we are facing or provides solutions to all social, communication, interactions and learning challenges experienced by individuals with autism. However no single approach can do this therefore it is important to identify and prioritise what we want the approach or intervention to address. Simply making a list of what you want from the approach and matching this against what the approach offers can be worth the time spent.
(6) Being clear about what the approach is able to offer and if it is capable of doing what is stated.
Significant and more permanent changes and improvements are often only achieved through hard work over time. Personally, I am always sceptical about approaches that claim too much and particularly to achieve it quickly. A good source of information on intervention, treatments and therapies for autism and current research around this area can be found on the Research Autism site which is provided by an independent charity (www.researchautism.net).
(7) Being clear about the downside of the intervention or approach.
Some of the common downsides of intervention and approaches can include,
  • Having to invest large amounts of time in implementing the intervention. This may not be possible with all the other demands upon you or your organisation. The same is also true of other resources such as equipment.
  • The positive impact being outweighed by the negative not for the individual with autism but for the whole family or organisation.
(8) Addresses the need for meaningful and leisure physical activity.
This is more of a personal approach, however I prefer to see individuals with autism in a holistic way and recognise the importance of engaging the whole person. For example, providing for leisure and recreation as well as addressing common areas of need such as communication etc.
In conclusion
There are a variety of interventions and approaches that will enrich the lives of individuals with autism and their families however they should be approached with a degree of healthy scepticism and acceptance. In order to be effective we are required to do the basics in terms of consistency and structure.
To subscribe to their newsletter so you can regularly read Geoff's advice and about the Options group work www.optionsgroup.co.uk

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