Developmental Interventions

According to the National Association of Cognitive Behavioral Therapists, Cognitive-behavioral therapy does not exist as a distinct therapeutic technique. The term “cognitive-behavioral therapy (CBT)” is a very general term for a classification of therapies with similarities. There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy. However, most cognitive-behavioral therapies have the following characteristics: CBT is based on the Cognitive Model of Emotional Response. Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change. Brief report: effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism.

There are many programs specifically designed for autism spectrum disorders. They are used for additional educational intervention.

Daily Life Therapy was developed by Dr. Kiyo Kitahara of Tokyo in the 1960s. Originally a regular kindergarten school teacher, she derived her method from working with a child with autism who was included in her classroom (Kitahara,1984). Placing heavy emphasis on group dynamics, the method incorporates physical education, art, music and academics, along with the acquisition and development of communication and daily living skills (Boston Higashi School,1999). Specifically, Dr. Kitahara’s method focuses on social isolation, anxiety, hypersensitivity and hyposensitivity, and the apparent fragility of children with autism. According to Dr. Kitahara (1984), stability of emotions is gained through the pursuit of independent living and development of self-esteem. Mastery of self care skills allows for the development of self-confidence and a desire to attempt other adaptive skills. The second focal point, extensive physical exercise, is used to establish a rhythm of life. Many of the exercises are founded upon principles of sensory integration and vestibular stimulation that lead to coordination and cooperative group interaction. Vigorous exercise releases endorphins, which help reduce anxiety. In addition, exercise has been found to reduce incidences of self stimulatory behavior and aggression (Allison, Basile, & MacDonald, 1991; Elliot, Dobbin, Rose, & Soper, 1994; Koegel & Koegel, 1989), along with hyperactivity and night wakefulness while increasing time on task. Children also learn how to control their bodies as they master riding a bicycle, rollerblading, the balance disk and other Higashi exercises. Physical education is carried out in different sized groups, thus serving as a bridge to social development. Stimulation of the intellect with academics, including language arts, math, social studies and science is compatible with typical school curricula to prepare each student for inclusion opportunities. In the Higashi program, medication is not recognized as a therapeutic technique for working with children on the autism spectrum. Finally, art and music provide opportunities to gain mastery and appreciation for aesthetics. — Stephen M. Shore, Ed.D. (from the US Autism Association Conference Proceedings Manual 2010)

Discrete Trial is a process used to develop many skills, including cognitive, communication, play, social and self help skills. TeachTown, used in many educational settings (public schools), explains the discrete trial training into their program: The program breaks down individual skills into small discrete tasks and guides a student’s learning through prompting and reinforcement. Each trial follows the traditional discrete trial model that has been used in multiple studies (e.g., Lovaas, 1987; Smith, Groen, & Wynn, 2000) where the discriminative stimulus is presented (i.e. the instruction or cue that the child should respond to) by presenting 1 or more images (e.g., a happy, a sad, and an angry face) with a vocal instruction (e.g., “Find the person that is happy”). Next, the child is expected to respond by selecting one of the images (e.g., clicking on the happy face) (the child can also touch the screen on touch screen monitors). If the response is correct, a positive statement is heard (e.g., “You did it!”), there is a brief (3 second) inter-trial interval (i.e. pause between trials) and the next trial is presented. If the response is not correct, the correct answer is shown.

Floortime/DIR Floortime (or DIRFloortime) is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional, and intellectual capacities. With young children these playful interactions may occur on the floor, but go on to include conversations and interactions in other places. DIRFloortime emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child. The DIR Model, however, is a comprehensive framework which enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths. Central to the DIR Model is the role of the child’s natural emotions and interests which has been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together and build successively higher levels of social, emotional, and intellectual capacities. It often includes, in addition to Floortime, various problem-solving exercises and typically involves a team approach with speech therapy, occupational therapy, educational programs, mental health (developmental-psychological) intervention and, where appropriate, augmentative and biomedical intervention.

Developed by Dr. Steven Gutstein and Dr. Rachelle Sheely, relationship development intervention is a parent-based model program that provides a means for individuals with autism and asperger disorder to learn about and experience authentic emotional relationships in a gradual, systematic way. The enjoyable activities in this program emphasize foundation skills such as social referencing, regulating behavior, conversational reciprocity and synchronized actions.

SCERTS is an innovative educational model for working with children with autism spectrum disorder (ASD) and their families. It provides specific guidelines for helping a child become a competent and confident social communicator, while preventing problem behaviors that interfere with learning and the development of relationships. It also is designed to help families, educators and therapists work cooperatively as a team, in a carefully coordinated manner, to maximize progress in supporting a child. The acronym SCERTS refers to the focus on: SC – Social Communication - the development of spontaneous, functional communication, emotional expression, and secure and trusting relationships with children and adults; ER – Emotional Regulation – the development of the ability to maintain a well-regulated emotional state to cope with everyday stress, and to be most available for learning and interacting; TS Transactional Support - the development and implementation of supports to help partners respond to the child’s needs and interests, modify and adapt the environment, and provide tools to enhance learning (e.g., picture communication, written schedules, and sensory supports). Specific plans are also developed to provide educational and emotional support to families, and to foster teamwork among professionals.

The Son-Rise Program Start-Up is a 5-day group training program for parents, relatives and professionals looking to facilitate meaningful progress in their children (ages 18 months through 60 years) challenged by Autism, Autism Spectrum Disorders, Pervasive Developmental Disorder (PDD), Asperger’s Syndrome, High Functioning Autism and other related developmental difficulties. Exciting, inspiring and diverse presentations by a group of seasoned and dedicated teachers, will deliver to you the autism strategies, expertise, motivation and knowledge honed through years of working with thousands of families and children with Autism Spectrum Disorders. At the end of this course, you will have all the tools necessary to design and implement your own home-based Son-Rise Program, as well as the skills and attitude to impact your child’s growth in all areas of learning, communication, development and skill acquisition.