Effective Intervention Program features
Interventions Supported by Research
Examples of Therapeutic Intervention Programs
Other Models of Intervention
Goals for Educational Services
Key Points and Next Steps

Interventions Supported by Research

There is little evidence concerning the effectiveness of discipline-specific therapies, and there are no adequate comparisons of different comprehensive treatments. There is, however, substantial research supporting the effectiveness of many specific therapeutic techniques and of comprehensive programs.

Overall, many of the programs are more similar than different in terms of levels of organization, staffing, ongoing monitoring, and the use of certain techniques, such as discrete trials, incidental learning, and structured teaching. However, there are real differences in philosophy and practice that provide a range of alternatives for parents and school systems considering various approaches.

The key to any child's educational program lies in the objectives specified in the IEP. Much more important than the name of the program attended is how the environment and educational strategies allow implementation of the goals for a child and family. Effective services will and should vary considerably across individual children, depending on a child's age, cognitive and language levels, behavioral needs, and family priorities.

Examples of Therapeutic Intervention Programs

Behavioral Programs

Behavioral models are best described as a natural science approach to understanding behavior. Applied behavioral Analysis (ABA) refers to the use of behavior analytic methods and research findings to change socially important behaviors in meaningful ways.

For each learner, skills to be increased and problem behaviors to be decreased are clearly defined in observable and measurable terms. An initial assessment is done to determine skills that the learner does and does not have. Selection of treatment goals for each individual is guided by data from that initial assessment, and a curriculum that lists skills in all domains (learning to learn, communication, social, academic, self-care, motor, play and leisure, etc.), broken into smaller component skills and sequenced developmentally, or from simple to complex. The overall goal is to help each learner develop skills that will enable him or her to be as independent and successful as possible in the long run.

A variety of behavior analytic procedures are used to strengthen existing skills and build those that have not yet developed. The learner has multiple, repeated opportunities to learn and practice skills throughout every day, with plentiful positive reinforcement.

One way to arrange learning opportunities is for an adult to present a series of trials to the learner, each consisting of a specific cue or instruction from the adult, an opportunity for the learner to respond, and a consequence delivered by the adult depending on the learner's response. Such arrangements are called discrete trials, and they are essential for building many important skills in learners with autism. Programming that relies exclusively on discrete trial procedures, however - often referred to as "discrete trial training" or "DTT" - is not state-of-the art ABA, particularly when "drills" are not individualized to each learner.

Overusing discrete-trial procedures tends to produce skills that do not carry over (generalize) from the training situation to other everyday situations. Effective ABA programming, therefore, blends discrete-trial procedures with a variety of other ABA methods, including child-initiated instructional sequences (known as incidental teaching procedures), task analysis and chaining to teach skills involving sequences of actions or steps, instructional trials embedded in ongoing activities, and others. There is a heavy emphasis on making learning enjoyable, and on engaging the learner in positive social interactions.

In a quality ABA program, behavior change procedures are specified clearly. The instructions and prompts, reinforcers ("rewards"), materials, and so on that are used to develop each skill are tailored to the individual learner. There is a written program or set of instructions for teaching each skill; the behavior analyst in charge of the programming trains everyone who works with the learner to implement those programs consistently. It is particularly important for parents to be trained to implement the procedures outside of formal treatment sessions, in a variety of settings (home, playground, community); research has shown that otherwise, the learner's skills are not likely to generalize.

Maladaptive behaviors (such as stereotypic behavior, self injury, aggressive and disruptive behavior) are explicitly not reinforced and appropriate alternative behaviors are taught and reinforced instead. Learner progress is measured frequently, using the direct observational measurement methods mentioned earlier. Data are graphed to provide visual pictures of what is happening with each skill and each maladaptive behavior targeted for treatment. The data are reviewed regularly by the behavior analyst directing the programming so that learning errors can be caught early and intervention methods adjusted promptly if progress is not satisfactory. The behavior analyst also observes treatment and provides feedback to interventionists on an ongoing basis.

A defining feature of ABA programs is that they are directed by professionals with advanced formal training in behavior analysis as well as supervised experience in designing and implementing ABA programming for learners with autism and related disorders. These professionals have either met the educational, experiential, and examination performance standards of the Behavior Analyst Certification Board (in the USA) and are Board Certified Behavior Analysts, or can document that they have at least the equivalent training and experience.

They adhere to the BACB's Guidelines for Responsible Conduct, and base treatment on the best available scientific evidence. For further information about the training and skills required to direct ABA programming for learners with autism, see the guidelines for consumers developed by the Autism Special Interest Group of the Association for Behavior Analysis.

Comprehensive program models designed around the ABA model that have been validated through rigorous research include:

Applied Behavioral Analysis (ABA) service providers

There are many individuals and organizations providing ABA services. In the U.S. these are certified through a regulatory body known as the Behavior Analyst Certification Board, Inc.®, http://www.bacb.com/

There have been many studies of behavioral interventions, which demonstrate the effectiveness of ABA for improving a wide range of skills in both children and adults with autism. The most thorough body of research comes from the pioneering work of Dr O. Ivar Lovaas and his colleagues who employed an early intensive behavioral treatment for children at The University of California, Los Angeles (UCLA).

The University of California at Los Angeles (UCLA) Young Autism Project

http://www.peach.org.uk/AboutAutism/LovaasResearch/LovaasResearch

The development of this program was based on earlier research with older children and adolescents with autism; its applications to young children with autism began during the 1970s. The behavioral intervention curriculum is delivered in a one-to-one discrete-trial format, which is implemented by parents and trained therapists who work in a child's home. The treatment is focused primarily on developing language and early cognitive skills and decreasing excessive rituals, tantrums, and aggressive behaviors.

The first year of intervention is aimed at teaching children to respond to basic requests, to imitate, to begin to play with toys, and to interact with their families. During the second year, the focus on teaching language continues; the most recent curriculum descriptions note a shift toward teaching emotion discriminations, pre-academic skills, and observational learning. For children who eventually enter inclusive settings, a paraprofessional assists with participation in regular preschool.

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