راهبردهای اوتیسم و مداخلات
Without deviation from the norm, progress is not possible.
Living with autism
People with autism experience the world in different ways to those who are not on the spectrum. How they experience it varies widely from person to person, but there are some things in common.
Generally, they experience sensory and cognitive processing differently, and have difficulties with social interaction and interpreting other people’s behaviour.
Some individuals are extremely passionate about a particular topic and like to talk about this topic for hours on end, while others may have very limited language skills. Some like loud noise and lots of movement, others are highly sensitive to noise and don’t like to be touched. Some enjoy a consistent routine and don’t like it to change, while others are more flexible with routines.
As individuals process the world differently, they have unique insights and can often see things in ways others don’t.
While we celebrate this difference, living with autism comes with its own set of challenges.
It is common for people with autism to become anxious with changes to their routine or environment. This can make everyday tasks like leaving the house – even popping up to the shops – a difficult task.
Some individuals are highly sensitive to particular noises or touch, so being in public places or at social occasions can be overwhelming and upsetting.
Musician and speaker Lori Sealy blogs about her experience of living with autism and explains sensory overload in her blog as follows:
In a room full of people, I literally can hear when someone’s hair moves in the wind or when they brush their fingers through it. In that room as you and I are trying to talk, I am hearing everyone else’s conversations as clearly as our own (along with their hair!) — and that’s a confusing thing, because which words am I supposed to be interacting with as we chat? Take that scenario and apply it to the classroom, the park, the church, or Walmart. It can be absolutely overwhelming!
What she is describing is known as hypersensitivity – where the senses are heightened and everything is experienced intensely. The opposite of this is hyposensitivity – where the senses only respond to extremes. This can extend to not feeling any pain or only seeing the outlines of objects.
Some people on the autism spectrum – particularly children – might have trouble managing their emotions. This can lead to meltdowns or self-harming behaviours.
What are the benefits of intervention?
Understanding how autism will impact on you, or your child’s life, allows you to put strategies in place that will help manage challenges and build on strengths.
Once you have a diagnosis, it’s normal to feel a bit overwhelmed about what to do next. The good news is there are many options for getting assistance. Due to there being so many options it can also be a little overwhelming, and can take a while to get your head around what’s best for you, or your child.
Make sure you give yourself time to research what is available and what best suits your unique circumstances. Talk to your health professionals and don’t be afraid to ask questions until you’re satisfied you have the answers you need.
A diagnostic report will often provide information regarding strengths and weaknesses, which can help you develop an intervention plan – this is basically a plan that combines different therapies and types of support specifically designed to meet you or your child’s needs.
Some areas that intervention might focus on include daily living, social and community participation, health and wellbeing, lifelong learning, relationships, and choice and control.
While the term ‘intervention’ refers to taking action or using a technique to try to improve or develop skills in a particular area, there are varied terminologies for these developmental actions or activities.
Some common terms for interventions include:
- Early interventions
Strategies and practices are generally designed to address a single skill or goal for people on the autism spectrum, these include things like: visual supports, video modelling, prompting, reinforcement, and time delay.
Programs, comprehensive approaches, comprehensive treatment approaches, and interventions generally consist of a set of practices designed to achieve a broad learning, or developmental impact, on the core symptoms of autism.
Some evidence-based interventions or programs include: TEACCH, ABA, Early Start Denver Model, and More Than Words.
Therapy, therapeutical intervention, and treatments are generally practices or interventions that are provided by a health professional including: Speech Therapists, Occupational Therapists, Psychologists, Social Workers, Psychiatrists, and Art and Music Therapists.
Early intervention refers to interventions that are applied specifically to the development of children under seven years old, and can be put in place as soon as a diagnosis is made, or sometimes even before a diagnosis.
For more information about key evidence-based interventions and strategies for people on the autism spectrum visit our Communication strategies, Behavioural strategies, Sensory strategies, and Social strategies pages in this section.
The value of early intervention
Children who are diagnosed with autism at a very young age – that is, before the age of seven – can benefit from what is called ‘early intervention’.
Early intervention combines practices, interventions and therapies that help children develop skills that can improve their quality of life. Intervention is often applied through play, so the child doesn’t even realise they’re learning.
While intervention can be beneficial at any age, early intervention can be important because new skills are much easier to learn when you’re very young.
That’s because there are key developmental stages that our brains go through in early childhood and tapping into these stages can make it easier to learn new things.
Think of how children pick up a second language or learn to play a musical instrument much more easily than an adult trying it for the first time. This ability to learn is related to what scientists call brain plasticity, which really just means how easily the brain develops.
We never lose ‘brain plasticity’ though, so don’t worry if your child isn’t diagnosed until later. Interventions are still an important and necessary part of your child’s development and can have a positive impact on their life at any stage.
And while more research is required on the long-term benefits, initial studies suggest that early intervention can lead to improved communication and daily living skills, and build the skills that may enable children to live independently, have a career, and build lasting relationships as adults.
What is early intervention?
Our ability to focus, absorb information, communicate and socialise has a direct impact on our quality of life. If we can focus, we can learn new things more easily. If we can communicate, we can not only express our needs but also form connections with people. If we can socialise, we can build meaningful relationships.
People with autism can have difficulty with some or all of these things. Early intervention is designed to develop skills in these, and other areas, so that children develop essential skills early in life.
Early intervention generally focuses on developing social and communication skills, along with behavioural and cognitive skills. This includes things like helping them focus so it’s easier for them to learn, and build language skills so they can communicate and understand language, as well as develop daily living skills.
Early intervention brings together different therapies, interventions and strategies that can assist your child, and are tailored to their unique strengths and challenges.
Early intervention might be offered by one professional, or may bring together several professionals, either through a service provider, organisation, private or government practice. Some programs can be delivered one on one, in small groups, at home, in a centre, or in the community.
Early intervention is most effective when it is intensive so you want therapies that will give your child the most benefit for time spent, and that will also fit in with your family.
Be sure to engage a professional who is well-trained in the intervention or therapy they are providing, and who also sees and responds to your child, and your family’s needs.
How do you choose the right interventions for your child?
As everyone’s experience of autism is unique, there is no one-size-fits-all solution. Knowing your child’s strengths and needs will assist you in finding the right interventions for them.
There are a wide variety of therapies, strategies and interventions available, some backed by scientific studies and others built on anecdotal evidence.
That means you’ve got to do your research to find out what is best for your child.
It seems that for success in science or art, a dash of autism is essential.
We encourage you to look into the interventions and strategies you are considering to see how well researched they are.
Here is a comprehensive guide to analysing the Scientific Evidence for strategies and interventions.
It is also good to talk to accredited professionals about how they are evaluated.
Don’t be afraid to ask questions of the people who are offering intervention programs to be certain they are right for your child. Ask for more than anecdotal evidence – that is, more evidence of their effectiveness than personal testimonials.
There is a need for greater research into autism therapy programs to fully evaluate their effectiveness, but some are better researched than others and recommended by professionals.
Beware any programs that claim to ‘cure’ your child or make overly optimistic claims about the results they can achieve. Unfortunately, not all interventions work, and some are based on outdated ideas of autism being something that should be fixed or are built on ideas about the causes of autism that simply aren’t true. In worse case scenarios, some can be harmful to your child.
The Early Intervention for Children with Autism Spectrum Disorders: ‘Guidelines for Good Practice’ 2012 lists these questions when considering whether an intervention is for them:
- What are the specific aims of the program?
- Are there any medical or physical risks?
- What assessments of individual children are carried out prior to the intervention?
- What is the evidence base for this intervention?
- What evaluation methods have been used to assess the outcome of intervention?
- Do the proponents of the treatment program have a financial stake in its adoption?
- What is known about the long-term effects of this treatment?
- How much does it cost?
- How much time will be involved?
Essential, we need to ask our selves; ‘Am I doing the right thing in the right way with the right person at the right time in the right place for the right result – and am I the right person to be doing it? … and, is it at the right cost?’ (Cusick, 2001, p. 103).
Services that have been evaluated by the Department of Social Services can be found here. Or visit our Support and Services page for further information about services and supports in your community, specific to autism.
You can also check if a provider is registered with their professional association or the Australian Health Practitioner Regulation Agency website.
The National Disability Insurance Scheme covers early intervention for children 0-6 years. The service is still being rolled out, but if you are under the NDIS, you can find recommended providers on the website here. Or visit our Financial support page.
What makes an early intervention effective?
Generally speaking, interventions should be family-centred, inclusive, have a collaborative nature and use evidence-based principles.
The Early Childhood Intervention Australia guidelines for evidence informed practices in early intervention outlines the key elements of effective interventions in early childhood for children on the autism spectrum as follows:
- Parents/carers of children with autism should be supported during the early intervention years.
- Supports for children with autism should be evidence‐based and delivered using a family‐ centred approach that incorporates individual planning.
- The specific early intervention program chosen will take into account family preferences and capacity and each child’s strengths and difficulties, age and stage of development.
- Aims of support for the child with autism are to improve social communication and minimise behaviours that challenge to enhance learning and participation.
- Approaches recommended are environmental modification, building on opportunities and supporting transitions.
- A large number of evidence‐based strategies can be used to achieve these aims.
- Early intervention or support should start as soon as a diagnosis is made and the family are ready.
- Having well‐trained professionals working as teams to support children with autism and their families is needed. Parent or peer training is promoted, as long as it is incorporated to take into account a family‐centred approach.
- Intervention programs for children with autism should be comprehensive, that is, across all domains of learning, with clearly stated, replicable process and content, or one that is developed for an individual child through an individual planning process designed to identify and achieve agreed aims, using good‐ practice principles and evidence‐based strategies.
- Early intervention programs for children with autism must be of sufficient intensity and fidelity (i.e. implemented consistently and accurately) and be evaluated to ensure program quality.
- Difficulties that may co‐occur with autism or present in a similar way, but need separate diagnosis and specific or targeted interventions, should be considered.
Applying an early intervention can involve everyone assisting your child, including family members, therapists, any childcare providers and/or teachers.
The intervention should outline your child’s strengths and needs, set goals for the intervention (agreed by you and your family and those involved) and outline how these goals will be monitored and achieved.
Once an intervention is in place, it should be reviewed every six months to make sure it is continuing to meet your child’s needs.
One of the most important things is that you and your child feel comfortable with the person, or people, you’re working with.
Children respond more to people they feel safe with and are more likely to learn in a comfortable environment.
What types of interventions are there?
An intervention is the word used to describe any treatment, therapy or service that is used to help support a person with autism’s quality of life.
These generally fall into one of the following categories:
As the name suggests, these types of interventions focus on behaviour – understanding it, and then teaching new behavior, that is more beneficial to you or your child.
They teach new behaviours and skills, usually around simple everyday tasks, using structured techniques and gradual progress.
Behavioural interventions are among the most commonly used, so they are likely to be better researched than other types, though you should always look at what evidence-based research is available.
When talking about behavioural interventions, you might hear the term Applied Behaviour Analysis (ABA).
ABA is a range of techniques and/or strategies that are used in some behavioural therapies.
Generally, they involve identifying a behaviour or skill, setting a goal towards it and breaking it into tiny steps to teach in a highly structured way.
This might target a specific behaviour, such as banging their head on the wall when they’re upset, or skill, such as washing their hands or saying a particular word. Or it might look at a broader area of self-development, such as improving overall communication abilities.
Progress is measured throughout so that changes can be made to suit the child’s needs.
Rather than being focused on outward behaviour, developmental interventions look at what skills a person needs to develop to assist with daily life and enhance their ability to form meaningful relationships with others.
This focus is often on emotional and social skills. For example, facial expressions and gestures might be exaggerated to help people on the spectrum, specifically children, associate them with the emotion and learn to ‘read’ people’s emotional responses.
Generally, these therapies are child led, in that the therapist reacts to the child rather than the other way around. Playful techniques are used to encourage interactions and any response from the child is treated as meaningful.
Over time, therapists build engagement with the child, encouraging more interaction. Once a relationship is established, specific skills can begin to be taught.
These types of interventions also often use settings that are part of everyday life but in a safe and structured way that makes the child feel safe enough to learn skills.
Some therapies combine elements from both the behavioural and developmental therapies, or aspects of other types of interventions.
These can be highly effective as they bring together the relevant parts of different styles of interventions, depending on the therapies they are combining.
Any single therapy that targets one particular aspect of a person’s development is classified as a therapy-based intervention.
An example of this is speech therapy for building communication skills or occupational therapy for developing physical movement. This can also include Art or Music Therapy.
Therapy-based approaches are often combined with other interventions.
As the intensity of therapies – that is, how many hours are spent on them – can have a big impact on their effectiveness, family involvement is a powerful tool.
Family-based interventions put family at the core of any therapies and are built around strong, collaborative relationships between the family and professionals, who provide training, support, guidance and information for family members to be able to work with a family member or child on the spectrum.
Medical interventions are generally prescribed for problems or underlying conditions associated with, but not necessarily caused, by autism, these are considered to be co-conditions.
It’s very important that any medical intervention is prescribed by and managed by your doctor or health professional. What works for one person may not work for all, and all medications can have harmful side effects. For some medications, the long-term effects are unknown.
Therapies that are generally are not widely accepted as part of conventional Western medicine or that aren’t supported by scientific evidence are classified as alternative interventions.
While alternative therapies have become more popular in recent decades, they should be considered with caution, especially in relation to autism. Some alternative therapies – especially those that make wild claims or promise to ‘cure’ autism – may do serious harm.
As with any intervention, don’t rely on personal stories or let promises that sound too good be true sway your judgement. Always ask questions and do your research to see whether the therapy will benefit you, or your child.
Evidence-informed strategies and interventions
There are a range of strategies and interventions that can be used to develop skills and to support the needs of people on the autism spectrum.
- Evidence Informed Practices: designed to address a single skill or goal of a people on the autism spectrum.
- Evidence Informed Interventions and Programs: consisting of a set of practices designed to achieve a broad learning or developmental impact on the core symptoms of autism.
Generally, these programs are characterised by:
- Organisation: around a conceptual framework)
- Operationalisation: manualised procedures
- Intensity: a substantial number of hours per week
- Longevity: occur across one or more years
- Breadth of outcome focus: multiple outcomes such as communication, behaviour, social competence targeted.
The different types of evidence-based interventions include:
- Applied Behaviour Analysis (ABA)
- Early Start Denver Model (ESDM)
- Treatment and education of autistic and related communication handicapped children (TEACCH)
- Learning Experiences – An Alternative Program for Preschoolers and Parents (LEAP)
- Pre-school Autism Communication Trial (PACT)
- DIR/Floortime Approach*
- Developmental Social-Pragmatic (DSP) model
- RDI – Relationships Development Intervention
- The P.L.A.Y. Project® – Play and Language for Autistic youngsters
- Speech Generating Devices (SGD) and other Augmentative & Alternative Communication (AAC)
- PECS – Picture Exchange Communication System
- Triple P – Stepping Stones adaptation
- Hanen ‘More than Words’*
- The P.L.A.Y. Project® – Play and Language for Autistic youngsters