The data coming from scientific studies allows us to confirm today that the cause of autism is biological (with a very significant influence by genetic factors) and not a psychogenic disorder, that is to say, the clinical expression of psychological trauma. This realisation has allowed us for quite a while now to create programmes with individualised educational psychological programmes and to apply pharmacological treatments that could improve certain symptoms and which therefore allow the children or adult to have more possibilities in developing their potentials.
In order to improve the prognosis of people affected by ASD, it is very important to make an early diagnosis and to start treatment as early as possible. Intervention programmes must be comprehensive (addressed to all evolutionary areas and different contexts) and take into account the individual characteristics of every person. Coordination with different professionals and services helping the child affected must be very effective and it is recommended that one of the professionals involved act as a reference point, with the mission of coordinating the various actions and becoming the preferred speaker with the family. In that regard, it is very important that the parents receive suitable counselling and support, and that a programme be created for the home, with a description of specific objectives and working methods.
The basic services aimed at those affected must cover their needs, from the moment they are diagnosed and throughout their entire lives, with support services for their families, which will allow the parents to live with the affected child as much time as possible, without breaking apart the structure of the family unit and thus achieving true integration into society.
Some of the current behavioural treatments are:
- ABA (Applied Behaviour Analysis)
- DENVER (Early Start Denver Model)
- PECS (Picture Exchange Communication System)
- TEACCH (Treatment and Education of Autistic Related Communication Handicapped Children)
ABA is the science that systematically applies the principles of behaviour analysis in order to improve the social behaviour of people with Autistic Spectrum Disorder. Applying ABA means adapting knowledge based on empirical studies on Learning Theory and modifying the behaviour of people with ASD. Initially, the priority areas of intervention must be identified, in order to be able to work according to the ABA method and improve behaviour. On the one hand, this method is intended to increase social and communicative behaviours, and, on the other hand, to reduce stereotyped, repetitive and inflexible behaviours. The ABA must be individualised, structured, intensive and extensive, that is to say, applied to all contexts of the person with ASD and everyone must be involved: family, teachers, therapist, friends, etc. The techniques used are based on the following foundations: consequences (reinforcement and punishment), extinction, discriminated operants, discrete trial, support, breakdown and moulding...
The Early Start Denver Model (ESDM) is an approach in early behavioural comprehensive intervention with children with autism between 12 and 48 months. The programme includes a development curriculum, which establishes the skills that must be taught at a given time and a set of teaching procedures. It can be carried out by therapy teams and/or parents in the group programmes or individual therapy sessions, whether in a clinic or the home of the child.
Psychologists Sally Rogers and Geraldine Dawson developed the Early Start Denver Model as an extension to early ages of the Denver Model which Rogers and her colleagues developed and refined. This early intervention programme includes a development model focused on the relationship with well-assessed teaching practices of the Applied Behaviour Analysis (ABA).
Its main characteristics are the following:
• Naturalistic applied behavioural analytic strategies(owing to generalisation problems)
• Sensitive to normal development sequence
• Deep parental involvement
• Focus on interpersonal exchange and positive affect (create positive emotional states)
• Shared engagement with joint activities
• Language and communication taught inside a positive, affect-based relationship
• Intensive therapy (owing to them having less learning opportunities)
• Play as a framework of intervention (the adult has to be a good playmate)
• Intervention based on the interpersonal relationship
The quality of the development depends on positive affect, reciprocity, sensitivity and responsibility of the adult towards the child. The biological disorders of ASD imply a deficiency in social motivation, due to the lack of sensitivity to social reinforcement from these people (hypothesis of social motivation). This lack of sensitivity is due to a failure in the preference for social information in their environment: the faces of others, voices, gestures and speech.
Early attention halts the negative symptoms which cause autism and increase the learning of mimicking, game, shared attention, verbal and nonverbal communication, social and emotional development, cognitive and motor skills.
The Picture Exchange Communication System is an augmentative and/or alternative communication system that, using the exchanging of images, supports the learning of speech. It was designed by Andy Blondy and Lori Frost in 1985. It deals with teaching a person with severe communication difficulties to use a useful system to communicate. In the case that the person can talk, it will be a system that increases speech.
The PECS programme was used for the first time in the “Delaware Autistic Program” and has gained worldwide recognition due to focusing on the component of initiating communication. PECS does not require complex or expensive materials, it was created by educators taking into account their homes and families, due to which it could be useful in multiple situational contexts.
The system consists in having the student obtain a reinforcer after exchanging it for one (or multiple) images. This is based on the applied behaviour analysis (ABA) and the pyramid approach to education by Andrew Bondy which posits functional communication as one of its pillars. Therefore, this is the model for working on communication based on behavioural therapy.
The age to use PECS is not important so long as there are sufficient motor skills to pinch and grab the picture (20 months) and they are capable of walking to find the thing they want. However, with early intervention there can be very good progress and it does not impede their cognitive level since it teaches them to discriminate between pictures.
It is structured into 6 phases plus an attributive phase and all the phases are built on the previous ones, in such a way that if we were to skip a phase we could not expect the same results. Before beginning the phases, a previous step must be taken: a recording in order to assess what the reinforcers are for the student. The student will advance in the phases when they reach a control criterion (objective), which can be used using the records of data that the coach collects.
The TEACCH method (Treatment and Education of Autistic Related Communication Handicapped Children) is a holistic therapeutic and educational approach serving people with ASD. It is a state programme in North Carolina, created in 1966 and developed by Eric Schopler. The main objective is to prepare people with ASD to live and work more efficiently at home, school and in the community.
It is a philosophy of intervention that takes into account the difficulties and potentials of every person and which adapts the different environments structuring time and space, so that the person with ASD understands them.
The basic components of structuring are the following four:
- Physical structure of the environment and time: clear physical and/or visual limits are established, in such a way that every space makes sense. Every activity is clearly associated with a space. Visual and auditory distractions are also limited. In a classroom there could be spaces such as:1-to-1 work, autonomous/independent work, play area, eating area and group activity. This structuring provides information about “where people are”, “where I am”, “where does everything go”, “where I need to do each activity”, “where to find each thing”, etc.
Visual media is used that is adapted to the abstraction level of the person and which facilitates time comprehension. An individual schedule is designed for them that provides them information on “where I will be”, “what I will do” and “when I will do it”.
- Structuring of the organisation of work. Working systems: Normally it is used when the person with ASD learns to work autonomously. It is a way of structuring the work responding to 5 basic questions: “what work do I need to do?”, “how much work do I need to do?”, “how will I know that I have finished?”, “what will happen when I finish?”, and “how should I carry out the different tasks?”
- Visual structuring: This component has 3 elements:
A. Visual organisation in order to facilitate the realisation of a task.
B. Visual instructions, to teach the sequence of specific steps the person with ASD must follow in order to complete a task.
C. Visual clarity, in order to get the person with ASD to focus on the more useful and relevant information.
- Carrying out functional routines: useful and effective routines must be designed for the person with autism, since they prefer the feeling of security and autonomy.