Chapter 12 - Intervention

Question 1

What are the aims of intervention?

Answer 1

Prevention (reduce incidence of autism), cure (reduce prevalence of autism), and treatment (increase individual’s competences, quality of life)

Question 2

What are the advantages of prevention and cure?

Answer 2

Beneficial for individuals and families (spare them the stress and sacrifices), beneficial for society (costs)

Question 3

What are the disadvantages of prevention and cure?

Answer 3

Many autistic individuals view themselves as different but not disabled (they don’t want to be cured), not all families have a negative experience with living with someone with autism, wrong to assume that autistic individuals cannot make contributions to society (many autistic people can be geniuses and make great contributions)

Question 4

What are the advantages of treatment?

Answer 4

Treatments can empower the individual and increase self-esteem, reduce demands on carers, reduce financial demands on the State

Question 5

What are the disadvantages of treatment?

Answer 5

Wrong to assume that being like the majority (being normal) is inherently desirable, treatment should focus on the quality of life (not ‘curing’), benefits of treatment may not outweigh the cost/ side-effects

Question 6

What are the methods of prevention?

Answer 6

Genetic counselling, in utero detection (and abortion), eliminate exposure to environmental factors, intervention during first year of life

Question 7

What are the methods of cure?

Answer 7

There is no official cure, but many parents are sold ‘cures’ that are fake (‘snake oil’)

Question 8

How should different treatment options be considered?

Answer 8

Evidence-based vs non-evidence-based, comprehensive treatment models (CTMs) that target behaviours that define ASD vs focused intervention practices (FIPs) that target a facet of ASD behaviour, non-physical treatments vs physical treatments, age group, where and by whom and how, the cost

Question 9

What are some evidence-based psychosocial and educational treatments?

Answer 9

Applied Behaviour Analysis (ABA), Cognitive Behaviour Therapy (CBT), Early Intensive Behavioural Intervention (EIBI), Functional Communication Training (FCT), Early Start Denver Model (ESDM), Pivotal Response Treatment (PRT), Incidental Teaching, Preschool Autism Communication Trial (PACT), Learning Experiences (LEAP), Social Communication Emotional Regulation Transactional Supports (SCERTS), Relationship Development Intervention (RDI), Developmental Individual-difference Relationship-based (DIR) Floortime, ‘Talking Therapies’, Augmentative and Alternative Communication systems (AACs), Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH), EarlyBird, etc

Question 10

What is ABA?

Answer 10

It is based on the principles of behaviourist learning theory as exemplified in the ‘Lovaas model’. It is used to shape behaviour (eliminate challenging behaviours, increase use of verbal requests). Some practices associated with ABA are very controversial/ criticized

Question 11

What are the key features of the Lovaas Model?

Answer 11

Accurate and objective observation and data-recording of an individual’s behaviour, an understanding of the immediate causes of the behaviour, a step-by-step cumulative process to replace maladaptive behaviour with adaptive behaviour by manipulation of the precipitating and sustaining factors

Question 12

What is CBT?

Answer 12

It is a highly structured focused intervention practice (usually for mental health disorders). It is useful for reducing anxiety and mental health issues related to ASD

Question 13

What is PRT?

Answer 13

It utilizes some of the principles of behaviourist learning theory (ABA) but in naturalistic settings and using naturalistic forms of reward. The aims include: motivation and self-initiation of behaviour, responsiveness to multiple environmental cues, self-regulation of emotional state (emphasis on social, emotional, communication abilities). It is designed to be used across a range of settings (at home, with a therapist, at school…). It may follow the lead of the child (building on their interests)

Question 14

What is DIR?

Answer 14

It is a play-based CTM that uses the child’s preferred interests as the basis for establishing a relationship through shared play. The goal is to engage in reciprocal or shared play

Question 15

What is TEACCH?

Answer 15

It is focused on structured teaching. It capitalizes on autistic individuals’ tendency to develop routines and their bias towards visual stimuli over auditory. Different competencies such as number concepts or tying shoelaces are targeted

Question 16

What pivotal skills do NLP and PRT focus on?

Answer 16

Motivation, self-initiation, joint attention, self-regulation, empathy

Question 17

What are some examples of good NLP/ PRT training?

Answer 17

When teaching colours use the child’s favourite toys to label colours, when teaching follow instructions immediately reward the child when they complete the task, when teaching the difference between fast vs slow have the child ask for a slow or fast pitch and pitch it as they requested, etc. (Overall focus on child’s choice, interaction, activity, interests)

Question 18

What is a difference between discrete trial methods and PRT?

Answer 18

In discrete trial methods the therapist is forced to focus on eliminating disruptive behaviour, while in PRT the therapist can focus on teaching the task

Question 19

What are the collateral effects of initiations (ex: ‘what’s that?’) in NLP/ PRT?

Answer 19

Decrease disruptive behaviour, expand communicative function, increase socialization, support information seeking, improve long-term outcomes

Question 20

What is the Analysis of Verbal Behaviour (AVB)?

Answer 20

It is based on ABA and was developed by Skinner. It has an increased emphasis on teaching the power of communication (ex: requesting the desired object). It focuses on echoic language (verbal imitation), motivating operations, making demands for positive rewards, labels, social reinforcement of conversation

Question 21

What are some physical treatments?

Answer 21

Comprehensive treatment models like acupuncture (not recognized in Western societies) and oxytocin (mediates emotion and social bonding) or focused intervention procedures like medications with melatonin, risperidone, methylphenidate (Ritalin), anticonvulsants, and antidepressants

Question 22

Are the various treatments for autism effective?

Answer 22

There is not a lot of evidence for their effectiveness, placebo effects may occur