Running Head: INTERVENTIONS AND METHODS FOR TEACHING CHILDREN WITH AUTISM

Interventions and Methods for Teaching Children With Autism University of Nevada, Las Vegas Ashlei Livingston

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Abstract This paper explores five major interventions and methods for teaching children with deficits on the Autism Spectrum Disorder. Applied Behavioral Analysis, Pivotal Response Training, Floortime/DIR, The P.L.A.Y. Project, and TEACCH represent some of the most currently utilized interventions and methods for teaching and developing skills in children with Autism Spectrum Disorders (Mesibov & Shea, 2011). The focus on which intervention to utilize is determined by the differentiated instruction and targets of each intervention. Applied Behavioral Analysis and Pivotal Response Training focus on decreasing problem behaviors and increasing desired ones through trials and positive reinforcement (Dunlap, Kern & Worcester, 2001, Koegel, Koegel, & Carter, 1999). According to Mesibov and Shea (2011), Floortime/DIR and TEACCH are both methods that rely on individualization of programs aimed at a more theoretical development of skills. The P.L.A.Y. Project is an intervention that aims to increase the Emotional Quotient of a child with ASD through interactions, similar to DIR (Pullen, 2008). Although similarities exist between interventions, each of the individual interventions addresses the issues that arise for children with Autism Spectrum Disorders in different ways.

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Interventions and Methods for Teaching Children with Autism Autism is a disorder that presents itself with multiple symptoms and is highly varied from one individual to another. Since autism manifests with a variety of abilities and disabilities, it is often looked at on a continuum referred to as Autism Spectrum Disorders (ASDs). Though autism has a wide range of behaviors and deficits, Pajareya and Nopmaneejumruslers (2001) have noted that are two commonalties which appear throughout the spectrum. The first is a deficiency in language, both receptively and expressively, and effects social interactions and relationships. The second is the stereotyped movements and self-absorption that are more readily noticed due to their visibility. The self-absorption shown in children with ASD presents itself in motivational problems that are usually seen as unresponsive reactions to directions or stimuli (Koegel, Koegel, & Carter, 1999). The Centers for Disease Control (2011) now estimates that 1 in 110 children will be diagnosed as having an ASD. This reflects a growing trend in diagnosing children with an ASD. According to Mesibov and Shea (2010), the emerging recognition of autism has led to an increase in fad interventions. However, despite these fad interventions, new ideas and theories have emerged to help parents and teachers instruct children with ASD. There are two main intervention types which focus on either a behavioral approach or a more naturalistic progression of skills. The behavioral interventions are more empirical in nature and focus on data and measurable trials, including Applied Behavioral Analysis and Pivotal Response Training. The second type of intervention focuses on the progression of skills, as opposed to data and trials, including Floortime/ Development Individual Difference (DIR), the P.L.A.Y. Project, and the TEACCH approach (Treatment and Education of Autistic and related Communication for Handicapped Children) (Pajareya & Nopmaneejumruslers, 2011).

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Discussion Applied Behavioral Analysis Applied Behavioral Analysis (ABA) is one of the most common intervention methods used for children with autism. The main focus of ABA is to shape the behavior using antecedents by altering the environment to produce the desired outcomes. Discrete trials are used which creates a highly structured atmosphere in which the interventions are strictly controlled (Stahmer, Suhrheinrich, Reed, Bolduc, & Schreibman, 2010). Dunlap, Kern, and Worcester (2001) have outlined the main components of ABA. Firstly, ABA requires a great deal of data taking and measurement. Each program is individualized and created based on data analysis. Secondly, ABA is built on a motivational aspect that utilizes positive reinforcement to produce desirable outcomes. This may include a token economy or other reinforcement schedules. This intervention also employs multiple techniques, including shaping, fading, and prompting to increase social skills and decrease disruptive behaviors. As an empirical model of intervention, ABA requires rigorous and continuous data collection (Mesibov & Shea, 2010). ABAs development from behavioral psychology lends itself to the Antecedent-Behavioral-Consequence model. The antecedent is a valuable tool and component of ABA intervention. Dunlap et al. (2001) have shown that ample time and data taking is spent to isolate antecedents that trigger behaviors. The antecedents are then modified and used accordingly to either increase desired behaviors or decrease inappropriate ones. In order to pinpoint the effectiveness of a strategy in response to an antecedent, detailed data is taken after each trial. As the program progresses, this data has a clear and measurable effect which will determine whether the intervention is successful or needs modification. This focus on antecedents produces individualized programs that are specific to the needs of the child.

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Dunlap, Kern, and Worcester (2001) have noted that within the classroom, ABA is often utilized due to its ability to measure outcomes of strategies and its focus on decreasing or increasing desirable behaviors. Modifications are made to include the preference of the student, which has been shown to increase the effectiveness of the intervention. Choice is often added to the program in multiple ways in order to raise the success level of the intervention and motivation of the student. However, the use of choices are at the discretion of the interventionist or teacher who usually sets limitations due to time restraints, especially those of a classroom. Despite its widespread use and the benefits of its flexibility across a large population, Stahmer, Suhrheinrich, Reed, Bolduc, and Schreibman (2010) have noted that there are opponents to the rigidity of the program. Complaints have been aimed at its lack of application outside of the reinforcing environment and the overly structured nature of the intervention. Opponents of ABA seek a more naturalistic approach to the development of desired behaviors. Pivotal Response The tenants of the Pivotal Response Therapy (PRT) are derived from ABA. The pivotal behaviors focused on are behaviors that have a generalized effect to other areas of functioning (Koegel, Koegel, & Carter, 1999). PRT was created out of the need to address the issues with ABA, including its lack of application in other environments and its less naturalistic approach. PRT serves to elicit responses that are relevant to the instruction and generalize to other situations (Stahmer et al., 2010, Koegel et al., 1999). Stahmer et al. (2010) have generated several elements vital to PRT. Firstly, the instructor or teacher needs to gain the attention of the child in order to deliver the appropriate directions. In order to motivate and gain the attention of the child, a choice in activity, topic, reinforcement,

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or location of intervention is encouraged. During the trials, remedial tasks that have previously been mastered are mixed within the current target. The trials center on discrimination so that the child must focus on multiple cues and not simply one element, such as picking out a green triangle in a pile of shapes with varying colors. As in ABA, the consequence is given immediately following the response but PRT administers a direct reinforcer, as opposed to an indirect reinforcer, such as food. Another difference between PRT and ABA is that every response receives reinforcement, even if the attempt is incorrect. This is done to encourage participation. Koegel, Koegel, and Carter (1999) have noted is the lack of independent responses that occur without an antecedent for children with ASD. PRT also focuses on social interaction which is one such activity considered to be a self-motivating task, therefore motivation becomes a pivotal behavior. Through self-motivation, the child takes a role in their learning, eliminating the constant need for a therapist or teacher presence. Stahmer, Suhrheinrich, Reed, Bolduc, and Schreibman (2010) notes that most PRT can be adapted for the classroom to match home and is most often used in conjunction with other methods, such as Picture Exchange Communication System (PECS). According to Koegel et al. (1999), instruction in the school setting must be matched in the home or community. Coordination is vital to ensuring that the child receives consistent instruction in order to maintain progress. Koegel et al. (1999) has shown that PRT is highly effective in decreasing problematic behaviors while increasing the number of correct responses through naturalistic motivation. While PRT addresses some of the concerns present with ABA, there are still opponents who view the trial method too binding and inhibiting for children with ASD. Floortime/ DIR

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Floortime or Development Individual Difference (DIR) is a social approach that addresses the deficits of children with ASD (Pajareya & Nopmaneejumruslers, 2011). While this approach differs from ABA and PRT by not relying on discrete trials, this program also directs its training at the parents as opposed to the children in order to increase spontaneous language development and social skills. The parents are instructed on how to interact with their child to foster language, social, and relationship skills while moving through the 6 levels of DIR (Wieder & Greenspan, 2003). The six levels of DIR progress through a series of interactions with the parents or caregivers leading the intervention process. According to Wieder and Greenspan (2003), the parents or caregivers interact using a series of cues that encourage the child to develop basic skills that will lead to higher order thinking. The first step is to engage the sensory motor elements of the child by finding an enjoyable shared interaction between the child and caregiver. This may include tickling, facial expressions, or playing with a toy. The second stage is aimed at increasing the positive feelings created in the first stage and to expand on and deepen the relationship. The third stage of DIR is guided by the child. The caregiver uses nonverbal language, gestures and facial expressions, to show an interest in the childs desires. The parent or caregiver challenges the child to interact and express desire for objects and activities through the exchange of gestures, such as smiling, while giving the child a toy that is desired. The fourth stage involves verbal language. After the child expresses interest and makes gestures, the parent or caregiver continues this flow of interactions by asking a series of questions pertinent to the activity. In the fifth stage of DIR, the child is allowed to explore, through play, various feelings such as anger or sadness. The child is encouraged to express those feelings and desires verbally in a safe environment. The sixth and final stage involves the childs ability to express the

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feelings experienced in play through ideas that can be reasoned and generalized to other areas. Parents or caregivers set up a scenario that has missing information that the child must work through, recognizing a beginning, middle, and end. For example, the child will verbally or with visual aids, associate being happy with an activity or idea. DIR is an intensive program that requires a considerable amount of time. This program is child-centered, relying on the child to direct the progress as opposed to the adult in other programs like ABA. Also, it requires a considerable amount of time on the part of the caregiver or parent to establish the bonds necessary to enact this program (Wieder & Greenspan, 2003). The P.L.A.Y. Project According to Pullen (2008), Play and Language for Autistic Youngsters, or P.L.A.Y., is another therapy based on the interaction between parents or caregivers and children with an ASD. P.L.A.Y. is typically used for children aged seven and under, aiming to increase social skills by using physical involvement through play to foster those skills. Parents involved in P.L.A.Y., are taught to accept their children as what they are capable of doing instead of trying to force children with ASD to interact in ways that are not natural to them. P.L.A.Y. and DIR are similar in many fashions. P.L.A.Y. focuses on the child and creating an emotional connection to the world around them. As the child discovers an activity of interest to them, the parents or caregivers engage in play, giving feedback that enhances proper communication skills. P.L.A.Y. also makes use of other communication therapies including SCERTS (Social Communication, Emotional Regulation, and Transactional Support) (Pullen, 2008). The ultimate goal is to have the children monitor and control their own emotions. TEACCH

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Treatment and Education of Autistic and related Communication for Handicapped Children (TEACCH) (Blubaugh & Kohlmann, 2006) is a theory that employs multiple instructional methods that aim to emphasize the abilities of those with an ASD as oppose to changing or modifying behaviors to reach normalcy. Instead of attempting to modify behaviors, strengths and interests of the child are used to create individualized programs while accommodations are used for areas that are deficient. TEACCH focuses on the Culture of Autism, a concept recognizing the unique learning styles of children with ASDs and using their strengths rather than trying to change the individual (Blubaugh & Kohlmann, 2006). Mesibov and Shea (2010) have noted that TEACCH does not rely on trials and empirical data, elements that are desired by many teachers and schools. For the classroom, Blubaugh and Kohlmann (2006) have defined aspects of TEACCH that focus on the principles of Structured Learning. Schedules play a vital role in the functioning and flow of the classroom. Predictability is paramount in decreasing disruptive behaviors that children with ASD experience when presented with changes and unpredictable situations. In order to lessen the apprehension and fear, visual aides are employed to make use of strengths in visual learning that most children with ASD display. If a routine and schedule are used on a daily basis, the child will learn how to independently follow that task and achieve one of the goals of TEACCH. As the child learns various schedules, they learn that situations are more controllable and predictable showing that success is possible. TEACCH lends itself well to a classroom and can be used with nondisabled peers as well by developing a routine to help alleviate disruptions in the classroom (Blubaugh & Kohlmann, 2006). Summary

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Each of the programs has their own positives and strengths dependent upon the goals of each child and the available time and environment for both the child and the parents or caregivers. ABA, PRT, and TEACCH can be easily applied to the classroom and home, creating a consistent environment in which to nurture skills. However, concise data must be taken as each trial is completed in order to direct the focus of the intervention and measure results. DIR and the P.L.A.Y. Project rely on a looser model that focuses on a naturalistic environment based on play. Both of these programs are less rigid and can generalize to other situations on an emotional level (Pullen, 2008). It is not necessary for parents or educators to participate in one program to the exclusion of others. The interventions or methods can be combined to create a more comprehensive program that is suitable to help a child with ASD in multiple fashions (Pullen, 2008). Invoking several strategies may prove to be more beneficial to arrive at a program that not only serves multiple purposes, such as focusing on language or behavior, but a program that can motivate a child through multiple instructional strategies. Each instruction and method has its own merits but what is agreed upon is that intensive individualized instruction is needed to help students with ASD learn vital communication and cognitive skills.

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References Blubaugh, N. & Kohlmann, J. (2006). TEACCH Model and Children With Autism. Teaching Elementary Physical Education, 17(6), 16-19. Centers for Disease Control and Prevention (2011). Autism Spectrum Disorders (ASDs). Retrieved from http://www.cdc.gov/ncbddd/autism/index.html Dunlap, G., Kern, L., & Worcester, J. (2001). ABA and Academic Instruction. Focus On Autism & Other Developmental Disabilities, 16(2), 129. doi:10.1177/108835760101600209 Pullen, L. C. (2008). The P.L.A.Y. Project: A Revolutionary Treatment Approach for Children with Autism. Exceptional Parent, 38, 42-43. Retrieved from http://www.eparent.com/various_articles/PLAY_Project.asp Koegel, R. L., Koegel, L., & Carter, C. M. (1999). Pivotal Teaching Interactions for Children With Autism. School Psychology Review, 28(4), 576. Retrieved from Academic Search Primer Mesibov, G. B. & Shea, V. (2010). Evidence-Based Practices and Autism. Sage, 15:1. Retrieved from http://aut.sagepub.com/content/15/1/114.full.pdf+html Pajareya, K. & Nopmaneejumruslers, K. (2011). A Pilot Randomized Controlled Trial of DIR/Floortime Parent Training Intervention for Pre-school Children with Autistic Spectrum Disorders. Sage, 15. Retrieved from http://aut.sagepub.com/content/15/5/563.full.pdf+html Stahmer, A.C, Suhrheinrich, J., Reed, S., Bolduc, C., & Schreibman, L. (2010): Pivotal Response Teaching in the Classroom Setting. Preventing School Failure: Alternative Education for Children and Youth, 54:4, 265-274. doi:10.1080/10459881003800743 Serena Wieder, S. & Greenspan, S. (2003). Climbing the Symbolic Ladder in the DIR Model

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Through Floor Time/Interactive Play. Sage, 7(4), 425435. doi:10.1177/1362361303007004008