Autism Spectrum Disorder (ASD): Behavioral Training and Management

Overview

There are many different programs that can help a child who has ASD.

Some programs start early in your child's development to help with symptoms. These help your child focus on improving his or her ability to communicate, learn, be social, and adapt to new situations. Children usually work one-on-one with a trained therapist for 30 to 40 hours a week.

Another program that may be used is structured teaching. This involves organizing a child's day and school setting to help a child learn new skills.

Certain methods, like modeling behavior or modifying a child's environment, may be used. With modeling, a child with ASD learns a skill or desired behavior by watching you, a therapist, or another child.

A benefit of these programs is that they teach you how to work with your child at home and help your child practice new skills.

You and your care team can decide which program might be best for your child. By sharing what you know about your child and combining it with your doctor's advice, you can help your child get the help he or she needs.

No matter what program you choose, all of the child's family members, teachers, and caregivers need to be trained in the techniques of the program you choose. Consistent use of the techniques gives the best results.

Behavioral programs and structured teaching

Applied behavior analysis (ABA) is a common technique used. This method rewards appropriate behavior to teach children social and other skills. It's based on the idea that behavior that's rewarded is more likely to continue than behavior that's ignored. It focuses on giving the child short, simple tasks. The child is rewarded when the task is completed.

Many programs are based on ABA. Some examples include:

Early Intensive Behavioral Intervention (EIBI).

EIBI (also known as the Lovaas model) can help children:

• Develop age-appropriate skills and behaviors.
• Increase their ability to think, learn, and remember.
• Learn how to interact with others and how to help themselves as they grow older.

EIBI takes a stepwise approach to helping your child learn and master new skills.

To set your child up for success, a trained therapist teaches your child how to do a task one step at a time.

Take a task like putting on pajamas. The therapist shows your child the drawer the pajamas are in. He or she will do this many times, and then ask your child which drawer the pajamas are in. The therapist will continue until your child points to the correct drawer. The behavior is rewarded with a treat or praise like "good job." When the task is complete, the therapist will introduce new tasks, like picking out pajamas or putting on pajamas. These steps are repeated and rewarded until your child learns all the steps to put on pajamas and can do it by themselves.

As your child progresses, he or she will learn to use these skills outside of the home. And your child will have opportunities to practice social skills with children (peers) who don't have ASD.

Pivotal Response Training (PRT).

PRT can help your child gain language and social skills. It focuses on "pivotal" areas of your child's development, such as:

• Increasing a child's motivation and awareness of self and others.
• Improving a child's ability to manage tasks.
• Teaching a child to initiate learning and asking for help.

These areas are thought to affect your child's ability to gain other skills.

To help your child, the therapist may focus on:

• Building your child's motivation to learn new skills by using things he or she is interested in, like a favorite toy. Or a therapist might use the power of choice, such as what color of pen to use, to encourage your child to try a new activity or learn a new skill.
• Helping your child learn how to read and respond to cues, like colors or letters on a toy. For example, the therapist may ask your child to get the red block with the letter "A" on it. Over time, the cues become more complex.
• Teaching your child how to manage specific tasks. The therapist will also help your child learn how to ask for help and to ask questions to promote learning and independence.
• Helping your child start a conversation or initiate play. This is most often done with a peer who doesn't have ASD. For example, the peer may ask your child questions while playing a game to help your child develop his or her verbal and social skills.

Early Start Denver Model (ESDM).

ESDM can help children as young as 12 months of age and up to 4 years of age develop and maintain communication and social skills.

A key part of this program is helping children connect with others. Children with ASD often prefer to play alone and don't make eye contact with others.

Through interaction and play, your child learns how to interact with others. For example, your child may learn how to pick up on and respond to social and emotional cues. These include gestures or pointing, smiling, laughing, or crying. Children with ASD may have a hard time understanding these cues. This can affect how well they relate to others. This interaction builds a shared interest in activities with others, such as playing a board game or with a toy.

This program also helps children develop age-appropriate behavior. This may be done in a classroom or a child care center. This usually involves a child who doesn't have ASD. He or she models a desired behavior as your child watches.

By building positive relationships at a young age, most children improve their ability to communicate and interact with others.

Learning Experiences—An Alternative Program for Preschoolers and Parents (LEAP).

LEAP is for preschool children ages 3 to 5 years old. You and your therapist will set goals for your child based on your child's strengths and weaknesses. These may be individual skills they need to learn or practice. In addition to working on their goals, your child will follow the standard preschool curriculum. This will help your child learn skills that will prepare him or her to be successful in a regular classroom later.

LEAP pairs your child with peers who don't have ASD in a classroom setting. The peers help your child practice new verbal and social skills. For example, the peer may ask your child to play with them or model how to take turns when playing a game.

A program that uses structured teaching includes:

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH).

TEACCH is based on the idea that the environment should be adapted to the child, not the child to the environment. Teaching strategies are designed to improve communication, social, and coping skills.

For example, children who have ASD may be too stimulated in a regular classroom. They may do best in a smaller group with a highly structured environment. TEACCH helps children understand their environment by having clearly defined areas for activities like playing or eating. It also helps children organize their day and schoolwork using schedules, calendars, written instructions, checklists, and notes.

The TEACCH program in general hasn't shown to be effective. But some parts of the program, like having defined areas for eating and play and visual aids like written instructions, seem helpful.

Targeted Interventions

Some programs target a specific problem area like behavior issues and problems communicating or being social.

Addressing problem behaviors.

These programs focus on replacing problem behaviors with positive ones. One way this is done is to understand why the child behaved that way. Since a child with ASD may not yet have the skills to express strong emotions and needs in other ways, he or she may act out or have other problem behaviors, like aggression. Sometimes this "acting out" is a normal response when something blocks a young child from gaining independence or learning a skill.

By understanding the "why," you can show them how to respond in a positive way. For example, you may teach your child to use words when he or she is angry instead of hitting.

Building communication and social skills.

There are many ways to help build a child's communication skills. One is to use photographs, line drawings, or flash cards with pictures or numbers on them. Children can use these to ask or answer questions. Or therapists and parents can use them to help the child build language skills.

Therapists and parents can also help a child improve social skills using short stories that show appropriate behavior in social situations. They can also be used to help your child understand someone else's point of view or feelings.