What Constitutes Effective Intervention for Individuals with Autism? The National Research Council’s report on Effective Treatments for Autism Still Stands True
In 2001, the National Research Council published findings effective treatments on Educational Interventions for Children with Autism from birth to age 8. The committee set out with the question “What are the characteristics of effective interventions in educational programs for young children with autism spectrum disorders?” The findings were published in a comprehensive book titled, “Educating children with autism.”
In answering the above question, the committee recognized that there were numerous articles written on autism treatment and that there were numerous treatment programs across the country claiming to be effective in helping children with autism. Treatments ranging from ABA-based programs to developmentally-based programs to diet-based programs or more idiosyncratic programs such as sensory integration. In order to base their recommendations on clear evidence of effectiveness, the committee ruled out treatment that did not base their statements on some form of data regarding the outcome of the children.
They took a look at over 900 articles written on the treatment of autism and also enlisted the assistance of ‘model’ programs currently in place for the treatment of autism. These model or state-of-the-art programs were typically university or research ran programs who that enlisted the services of highly qualified professionals. Of the ten model programs selected, seven were from an applied behavior analysis framework, one was from a developmental framework, one was purely parent training, and the last was a combination of behavioral and developmental frameworks.
The committee listed key features seen as variables of effective programs in an effort to use this information from these state-of-the-art programs and translate it to publicly funded early education programs across the country and to begin some quality control.
The first characteristic identified as a key feature of an effective treatment program is that of early entry into a program. When reviewing the information from these model programs and based on findings from the literature, the committee saw that the earlier a child is placed in treatment the better their chances of making gains. Therefore, their first recommendation was that educational services begin as soon as a child is suspected of having an autism spectrum disorder highlighting the importance of early intervention. Early detection and treatment are key phrases often heard in the medical field and this is the exact same case when it comes to the treatment of autism. So, early entry is recommendation number one.
Next, the committee looked at the intensity of these programs and what has been shown in the literature to be an effective level of intensity. Their conclusion upon review of the information was that educational services include a minimum of 25 hours a week, 5 days a week, 12 months a year during which time a child is actively engaged. The word minimum in this recommendation is key as some children may need more than this minimum of hours given the severity of their symptoms or their resistance to treatment.
Additionally, the notion of active engagement is very important as the recommended number of treatment hours is not merely the number of hours recommended for a child to be placed in a treatment program, but the number of hours to child is actively learning while in the program. This means that the child should not be just physically present in a treatment program, but that each and every hour of that program is designed in a way in which the child will learn for a minimum of 25 hours per week.
Another way of looking at this is if it was recommended that a child attend a special education program 30 hours a week, one would initially think that the recommendation for a minimum number of hours has been met. However, if, within these 30 hours, the child spends at least two hours a day playing alone in the playground, one hour a day eating lunch, a few hours a day in unstructured and unsupervised solitary play activities, and only two hours of actual teaching occurs within the school day, a child is left with only a 10-hour a week treatment program. And while play time is extremely important for any child, if a child does not yet have the skills to know how to play, how can the child be expected to interact with other children during these free play times without specific structured teaching? So, it is important to look beyond the number of hours and actually look at what each hour of the treatment program will entail whether that be an ABA program, school-based program, or any type of recommended treatment program. It’s imperative that a child be placed in a program where they can access the curriculum and where the teachers or therapists are actively engaging the child so as to capture each and every teaching opportunity and make it a worthwhile experience. There needs to be intensive teaching and learning occurring during a child’s time in an intervention program.
The committee actually described intensity as a “large numbers of functionally, developmentally relevant, and high-interest opportunities to respond actively.” In other words, a child’s time spent in a treatment program should result in high levels of learning when it comes to the matter of reaching their educational goals. So, the higher the level of active engagement, the higher the intensity, the higher the change rate for steady gains.
Next on the list of key characteristics was the child to teacher ratio. The committee recommended that programs consist of sufficient amounts of adult attention in order for a child to meet their educational goals, either learning with one-to-one or very small group instruction. The decision of student-to-teacher ratio should be made, depending on the learning ability of the child rather than depending on the staffing needs of the program. Therefore, if a child can learn in a small group of maybe two children and one teacher, then that should suffice; however, as is the case for many young children with autism, if the child cannot occupy their own free time in a constructive manner, redirect their attention when asked, or learn via observation of a peer, then the teaching instruction should be in a one-to-one manner, that is one teacher with one child.
The committee recognized the need for well-trained personnel. The committee noted that all the model programs they reviewed were developed by persons with Ph.D.’s in autism-related fields and the programs were directed and implemented by teams of professionals who had extensive training and experience in autism spectrum disorders. It is so important that the person designing a treatment program for a child with autism has extensive knowledge not only in the field of autism, but hands on experience in designing effective programs.
Next, the committee recognized the notion of individualization. A key characteristic of these model programs was that of comprehensive, individualized treatment goals based on the needs of each individual child rather than a one-size-fits-all curriculum for all the children in the program. The curriculum or individualized plan developed for each child should be based on their own personal strengths and weaknesses. The goals for each child should also focus on the development of a child’s social and cognitive abilities, their verbal and non-verbal communication skills, adaptive or self-help skills, and the reduction of behavioral difficulties using more positive behavioral approaches rather than punitive approaches.
The second part of this recommendation, that “goals “are frequently adjusted,” cannot be emphasized enough. While the initial curriculum and targets developed for a child may be individualized at the onset of a treatment program, it is critical that these goals and targets be reviewed routinely and adjustments be made when necessary.
And lastly, the committee recognized the important role parents have when it comes to the effectiveness of treatment programs. A key characteristic amongst all model programs was their emphasis on parental training and involvement in the program. The involvement of parents is a very valuable tool in the treatment of autism because children spend most of their time with their parents; therefore, parents must play an active part in the treatment team so as to continue where the formal treatment sessions end. With parents as active participants of the program, a child will always be in a consistent environment where their skills can be generalization generalized and maintained.
