Programs for the Treatment of Autism Essay

This essay has a total of 2104 words and 10 pages.


Programs for the Treatment of Autism





Autism is a pervasive developmental disorder first termed by a man by the name of Kanner
in 1943. He described a group of children as having severe language, behavior, and social
interaction difficulties. These descriptors are what have come to be the core elements of
autism today. Autism is characterized in the Diagnostic and Statistical Manual (4th ed.)
by a continuum of abnormal development in social interaction and communication combined
with a restricted repertoire of activities and interests. Children with autism are
typically diagnosed by the age of two, with the prognosis generally being poor. The
American Psychiatric Association’s 1994 estimated prevalence is about 1 per 1,000
individuals with males being diagnosed 3 times more than females. However, females are
more likely than males to function in the mental retardation range (Gresham et al., 1999).
Currently there is no known “cure” for autism. Therefore, in the following
composition I am going to discuss some of the methods designed to manage the behavior of
individuals with autism.

The first program I am going to discuss is a project that was conducted by Lovaas
beginning in 1970 called the UCLA Young Autism Project (YAP). The goal of this project
was to increase behavioral functioning in children with autism by the use of simple
commands (e.g. “Sit down,” “Look at me”). During the treatment,
aggressive and self-stimulatory behaviors were either ignored or reacted to with a
contingent physical and/or verbal punishment such as a slap on the thigh and/or a loud
“No!” while alternative behaviors were reinforced (Gresham et al, 1999).

The research design used in this project was a quasi-experimental design. The
participants were not randomly assigned, but were coordinated into groups of 19
(Experimental, Control 1, and Control 2). Both children in the experimental group and
control 1 received intensive one-to-one treatment beginning at average ages of 34.6 and
40.9 months respectively and continuing for two or more years. Children in the
experimental group received at least 40 hours of treatment per week, whereas children in
control 1 received 10 hours or less per week. Children in control 2 were not treated by
the YAP personnel, but were given an unspecified form of treatment (Gresham et al., 1999).

At the end of the project, 47% of the children in the experimental group were reported as
having “recovered.” This indicating that their IQ scores were in the normal
range (M=7, Range=94-120), they had passed the first grade in a regular education
classroom, and they showed continuing increases in social, emotional, and educational
functioning. Lovaas also reported that the school staff described these children as
indistinguishable from their normal peers. No children from control 1 and only one child
from control 2 reached this point of “recovery” (Gresham et al., 1999).

Although the YAP appears to have been successful, there are many methodological issues to
be considered. Most importantly is the lack of random selection, being a threat to both
internal and external validity. For example, we cannot prove that the improvements were a
direct cause of the treatment and had nothing to do with the children being from the same
area. This study has not been able to be replicated, leaving even more questions about
the study’s effectiveness and efficiency. Ethical issues also need to be taken into
account. Would it be right to put children in a control group with no treatment if we
know they will fare worse without it? Though the finding that discrete trail training can
create normal functioning may be controversial, this does not mean that the program was of
absolutely no benefit. The use of this type of treatment has been shown to be helpful in
teaching children discriminations among stimuli (Gresham et al., 1999). This program is
only one of many designed to aid in the training of individuals with autism.

Another project that has received much attention is the program for the Treatment and
Education of Autistic and Related Communication Handicapped Children (TEACCH). This
program was first conducted by the Department of Psychiatry at the University of North
Carolina in 1971. And in 1972 became the state organization mandated to serve children
with autism and their families. In 1979 the mandate was extended to include adolescence
and adults as well. The goal of the program is to combine the expertise of both the
professional and the parent to develop the child’s vocational, social, and living
skills through the use of visual prompts or cues in the environment (Gresham et al.,
1999).

The TEACCH model believes that behavioral difficulties are due to the individual’s
inability to understand and successfully cope with their environment; therefore, there is
a focus on making alterations in the environment to accommodate the child’s deficits
in addition to developing new skills. An example of this is the way TEACCH takes
advantage of students’ strengths in visual processing by using schedules, work
charts, and overall organization to accommodate for the auditory deficits in many children
with autism. Although children with autism may have many similar deficits, every child is
different; thus, individualized assessment strategies, both formal and informal, are
utilized as a basis for treatment. In determining the particular strategies for each
individual, cognitive and behavioral therapies are the preferred forms of treatment (Van
Bourgondien & Schopler, 1996).

Overall, studies of the efficacy of the TEACCH program have shown positive results,
however, as in the YAP studies, methodological issues were a concern. One study by
Schopler et al. done in 1982 reported that of individuals with autism who underwent
treatment through the TEACCH program, only 7% were institutionalized. A significantly
lessened amount compared to rates of 39-74% in the 1960’s. However, government
policies about the institutionalization of disabled individuals also started to change in
the 1960’s. This leaves the question of whether this decrease in
institutionalization was due to the treatment or the government policies (Gresham et al.
1999).

A more recent study (Ozonoff & Cathcart, 1998) tested the effectiveness of a home-based
TEACCH program. In this program the children in the experimental and control groups were
matched rather than randomized as in the YAP. And there was no supervision of the program
in the home to guarantee that the correct procedures were being used. These studies show
that the TEACCH program may be effective in improving the symptoms of autism, but, as with
most research, cannot tell us with complete accuracy (Gresham et al., 1999).

The final program I am going to discuss, LEAP (Learning Experiences: an Alternative
Program), is a less well known model. This program began in 1982 as a federally funded
program serving young children as well as typical children ages 3 to 5 and was one of the
first early intervention programs that focused on inclusion (Gresham et al., 1999).

There are five key features of LEAP that are laid out by Strain and Hoyson. These are as
follows: First, it is an individualized program. As in TEACCH individual objectives and
strategies for treatment are planned for each child. Second, LEAP relies heavily on data.
Data is collected in several areas including IEP objectives, social interactions, and
classroom conduct. This data is then used to make decisions on whether teaching
strategies should be maintaining, changing, or discontinuing strategies. Third, there is
a focus on generalization. The IEPs used in LEAP are written to promote learning in all
settings. Fourth, child participation is widely encouraged. Children are given every
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