DEVELOPMENTS IN AUTISM

Mitchel Fleming reviews two articles which outline some new approaches to educational interventions for young children with autism.

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Applied behaviour analysis procedures are at the centre of most of the successful educational approaches for children with autism. The two models described below incorporate these procedures into their programmes but are quite different from the more traditional behavioural approach.

Pivotal response intervention

Lynn Koegel and her colleagues from the University of California, Santa Barbara, provide an overview of their work in the area of pivotal response intervention. In this approach the authors have identified a small number of pivotal areas which, when targeted for intervention, result in generalised, widespread gains in other areas of development. The ultimate goal of pivotal response intervention is to provide people with autism with the social and educational skills that will allow them to lead meaningful and enriched lives in inclusive settings.

A number of pivotal areas have been identified: multiple cues, motivation, self-management and self-initiation. Research shows that many children with autism are often over-selective in the cues that they attend to, e.g. they may attend to a bend in a picture card rather than any relevant feature of the picture. This tendency impedes learning. The authors have developed various approaches that help children to focus on salient features of materials or social situations. These include exaggerating relevant components which you want a child to focus on and then gradually fading these back, or directly teaching a child to respond to multiple salient cues, e.g. asking a child to get the new green sweatshirt as opposed to the shirt.

Children with autism often lack motivation in teaching situations and everyday social interactions. Motivation can be enhanced by responding to a child’s choices (i.e. following the child’s lead), ensuring that rewards are a natural consequence of learning, providing ample opportunities for success by interspersing previously learned tasks with new tasks, and reinforcing all reasonable attempts made by the child.

Self-management is a common difficulty experienced by many children with autism. Pivotal response intervention teaches children self-management procedures, which have been found to be effective in reducing disruptive behaviour, increasing daily living skills and in improving social and play skills. The authors report that once a child has learned these techniques they can then use them in other unsupervised settings with equally positive outcomes.

Children with autism often ask few or no questions, show little curiosity, and use language only to obtain desired items, not to initiate conversation. Teaching children to spontaneously initiate questions (e.g. ‘What’s that?’, ‘What’s happening?’) can increase a child’s learning opportunities in many settings, without the need for adult-initiated interventions.

Research shows that pivotal response intervention is effective, and the authors hope that the approach will be less costly and time-consuming than other, more traditional educational approaches which target numerous behaviours, each of which is taught separately. Future research is needed to identify other pivotal areas.

Incidental teaching

Gail McGee et al. from Emory University in Atlanta, Georgia, have developed an early intervention approach for use with children in their own home and in inclusive preschools. The approach is an adaptation of the Walden Toddler Programme and is based on the following principles. Children with autism should receive educational intervention as early as possible, ideally starting at 15 to 30 months. Intervention should be intense, i.e. 30-plus hours a week. Parent involvement is critical. Social engagement with normally developing children is essential. Childhood learning should be fun. Incidental teaching must be carefully planned.

The approach addresses what toddlers with autism need to learn, how the environment should be arranged and the teaching approaches that best promote learning. An interdisciplinary team identified a range of suitable learning goals for children with autism. These include verbal expressive language, ability to play meaningfully with toys, social responsiveness to adults, social tolerance and imitation of peers, and independence in daily living activities. Environmental arrangements include zone-based teaching in preschools, incorporating teaching goals into natural activities, one-to-one instruction when required, using a child’s preferred toys, and systematically displaying and rotating toys to maintain interest, novelty and child engagement. The teaching approaches used are: following the child’s lead or gently prompting the child to take an interest in an activity or toy, vigorous speech training, strong encouragement for playing alongside or with others, and using a wait-ask-say-show-do approach to teach daily living skills. Children’s progress and teachers’ performance are carefully monitored using specially developed checklists. Finally, the authors report research findings which suggest that incidental teaching is an effective approach for children with autism.

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