Treatments

for Autism
Spectrum
Disorders
AUTISM
SPECTRUMNavigating

the
Maze

Lynda Maniscalc
M.S. CCC-SLP

Introduction
The diagnosis of an Autism Spectrum

Disorder presents parents and clinicians

with a veritable maze of programs and
therapies.
What is out there?
Which programs are best for my
child/student?
What are the pros and cons?

1. What will the role of the clinician (OT,

PT, SLP) be in implementing this

program or therapy?
2. For the next few minutes we will look at

an overview of the most standard and

popular treatment programs and
therapies for individuals on the Autism

Treatments for Core Symptoms

Treatments for Autism Spectrum Disorders

can be divided into two categories:

Treatments for Core Symptoms which
address behavioral, developmental and
educational needs specific to autism.
Other therapies such as Occupational,
Physical, or Speech Therapy that while
essential to the treatment of Autism is not
exclusive of other disorders such as
developmental delays or cerebral palsy.

Applied Behavioral
Analysis
This treatment program (ABA) is based

on the principles of positive

reinforcement of B.F. Skinner.
Simply, it is the repetitive use of positive
reinforcement to teach specific skills and
decrease inappropriate behaviors.
What is occurring in the childs
environment to cause negative
behaviors?

ABA Three Step Procedure

Antecedent: The verbal or physical

stimulus such as a command or request.

Resulting Behavioral response to
stimulus or a lack of response
Consequence: the positive reinforcement
or no response for inappropriate
behavior

ABA Intervention
ABA is not synonymous with Discrete Trial

Training. DTT was developed by Dr. O. Ivar

Lovass. DTT is a strategy used in ABA
In ABA, skills are broken down into small,
discrete tasks which are taught using
prompts, which are faded out gradually as
a skill is mastered.
Students are positively reinforced with
either verbal praise or something tangible
that he/she finds rewarding.

ABA programs are carried out at school

or in the home with a one on one aide

The goal is the carryover of the skills to
other environments.
Facilitated play with peers is also part of
this program.
The ABA provider is responsible for data
collection and analysis.

Providers must be board certified behavior

analysts. The provider is responsible for

writing and managing the program.
Individual Trainers, who are not necessarily
board certified provide the daily intervention.
Sessions last between 2-3 hours with 10-15
minute breaks at the end of each hour for
incidental teaching and play time.
Intervention requires 35-40 hours per week
with families encouraged to use these
techniques daily.

While punishments are not generally

used, a therapist may intervene if a child

is hurting himself by non-injurious
methods such as a light spray of water in
the face.

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Pros:
ABA is reputed by many to be the most

successful therapy available.

We found that 48% of all children showed
rapid learning and achieved average posttreatment scores, and at age 7 were
succeeding in regular classrooms.(Lovaas,
1987; McEachin, Smith and Lovaas, 1993)
The data collected on a daily basis allows
parents and team members to closely
follow the students progress.

Cons:
40 hours of intervention a week is often

considered to be just too much for many

families.
The cost is prohibitive. While some
schools will provide ABA, few will pay the
cost of 40 hours per week of one on one
intervention for just one child.
Critics suggest that ABA can create an
emotionless, robotic child who has
difficulty carrying over skills to a natural
environment.

The Therapists Role in ABA

ABA is usually paired with speech therapy in early

intervention. The SLP must be aware of the

specific plan for each child and regularly
communicate the the ABA therapist.
Speech Therapy, Occupational Therapy, and
Physical Therapy are often areas where the child
can generalize and practice skills learned in ABA
Therapy.
Each discipline brings to the ABA program differing
goals and objectives in terms of communication
modalities, positioning and sensory needs.

www.slp-aba.net

Pivotal Response Treatment

This program was developed at the

University of California at Santa Barbara

by Dr. Robert Koegel, Dr. Lynn Kern
Koegel, and Dr. Laura Shrubman.
It is also referred to as the Natural
Language Paradigm and is based on ABA
principles.

Pivotal Response Treatment

The goal of this intervention is to teach

language, decrease inappropriate

behaviors, and increase social skills and
academics. The focus on intervention is
on those skills pivotal to the normal
development of many other skills and
behaviors.
Pivotal skills include: communication
skills, play, social skills, and the ability to
monitor ones own behavior.

PRT differs from ABA in that it is child

directed
PRT is provided by psychologists, SPED
teachers, Speech Pathologists, and other
providers specifically trained in PRT.
PRT Certification is offered through the
Koegel Autism Center:

www.education.UCSB.edu/autism

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PRT programs require at least 25 hours of

intervention weekly.
All family members are encouraged to use
PVT methods consistently with the student.
Some disadvantages include: financing,
finding local providers and trying to live a
normal family life while constantly in
therapy mode.

The Therapists Role in PRT

As in ABA, the SLP, OT, and PT work with the

PRT provider in developing a treatment

program. The PRT provider should provide
suggestions to other professionals on
targeting pivotal behaviors. Communication
between therapists and families is a must.
All providers should focus on using the same
prompting strategies.
PRT blends especially well with Speech
Therapy as it can be adapted to teach a variety
of skills including symbolic and sociodramatic
play and joint attention.

Verbal Behavior
This program uses Skinners analysis of

language as a system to teach language

and modify behaviors.
It encourages the student to learn
language by developing a connection
between a word and its meaning.
Verbal Behavior is based on the idea that
the way we talk influences how sensitive
or aware we are of changes to our
environment.

The intervention first focuses on using

language to request or mands.

Then the focus turns to naming or
labeling referred to in the program as
Tact
Finally the focus of treatment moves to
Intra-Verbal Communication which
includes understanding and use of whquestions and conversation.

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Verbal Behavior and the

Clinicians role

Floor Time
This approach is

based on the
Developmental
Individual Difference
Model from Dr.
Stanley Greenspan.
Floor Time is simply
the idea that a childs
communication skills
can be improved by
building on his/her
strengths while
playing together on
the floor.

Floor Time:
The overall goal
Six developmental milestones
Self regulation and interest in the world
Intimacy or a special love for others
Two way communication
Complex communication
Emotional ideas
Emotional thinking

Implementation
The therapist enters the childs activities

and follows the childs leads in play and

guides the child in expanding his/her
interactions.
Parents are instructed on how to move the
child to more complicated interactions
which are referred to as Opening and
Closing Communication Circles.
Speech, motor, and cognitive skills are
addressed Through a synthesized
emphases on emotional development.

Floor Time is sometimes used in conjuction with ABA.

Intervention is delivered in a low stimulus environment

from 2-5 hours per day with the childs family using the
principles in daily life.

www.floortime.org
www.stanleygreenspan.com
Interdisciplinary Council on Developmental Learning

www.icdl.com
www.play-to-learn.com/dir_floortime.htm
Disorders

Greespan, S., & Weider, S. (1998). The Child with

Special Needs. Reading, MA: Addison-Wesley.

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Floortime: Playtime
for the Clinician
The principles of Floortime can easily be

included in the therapy techniques of

Speech, OT and PT.
Floortime allows for a fun, naturally
reinforcing therapy environment.
SLPs, OTs, and PTs already employ a
variety of play therapy techniques in
their interventions.

Relationship Development
Intervention
Developed by Dr. Steven

Gutstien
It is a parent based
program using the
following Dynamic
Intelligence Objectives

Dynamic Intelligence Objectives

Emotional Referencing:

the use of emotional

feedback to learn from the
experiences of others
Social Coordination: the
ability to observe and
continually regulate ones
behavior in order to
participate in spontaneous
relationships involving
collaboration and
exchange of emotion.

Dynamic Intelligence
Objectives

Declarative Language: using language

and non-verbal communication to
express curiosity and inviting others to
interact and share perceptions and
feelings and to corridinate ones action
with others.
Flexible Thinking: ability to adapt rapidly
and change strategies and alter plans
based on changing circumstances.

Dynamic Intelligence
Objectives
Relational Information Processing: the
ability to obtain meaning based on a
larger context and solving problems that
have no clear right or wrong answers.
Foresight and Hindsight: the ability to
reflect on past experiences and
anticipate potential future scenarios.

Intervention
In this program, the child begins working

one on one with the parent. Then another

peer is added who is at a similar level of
relationship development. As the child
progresses, other children are added to the
group and the environments are changed.
The curriculum consists of six levels:
Novice, Apprentice, Challenger, Explorer,
and Partner. The program guides the child
to develop friendships, and show empathy.

Intervention
Parents learn the program through

training seminars from an RDI certified

consultant

www.rdiconnect.com

Pros and Cons

RDI is not considered a complete

treatment program.
It is a program designed specifically for
parent implementation.

RDI: A Therapists
Perspective
Since RDI is meant for implementation

by the parent only, it would be important

for the SLP, OT, and PT to be aware of
the principles of RDI and the progress of
the student in this intervention.
Communication with parents and floor
time intervention specialist is vital to the
development of a multi-disciplinary team
approach.

TEACCH
Training and Education of Autistic and
Related CommuniCation for
Handicapped Children (TEACCH)
Developed by Eric Schopler, PhD of the
University of North Carolina
This is a highly structured program
based on the Culture of Autism.

Culture of Autism
This term refers to the relative

strengths and difficulties shared by

people with autism and that are relevant
to how they learn.
(www.autismspeaks.com)

Intervention
In this approach, children are evaluated

to determine emergent skills and

intervention is designed to build on
these skills.
The intervention plan is developed for
each individual child to help plan
activities and experiences.
The child refers to visual supports such
as picture schedules to help them
predict and cope with daily activities.

The TEACCH program is for home or

school interventions.
Training is available through TEACCH
Centers in North Carolina and by TEACCH
trained pshychologists, SPED Teachers
and SLPS

www.teacch.com

Pros and Cons

This program focuses on cultivation of

the childs strengths and interests rather

than focusing on his/her deficits alone.
The strengths of those with autism
(visual skills, recognizing details, and
memory can become the basis of
successful adult functioning (Ohios
Parent Guide to Autism Spectrum
Disorders Mesibov and Shea, 2006).

TEACCH and the

Therapist
SLPs, OTs, and PTs can easily include

TEACCH procedures in their therapy

sessions.
Therapists can incorporate the use of
schedules, social stories and other
techniques in their therapy plans,
encouraging skill generalization.

SCERTS
Social Communication, Emotional

Regulation, and Transactional Support

Developed by Barry Prizant, PhD., Amy
Wetherby, PhD, Emily Rubin and Amy
Laurent
SCERTS draws from other programs such
as ABA, Pivotal Response Treatment,
TEACCH, Floor Time and RDI.

SCERTS
The main difference between SCERTS

and ABA is that SCERTS encourages child

initiated communication in daily life.
SCERTS aim is to help the child achieve
Authentic Progress, which is defined as
the ability to learn and spontaneously
carry over functional skills into various
settings and with many communication
partners.

The Focal Aspects of SCERTS

Social Communication: spontaneous

functional communication, emotional

expression and secure and trusting
relationships with others
Emotional Regulation: the ability to
maintain a well-regulated emotional
state and the ability to cope with daily
stresses.

Transactional Support: development and

implementation of supports to assist

communication partners to adapt the
environment and provide the tools to
enhance learning(picture communication,
written schedules, sensory supports).
Specific plans are developed to provide
education and emotional support for
families and to encourage teamwork
among the intervention team.

Intervention
This program provides

for children with Autism

to learn with and from
other children who are
good social and language
models
Transitional supports
(environmental
accommodations) and
learning supports
(picture schedules or
visual organizers)

This program is usually provided in the

school settings by SCERTS trained

professionals

www.scerts.com
www.barryprizant.com

Pros and Cons

Unlike ABA, this program focuses on

group intervention rather than one on

one treatment.
Uses a multidisiciplinary team approach
SCERTS is not an exclusive program and
accepts other educational models that
the team deems appropriate.

Therapists Perspective
The SCERTS model is an interdisciplinary

approach. The model uses the

knowledge base and experience of
general and special educators, SLPs, OTs,
PTs, and other professionals.
Therapists should be familiar with
SCERTS principles and techniques and
communication with the SCERTS
provider, parents other members of the
intervention team is critical to the
success of the program.

The Hanen Approach

This approach is based on

the belief that parents

should be the childs
language teachers,
because they have the
strongest bond and have
many opportunities to
teach language in the
natural contexts of daily
living.
Parents are trained by
Hanen certified SLPS.

The Hanen Approach

Trained parents can then adapt the

approach to meet the individual and unique

needs of their child.
Programs for Parents include:
It Takes Two To Talk-Hanen program for
parents.
More Than Words- Hanen program for
parents of children with Autism Spectrum
Disorders
Target Word Hanen program for parents
of Late Talkers.

The Hanen Approach

The Hanen Centre has also developed

supports for teachers (Learning

Language and Loving It A Guide to
Promoting
Childrens Social, Language, and Literacy
Development second edition Weitzman
and Greenber, 2002).

www.hanen.org

Pros and Cons

Parents are to be the sole providers for

this approach.
It is not intended to be a curriculum
It does not exclude of other educational
models.

Integrated Play
Groups
Developed by Pamela J. Wolfberg, PhD.
Promotes socialization and imagination

in children with ASD or Developmental

Delays through play with non-disabled
peers.
Integrated Play Groups follow rules for
creation of an appropriate play
environment and selection of materials,
preparation of peers for play,
measurement of progress and guided
play.

Integrated Play
Groups
Focus is on social communication in

the areas of imitation, joint attention,

and imaginative and creative play.
Ohios Parent Guide to Autism
Spectrum Disorders
Wolfberg, P.J. (2003). Peer Play and
the Autism Spectrum: The art of
guiding childrens socialization and
imagination. Shawnee Mission, KS:
Autism Asperger Publishing Company.

Pros and Cons

This is a wonderful venue for

addressing social skills and

developing peer relationships.
Care must be taken to follow
procedures for the appropriate
environment, selected materials, peer
preparation, and data collection.

Play and Therapy!!

As in Floortime, Integrated play groups
fall in line easily with play therapy
techniques across professions.
The SLP would see significant benefits
to the inclusion of Integrated Play
Groups in addressing social skills.

The Son-Rise Program

The Son-Rise Program was developed by

Barry Neill Kaufman and his wife when

their son Raun was diagnosed as
severely and incurably autistic.
The program is a system of treatment
and education focusing on joining
children instead of working against
them.

Principles of the Son-Rise

Program
Joining in the childs repetitive and

ritualistic behaviors is considered the key

to unlocking the mystery of these
behaviors, facilitating eye-contact, social
behaviors and the inclusion of others in play.
Utilizing a childs own motivations advances
learning and builds the foundation for
education and skill acquisition.
Teaching through interactive play results in
effective and meaningful socialization and
communication.

Principles of the Son-Rise

Program
The program encourages providers and

parents to teach with enthusiasm and to

employ a non-judgemental attitude.
This approach considers the parent to be
the most important and best resource. It
encourages the creation of a distraction
free work and play environment to
facilitate optimal learning.

Intervention
Intervention is provided through parent-

training at one the Autism Treatment

Centers of America.
Parents are the primary providers,
however they can include family and
friends in the intervention process.
The Son-Rise Program combines
effectively with other complementary
therapies (ie. Biomedical interventions,
sensory integration, diet and Auditory
Integration therapies).

Pros and Cons

The cost in terms of finances and time

required for daily intervention may be

prohibitive for many parents.
The Son-Rise Program has come under
fire for promoting a cure for autism.
It is interesting to note that this
program is not even listed in the Ohio
Parents Guide to Autism Spectrum
Disorders or on the Autism Speaks
Website.
www.autismtreatmentcenterofamerica.c

The Role of other therapies in the

Son-Rise program

Resources
Autism Speaks www.autismspeaks.com
Ohio Center for Autism and Low Incidence

www.ocali.org
SLP-ABA Journal www.slp-aba.net
www.about.com
Koegel Autism Center

www.education.UCSB.edu/autism
www.floortime.org
www.stanleygreenspan.com

Resources and Credits

Interdisciplinary Council on Developmental Learning

Disorders www.icdl.com

www.play-to-learn.com/dirfloortime.htm
Greenspan,S.,& Weider, S. (1998). The Child with

Special Needs. Reading, MA: Addison-Wesley

Relationship Development Intervention

www.rdi.com

TEACCH www.teacch.com
SCERTS www.scerts.com
The Hanen Approach

www.hanen.org

www.autismtreatmentcenterofamerica.com
American Maze, Dale Wilkins. Used by permission

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In Summary
There are many, many different

approaches to treating Autism Spectrum

Disorders.
This list is by no means comprehensive.
Parents and therapists should engage in
careful research before committing to
any specific program.

The End of the Maze!!