Orton – Gillingham Approach – uses “multi-sensory” methodology – “triple enforced” learning means that students may use visualizations/mental imagery, written, and spoken modalities – highly structured, systematic and hierarchical – has been around since the 1930s – primarily for dyslexia, though claims to help various language disorders, including autism – when used as intended, it is intensive and expensive – research generally positive, though some contradictory
Pivotal Response Training (PRT) – pivotal is another word for crucial, and includes general areas, such as motivation, social initiation, and understanding rather than specific behaviors – derived from ABA, but is more child initiated, play based, and does not focus on specific behaviors – part of Early Start Denver Model approach – research seems generally positive but limited
The PLAY Project – (Play and Language for Autistic Youngsters) – uses DIR/Floortime model – focus is on teaching parents to become interventionists using strategies of DIR/Floortime, such as following child’s lead – intensive and expensive, but perhaps a little less so than most other approaches – research limited, but generally positive
PECS (Picture Exchange Communication System) – approach most effective for establishing communication motivation and initiation – children are taught to use basic pictures to request objects and basic needs – the official approach, taught by the Pyramid Educational Consultants, is, wait for it…intensive and costly, although probably not as much as many other methods – research generally positive, though mainly for short term use and in single settings – difficult to implement, as at least early on requires multiple caregivers
Rapid Prompting Method (RPM) – the main provider of this is called HALO, which labels their method Soma-RPM, developed by a mother (named Soma) with an autistic son – uses stimuli such as rapid speech and paper tearing to supposedly match the preferred modality of the autistic individual – appears to at least sometimes use facilitated communication to “encourage” communication via pointing – has received media attention from PBS, HBO, and CBS – not backed by any good research, and the long debunked methods of facilitated communication have had multiple tragic results
Relationship Development Intervention (RDI) – developed by Dr, Steven Gutstein – intensive training program, primarily for in home use, intended to gradually strengthen social connections – has multiple catch phrases, such as dynamic intelligence, emotional referencing, flexible thinking, relational information processing, etc. – the RDIconnect company trains certified consultants, who then train parents their specific strategies – potentially expensive, and independent research almost nonexistent
Relational Frame Theory (RFT) – extremely confusing theory of language , using operant conditioning principles and loads of jargon – I haven’t heard of anybody actually using this to treat language disorders, but there is tons of information on the internet from its adherents as if RFT is the greatest thing since sliced bread, and that it can treat everything from stress to autism
Reciprocal Imitation Therapy (RIT) – Dr. Brooke Ingersoll – uses principles of ABA and pivotal response training to specifically address imitation and play abilities – involves parallel play and ties imitation into social reasons for imitating – starts by adult imitating, and providing opportunity for child then to imitate – spends more time selecting things with intrinsic interest than traditional ABA like therapy – seems possibly helpful for specific groups – research very limited at this point
TEACCH – Treatment and Education of Autistic and Communication related handicapped Children – school based program developed state-wide in North Carolina, and sometimes used elsewhere – prototype TEACCH model places several children in small self-contained classes, usually with one teacher and one aide – intended to provide autistic individual with structure and organization, with such things as physical boundaries, routines, visually based cues, etc. – sometimes used along with other strategies – some research suggests it may be beneficial, but as usual, almost all research has not been independently verified – also, research results seem to be largely dependent upon skills and experience of staff
Stem Cell Therapy – intended to address possible immunologic based inflammatory conditions that are thought to contribute to autism – treatments involve IV injections of a child’s own banked cord blood – research has yet to link autism and neuroinflammation, let alone demonstrate that this particular treatment works – this may show promise many years in the future, but at this stage it is extremely experimental
Son-Rise – similar to DIRFloortime and RDI in that parents become therapists and engage at child’s level of interest – opposes itself to behavioral therapies, such as ABA – attempts to build relationships between autistic child and caregivers – very time consuming (requires home volunteers or at least one stay at home parent) and very expensive – program may not always be implemented in the same way every time, which impedes research – reliable research very limited, but there seems to be some positive anecdotal evidence (although that can be said for just about all of these programs)
Visual Therapy – addresses areas of focus and concentration, among others – sometimes claimed to help general learning problems or other areas, such as ADHD – various approaches addressing visual deficits in autism go by monikers such as visual therapy, vision training, developmental optometry, and visual management training – these address eye tracking, aim, depth perception, visual perception – multiple groups have condemned behavioral vision therapy as scientifically unproven, including the American Academy of Pediatrics, and U.K. College of Optometrists
Sensory Integration Therapy – used to treat Sensory Processing Disorder, and often used in addressing sensory issues common in autism – these sensory issues include hypersensitivity, and sometimes hyposensitivity, to light, sound, and touch – Sensory Integration Therapy is usually done by occupational therapists, and includes activities such as deep pressure, bouncing, swinging, and systematic desensitization – very popular, with adherents espousing several studies that support it – unfortunately, there seem to be more studies showing mixed or no benefits
SCERTS – stands for Social Communication, Emotional Regulation, and Transactional Support – Practitioners following the SCERTS model use a combination of techniques and strategies, many borrowed from other interventions, in order to meet the specific needs of the individual child – more child directed than ABA approaches, and so implements aspects such as following child’s lead, manipulating the environment, and communication temptations – emphasizes social-pragmatic language therapy – parents and professionals are trained to implement strategies as a team approach – independent research and reviews are extremely rare
Social Stories Therapy – can refer to these generally, or Carol Gray’s extensive program with tons of books and materials for sale – social stories provide an individual with information about those situations that he may find difficult or confusing – various situations are described in detail with the goal of the stories to increase the individual’s understanding of, make him more comfortable in, and possibly suggest some appropriate responses for the situation in question. – while the term “Social Stories” is actually trademarked, and refers to a specific program, many of these created by professionals and caregivers are offered free or for lower cost on the Internet and within applications for technology devices – these all seem to be useful as a tool for specific behaviors that can be used in addition to other strategies for other skills and behaviors
Ziggurat Model – uses checklists filled out by team members to determine underlying deficits of child with autism – team members are supposed to work on needs as determined by levels, starting with sensory and biological needs, then reinforcement, then structure and visual supports, then task demands, then skills to teach – seems complicated and jargon laden, with many new acronyms to learn – no apparent independent research or reviews
One I forgot earlier:
Cognitive-Behavioral Therapy (CBT) – psychotherapy approach that addresses how people think and feel, trying to eliminated negative thoughts and feelings – used for various pyschological disorders, but research suggests CBT may be very effective, especially in helping treat specific behavioral aspects of high functioning autism
In summary; looking at the various autism therapies in this way can accomplish some things: one major similarity between all of these therapies becomes evident (besides their high cost). They all are intensive. In fact they often rely on this intensity, which tells us that intensity is crucial. Also, one can’t help but to feel that the time involved in relying on any one program, must preclude one from learning about what other programs have to offer. The evidence suggests that at this point no one approach is more effective than the others, and that the most effective intervention is likely one in which strategies and techniques overlap.
It is my conviction that any of these programs would be best utilized as adjunct or complementary therapies. Not only do these methods tend to take a lot of time at a lot of cost, they sometimes tend to essentially over-simplify more complex disorders. There is no short cut to simply treating the deficit. Ultimately, there is nothing better than having a comprehensive evaluation designed to identify deficits, and then working on the deficits themselves one by one. Various programs can be effective in supplementing this, but skepticism is warranted when someone advocates one method at the exclusion of all others, or the ignorance of treating complex sets of disorders.
One more part remains in this multi-part look at autism/language interventions: I will look at various specific techniques and strategies, many of which come from the specific autism programs that I’ve already looked at, and many of which don’t.