Psychological Treatment for Autism
Nowadays, there are various treatments that both children and adults on the autism spectrum can try. Some of them possess a robust scientific foundation and show results, but others aren’t quite as successful or may only work with people who fit a very specific profile. On the other hand, what we know is that effective psychological treatment for autism is based on evidence and is both integrative and holistic.
Austrian psychiatrist Leo Kanner was the first to recognize autism formally in the 1940s. Kanner studied characteristics that are typically present in autism, such as isolation, language problems, limited communication, or obsession with stable environments.
The exact definition of autism is still controversial today. Since a few years ago, people use the term “autism spectrum disorder (ASD)” to classify a wider group of disorders that share clinical characteristics that define “classic” autism.
Autism affects 10 to 15 out of every 10,000 people. When you include other conditions such as Asperger’s syndrome, the prevalence reaches up to 57 out of every 10,000.
When it comes to prevalence by sex, 4 out of every 5 people affected are male, although women tend to show greater intellectual disability. This affects 75% of people diagnosed with autism; in addition to this, 50% are mute or have impaired language skills.
Psychological treatments for autism
Of the many therapeutic options, one thing is for certain: no one intervention program works for everyone with autism. Indeed, no one therapeutic treatment is valid even for the same subject during different phases of their development.
What is clear is that behavioral interventions are the preferred psychological treatment for autism. They all base themselves in the applied analysis of behavior to specify the needs of that specific person and then modify the behaviors that need adjusting.
Theoretical foundations for the behavioral treatment of autism
- The principals of learning are universal and apply to people with and without autism in the same way.
- It’s not necessary to know the etiology of autism to apply behavioral techniques (Lovaas, 1993). This contrasts with the theories that are based on the alleged mechanisms of autism.
- Autism is a syndrome with tendencies for certain types of behavior and excesses of others. Though there’s a neurological base, behaviors are susceptible to changing thanks to organized interaction with a pre-arranged environment.
The general objectives for intervention are to:
- Firstly, to develop communication skills that let them understand other people better and to make sense of their relationships and actions.
- Also, to lessen behaviors that interfere with or that make difficult emotional stability and independence.
Over the past few years, several programs have presented compelling empirical evidence. Discover them below.
Psychological treatment for autism: Applied Behavior Analysis
Applied Behavior Analysis (ABA) uses scientific knowledge about learning. It does this to develop teaching techniques for relevant behaviors to be encouraged in the social sphere.
Most people think that global behavior interventions try to instruct the subject through a list of techniques for a set period of time. What they really do, however, is promote certain abilities through one or a handful of different techniques. Both types of interventions are considered equally effective.
The three basic principles of the ABA model of intervention are:
- Analysis. The progress is evaluated from the starting point of the interventions and by measurement of the progress.
- Behavior. Based on the scientific principles of behavior.
- Appliance. Applied principles of the observed behaviors.
On the other hand, the most common elements in global interventions are:
- The learning environment is controlled and structured.
- Those working with the patient direct treatment to all domains of ability and individuality based on the patient’s deficits and excesses.
- It uses procedures of applied behavioral analysis.
- One or more therapists carry out the treatment.
- The treatment lasts from 34-40 hours a week.
- Counselors select short-term goals according to normal development.
- Counselors make a set plan for generalization and maintenance.
- The patient must learn some skills first in order to learn other skills later.
- Language learning is the primary goal.
- Learning by rehearsal or error produces an increase in negativity, behavioral alterations, and demotivation. Thus, errors are avoided.
Results of global interventions
Of the different interventions, Applied Behavioral Analysis as a treatment for autism shows results in the following areas:
- An accelerated rate of development, with an IQ improvement as high as 20 points. It allows patients to achieve normal levels.
- It can improve adaptive behavior to a normal level.
- Also, it can eliminate autistic characteristics, such as self-stimulation, self-harm, and stereotyping, among others.
- Language acquisition is possible for the majority of children, usually from around the age of 5.
- Behavioral improvements and social abilities are common.
- Students can attend regular schools.
- The results persist during the following years.
Variations in global intervention that affect its effectiveness
Studies about behavioral treatments have shown that certain data can indicate some differences in the effectiveness of the treatment:
- The sooner the intervention begins (preferably before the age of 4), the higher the possibilities are of integration into an ordinary school.
- The more intense, the more effective. That being said, the needs can be different according to each child.
- If there’s an improvement in the first year, there will be in the second as well. The advances can continue at the same rhythm even two years later.
- Behavior therapy yields better results than all other treatments.
- The quality of the training of instructors, teacher supervisors, and parents doesn’t seem to interfere with results. In some studies, professionals who weren’t necessarily experts in autism participated.
- Parent collaboration showed the best maintenance and generalization of the results.
- It cements treatment protocol in the knowledge of the psychological characteristics of people with autism.
Psychological treatments for autism: specific interventions
Many studies have used behavioral interventions to establish success from the basic conditions necessary for learning to the most complex behaviors, such as language.
On the other hand, one of the most important findings of behavioral intervention in autism is this: the fewer disruptive behaviors (such as self-stimulation), the higher the possibility of learning.
Researchers drew two conclusions in this area:
- When a child with autism isn’t allowed to answer a certain question on a test, they will distribute their answer among the other items.
- As disruptive behavior decreases, children’s probabilities of learning to be discriminatory increase.
Investigations have sought to clarify in what way disruptive behavior maintains itself: by negative reinforcement, positive reinforcement, or the absence of another stimulus.
The main conclusion has been that to reduce disruptive behaviors, it isn’t effective to focus directly on stopping or decreasing them. One of the most efficient strategies for eliminating these behaviors is differential reinforcement of other behaviors.
Concrete techniques that center on teaching social, language, and reading abilities, as well as academic abilities, are the focus of treatment.
Psychological treatment for autism: naturalistic developmental behavioral interventions (Koegel et al., 1998)
Several current studies based on behavioral intervention use a more “natural” focus oriented toward development. This marks a big difference between more traditional interventions based on ABA.
For example, recently developed interventions for preschoolers consist of putting them in natural and socially interactive environments.
During routine and daily games, and from the very beginning of the intervention, the child directs the learning situation.
These interventions based on empirically tested methods find their basis just as much in learning principles as in the science of development.
It arose as a result of the difficulties with more traditional methods that were based on discrete rehearsals for the generalization of learning.
Incidental teaching, Pivotal Response Training, Milieu teaching, and natural language teaching, among others, have the intention of finding a more natural method. According to this school of thought, this is the way that autistic children achieve language development and communication.
These interventions are based in part on the principles of the interactive processes that stemmed from the development models, ABA, and the importance of parent-child interaction.
Psychological treatment for autism: the Pragmatic Evolutive Model (Prinzant and Wetherby, 1998)
This model puts the focus on pragmatic and social development. It emphasizes the need to focus on preverbal and verbal language, as well as communication abilities in general.
In addition to this, it works to decrease the difficulties associated with imitating, as well as the peculiarities of the sensorial process.
In addition, it puts emphasis on a natural socio-pragmatic context, insists on the participation of the family, and recommends the inclusion of pair work.
Construction of intentionality, taking turns, shared attention, and abilities in the initiation of communication all facilitate this. Children can expand their repertoire of functionality and with different instruments in a natural context.