[toggle title=”Behavior Therapies”] This category encompasses a wide range of behavioral programs. The goal of these therapies is to build skills in a number of developmental areas and/or to reduce unwanted, undesirable behaviors (e.g., hitting, tantrums, etc.).
Who is qualified to provide behavioral therapies?
BCBAs are the only qualified individuals to develop and supervise ABA therapy plans. Licensed or LLP Master’s or Ph.D. level psychologists are qualified to provide other, non-ABA therapies.
What does a typical behavioral therapy session look like?
There are many different types of therapy that address behavior. The following types of therapy are included in this category:
Applied Behavioral Analysis:
1. Examples of therapy goals/objectives:
2. Increase/improve skills:
a. Sitting to pay attention
b. Using a word to ask for something
c. Imitating an action
d. Social skills
e. Academic skills
3. How is ABA therapy conducted?
a. To reduce unwanted/undesirable behaviors: Difficult and unmanageable behaviors are targeted for change through a process of functional behavioral analysis (FBA). The purpose of FBA is to identify the problem situation or “trigger” and consequences (i.e., what happens after the behavior is displayed) which result in unwanted behaviors and developing a plan to change those “triggers”, replace the undesirable behaviors with newer, more functional and appropriate behaviors, and reinforce the newly acquired skill/behavior. Those who interact regularly with the individual are taught to ignore undesirable behaviors, thereby minimizing the likelihood the behaviors will reoccur in those same situations in the future. Many times, caregivers and those who work with individuals with ASD are not aware of the specific events which trigger difficult behavior and/or how their responses can maintain that behavior. FBA may be conducted in the home, school, or any context where the problem arises (e.g., stores, parks, etc).
b. To increase/improve skills: Children with ASD present with highly varied skills and strengths and challenges across a number of developmental areas. At the beginning of an ABA program, the therapist will analyze the child’s skills to determine which skills are deficient and what will be targeted in therapy. A behavioral plan is then developed and adjustments are made over time as progress data is analyzed. In most cases, a child will make steady progress and the plan will be updated accordingly. When progress is not documented, the plan is modified, perhaps to increase the frequency or intensity of therapy, or to address other needed skills that act as precursors to higher level skills.
4. Traditional ABA (A.K.A. Discrete Trial/Lovaas Therapy) is based on principles of behavioral psychology to include a stimulus, response and consequence. An example includes:
a. Therapist asks child a question (stimulus)
b. The child responds accurately with a word (response)
c. The therapist rewards the child with a reinforcer (toy, candy) (consequence). By reinforcing the behavior, the child is likely to perform successfully again, during another trial.
d. Skills are developed one at a time, and build on each other.
e. Once the skill or behavior is established with the therapist, in the clinic, new activities are introduced to generalize the behaviors and skills with other individuals (caregivers, teachers) in different situations (home, school).
5. There are a number of programs that follow ABA principles, but may vary in the approaches used to modify behavior or build skills. These include:
a. Pivotal Response Therapy (PRT): Based on ABA principles, but differs in that PRT specifically focuses on key pivotal areas of motivation and self-initiation (Koegel et al., 1999).
b. Parent as Therapist ABA: Parents trained by a BCBA to become their child’s ABA tutor.
c. Consultative ABA: The BCBA may work with the child’s teachers or with the parents in the home to develop a behavior plan for those settings. The plan will provide recommendations for identifying antecedent/triggers, understanding the function of a behavior, teaching replacement behaviors, and how to respond appropriately (use of reinforcers), in an effort to reduce or eliminate problem behaviors in the future. Positive Behavior Support is also characterized by these same objectives.
1. Cognitive Behavioral Interventions: Addresses deficits associated with social cognition, including Theory of Mind approaches which teach identification of the mental state of another person, learning to understand, define, and respond to different emotions, and gaining information about internal (feelings) and external (facial expressions) social cues.
2. Love and Logic: A parenting program designed to teach caregivers with specific discipline strategies and how to respond to their child’s behavior in the context of a loving, supportive relationship.
3. PCIT: Parent Child Interaction Therapy: A data driven parent training program that empowers parents to manage their child’s behavior more effectively with in-vivo coaching by a PCIT trained therapist.
[toggle title=”Communication Therapies”]These therapies address any type of communication deficits presented by an individual. These may include traditional speech/language therapy to improve receptive and/or expressive language, social language skills, such as greetings or conversational turn taking, reading others non-verbal cues, such as eye contact and facial expressions, for example. The goal of these therapies is to improve how an individual communicates with others for a variety of reasons, in a variety of settings.
Who is qualified to provide communication therapies?
You should look for a certified Speech Language Pathologist (SLP). SLP’s who are certified by the American Speech Language Hearing Association (ASHA) have completed extensive coursework at the Master’s degree level and have met stringent clinical qualifications to practice in their field.
What does a typical speech/language therapy session look like?
How is therapy conducted? Because communication includes so many areas, a therapy session may look very different from what you imagine, depending on the age and/or functioning/severity level of the child, the specific goals/objectives being addressed, and/or the therapy model used by the clinician. Most therapy programs will fall somewhere between a child-centered model where the therapist uses a less structured, play-based context to address therapy goals and a clinician-directed model, where the therapist chooses the treatment activities and directs the session in a more structured manner. Typically, a therapy session will look more like a “hybrid” approach, encompassing components of both. There are a number of newer, computer based communication therapies which exist, as well. For example, FastforWord, is a software program to improve auditory processing skills.
Examples of therapy goals/objectives:
1. Building play behaviors: how to use objects, how to play appropriately with toys, and/or playing with others.
2. Developing a communication system; how to use and understand pictures (e.g., PECS), learning signs/gestures, voice output systems, for example.
3. Improving understanding/comprehension of language; identifying objects or pictures when named, for example.
4. Developing early word/vocabulary learning, putting words together, improving sentence grammar, and/or developing story structures to describe experiences or procedures, retell stories, or engage in conversations with others.
5. Building communicative intent: The therapist may be trying to get the child to communicate more often, for more reasons. For example, by placing desired objects out of reach, or violating a routine, the child is pushed to communicate a request, or even a protest (which is better than no communication at all). The way the parent responds to the child, combined with environmental modifications, more frequent, varied attempts to communicate can be elicited.
6. Improving auditory processing skills.
7. Strategies to reduce word retrieval deficits
[toggle title=”Social Therapies”]These therapies may overlap with ABA and communication therapies since communication is a social function. Social therapies address behaviors that lead to improved social interaction with others, such as social stories, which teaches appropriate responses in various situations (e.g., going to the store, playground, doctor’s office). The goal of these therapies is to improve how an individual behaves in social settings by responding appropriately to others.
Who is qualified to provide social therapies?
Social therapies are provided by a number of service professionals: social workers and psychologists, speech/language pathologists, or even occupational therapists. ABA therapists may also provide social therapies. Since there are no best practice guidelines for qualified individuals to provide this service, you should consider licensing, certification, or other indicators of a qualified professional. Caregivers should consider the same guidelines noted above regarding communication therapies (e.g., access to child’s progress data, ability to observe social group sessions, monthly progress meetings).
Examples of therapy goals/objectives:
1. Improving eye contact/looking at others
2. Knowing what to say, how much to say, and what is appropriate to say to certain persons, in certain situations.
3. Learning to start or continue a topic of conversation
4. Improving awareness of non-verbal cues (e.g., reading another’s facial expressions or tone of voice, for example).
How is therapy conducted?
1. Social therapies may be delivered in individual or group therapy contexts.
2. Direct teaching, such as Social Stories (Gray & Garand, 1993) or modeling of appropriate social behaviors by the clinician or another group member.
3. Videomodeling : Appropriate behaviors are videotaped and reviewed (repeatedly) by the individual with ASD until skills are acquired.
4. Role play: The therapist may design/create situations for an individual to practice skills or generalize these to situations.
Are there other types of Social Therapies?
There are a number of various treatment programs that could fall into this category. These also overlap with Communication Therapies.
Developmental, Individual-Difference, Relationship-Based Model (DIR), AKA, Floor-Time : The intervention is designed to focus on the child, attend to their needs and create mutually enjoyable, shared experiences between the child and caregiver to promote confidence and comfort in their interactions with others.
Relationship Development Intervention (RDI): Similar to Floor Time (builds on the sharing and joint attention that naturally occur b/w parents and children). Specific behaviors are developed in three areas: Functions precede Means, Social Referencing, and Co-Regulation.
Social Communication Emotional Regulation Transactional Supports (SCERTS): General Principles
Authors believe improved social communication and emotional regulation are primary developmental goals for ASD children. Transactional supports allow for meaningful learning experiences (persons, environment).
[toggle title=”Cognitive Therapies”]This category includes programs to improve cognitive areas of function, such as memory, attention, processing, etc. The goal of these programs is to improve brain functioning across many, varied cognitive processes.
Who is qualified to provide cognitive therapies?
There are no clear guidelines for who is qualified to provide these types of therapies, with exception of Cog-Med, which requires a licensed psychologist or medical doctor in addition to the Cog-Med training. For many cognitive therapies, programs require that the therapist complete a training program in order to become a provider of that service. You should always look for licensed and/or certified professionals and for specific programs, documentation that the provider has completed all of the training.
What does a typical cognitive therapy session look like? Many of the cognitive therapies are computer based, and require the user to work through a specific software program. For example:
Cog-Med Therapy: An evidence-based computer training program designed to train both visuo-spacial and verbal working memory. May be appropriate for some, higher functioning individuals with attention and memory deficits.
[toggle title=”Sensory Motor Therapies”]These include programs to improve sensory processing and responsiveness, such as sensory integration therapies. Additionally, these programs target improved motor control and function, such as physical therapy.
Who is qualified to provide sensory-motor therapies?
You should look for a certified Occupational (OTR) or Physical Therapist (PT), depending on your needs. For some specific therapies, such as Sensory Integration (SI) Therapy, you should inquire if the therapist has SI certification, which requires training and coursework to be qualified. Occupational therapists should be certified by the National Board of Certified Occupational Therapists (NCBOT) and Physical therapists should be certified by the American Physical Therapy Association (APTA).
What does a sensory motor therapy session look like?
There are many types of sensory motor therapies, with goals and objectives being very different for each.
Sensory Integration (SI): The therapist will plan treatment activities which introduce and eventually desensitize a child to problematic sensory stimulations. Over time, the child develops more appropriate responses to and tolerance for different textures, sounds, tastes and smells, for example. A therapy sensation may involve sand play, eating foods with varied textures, rolling on a ball, or wearing a weighted vest, as examples.
A consultation with an OT certified in SI may be helpful in providing recommendations for special equipment or tools such as swings and balls for those needing sensory stimulation throughout the school day, for example.
Gross and fine motor therapies: The therapist will utilize various treatment activities to improve, strengthen, range of motion, and flexibility across targeted muscle groups. The end goal of these therapies is to improve functioning in daily living activities, such as, riding a bike, tying shoes, or handwriting.
[toggle title=”Recreational Therapies”]This category captures all programs and services that serve a recreational functional. These programs may not necessarily have the evidence-base research to support effectiveness, but lead to improved quality of life for individuals with ASD and their families.
Who is qualified to provide recreational therapies?
A number of different individuals or organizations can offer recreational programs. For example, high school or college students are often employed to assist with summer camps or after school programs for individuals with ASD. Typically, you should look for an educational specialist or teacher, a social worker, psychologist, or another certified or licensed individual who develops and directs the program. This person is responsible for designing the activities and assuring procedural safeguards are in place, especially for higher risk recreational activities, such as swimming and therapeutic (horse) riding. Importantly, make sure the instructor is qualified to work with individuals with ASD.
What do recreational therapies look like?
These can include specialized camps or after school programs (theatre, sports), therapeutic riding, social outings, etc.
[toggle title=”Alternative Therapies”]These include programs and services which are nonconventional (not supported by professional organizations, such as the American Academy of Pediatrics, due to lack of evidence-based research to support their efficacy. Therapies which lack strong group studies demonstrating effectiveness are found in this category.
Who is qualified to provide alternative therapies?
Unfortunately, no clear standards exist for who is qualified to provide these types of therapies. Frequently, a specialist from another discipline (e.g., pediatricians, OTs, PTs, MSWs, etc.) may complete some (minimal) training in a particular approach and then market themselves as “qualified”. Use extra caution when considering alternative therapies, since these lack research support and can be implemented by individuals with very little experience and knowledge.
- Biological based approaches such as restrictive diets (gluten- casein free), nutritional supplementation, chelation (removing heavy metals), and hyperbaric oxygen therapy (HBOT). These are considered biological since the goal is to induce change in a physiological bodily function.
- Non-biological approaches include interactive metronome, listening therapies, biofeedback, etc. These therapies usually require the child to listen to sounds, music, or another auditory stimulus or placement of electrodes on the head. They overlap with sensory motor and some cognitive therapies, since the goal is to improve processing and function in particular areas.