Medically Reviewed By Sonam Kothari, Written By Tejasvi Parekh
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, characterised by the differences found in the development of the brain. It was Leo Kanner, who in 1943 went on to publish the first organised description of infantile autism.
Kanner claimed infantile autism to be innate, a courageous hypothesis against the dominant view of Freudian Psychology and the ideas of “poor parenting” and “frigid mothers” to be some of the causes of this disorder.
Since 1943, science has taken numerous leaps and notable progress has been made to understand the causes of ASD. The Diagnostic and Statistical Manual of Mental Health (DSM-5 TR) defines ASD as persistent deficits in social communication and restricted, repetitive patterns of behaviour.
Research evidence suggests that the disorder exists on the spectrum, consisting of a diverse range of conditions. With the progress made in understanding the causes of ASD, there are also intervention strategies that have been designed to help optimise and quality of life, development as well as well-being of people with autism.
Seeking timely assistance through various evidence-based psychological intervention programmes can help improve social communication.
It’s crucial that after an individual is diagnosed with autism, they, as well as, their caregivers/loved ones, get the appropriate help, care, and support that will cater for their unique needs as they grow and change.
This article discusses three early intervention strategies for autism. Each strategy has been explored in detail, examining its advantages, disadvantages, optimal time for intervention, and other pertinent information that will aid one in understanding and decision-making.
Applied Behaviour Analysis or ABA, as the name suggests, is a strategy focused on identifying and modifying behaviour. Commonly used for children with autism who are under the age of five years old, safe ABA can cater to the unique needs of every individual.
It respects neurodiversity and aims to work with the children's strengths by using positive reinforcements and rewards to encourage positive behaviour.
Simply put, applied behaviour analysis (ABA) is based on the theory of behaviour. Therefore, it rewards positive behaviour, reinforcing it to occur again and ignores negative behaviour, decreasing the likelihood of it happening again.
Moreover, ABA also pays attention to the triggers that lead a child with autism to behave the way they do, as well as the consequences of a child's behaviour.
This helps one to understand whether certain modifications can be made in the child's environment that will lead to a positive change in the child's behaviour. Furthermore, it also helps with the development of an intervention strategy that will promote new skills and behaviour.
Through ABA, a child can learn new skills such as asking someone for help or packing their school bag. Harmful behaviour is unlearned, such as ABA focuses on reducing behaviours such as hitting oneself or damaging property when annoyed.
Some of the intervention programs that make use of ABA principles are the Early Start Denver Model (ESDM) and the Picture Exchange Communication System (PECS).
The Early Start Denver Model (ESDM) is a behavioural therapy program for children between the ages of 12 months to 48 months. This early intervention aims to support children in developing skills from an early stage so that the differences between the child and their peers can be reduced significantly.
The caregivers of the child are actively involved in supporting the child’s development ESDM focuses on helping the child learn and grow by engaging them in activities that they truly enjoy, such as playing or daily activities.
ESDM helps a child develop skills such as social skills, cognitive skills, language skills, etc. Since ESDM has a personalised and structured approach, it can Target every child’s unique needs and works well with children who have significant learning challenges as well as those without these challenges.
Therefore, through ESDM, the right support system is created which allows all children to have the opportunity to thrive and reach their full potential. However, it is important to note that EDSM is time and resource-intensive. It also faces the limitation of being geographically and financially inaccessible.
The Picture Exchange Communication System (PECS) is useful for children who experience difficulty with verbal expressive language. The program teaches children to make use of cards with pictures to communicate their needs.
For example, approaching a person and giving them a card with a picture of the desired item, to obtain that said item. A fast and functional communication system is thus established as the individual with autism can now communicate and put forth a request or a thought in a symbolised form with the help of a picture card.
PECS begins with communication through the exchange of only simple items and later builds on more complex sentence structures. The method has been known to help aid in decreasing tantrums as well as odd behaviour.
Several studies have also revealed that it helps in the development of spoken language rather than hindering it. However, the biggest challenge in teaching this form of self-initiating communication is to discover a way that motivates children with autism to participate and learn.
While experts have suggested applied behaviour analysis (ABA) to assist children with autism, concerns have also been raised by caregivers and advocates that ABA fails to honour children with autism and can lead to potential harm.
The advantages of ABA state that it can help improve IQ as well as lessen the severity of the autism diagnosis. As ABA also involves the parents and caregivers of the children, it gives them strategies to inculcate learning at home.
On the other hand, critics of ABA have stated that this intervention focuses too much on behavioural problems.
For example, sometimes, rather than helping children develop new skills, it focuses on eradicating ‘problem behaviours’. By teaching a neurodivergent child that their stims are wrong or problem behaviour, ABA disregards the needs of the child by trying to make them like everyone else.
Kupferstein (2018) conducted a study which provided evidence that children with autism who undergo ABA show increased post-traumatic stress disorder (PTSD) symptoms.
Therefore today, ABA tries to focus on helping children with autism to live an independent life rather than trying to fix them and their neurodivergent traits.
Play Therapy is often used for children with autism who display repetitive patterns of behaviour, are more likely to stay alone and stick to only a limited number of activities that don't allow them to learn and grow as they are unable to explore their abilities and potential.
Originally, play therapy was used for children to cope with their anxiety and trauma, as they could act out their feelings and consequently develop healthy coping mechanisms. Play therapy for autism is based on the idea that play becomes a way for children to express themselves in a safe and non-judgmental environment.
Through play therapy, emotions and feelings can be communicated in a non-verbal way, and a child can also learn to communicate and develop social skills.
It's worth noting that play therapy becomes beneficial not only for the child but also for their caregivers and parents. as they can understand how their child interacts and communicates. This facilitates an understanding of the child’s needs and forms are closer bond between the parent/caregiver and the child.
One of the major questions that arises is why would a child with autism need to see a play therapist. Here it is important to keep in mind how children with autism are different from other children.
They might not engage in “pretend play” like others, for example, they might not see soft toys as animated beings who can talk to each other. Similarly, they might also intensely focus on one particular toy as a form of self-stimulation.
Therefore, a play therapist will pay attention to the way a child engages with the toys, what interests them and how they interact with them.
A play therapist’s goal would be to inculcate skills such as turn-taking and sharing as well as imaginative skills such as seeing a doll as an actual baby or pretending to cook a meal. These skills can help in the later development of abstract thinking.
Group play might also be introduced at a later stage of the therapy, as it may help develop social skills and communication. The Floortime Approach and the Play Project are some of the approaches that make use of play to aid in the learning and development of children with autism.
It is said that play therapy is most beneficial for children between the ages of 3 to 12 years. Play therapy's benefits are that it helps in inculcating communication skills and promotes independence, confidence and self-esteem.
Play therapy also has a positive effect on the brain as it has been shown to encourage neuroplasticity. As parents can also engage in play with the child, it fosters a closer parent-child bond which can be beneficial.
However, some studies show that play therapy might lead a child to develop a dependency on the therapist. The things learned in the therapy room might become too generalise in other settings and situations. Some children exhibit resistance to change which might hinder the progress promised through play therapy.
Children with autism might have a deficit in using and understanding language in a social context. To overcome this, speech therapy as an early intervention strategy has been proven to be beneficial.
As mentioned before, autism is characterised as a social communication disorder. Therefore, children with autism might have oral vocabulary skills and be extremely nonverbal. On the other other, some children can efficiently develop their verbal skills but show limitations in their nonverbal communication.
While speech therapy can be beneficial for both children and adults with autism, it is important to note that the first five years of a child are very critical for brain development.
Therefore, providing an early intervention can prove to be highly beneficial. A speech therapist, also known as a speech-language pathologist (SLP) might play a major beneficial role in helping a child develop communication and interaction skills.
A speech therapist might help the children with prosody. Prosody refers to the melodic tone of voice that keeps changing as one converses. Autism can lead to people having a flattened prosody, which is often mistaken as having no emotions.
A speech therapist helps in the development of vocal skills. Some autistic children might be unable to use grammar properly, such as using third person to refer to themselves. Speech therapists work with these children to help improve their grammar skills.
Speech therapy as an early intervention strategy has proven to be beneficial. It helps children with autism to develop language fluency which will aid in their holistic development later in life.
Language fluency also aids in facilitating social skills and communication skills. A child can better express their emotions, feelings and thoughts which in turn helps in improving their self-esteem and overall quality of life.
Speech therapy does have certain drawbacks. Firstly, it is time-consuming and a long-term therapy process. The therapy progresses slowly and also requires help from parents and caregivers to give their children home training.
It becomes important for caregivers and parents to receive counselling regarding the therapy so that they can develop adequate and critical expectations. Speech therapy has also not proven to be cost-effective. Due to its expensive nature, it might not be accessible to many.
It is important to note that every child is different and therefore it becomes important to understand the unique needs of the children and provide them with the intervention strategy that will best cater to their needs. This will ensure the holistic development of the child and help them reach their full potential.
