Behavioral Treatments for Autism
Behavioral treatments have been created to help children on the spectrum build skills they don’t develop automatically and reduce behaviors that are interfering with learning and communication. Several common types of treatment are described here:
Applied Behavior Analysis:
What it is: Applied behavior analysis (ABA) has been shown to help autistic children develop needed skills and minimize undesired behaviors such as self-injury, and it has been shown to be successful for kids all across the autism spectrum. Its effectiveness is backed up by hundreds of studies.
How it works: ABA is an evidence-based behavioral therapy that can take many forms, but they are all based on the same simple concept: reinforced behaviors will increase; behaviors that are not reinforced will reduce and eventually disappear.
Types of ABA:
- Discrete Trial Training, the original “brand” of ABA designed for young children on the spectrum, remains the most structured form of ABA. It is always done one-on-one. The child sits at a table, and the therapist lays out materials in front of the child. The child is given a task to perform with the material and when he does it right, he is rewarded with what’s called a “primary reinforcer”: an M&M or a Frito, a tickle, a sticker, access to a favorite toy, etc.
- Pivotal Response Treatment is more child-driven and less therapist-structured. “Rather than focusing on individual behaviors, PRT looks to target “pivotal” developmental functions. Natural forms of reinforcement related to the behavior are stressed, rather than non-related tangible rewards, such as an M&M. The concept is that if you build these learning modules into a more natural environment, the child is more likely to generalize them.
- Naturalistic Developmental Behavioral Interventions: These interventions — for example, Early Start Denver Model (ESDM) or Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) — incorporate behavioral principles of reinforcement, but are specifically designed to be utilized in natural, social interactions, using natural reinforcers (for example, if the child asks for a red car, he is given a red car), and incorporates multiple teaching objectives within the same activity. For example, one goal might be for the child to learn shapes or letters. But the therapist might also have goals for this child to have the motor coordination to get a piece into a puzzle, and to have the patience to finish something that involves three parts. So, during the course of a puzzle activity the child would be working on cognitive, motor and behavioral goals.
Functional Communication Training:
What it is: FCT involves teaching an individual a reliable way of expressing their wants and needs with language, signs or images. It’s called “functional” because it doesn’t just teach kids to label an item (such as associating the word RED to a picture of an apple) but focuses on using words or signs to get something needed or desired — a food, a toy, an activity, a trip to the bathroom, a break from something. FCT uses positive reinforcement to teach children to communicate effectively with others to get their needs met and reduce problematic behavior.
How it works: Initially the therapist prompts the child to use the word, sign or picture and obtain the reward. This supported communication is repeated, each time resulting in the earned reward, until the child is able to succeed with less and less prompting from the therapist. Once kids are reliably using the functional communication for that item when the item is present, the next step is for them to “generalize,” or use it outside the specific situation in which it’s been taught, such as communicating with people other than the therapist.
The Verbal Behavior Approach (VB):
What it is: The verbal behavior approach, based on ABA, emphasizes teaching children language and other skills in a child-centered learning environment.
How it works: Therapists using a VB approach teach children language in a way that links language to its different purposes or functions. Initially, therapists using a VB approach focus on pairing the learning environment with activities and items that a child enjoys so that the learning environment is somewhere the child wants to be. This might involve the therapist giving a child fun toys or snacks for free. The therapist then teaches children to request (what VB therapists call, to mand) for these things. Once children are independently requesting things they want, the therapist gradually begins teaching other language and skill goals (such as labeling and responding to questions). The VB approach is used with children who communicate with spoken language as well as children who communicate in other ways, such as sign language. Books like The Verbal Behavior Approach: How to Teach Children With Autism and Related Disorders provide more information about this teaching approach.
Parent Training for Disruptive Behaviors in Autism Spectrum Disorder:
What it is: This evidence-based treatment, from the RUBI Autism Network, is based on the principles of ABA. It addresses challenging behaviors in youth with ASD, including noncompliance, aggression, temper outbursts and difficulties with transitions.
How it works: The therapist works closely with the parent to teach techniques (such as prevention strategies, daily schedules, reinforcement, compliance training, functional communication training) to reduce their child’s challenging behaviors and to encourage more appropriate behaviors.
Program for the Education and Enrichment of Relational Skills (PEERS®)
What it is: PEERS® is an evidence-based social skills intervention for youth with social challenges.
How it works: The intervention is delivered in a group format (parent and youth groups) to teach practical social skills, such as how to start and end conversations, select appropriate friends, handle teasing and bullying, handle arguments with peers, and show good sportsmanship.
Facing Your Fears (FYF):
What it is: Facing Your Fears is a group-based cognitive behavioral treatment designed to help youth with ASD who also have anxiety symptoms.
How it works: Facing Your Fears helps children learn to identify their worries and develop healthy coping strategies they can rely on when they are feeling anxious. Children are also given the opportunity to practice these new strategies inside their group. In addition to the child group, there is a separate group for parents to learn how to help support their child with ASD and co-occurring anxiety.
What it is: Occupational therapy, known as OT, is designed to help children acquire the skills needed to perform the activities—or “occupations”—of daily life.
How it works: Occupational therapists work with children to develop a variety of skills or abilities. This may include fine and gross motor skills, help with feeding issues or sensory issues, or developing essential self-help skills, like brushing teeth, dressing, toilet training, and more.