Understanding Therapy in Autism –II

Now that we have established that there are autism specific therapies, let’s look at it in more detail. There are two aspects to this – autism specific methodology and autism specific curriculum.

Autism specific methodology refers to how to teach/interact with a child on the autism spectrum and shall be the topic of another post (or several other posts).

Autism specific curriculum refers to what to teach. One of the first autism specific curriculums to be published (to the best of my knowledge) was the Psychoeducational Profile (PEP). This was published by Eric Schopler and Robert Reichler from Project TEACCH way back in 1976. Currently in use is the PEP-3. They also have a preschool version of the same.

There are several autism specific curriculums available in the market today:

1. Psychoeducational Profile 3 (from Project TEACCH)
2. Teaching Developmental Disabled Children-The ME Book (Ivar Lovaas, 1981)
3. Behavioural Intervention for Young Children with Autism (Catherine Maurice, 1996)
4. ABLLS - Assessment of Basic Language and Learning Skills-Revised (James Partington, 2006)
5. VB-MAPP – Verbal Behaviour Milestones Assessment and Placement Program (Mark Sundberg, 2008)
6. Early Start Denver Model Curriculum Checklist for Young Children with Autism (Sally Rogers and Geraldine Dawson, 2010)

All these curriculums focused on all areas of development –

·        Motor development

·        Language and communication

·        Cognitive development

·        Social skills and behaviour

Skills in each area have been sequentially laid out which will help make a clear decision on what to teach the child. Some of the areas of development have been further sub-divided into different areas in some of the curriculum protocols. For example, in the ABLLS, language and communication is actually assessed through several functional areas.

The functional areas dealing with language and communication in the ABLLS are:

·        Receptive Language

·        Vocal Imitation

·        Requests

·        Labelling

·        Intraverbals

·        Spontaneous Vocalizations

·        Syntax & Grammar

Frequently when children are referred to intervention centres, they come with a diagnostic report which is not sufficient to make the decision on the curriculum planning. However, having gone through a lengthy assessment process at the referral centre, most parents get extremely upset at the thought of going through another assessment process. While we empathize with the parental stress, it is still something that needs to be done in order to formulate an appropriate individualized curriculum for difficulties while the assessment being carried out at the intervention tells us what the child can and cannot do. This in turn helps the therapist make a decision on what to teach. Sadly, many diagnosing physicians are also not aware of this and do not counsel parents accordingly when referring them for intervention.

The essential difference between these two assessments is that a diagnostic assessment tells you which developmental disability label best describes the child while a functional or curriculum assessment tells you where to start in the intervention and what to include in the curriculum.

These curriculums protocols can be used by any professional, speech therapists, special educators or psychologists. They can also be used by a parent with some amount of training. The individual therapists can either work with different functional areas related to their field of training or they can work with all the functional areas. A therapist who is working with all the functional areas in a given protocol will essentially be taking care of all the areas of development.

Even if the therapists are not using these protocols, parents must educate themselves to ensure that the curriculum that the therapist has planned is not too out of sync with the child’s developmental levels. It is not uncommon to see therapist using a regular pre-school curriculum despite the fact that the child has not even reached pre-school level in his or her development. For example, I have seen a toddler being taught “what does a cow say?” when in reality he has not even learnt to identify a cow.