Advantages of Early Intervention
Speech is easily learned by most children during the first three to four years of life, but is much more difficult to learn later, as anyone knows who has tried to learn a second language. While this is merely difficult for us, imagine how much harder it would have been if you did not already know that letters and sounds could be combined to form words that stood for objects, actions, etc. It is known that the brain of a toddler goes through a period of rapid growth, which last for several years. This allows the young child to learn a large amount of material very quickly. During childhood, the brain becomes more efficient, and the pathways that are not used are lost through neuronal atrophy (Nichols et al, 1992). If a child has not learned to speak by six or seven, it is extremely difficult for him/her to ever learn to speak. This may be because the neural pathways necessary for the development of language have atrophied from lack of stimulation. The impact of restricted early stimulation on later inability to learn has been clearly shown in animal studies (Nichols et al, 1992).
Early intervention accomplishes larger gains perhaps because in a younger child the neural pathways necessary for language are more intact. It may also be that there are more “extra” neurons in younger children because the normal process of neuronal loss has not progressed as far. If stimulated, these extra neurons may be able to take over the function of deficient areas in order to overcome the abnormality, which resulted in problems learning language and social reciprocity (Cohen, 1994).
Lovaas Intensive Behavioral Treatment
Building on earlier experimental and laboratory work, Dr. Lovaas has developed a way of presenting information that allows autistic children to understand and respond correctly. The presentation strategy builds on the child’s strengths in visual processing and memory for routines. Thus, the initial treatment procedures rely on visual presentation, and are very habitualized. Since many autistic children have difficulty processing language, verbal instructions are initially minimized.
All information is presented using the same format, referred to in behavioral terms as a “discrete trial” which has the following form: SD (discriminative stimulus, or loosely, the instruction) --R (response of the child) -- SR (reinforcing stimulus, or consequence). For example, the therapist says, “Come here” (this is the SD), the child comes (this is the response), and the therapist says “very good” and hugs the child (this is the reinforcing stimulus).
Dr. Lovaas emphasizes the importance of the child feeling successful, and uses the rule of thumb that the child should succeed 90% of the time. Therefore, if in the above example the child did not respond correctly when the therapist said, “Come here”, he/she would be prompted to move toward the therapist so that he/she would be correct and would still be rewarded. Since the treatment is so positive, children typically enjoy it, and come to like their therapists, which of course is quite reinforcing for the therapists (see Lovaas, 1981 for a detailed description of the treatment procedure).
The Treatment Plan
Children with autism have several problems, which must be addressed before they are able to learn. First, they do not pay attention to people very well. Second, they have not learned to imitate. Third, they are often noncompliant with instructions. It is not clear whether these problems are the cause or result of their lack of speech and poor social skills, but they do make it difficult to teach them.
Lovaas’ initial “readiness” exercises address these problems directly. The children are taught to pay attention, imitate, and to comply with simple instructions. Most children are on their way to learning these skills within the first week.
Once the child is attending and responding to instructions, the program begins to teach him/her to emit sounds, which are gradually shaped into syllables and words. The child learns that objects have names, and he/she learns to say them. He/she is then taught to use simple sentences such as “I want the ball” and to answer questions such as “What is your name”. Abstractions and concepts such as size, pronouns, prepositions, order, and describing past events are each addressed individually. Although the early responses are learned with great effort and are memorized, after many such responses have been taught, the child begins to “get the idea” and to learn much more quickly. Generalization to real life settings is addressed directly so that the child actually begins to use his/her new abilities.
Social skills and peer interaction are taught one step at a time, beginning with teaching the child about topics and toys that are popular with age mates. Initial interaction treatment is nonverbal and addresses such skills as turn taking, imitation, and following the other’s lead. Verbal interaction is similarly addressed one step at a time, moving from answering simple questions that have been previously learned, to using the other child’s statements as a cue, and then initiating statements and responding to comments.
Treatment is typically done in the home until the child has enough language to interact socially. Working in a familiar setting instead of a treatment room reduces distractions, and may facilitate the generalizations of treatment gains to the natural environment. Sonnenberg Consultants vary the type of therapy done depending on each child. The foundation is Lovaas based but other types of therapy are combined for a very eclectic way of teaching.
Line-staff (tutors), often college undergraduates, are hired, trained, certified and supervised by experienced Behavior Consultants. Each Line-staff works at least six hours per week, for a total of approximately 40 hours per week. It may be necessary to reduce a child’s time in other activities such as preschool during the initial intensive phase of therapy. The length of therapy varies with each child. For approximately half of the children who undergo this treatment, the result is development of approximately normal social relatedness, communication skills, self-help skills, cognition, and placement in regular kindergarten classes with no support services required then or in the future (McEachin, Smith, Lovaas, 1993).
- Therapy is based off of positive reinforcement
- Therapy is molded to the child’s specific needs
- Therapy can be implemented in play, table or through relationship development
- "Sensory" issues are addressed through behavioral methods (ex: stress management prior to agitation or sensory tolerance programming)
- Therapy is fun and motivating
- Therapy involves siblings and family for generalization and consistency
Areas addressed through therapy:
- Language Comprehension
- Reciprocal Conversations
- Creating the skills to have a shared experience through social interactions
- Cognitive skills
- Reducing non-desired behaviors and increasing desired behaviors
- Decreasing self stimulatory behavior that is inappropriate
- Independent self help skills
- Appropriate play with toys and games