Developmental and behavioral interventions are interrelated and are the mainstay for educating and supporting people with autism spectrum disorder (ASD). Read on to learn more from the American Academy of Pediatrics about these interventions.

Developmentally based interventions tend to focus on the basic building blocks in motor, visual, and hearing processing; sequencing; attention; problem-solving; communication; and social skills.

This may be most effective for some children if done in a play setting where an adult helps a child build skills through engagement. For children with ASD, strengthening communication and social skills often helps decrease behavior problems. Alternative and augmentative communication aids (such as picture cards) may be useful in the development of communication skills.

Behavioral interventions focus on changing specific behaviors and symptoms. As these behaviors change, social relationships and mastery of basic developmental capacities improve. Behaviorally based programs that are tailored to teach children the skills needed for play and communication can take place in the classroom or individualized settings. When language and social skills are lacking, challenging behaviors are often children’s only means of communicating their needs or fears to others. While behavioral interventions may be used to decrease challenging behaviors, they are also used to teach children the things we want them to do. There are several different types of behavioral interventions.

Behavioral intervention strategies may be directed by a therapist or teacher by prompting the child toward an intended goal or intervention. The therapy can also be incidental, such as when the child is caught attempting a desired task and the adult helps the child accomplish it. The goal of behavioral approach is to teach new skills using reinforcement. These may be to advance developmental skills or to substitute appropriate ways to behave in challenging situations. On the other hand, non-preferred behaviors are ignored, corrected, or redirected in an effort to stop them. Other general strategies include providing an overall structured learning environment for children with routines that support them in their daily activities. Behavior problems may be reduced when children are both told ahead of time that a routine may change and taught how to prepare for the change.

Regardless of the intervention strategy chosen, if a behavior is preventing developmental or educational progress, it is often helpful to begin with functional behavioral analysis (FBA). FBA consists of identifying the events leading up to the behavior and the consequences that maintain it. Sometimes this information is readily obtained by carefully observing children in their natural settings with their usual caregivers. Other times, a trained behavior specialist must be consulted. The behavior may be an effort to communicate the urge to escape, the need for attention or some tangible object (for example, food or a toy), or discomfort from too much or too little sensory stimulation. Once all causes of the problematic behavior are identified, the specialist will determine which caregiver reactions are promoting the behavior. Using FBA information, the behavior specialist will develop an intervention strategy to avoid or modify these conditions to help change the behavior. Finally, positive reinforcers that will aid in maintaining behaviors that are more appropriate and desired will be identified. This behavior intervention plan will need to be evaluated and modified on an ongoing basis as children mature. Data should be collected regarding progress of behavioral change to determine the effectiveness of the plan and to make changes when necessary.

Here are several approaches that are often used for children with ASD.

• The Treatment and Education of Autistic and related Communication handicapped Children (TEACCH) program is one of the oldest and most widely used programs in schools. The program focuses on individualized assessment and treatment and encourages parents and professionals to work closely together. Parents and teachers are taught how to develop structured teaching programs with an emphasis on building on the child’s learning strengths and functional communication. Visual organization cues are used to maintain a consistent and structured daily routine that helps build new skills and independence. The program spans from preschool to adulthood. Planning for transition from school to supported employment includes an emphasis on developing appropriate social, adaptive, and communication skills. Parents are regarded as critical agents of change, not only for their own child but in service development and the community as well. Read more about TEACCH at https://teacch.com.
• Applied behavior analysis (ABA)is the process of systematically intervening to increase the likelihood of desired behaviors or skills and decrease the likelihood of undesired behaviors. ABA strategies are not unique to ASD, but ABA-based programs have been used extensively and have been successful for children with ASD. Specific goals are set and the therapist works intensively with the child, one-on-one and one goal at a time. ABA has been found to improve functional skills and reduce challenging behaviors. Various programs have been created around the theme of ABA, such as discrete trial training (DTT), pivotal response treatment (PRT), functional communication training (FCT), and verbal behavior therapy (also known as applied verbal behavior [AVB]).
  • DTT is an important feature of ABA. A therapist working one-on-one with a child presents an instruction or a request (called a discriminative stimulus) to the child and delivers reinforcement for the correct response. This sequence is repeated until the child learns to make the expected response.
  • In PRT, the goal is to effect change in pivotal areas such as responding to cues, motivation, self-management, and self-initiation, in the hope that improvements in these areas will lead to changes in other functional areas.
  • FCT and AVB attempt to improve the functional communication skills of children with ASD using principles of ABA.

Skills learned in the educational environment need to be generalized to unstructured settings to be functional. Recently, there have been several modifications to this type of program to use natural environments and incidental learning (natural opportunities) in addition to the more traditional strategies.

• The Developmental, Individual Difference, Relationship-based (DIR) Model, also known as Floortime, was developed to provide a framework for families and therapists to help a child master communication and play in natural settings by building on the child’s unique skills and interests. It focuses on interactional experiences that include sensation, movement, and relationships, as well as communication. Unlike many approaches considered behavioral, the interaction often follows the interests and lead of the child. Floortime strategies are used to help the child learn to engage in interaction, play, and communication. Variations on developmental approaches are also practiced.
• Combined treatment programs. Researchers are examining how to best combine treatments to meet the needs of families and their young children with ASD. The Early Start Denver Model provides a combination of developmental and behavioral approaches to address the basic core symptoms of ASD in young children, first at home and then in a structured preschool. Core features of the Denver model include involvement of an interdisciplinary team to implement a developmental curriculum, focus on interpersonal engagement, development of spontaneous and reciprocal imitation and object use, focus on cognitive aspects of play, and partnering with parents. While the exact approach used in the research may not be available, some preschool programs may incorporate many of the elements that were studied.

Visit HealthyChildren.org for more information.

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