It's very difficult for any parent to hear that their child has a serious disability. Often parents go through specific stages of grief when coming to terms with this knowledge. On top to dealing with the pain associated with a diagnosis of Autism, many parents have expressed their frustration when they begin to examine different treatment options. While all of the different programs suggest that it is most helpful to begin working with the child intensively from an early age, there are many different programs to choose from and each one purports to be the "best". When parents talk to other parents they often hear very conflicting views about different treatment options. Parents often express fear in choosing the "wrong" program and being responsible if their child does not make monumental gains. What a stressful position to be in when you're already going through a grieving process!

The "Best"?

On the other side, many professionals and parents do see their programs or treatments as being the "best". Sometimes this claim is due to scientific research supporting the program and other times it's due to extensive experience with success. Sometimes this claim is made because "their" program is the only one the professional or parent has had any real contact with or knows much about! Many people, both parents and professionals become quite zealous in trying to convert people to "their way of thinking". This is not done out of malice but typically because the parent or professional honestly perceives what they know to be the best treatment and want to help as many children as possible. Sometimes parents or professionals choose to focus on one specific aspect of a program that they personally disagree with and use that aspect as "evidence" that the program has no benefits. Other times, parents may feel negatively about a program because of their individual experience with the program. If their child was not successful, they may feel that the program was to blame. While these beliefs may well be valid, there are many different factors that go in to the success of an individual child. Perhaps the parents had unrealistic expectations or did not follow recommendations. Perhaps the person running the specific program or the instructors using the techniques was not as educated or professional as they could have been. One never knows all of the factors relating to a child's success or lack thereof with a given program.

While science is very important, it is also important to recognize that the most valuable treatment method research is designed to be "single subject". In other words, the specific child and his response to the treatment is the subject of the research. This is because all children are different in their neurology, biology and environment so it's difficult, if not impossible, to make generalized claims based on the results of any one child participating in any one program or treatment. If scientific principles are used to guide each child's program, it will allow for sound decisions to be made on the efficacy of the treatment for that specific child.

The author has studied many different treatment programs and found that there are many common threads between them. While different terminology may be used to describe the techniques, the actual therapy may often look very similar. Some treatment programs focus on addressing one specific "piece of the puzzle" with regard to Autism and others purport to treat the "total child". The author has found that each one of the programs uses techniques that may be helpful to an individual child and suggests it is counterproductive to rely soly on knowledge of one specific treatment method. The more knowledge regarding different techniques that an individual has, the better able they are to develop a truly individualized program based on the needs of each child and family.

For parents, this often means that they must use "bits and pieces" from different programs and treatment methods to truly meet all the needs of their child and family. For example, parents may choose to use a visual schedule to allow their child to "see" what will happen during the day and assist in transitioning while also participating in an ABA program. Parents are often in the best position to truly understand the unique needs of their child. If treatment methods are suggested to deal with a specific issue, parents should be able to ask questions and fully agree that the suggested treatment is appropriate for their child. If they disagree with the suggestions and choose a different course, parents should be treated with respect in this decision. The author commends this practice and feels it is unprofessional for anyone to suggest parents should only use techniques from one treatment program.

Determining Factors

The author suggests that rather than following one treatment program guideline in its entirety, that the following core factors should be addressed:

1.  Treatment should begin early- It is possible to detect signs of Autism as early as 18 months or age or earlier in some cases. Treatment should begin as soon as there is a suspicion rather than waiting for an "official" diagnosis.

2.  Treatment should be intensive- The child should have as much one -to- one, pleasurable contact with another human being as possible throughout the day.

3.  When it is not possible for the child to be with another human being, techniques should be used to teach the child to stay focused on a specific activity or activities rather than engaging in self-stimulatory behavior.

4.  Early communication training is vital. If a child is able to communicate his wants and needs in an appropriate manner, the development of many negative behaviors can be avoided.

5. Knowledge and use of the basic principles of applied behavior analysis is critical for parents and program planners- This will insure that techniques are being applied correctly with a full understanding of all of the factors involved.

6.  Specific goals, objectives and targets should be developed- It is not possible to adequately measure progress unless specific behaviorally written objectives are developed.

7.  Progress should be determined through the collection of objective data- It is critical to use objective data to determine the effects of any treatment applied rather than relying on subjective opinions.

8.  Data should not be so cumbersome as to interfere with teaching- The data collection system should allow for the measurement of progress but not be so extensive that the instructor is unable to give their undivided attention to the child.

9.  When data indicates a specific treatment strategy is not being effective, alternate strategies should be employed. Program planners and parents should be open to a variety of alternatives based on the needs of the child.

10.  Determination of mastery should be based on the child's ability to use the skill in a functional manner in a variety of settings.

11.  Goals and objectives should be developed to address all the needs of the child including communication, socialization, neurological/biological and behavioral needs.

12.  The needs of the family should be considered in program planning. The number of other children in the home, the availability of support and other family resources should be considered when planning programs.

13.  Teaching strategies should involve compensating for a child's current weaknesses if needed in a specific environment as well as specifically targeting those weaknesses for treatment. For example, if it has been determined that a child performs much better at school when provided with a visual schedule, that schedule should be used in that setting. In addition, program planning should be occurring to teach the child to be able to function independently when the schedule is not available.

14.  Objectives and treatment strategies used should be based on the different settings the child is in throughout the day. For example, one three yr. old child may be attending a preschool program with typically developing peers so independent toileting may be a priority. If the child's language skills were not currently at a level to teach these skills through verbal means, a picture activity schedule may be used. For another three year old, at home with his family, it may be deemed more important to use this daily activity to work on language targets with an adult.

15.  Parents should be provided with enough information to make informed, rational decisions regarding any specific treatment strategy being suggested. This includes educational, behavioral, diet and medical treatments.

16.  The treatment strategies used should be based on the needs of the child rather than the needs of the program or classroom in which the child is currently involved.

17.  Understanding the neurological and biological functioning of the child is vital- This allows for appropriate stimuli to be used for teaching and can assist in determining possible reinforcers.

This author suggests that rather than looking at total program packages, professionals and parents should focus on specific treatment techniques that have been successfully used in a wide variety of treatment programs. These techniques should be used when deemed appropriate and the efficacy should be measured based on the response of each individual child.

T. Vail 6/01


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