| HISTORICAL OVERVIEW OF SOME EDUCATIONAL/CLINICAL INTERVENTIONS Psychodynamic approaches: Following environmental theories psychodynamic approaches were first recommended by Bettleheim and were dominant clinical practice in the 1960s-1970s. Presuming that children with autism needed to be granted as much acceptance, warmth and love as possible, clinicians looked for “reconstructing the client’s basic personality by uncovering unconscious motives derived from repressed conflicts of early childhood”. This approach needed to be provided even when they were withdrawing or exhibiting ritualistic or aggressive behaviors. Psychodynamic approaches have not been proven as beneficial for individuals with autism. It has been demonstrated that theories “blaming” the environment for generating autism as a psychological disorder, were incorrect. Gunilla Gerland a person diagnosed with Aspergers ellocuently expresses her opinion about the use of psychoanalyses with people with ASD. |
| Programs derived from Behavior Modification Theory: Behavioral theory in its purest form asserts that clinical interventions need to focus on nothing but observable behavior.The basic assumption of the behavioral approaches is that inept behavior is learned behavior which happens to be personally, socially or legally disapproved of or deviant. Behavioral therapies are based on several principles: 1) All behavior is learned; 2) Behavior is shaped by consequences; 3) Behavior is more likely to be repeated if the consequence is reinforcing (positive or negative); 4) Behavior is less likely to be continued if there is no consequence attached to it (ignoring), or if it is punished (aversive consequences). McEachin, Smith and Lovaas published the outcome of a study by the UCLA Young Autism Project (YAP), designed by Lovaas to evaluate an intensive treatment for young children with autism in 1987. It included 40 weekly hours of individual one-to-one care for over a period of two or more years. The YAP methodology adopted the name Applied Behavioral Analysis (ABA). It addressed different domains, such as socialization, communication and cognition, by using a direct instruction format in a highly structured behavior modification approach. Each lesson was provided in a one adult to one child setting, and was broken down into single behaviors, using desired objects or activities such as food, praise, hugs, or tokens as reinforcers. The YAP required that quantitative data on occurrence of specific behaviors be collected, generating a dynamic analysis of the effectiveness of the approach. The programs lead to more complex goals, once initial goals were reached, it often thought isolated skills such as “stand-up”, “collect dirt”, “put-in” one by one, eventually using them all together in a more complex task, such as throwing the dirt into the garbage. This approach is called Discrete Trial, and has been criticized for producing robotic-like children, because of their use of mechanical and repetitive set of trials which are alienated from the natural environment. One can claim, though, that applying an intervention in a mechanical manner may have more to do with practician's lack of skills, or his personality, rather than the technique. Moreover, many people who oppose ABA are unaware that this approach is not limited to the use of discrete trials, but often explores a variety of educational formats such as incidental teaching, pivotal responses, picture schedules and peer-mediated social skills. It is my experience, however, that combining ABA with the PECS approach does gives the children with enhanced opportunities to initiate communication. After the intense treatment phase, reduced care was provided at YAP. The interventions took place within different settings (home/school/clinic). The reported results indicated marked gains in several domains, including improvements in intellectual functioning that led to placement of some of the children in regular education classrooms. This research had, however, a variety of methodological problems, such as a small sample with a different average age of the groups at the onset of treatment and the lack of ability to randomize assignments to the groups. Additional studies have nevertheless been done by the May Institute (1987), the Mardoch Early Intervention Program (1993), and the UC-San Francisco Study (1996), indicating that early intensive behavioral intervention, when provided for an extensive period of time and with the help of involved parents, benefits many autistic people by increasing their IQ and improving their skills in a variety of areas. While many conclude that “behavioral is the therapy of choice”, this is not the only logical conclusion of the presented data, though. It would set a limitation on the use of options that if used properly could be equally benefitial. Before recommending |
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| There are many contemporary interventions derived from biological evidence which indicates that autism is a condition with a neurophysiological basis: |
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