Interventions and Approaches
There are many approaches, therapies and interventions you may become aware of as you work with a young person with autism. Before using any particular approach it is best to find out as much information as you can about it.
- training opportunities and costs
- ability to implement within your setting
- resource implications –practical, time and human
- if possible, links to schools or practitioners near you already using it.
Given the unique profile of individuals with autism, what may work for one person may not work for another.
The interventions and approaches included in this section is not an exhaustive list, nor intended as a recommendation of any particular approach. Their inclusion is to provide information about interventions you may have heard about or may be introduced to in discussion by other professionals or parents. Where possible there are links to relevant websites or contacts.
Scottish Intercollegiate Guidelines Network (SIGN) review scientific evidence for and against interventions of all kinds, including educational and pharmacological Click here for their guidelines.
Research Autism provides independent research into new and existing health, education, social and other interventions.
As part of the Scottish Strategy for Autism a Guide to Interventions and Supports for People on the Autism Spectrum has been published
Alternative and Augmentative Communication
AAC refers to methods that augment or replace usual methods where an individual has no reliable means of communication. These methods are typically used by individuals with impaired communication. People who use AAC may include, for example, individuals who have communication difficulties from birth as a consequence of cerebral palsy, learning disabilities, autism and other difficulties, or people who have an acquired communication difficulty following stroke, dementia, motor neurone disease and other neurological conditions. AAC systems may also be used by people with temporary loss of communication – for example, within intensive care wards. AAC systems vary from high-tech dedicated computer equipment to adapted mainstream technology with specialist software or simple low-tech picture communication books. AAC has the potential to enhance the lives of many individuals with communication impairments.
From; ‘A Right to Speak’ The Scottish Government 2012
Applied Behaviour Analysis
The overall goal of teaching based on Applied Behaviour Analysis (ABA) is to work with each individual to develop skills that will enable them to be as independent and successful as possible. As a person centred approach, ABA based intervention always begins at the level of the individual and as such works to establish a personalised and individualised approach to curriculum planning in order to address key skill areas, including (but not limited to) communication, leisure, social, academic and daily living skills. Skills are prioritised that will increase the quality of life for the individual and involves functional communication that may incorporate other augmentative systems to facilitate effective communication (e.g. vocal, PECS or sign). Generalisation is promoted from the start to ensure skills can be used across all environments.
ABA uses key behavioural principles and breaks down learning into smaller component skills to teach as a developmental sequence (e.g. from simple to more complex skills). Targets and intervention procedures are clearly defined to aid consistent teaching and learning progress is recorded on each target ensuring decisions are based on data, and progress towards targets can be easily assessed. ABA is personalised according to the needs and strengths of the individual and adapted to how that individual responds.
An ABA-based intervention can take place within any environment and appropriate education setting. A large number of studies investigating the benefits of ABA-based principles have been published in peer-reviewed journals. Please see the Behavior Analyst Certification Board (www.bacb.com) for information on credentialing for behaviour analysts.
Arts therapies are a way of using the arts – for example, music, painting, clay, dance, voice or drama – in a therapeutic environment with a trained therapist.
You do not need to have any special skill or previous experience of the arts in order to benefit from arts therapies, and the aim is not to produce a wonderful work of art, but to use the art form to understand yourself better with the help of the therapist.
Arts therapists are skilled in whichever medium they use, and they will help you to express yourself by creating something. They will then help you to make sense of what you have created in relation to your life experience and your state of mind.
Whatever you express is contained in the therapy room in a way that is safe; they will maintain professional boundaries, just as any therapist should, and act within the code of practice of their chosen therapy.
Extract from Mind (for better mental health)
Information on research in to Arts Therapies
Circle of Friends
'Circles of friends’ originated in North America as one of a range of strategies to enhance the inclusion, in a mainstream setting, of any young person (known as ‘the focus child’), who is experiencing difficulties in school because of a disability, personal crisis or because of their challenging behaviour towards others.
Setting up a ‘Circle of Friends’ requires a number of stages;
- explaining about ‘Circle of Friends’ in the school or class
- getting permission for involvement from school staff, parents and the ‘focus child’
- talking to the whole class or year group to recruit volunteers
- volunteers meeting regularly with the ‘focus child’ and an adult facilitator.
Those in the peer group are encouraged to look at their own behaviour while developing an understanding of the focus child’s behaviour and difficulties in order to develop strategies and practical solutions to help the individual. It is not an approach to provide instant friendship, but over the course of meetings and the evaluation of set targets, it is hoped that the focus child will be able to build closer and better relationships with other children (Barratt et al).
Comic strip conversations
Comic strip conversations by Carol Gray, help people with autism develop greater social understanding.
Comic strip conversations provide visual representations of the different levels of communication that take place in a conversation, using symbols, stick figure drawings and colour. By seeing the different elements of a conversation presented visually, some of the more abstract aspects of social communication (such as recognising the feelings and intentions of others) are made more 'concrete' and are therefore easier to understand.
Comic strip conversations can also offer an insight into how a person with autism perceives a situation. Extract from; National Autistic Society Website
Cognitive Behavioural Therapy
Also known as CBT, Cognitive Behavioural Modification or CBM is a type of psychological intervention used to change how people think and behave.
CBT is based on the idea that how we think, how we feel, and how we act, affect each other. For example, a person who thinks that an increased heart rate is the sign of a heart attack is more likely to panic than a person who thinks that it is just a normal variation in heart rate.
CBT uses a variety of techniques to help people become more aware of how they think, so that they can change how they think and therefore how they behave. For example some forms of CBT include keeping a diary in order to record feelings and behaviours.
There are several multi-component CBT programmes – such as Building Confidence, Cool Kids – which use a variety of techniques and which have been adapted specifically for use with people with autism (see Homuncili; T McKay & A Greig. Jessica Kingsley, 2013).There are also numerous other autism interventions which are based on, or which incorporate, the principles of CBT – such as social skills groups and social stories.
Emotion Works is a Community Interest Company (CIC) providing tools and services that support children to learn and communicate about emotion. The approach focuses on working with the adults who engage and interact with children on an everyday basis.
They have a particular interest in addressing barriers to emotional wellbeing, so work is especially directed at improving outcomes for children who face additional challenges in their lives due to disability or disadvantage, or who have specific needs relating to emotional wellbeing.
Intensive Interaction is an approach that is based on our first conversations in the mother-infant imitation dialogue, where the infant initiates a sound or movement, the mother confirms this and (eventually) the baby moves on. For example, the infant may say, 'Boo' to which the mother responds, 'Boo', confirming what her baby has said. After some trial and error, the baby moves on to try out another sound, say, 'Da'. The point being that the baby learns that if it makes an initiative it will get a relevant response.
Intensive Interaction is a way of working with the child (or adult’s) brain using signals with which it is so familiar that they do not trigger sensory distortions or sensitivities. It uses the child’s own body language to build up emotional engagement Extract from Pheobe Caldwell website
Much of the development of Intensive interaction was based on research related to the way which human beings learn to communicate during the first year.
The teaching sessions should be frequent, quite intense, but also fun-filled, playful and enjoyable. Both participants should be at ease with enjoyment of the activity as the main motivation. A session could be highly dynamic, with a great deal of vocalisation, sometimes with fun-filled physical contacts. A session could also be peaceful, slow and quiet Extract from Intensive Interaction website
Kitbag for Schools
Kitbag for Schools is a development of Kitbag for Families - a resource developed by IFF to help children grow their capacities for listening, understanding, staying calm and self-confidence.
IFF is a charitable organisation headquartered in Aberdour, Fife, dedicated to developing the capacity to thrive in a highly complex and uncertain world. A large part of IFF’s work has been devoted to exploring and growing the ‘21st century competencies’ required to flourish in the contemporary environment of rapid change, radical interconnectedness and boundless complexity in which most of us find we are ‘in over our heads’.
Kitbag for Families has grown out of this work. It is a set of resources including Calming Oil; two sets of cards containing mindfulness exercises (Presence Cards) and animals with positive attributes (Animal Cards); a Talking Stick; two Finger Puppets; a visualisation story (Wonder Journey); music (by Scottish composer, Malcolm Lindsay); a Feelings Card and a one minute Timer. With these simple items, children are able to explore and share their feelings in a safe and engaging way with other children.
Behind these seemingly simple resources lies a deep understanding of psychotherapy and neuroscience.
Kitbag arose originally out of a research project sponsored by the World Economic Forum to find ways to address the global epidemic of mental illness and mental distress. User-centred graphic designers and textile artists have worked with psychologists and psychotherapists to create Kitbag as a multi-sensory, holistic experience, which is soothing and evocative. It is designed to help children see what strengths they have and build their confidence to share these with others. The Presence Cards along with the Calming Oil help children relax and access their compassionate, self-soothing mind.
Devised in 1974, Makaton is a key word sign-supported communication system.
Makaton is a language programme using signs and symbols to help people to communicate. It is designed to support spoken language and the signs and symbols are used with speech, in spoken word order.
Picture Exchange Communication System
PECS begins with teaching students to exchange a picture of a desired item with a teacher, who immediately honours the request. For example, if they want a drink, they will give a picture of 'drink' to an adult who directly hands them a drink. Verbal prompts are not used, thus encouraging spontaneity and avoiding prompt dependency.
The system goes on to teach discrimination of symbols and how to construct simple "sentences." Ideas for teaching commenting and other language structures such as asking and answering questions are also incorporated. It has been reported that both pre-school and older students have begun to develop speech when using PECS. The system has been successful with adolescents and adults who have a wide array of communicative, cognitive and physical difficulties.
- Signalong is sign-supported communication for people with learning difficulties.
- Signalong has a very large range of vocabulary.
- Signalong supports users through the transition from childhood to adulthood.
- Signalong is based on British Sign Language.
- Signalong is user friendly for easy access.
- Signalong is designed to help children and adults with communication difficulties, mostly associated with learning disabilities, autism and other special needs.
- Signalong was founded in 1992 and now widely used across the UK.
The Son-Rise Method – sometimes known as the Options Method – is a type of relationship-based intervention used to help children with autism and other disabilities.
The Son-Rise Method is based on the idea that children with autism have trouble forming relationships with other people but can be helped to meet develop those relationships through playful interaction with an adult.
The adult follows the child’s lead rather than superimposing her own ideas of what the child should do. This includes ‘joining’ the child in his behaviour rather than trying to stop it. So, if the child is stacking blocks or flapping his hands, the adult does the same.
The aim is not simply to copy the activity but to build trust. By doing the same as the child, the adult shows the child that he is loved and accepted without judgement. It then becomes much easier to build a relationship. As the relationship develops the adult is able to use the child’s own motivation to teach him new skills based around his own interests.
The SPELL framework has been developed by The National Autistic Society's schools and services to understand and respond to the needs of children and adults with autism. It recognises the unique needs of each child and emphasises that all planning and intervention should be organised on this basis. SPELL stands for Structure, Positive, Empathy, Low arousal, Links.
- Structure makes the world a more predictable, accessible and safer place and can aid personal autonomy and independence.
- Positive approaches and expectations seek to establish and reinforce self-confidence and self-esteem by building on natural strengths, interest and abilities.
- Empathy is essential to underpin any approach designed to develop communication and reduce anxiety.
- The approaches and environment need to be Low arousal: calm and ordered in such a way as to reduce anxiety and aid concentration.
- Strong Links between the various components of the person's life or therapeutic programme will promote and sustain essential consistency.
SPELL - Autism.org.uk
Government policy recognises that colleges, schools and early years services should create a climate where seeking children’s and young people’s views and encouraging participation in decision making are part of everyday activities. Where children have additional support there is a requirement for them to be actively involved in planning and setting their individualised education targets.
Talking Mats is a communication framework that is widely used for this and staff find it easy to implement. It has been used with children and young people in nursery, school, college and university. As well as target setting Talking Mats has proved particularly useful as a transition planning and reflection tool for children and young people.
'Treatment and Education of Autistic and related Communication handicapped Children'. The primary aim of TEACCH is to help to prepare people with autism to live or work more effectively at home, at school and in the community.
Structured teaching is an important priority because of the TEACCH research and experience that structure fits the “culture of autism” more effectively than any other techniques we have observed. Organising the physical environment, developing schedules and work systems, making expectations clear and explicit, and using visual materials have been effective ways of developing skills and allowing people with autism to use these skills independently of direct adult prompting and cueing. These priorities are especially important for students with autism who are frequently held back by their inability to work independently in a variety of situations. Structured teaching says nothing about where people with autism should be educated; this is a decision based on the skills and needs of each individual student. Some can work effectively and benefit from regular educational programs, while others will need special classrooms for part or all of the day where the physical environment, curriculum and personnel can be organised and manipulated to reflect individual needs.
Cultivating strengths and interests, rather than dwelling solely on deficits, is another important priority
Extract from ‘What is Teacch?’ Gary Mesibov on www.autismuk.com
Video Interaction Guidance
Video interaction guidance is an intervention through which a “guider” aims to enhance communication within relationships. It works by engaging clients actively in a process of change towards realizing their own hopes for a better future in their relationships with others who are important to them. Guiders are themselves guided by the values and beliefs around respect and empowerment. These include a belief that people in troubled situations do want to change, a respect for what clients are managing to achieve in their current difficulties, and a conviction that the power and responsibility for change resides within clients and their situations. It is most typically used for interactions between children of any age and adults, either parents or professionals, although it can also be used within pairs (or even groups) of adults. When it is used by professionals to reflect on their own communication with service users it is usually referred to as Video Enhanced Reflective Practice (VERP). In both versions, its aim is to give individuals a chance to reflect on their interactions, drawing attention to elements that are successful, and supporting clients to make changes where desired.
Video modelling is a method of teaching in which an individual learns a behaviour or a skill by watching a video recording of someone – the model – demonstrating that behaviour or skill.
The model can be someone else – such as a parent or sibling – or it can be the individual him/herself – when the process is called video self modelling (VSM).
The supporters of video modelling claim that it has been used to teach a wide variety of social and functional skills, such as how to interact with other people or how to buy things. They also claim that video modelling can be used to teach an individual how to apply previously learnt behaviours and skills in new settings.
Video modelling is sometimes alongside or as part of other interventions, such as social stories or visual schedules.
NB Examples for modeling can also be taken from DVD, films, tv clips which reflect aspects of behaviours Extract from Research Autism