Children's Learning Connection - Orange County, CA

What are the Best Practices in a Treatment Program for Children?

A Review of the Research
Many parents are looking for the correct ‘formula’ treatment program for their child. The amount of information a parent must filter through is overwhelming. The National Research Council has published an excellent review of the research (National Research Council (2001) Educating Children with Autism. Committee on Educational Interventions for Children with Autism. Catherine Lord and James P. McGee, eds. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.).

The following is an excerpt describing characteristics of effective intervention per the committee’s position statement:

“There is general agreement across comprehensive intervention programs about a number of features of effective programs. However, practical and, sometimes, ethical considerations have made well-controlled studies with random assignment (e.g., studies of treatments that systematically vary only one dimension) almost impossible to conduct. In several cases, features have been identified through correlational or comparative analyses and then assumed to be factors of importance in intervention programs, without further direct evaluation. The consensus across programs is generally strong concerning the need for: early entry into an intervention program; active engagement in intensive instructional programming for the equivalent of a full school day, including services that may be offered in different sites, for a minimum of 5 days a week with full-year programming; use of planned teaching opportunities, organized around relatively brief periods of time for the youngest children (e.g., 15- to 20-minute intervals); and sufficient amounts of adult attention in one-to-one or very small group instruction to meet individualized goals. Overall, effective programs are more similar than different in terms of levels of organization, staffing, ongoing monitoring, and the use of certain techniques, such as discrete trials, incidental learning, and structured teaching periods. However, there are real differences in philosophy and practice that provide a range of alternatives for parents and school systems. The committee recommends that educational services begin as soon as a child is suspected of having an autistic spectrum disorder. Those services should include a minimum of 25 hours a week, 12 months a year, in which the child is engaged in systematically planned, and developmentally appropriate educational activity toward identified objectives. What constitutes these hours, however, will vary according to a child’s chronological age, developmental level, specific strengths and weaknesses, and family needs. Each child must receive sufficient individualized attention on a daily basis so that adequate implementation of objectives can be carried out effectively. The priorities of focus include functional spontaneous communication, social instruction delivered throughout the day in various settings, cognitive development and play skills, and proactive approaches to behavior problems. To the extent that it leads to the acquisition of children’s educational goals, young children with an autistic spectrum disorder should receive specialized instruction in a setting in which ongoing interactions occur with typically developing children.”

A good program should:

1. Consider parents to be active members of the therapy team
2. Establish baselines through the use of standardized and non-standardized testing before making recommendations for your child for level and type of services needed
3. Address each developmental domain area (e.g., cognition, speech-language-communication, sensory-motor, social-emotional-behavioral, and self-help and feeding)
4. Employ specialized staff with expertise in each developmental area, rather than a specialist from one discipline to program for all areas.
5. Be behaviorally-based and data driven
6. Have clinician-level staff (e.g., speech therapist, master’s level behavioral specialist, occupational therapist) work directly with your child on a weekly basis, rather than providing only “supervision” to paraprofessional staff on a bimonthly or monthly basis
7. Consider developmental norms when determining appropriate programming
8. Develop individualized programming for your child based on the current body of research.
9. Teach your child to utilize learning strategies so they can take in information on their own (e.g., not simply relying on direct imitation and rote memory).
10. Teach skills in a manner that will allow for immediate generalization
11. Teach curriculum to functional, fluent, spontaneous use
12. Evaluate progress and adjust programming on an ongoing basis (e.g., through clinician sessions with your child, team meetings, team communication and collaboration)
13. Make individualized level of service recommendation based on both the current body of research and your child’s individual needs