Early Intervention for Young Children with Autism

Introduction

In 1943, Leo Kanner described a developmental disorder in his article that sampled a case of eleven children (Corsello 2005; Levy, Ae-Hwa & Melissa, 2006). Since then, this research has inspired many scholars to examine the condition to curb its ever-increasing prevalence among young children. The evidence of this high prevalence was reported by the Department of Education in the United States in the year 2000, where the number of children with autism increased by 244 percent between 1993 and 1998 (Levy, Ae-Hwa, & Melissa, 2006).

Another study reported that ASD had recorded an increase of incidences from 2 to 5 percent per thousand of people in the 1970s to above 7.5 percent in 2007. It is however not clear whether these results are correlated with increased awareness and measures to assess autistic conditions. Nonetheless, what stands out is the need for service providers to address and try to curb this trend now than ever. The purpose of this paper is to assess many evaluations made for early intervention models for children with autism, to shed more light on the take of scholars and specialists on these interventional approaches.

This literature will rely heavily on behavioral intervention approach, parent oriented intervention approach and developmental approach with few examinations of related intervention approaches. There are insurmountable intervention methods and models which have been developed, some of which overlap in principle and philosophy, while others only differ in their characteristics of demographics under study.

Autistic Spectrum Disorder (ASD) is a developmental disorder that causes a lifelong disability and neural disorder and is characterized by restricted and repetitive behavior, abnormal social interaction and impairment in proper communication (Sally, 1996; Aubyn et al., 2005). All these signs have been found to show up when a child is less than three years. Therefore early intervention for the victims of autism is a life-saving action. This is because evidence has it that intensive early intervention, using behavioral and naturalistic approaches, gives the best results (Wetherby & Woods, 2003). Early intervention is also supported by research with a lot of effects when such intervention is provided before age 3, instead of after age 5 (Wetherby & Woods, 2003; Aubyn et al., 2005).

The autistic spectrum disorder includes the other four diagnoses among which two are characterized by retardation in skills, Rhett’s syndrome and childhood disintegrative disorder (Corsello, 2005). The other two ASD diagnoses include Asperger’s and Pervasive Developmental Disorders (Corsello, 2005). Child disintegrative disorder is characterized by two years of normal development followed by regression in several skills before age four and this leads to autism.

Asperger’s disorder is different from autistic disorder because, unlike autistic disorder, it does not result in communication impairment; but it has all other characteristics of autistic disorder (Corsello, 2005). For many years, professionals have developed a treatment for this condition in children and they have proposed several interventions such as developmental interventions, behavioral interventions, and cognitive interventions among others (Sally, 1996; Aubyn et al., 2005). Although these interventions are anchored on deferring schools of thought, they are related in their intensity and the time at which such treatments are initiated. They have therefore agreed on the fact that these interventions and treatments are more effective when initiated at younger ages, preferably before the age of four years (Aubyn et al., 2005).

Moreover, there are clinically defined systems that guarantee early interventions for all children with developmental disorders like autism such as; Detection and Intervention System in the Community for Very Young children with developmental disorders (DISCOVERY) (Shimizu & Honda, 2002). This model was developed in Yokohama in Japan and contains specific details on the effectiveness of the model on autism victims and their families.

This model is effective at all diagnoses of pervasive developmental disorders PDDs. In their evaluation of the model, Shimizu and Honda (2002) note that intervention for autism can not be initiated until parents recognize its symptoms in their children and make a step to consult a specialist to make a diagnosis. The argument is that early intervention steps can only bear fruits if early detection is made possible and this is to ensure that preschool children benefit from the program. Early detection is therefore essential and this can be facilitated by conducting routine checkups in the community (Sally, 1996; Corsello, 2005).

Behavioral approach

This approach bases its philosophy on the fact that social behavior change has a greater impact under integrated settings compared to segregated developmental settings (Koegel et al., 2001). Research has proved that a child’s life at the beginning is marked by very important developmental tasks like the formation of peer-related social behavior (Dunst & Trivette 2008). This approach has it that peers contribute substantially to the development of communicative and social proficiency.

However social isolation may be seen with peers as a result of communicative delays that children with autism usually exhibit. This isolation may be magnified by the social interaction among children. The interaction among children requires equal participation of parties as opposed to child-adult interaction where parents initiate the interaction. Therefore, children with developmental disabilities will display social proficiency to their parents but display abnormal behavior to their peers.

With adequate child interaction assistance and exposure, children with autistic disorder are likely to learn and gain experiences that can be used to detect their social developmental competencies. Research has shown that with this peer-initiated-social-behavior, children with autism display some abnormal development below their level of cognitive development. This is because those children with developmental disabilities find it difficult to engage in group play, and they have difficulty in forming reciprocal friendships. It has been shown that even if such children are introduced into social groups, they do not maintain such relationships (Koegel et al., 2001).

The behavioral approach puts a lot of emphasis on the importance of social competence in peer interaction for later adjustments, acceptance by others and one’s quality of life and thus it qualifies to be a design of early interaction for children with autism. Koegel et al. (2001) found out that, more placements on such an approach may not give positive results and may rule out specific social skills intervention (Hume, Bellini & Pratt, 2005).

Inculcating social behavior in these children is difficult because there is no objective definition of social behavior, and there is also a relativity of expected social behavior as evidenced by normal developing children (Gresham & MacMillan, 1998). However, this intervention approach has several advantages as compared to other approaches such as; its sensitivity to interventions, effects, and its conduciveness to frequent repeated measures. These make it suitable for evaluating treatment outcomes.

Early intensive behavioral interventions

This is another approach for intervention whose effectiveness has been put to task by professionals (Shea, 2004). This clinical early-intervention-behavioral approach has, according to Shea (2004), shown poor results in cases of severe and preformed mental retardation, Rhett’s disorder and pervasive developmental disorder. The high hopes placed on this intervention approach is misguided and Shea proposes that parents should be told by professionals that there is no guarantee of recovery or normal functioning, in 47 percent of the recipients, as the intervention proponents advocate (Gresham & MacMillan, 1998).

Parent oriented approach

As seen earlier in the foregoing discussion, early diagnosis for children with autism is very essential for early intervention. This early diagnosis can only be possible when professionals involve parents since parents are in a better position to notice difficulties in their children during their (children’s) first two years, a period when treatment of autism can have the greatest efficiency (McConachie & Diggle, 2007). Children with ASD therefore frequently display considerable behavioral dilemmas to their parents and other relatives, who are closer to them, than any other person.

This is why early intervention can be successful if parent-oriented approaches, which involve the parents, are deployed (Levy, Ae-Hwa, & Melissa, 2006). Just like in the social behavioral approach, this approach agrees that children require and develop early skills and communicate their interests. They are also believed to understand the language of others, get on with others, tolerate change and enjoy the company of others in peer play, fun among others (McConachie & Diggle, 2007; Levy, Ae-Hwa, & Melissa, 2006).

There have been researching studies and approaches that are sparked by the above broad spectrum. Most of the early interventions involve parents in implementation for instance; intensive programs involving a maximum of forty hours of input per week, which has on many occasions proved to restore normal functioning, must involve parents in one way or another (McConachie & Diggle, 2007). Some other approaches involve parents in training them on some required skills as well as offering support to them. A good example is where parents are involved and trained in behavioral management and promotion of skills such as communication skills, which are less intensive (Levy, Ae-Hwa, & Melissa, 2006).

The parent-implemented early intervention and its effectiveness have been analyzed by many researchers and its aim has been criticized for being over-ambitious. Parent implemented interventions have been proved to go well with monitored improvement in children and especially their social communication skills where parents have shown a greater capacity to apply behavioral change and positive language effectively (Dunst & Trivette, 2008). Training parents has also proved to benefit them by reducing their stress (Hume, Bellini & Pratt, 2005).

However, there is a call for the need to expand the study on the effectiveness of this approach considering that autism is a condition with multifaceted severity in children. This calls for professionals to sample larger populations in their future studies to have comprehensive results that can be inductively applied to the effectiveness of parent oriented approach as interventions for children with autism (Mancil, 2008). Mancil (2008) agrees with McConachie and Diggle (2007) in that, there is sufficient evidence that the parent oriented approach is an effective intervention in young children with autism, but more comprehensive research is required to ascertain this claimed efficacy.

Close to this intervention method is the LEAP (learning experiences and alternative programs for preschoolers and their parents) model that heavily deals with one-to-one trial or any effective adult-driven approach for intervention. The intervention approach has proved effective in ASD and also helps parents to shade off stress and depression related to difficulties (Strain & Bovey, 2011). In their study of the effectiveness of the LEAP program, Strain and Bovey (2011) found out that children with ASD reached high levels of fidelity after two years of exposure to the program. The model, like any other parent oriented intervention, can be effective when initiated at the right time and commitment is made to adhere to the program.

Walden toddler program

In this daycare modeled intervention program, children are exposed to incidental teaching and social inclusion thus, the stakeholders employ applied behavioral principles within a natural setting (Corsello, 2005). The environment, therefore, is set in a way that enables and encourages activities that attract the child as well as items like toys. In that case, parents engage the child in contexts and activities which are more than the child requires at that stage.

Social pragmatic communications

This was developed by Wetherby in 1999, and involves teaching communication to young children with autism and deploys facilitative, rather than directive approach that provides communicative opportunities and emphasizes the reinforcement of communicative attempts (Corsello, 2005).

TEACCH programs

Another program deployed for intervention in young children with autism is the TEACCH program. This program lays a lot of emphasis on environmental organization and visual support as well as teaching independent developmental skills on autistic children, based on the special needs of each child (Corsello, 2005). However, unlike the parent oriented intervention which is criticized for being over-ambitious, this approaches views autism as a lifelong condition and thus it is purely a treatment approach (Corsello, 2005; Strain & Bovey, 2011).

Developmental intervention

The term is specifically used to refer to a school of thought and the strategies used for managing those children with ASD conditions. This intervention approach is fashioned in a way that enables the child to direct and facilitate the intervention, communication and social interaction (Chawarska et al., 2008, Corsello, 2005; Strain & Bovey, 2011). Unlike a situation of behavioral approach where the parents initiate the response, in a developmental approach, the child leads and the parent responds. Developmental approach thus requires the child to take control of the behavioral actions which can get parents to respond to its actions. A teacher or the parent involved, therefore, must be sensitive to the expectation of the child; especially when it comes to responding so that the response is fitting. The developmental early intervention for children with autism can be achieved by two models and these are green span model and Denver model.

Green span model

This is a developmental approach that is relationship-based and aims at developing interpersonal ties that lead to mastery of cognitive and developmental skills in children with autism. Corsello (2005) lists the following as the core skills required for this model; “…attention and focus, engaging and relating, nonverbal gesturing, affect curing, complex problem solving, symbolic communication, and abstract and logical thinking” (Corsello, 2005 p. 82).

The program invests in monitoring the child and discovering opportunities to expand certain skills and interaction. This intervention program prescribes at least four hours of child-parent interaction, an hour for semi-structural skills and another hour in sensory-motor play activities (Hume, Bellini & Pratt, 2005). This intervention gives the best outcome when combined with inclusive preschool programs, occupational therapy, and speech (Hume, Bellini & Pratt, 2005). However, this intervention depends on the parent skill or professionalism in responding to the child’s actions and behaviors and therefore, it is not easy to be implemented in the society.

The Denver model

Denver model is scheduled and carried out in a setting similar to that of the classroom so that only positive effects in interpersonal interactions and pragmatic communication are emphasized in an environment and context which can be predicted. The child’s morale is boosted by the therapies administered together with the activities in a way that does not differ so much from those of the behavioral intervention approach. Denver model also relies on reactive language strategies to facilitate communication and coach mental representation. Research on the Denver model has proved that children exposed to the intervention demonstrate significant development in various areas. Corsello (2005) says;

… such children show significant development in cognitive language, social/emotional development, perceptual/fine motor development, and gross motor development after 6 to 8 months in the program”…. while only 53% of the children shows functional speech when they enter the program, 73% [demonstrate] functional speech at follow-up”. (Corsello, 2005, p.82)

Chawarska et al. (2008) quoted Wetherby as having identified some significant principles from the developmental researches that are essential for children with ASD and which need to be considered in the intervention. The major one is social communication development that involves development from preverbal to verbal communication. The development of preverbal communication is a necessary lead to the development of the international use of language to communicate.

Conclusion and recommendations

Autistic Spectrum Disorder is a severe condition that affects both the child and the parent and its understanding is helpful for both. In principle, the condition has no cure but there is considerable evidence that it can be treated and its severity reduced. The foregoing discussion has shown that research supports the view that when ASD is detected earlier, early intervention produces substantial results. Although most literature recommends more study and research to be geared towards some developed models for intervention, there is some hope that at least intervention of any kind is better than none and that these interventions are all anchored on parent efforts.

This is very encouraging because the first people to be affected by the condition are the children and their parents, whose expectations are thwarted by the disability. Therefore, before external stakeholders intervene, parents are encouraged to be extra observant so that any abnormality observed in their children is reported in time. Parents, therefore, require civic education so that they are aware of the positive effect of both early diagnosis and intervention for children with autistic disorder.

The concern is not only the parents’ but for the community at large and therefore community health professionals should be involved in educating parents (and the society) on the need to take their children for regular check-ups and on the interventions available to them in case such diagnoses turns positive. There is, therefore, a dire need for all stakeholders including the government to initiate civic education concerning this condition; the appropriate interventions and the expected results so that parents and relatives can participate in ensuring that children with autism share in enjoying a quality life.

References

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