What specific strategies can improve outcomes for these children?
Page 5: Early Childhood: Comprehensive Interventions
Young children sometimes participate in a comprehensive treatment program (CTP), a highly structured program that incorporates focused interventions, targets multiple developmental domains (e.g., cognitive functions, social skills, adaptive behaviors), and is employed for extended periods of time (e.g., one year). Many of these comprehensive treatment models (CTM) are based on ABA principles, yet some incorporate other theoretical models or approaches (e.g., social cognitive theory, developmental approach). For example, Naturalistic Developmental Behavioral Interventions (NDBI) incorporates ABA principles and developmental principles and is implemented in a naturalistic setting. Comprehensive treatment programs are usually implemented at the school or district level and most often require formal training.
comprehensive treatment model (CTM)
An intervention approach for children with autism spectrum disorder, which incorporates multiple focused intervention practices to address a broad learning goal or to target more than one developmental domain; typically used for an extended period of time (e.g., one year).
Research validated interventions for young children with autism spectrum disorder, which integrates both behavioral and developmental approaches. These interventions are implemented in natural settings, involve family members, incorporate behavioral strategies, and target developmental appropriate learning goals and social skills.
Now listen as Kara Hume discusses the importance of focused interventions even when implementing a comprehensive intervention. Next, Ilene Schwartz discusses how focused interventions and comprehensive interventions work together.
Kara Hume, PhD
Frank Porter Graham Child Development Institute
University of North Carolina-Chapel Hill
Focused interventions are always going to be the heart of programming for students in classrooms on the autism spectrum. And those focused interventions or EBPs are very important to learn and understand. Often, the decision to implement a comprehensive treatment model is made by a larger entity. Often, a teacher in a classroom isn’t making the decision that we are going to implement the STAR Model or the Hanen Model, but that decision usually comes by a school district or a special education department head who wants to identify with a more unified program. There are multiple classrooms across a school district. They want something that has more common language or common practices, a common training protocol, so that evaluation of practices and teachers is easier across those settings.
Usually, an individual teacher doesn’t often have the freedom to decide whether they’re going to use a comprehensive treatment model or focused interventions. But focused interventions will always be part of their practices, and spending time learning those is key. If a district decides to use a comprehensive treatment model, that typically requires that all the staff receive training in that model. Usually, it requires the support or guidance of the model developer or people who the model developer has trained. Usually, there’s more extensive training. There’s specific materials that need to be adopted, purchased, and then some sort of ongoing consultation or coaching. Usually, for teachers, I would say, invest your energy in learning these evidenced-based practices and then follow the lead of your district or your colleague that they have committed to a comprehensive treatment model, and you’ll learn better how to integrate those evidence-based practices as part of this larger model.
Transcript: Ilene Schwartz, PhD
A focused intervention and a comprehensive program are not mutually exclusive. In fact, they work together hand-in-hand. Every child with autism should have a comprehensive intervention. A comprehensive intervention lasts for six to nine months. A comprehensive program addresses multiple domains: reading, writing, and arithmetic. With children with autism, in addition social communication, peer interaction, organization independence, things like that. It should use evidence-based practices to address those domains, and it should provide the adequate intensity to ensure that the child is making progress.
You can actually think about every child’s program as, in the best of all possible worlds, being a comprehensive treatment model, and then within that you can use focused interventions to teach specific skills. If you have a child who has deficits in communication, you might use a focused intervention to work on their beginning communication skills. You might use some focused intervention on peer interaction or on conversation skills within that comprehensive treatment model. I think that it really is thinking about meeting all the needs of the student versus “How do I work on this specific skill?” But they’re certainly not mutually exclusive, and in the best of all possible worlds they work together.
In 1987, Ivar Lovaas published a study that changed the landscape of intervention for ASD. Though ASD was once believed to be nearly impossible to treat, Lovaas demonstrated that early intervention can have profound effects on the outcomes of students with the disorder. In his study, 47% of the very young children with ASD who received two-to-three years of home-based, behavioral intervention for a minimum of 40 hours a week, entered first grade indistinguishable from their peers. This study and its many replications changed forever how researchers, families, funding agencies, schools and other providers would view intervention for children with ASD. It also launched the practice of early intensive behavioral intervention (EIBI). (Lovaas, 1987)
early intensive behavioral intervention (EIBI)
A highly structured and intensive approach used to address the needs of young children with autism spectrum disorder; based on applied behavior analysis, this approach centers around discrete trial teaching, which involves teaching a skill or desired behavior through one-on-one instruction and repeated instances of the adult presenting information, the child responding, and the child receiving a consequence.
There are a number of established comprehensive treatment programs, such as Learning Experiences: Alternative Program for Preschoolers and Parents (LEAP) and Project DATA (Developmentally Appropriate Treatment for Autism). According to the National Research Council (NRC), a high-quality comprehensive treatment program for young children with ASD should include:
Appropriate types and amounts of services that are selected on an individual basis and documented in a child’s individualized family service plan (IFSP) or individualized education program (IEP)
A low teacher-to-student ratio
A family component
A minimum of 20–25 hours per week of systematically planned educational activity
Sufficient individual attention every day so that IFSP/IEP objectives can be addressed with adequate intensity
Opportunities for successful interactions with typically developing children
Instruction or interventions to address functional spontaneous communication, social skills, play skills, cognitive skills, and inappropriate or challenging behavior in a proactive manner
functional spontaneous communication
Any type of verbal or nonverbal communication that is not elicited through prompts or cues.
Listen as Ilene Schwartz, the developer of Project DATA, discusses the components of this program and how they benefit children with autism (time: 1:52).
Ilene Schwartz, PhD
Professor, Special Education
Director, Haring Center for Research
and Training in Inclusive Education
University of Washington
Project DATA has been used with toddlers and preschoolers, and one of the things that makes it unique is that it’s based on the idea that children with autism are children first. So we really work on the idea that inclusion is the centerpiece of our program. So every child with autism attends an inclusive program, whether it’s birth to three or three or five, from the first day they’re in the program and the first day of services, and we provide the support that the children need to interact successfully with their typically developing peers.
Then we have four components that wrap around the children’s participation in inclusive programming, and those four components are extended intensive instruction, social and technical support for families, collaboration across all professionals, and a quality-of-life influenced curriculum. And what those four components do is really provide the extra support that the children need to participate in this inclusive program because the inclusive program is their primary educational placement.
What we know about children with autism is that they need more intensity than most developmental preschools provide, and we know that children three to five need 20 to 30 hours of programming each week. In Project DATA preschool program, they spend about 12 hours a week in an inclusive program and about 12 hours a week in this intensive instructional setting where they’re working one-on-one or one-on-two with other children with autism and adults.
For Your Information
As with all EBPs, comprehensive treatment programs will not be effective for all children with ASD. However, children who begin treatment early are likely to make greater gains than those who begin treatment when they are older.
Many children with ASD require intensive early intervention services. When working to meet the needs of these children and their families, it is important to keep them at the center of the process. Doing so will help IFSP/IEP teams create service plans that are guided by a child’s needs.