INDIVIDUALIZED AUTISM INTERVENTION
Significant individual differences among children with ASDs challenge us to devise interventions that address that variability (Scherer and Schreibman,2005; Thompson and Contributors, 2011).
INDIVIDUAL DIFFERENCES AND CHOICE OF INTERVENTION
If we fail to appreciate these differences differences, it is difficult to validly assign interventions to individual children. Some of those features are more specific to autism than others, such as limited social understanding and lack of social skills, difficulties with pragmatic langua
ge, and fixed interests and repetitive behavior. Other factors are widely distributed throughout the population but interact with these three core features in autism. These include challenges with attention and activity level, anxiety problems, specific speech impairments (such as apraxia of speech), and intellectual functioning level. The particular blend of interventions that is most appropriate for a given child depends
first on the profile of those three core features and, second, on how those features are moderated by the second group of factors (e.g., anxiety, attention, activity, speech impairment, and intellectual functioning). The Autism Intervention Responsiveness Scale(tm) described in our forthcoming book, Individualzed Autism Intervention for Young Children: Blending Discrete Trial and Incidental Appraoches, provides a concrete step toward weighing these factors collectively in predicting the type and combination of interventions that will be most helpful for a child. Though the scale is in a preliminary form, it is a step in the right direction.
OUTCOMES OF COMBINED INTERVENTION APPROACHES
Parents, teachers, and therapists want to know how well a combined intervention approach actually works with young children with autism. Of the first 24 children served by the Minnesota Early Intervention Project who participated in from 0.5 to 3 years of intervention (about 22 hours per week average), 75% have graduated and are currently enrolled in regular education classrooms or are continuing at progressively reduced therapy hours while making the transition to school. About one in five of those children receive some paraprofessional support, two children have been placed in self-contained special education classrooms for students with autism or communication and intellectual disabilities, and two have been placed in early childhood special education classrooms integrated with typically functioning students. One child was discharged due to lack of progress, parents of two children transferred them to other providers (e.g., center-based services), and a fourth moved away. Of those 24 children, 6 received nearly entirely Discrete Trial Intervention, 6 received largely Incidental Intervention, and 12 were provided with a blended combination of Incidental Intervention and DTI. In Blended Interventions, Discrete Trial procedures were often used when introducing a new, especially difficult-to-learn skill, and as soon as the child began showing signs of acquisition, we made the transition to partial incidental teaching and eventually entirely incidental teaching. Supervisory staff members must be very experienced and well trained for this strategy to work. Hands-on therapists must be competent in using a range of intervention methods. This project suggests it is possible to individualize early behavioral intervention procedures incorporating elements of developmental strategies with behavioral approaches.
MEDICATION COMBINED WITH BEHAVIORAL INTERVENTION
The future holds great promise for preventing and reversing autism symptoms for many children affected with the disability. A promising line of work combines medication to promote brain connectivity with intensive early intervention, possibly as early as 1 year to 18 months of age. Dr. Diane Chugani and her colleagues at Wayne State University have conducted very promising work suggesting that treating children diagnosed with autism at 2 years of age with low doses of a medicine (buspirone) normalizes serotonin in their brain cells, which would otherwise be deficient. Proper levels of serotonin are necessary for normal brain connectivity. Dr. Chugani and her colleagues are currently combining EIBI with medication to determine whether these interventions produce a synergistic effect, possibly preventing emergence of autism in some susceptible children (D.C. Chugani,, 2010).Related work suggests it may be possible to treat youngsters with fragile X syndrome with a medication that corrects the balance of proteins that make components of brain synapses (Dolen, Carpenter, Ocain, & Bear, 2010; Penagarikano, Mulle, & Warren, 2007). About one quarter of children with fragile X syndrome meet the diagnostic criteria autism. Together with EIBI, this may make it possible to reduce or eliminate many of the symptoms of autism among children with fragile X and autism.
COMPONENTS OF EARLY INTENSIVE BEHAVIORAL INTERVENTION
The drive to contain educational and health care costs mandates employing the most effective aspects of interventions for specific students or clients. The National Research Council Report called Educating Children with Autism (Lord & McGee, 2001) and Reichow and Wolery’s (2009) quantitative summary of autism early intervention studies contained two important conclusions: 1) EIBI is highly effective for many children with autism, and 2) which aspects of early behavioral intervention are responsible for these outcomes in subgroups of children is not well understood. We must be able to identify which children benefit most from specific aspects and intensities of intervention. The goal is to identify which aspects of comprehensive early interventions account for the bulk of intervention outcome, so that children optimally benefit from more focused interventions.
Individualizing autism intervention has a promising future, one that may afford the possibility of overcoming or preventing emergence of autism symptoms in susceptible individuals.
Chugani, D. (2010) Wayne State University, personal communication, June 24, 2010
Committee on Educational Interventions for Children with Autism, N. R. C. (2001). Educating children with autism, C. E. Lord and J. McGee, Editors) Washington, DC: National Academies Press.
Dölen G, Carpenter RL, Ocain TD, Bear MF.Mechanism-based approaches to treating fragile X. Pharmacol Ther. 2010 Jul;127(1):78-93. Epub 2010 Mar 18.
Penagarikano O, Mulle JG, Warren ST.The pathophysiology of fragile x syndrome. Annu Rev Genomics Hum Genet. 2007;8:109-29.
Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. Journal of Autism and Develomental Disorders, 39(1), 23-41.
Sherer, M. R., & Schreibman, L. (2005). Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology, 73(3), 525-538.
Thompson, T and Contributors (2011) Individualized Autism Intervention for Young Children; Blending Discrete Trial and Incidental Approaches, Baltimore: Paul H. Brookes, Inc