DEVELOPMENTAL AND BEHAVIORAL INTERVENTIONS
Early Learning Assumptions
Disagreements regarding optimal early learning environments for children with autism begin with assumptions arising from the theoretical writings of Jean Piaget and Lev Vygotsky who wrote about development of neurotypical children (Piaget, 1955; Vygotsky, 1978). These theorists emphasized the importance of developmental appropriateness of materials available in the learning environment and viewed the teacher, parent or therapist as a facilitator, not an instructor or therapist. Through exploring learning materials, it is assumed the child moves from being undisciplined to self-disciplined, from disordered to ordered, and f
Young children with autism spectrum disorders seldom learn from watching adult models, at least not until they have been explicitly taught to do so. Moreover, if children with ASDs are left to their own devices to learn through observing others, or exploration of play or educational materials, they often lapse into repetitive, stereotyped behavior, such as rocking, flapping and repeatedly banging or twirling play materials in non-functional ways. Many children on the autism spectrum do not spontaneously perceive toys or play materials as symbolically representing actual objects (e.g. cars, houses, people), except some highest functioning children. They must be explicitly taught component play skills, which when combined in a supportive context, yield useful functional activities. The Piagetian strategy of multisensory experiential learning is seldom effective for young children with autism (Educating Children with Autism,
page 102).
SCERTS is one of the most complex, comprehensive approaches to autism early intervention (Prizant, Wetherby, Rubin, Laurent, Rydell, 2005). Though it emanates from the Constructivist theoretical tradition, it incorporates concepts from behavior analysis learning theory traditions as well. The emphasis on child learning in natural environments and intrinsic motivation (i.e. avoiding consequences that are not indigenous to the context) is one of several features that distinguishes the approach from discrete trial behavior analytic strategies. However, learning is more structured than suggested by most Constructivist theorists.
Behavior Analysis-based interventions, such as Lovaas’s UCLA Young Autism Model, are designed to provide planned exposure to a range of developmentally appropriate stimuli, such as play materials, their partner’s language and social cues. Explicit skills are taugh
Emotional Self-Regulation
A second underlying assumption of developmental approaches to early intervention are suppositions about emotional self-regulation in autism. Developmental psychologists have conducted extensive research on the processes by which typical infants and toddlers acquire ability to regulate his or her feelings (Calkins and Fox, 2002). They have also studied emotional dysregulation among children with various forms of emotional disturbance (e.g. borderline personality disorder) (Kernberg and Michels, 2009). Emotional self-regulation involves the child’s subjective experience of emotion, their thoughts in reaction to those feelings, physiological reactions within their body (e.g. heart rate, hormonal changes) and their overt behavior (e.g. laughing, crying), including facial expressions, related to emotion. Among neurotypical children, these processes depend on the child’s developing capacities to discriminate between and interpret their own personal experiences. The process builds on emotional experiences from infancy. Gradually children begin to be more capable of managing their own feelings. By kindergarten, typical children often have the ability to anticipate, discuss and use their awareness of their own and others' feelings, in order to negotiate everyday social interactions (National Scientific Council on the Developing Child, 2004, page 2). Several autism early intervention approaches attempt to directly promote emotional self-regulation, notably SCERTS, Relationship Development Intervention and Floortime.
The inherent skills in emotional self-regulation are typically absent or very limited among children with ASDs, such as distinguishing among one’s own feelings. Their absence is among the defining features of autism. Assumptions about the optimal way to overcome these deficits in children with autism have not been tested empirically. There is little evidence from controlled studies that it is possible to directly change emotional self-regulation among children with autism, as proposed. I am reminded of the expression, “get ahold of yourself!” which is intended to induce the listener to calm down, despite their emotional upheaval. If one could simply urge children with autism to “get ahold of themselves,” and they would be able to do so, they would have many fewer problems. That rarely, if ever, works.
What little evidence exists suggest changes in self-regulation of emotions by children with autism comes about by learning skills that gain control over circumstances causing dysregulation (e.g. being able to ask for help when facing a difficult task).
Behavior therapy interventions usually do not target emotional self-regulation as a goal in and of itself, with the exception of Pivotal Response Therapy, which views it as a component of behavioral self-regulation (e.g. Koegel, LK, Koegel, RL, Boettcher MA, Harrower, J and Openden, D. 2002, page 247-8). Most behavior analytic-based interventions operate on the assumption that as a child gains greater mastery of language and social skills, and makes cognitive gains, they have less reason for emotional distress. Their ability to emotionally self-regulate is thought to accompany those instrumental improvements in their daily relations with events and development of positive relationships with people around them. This assumption is similar to that in cognitive behavior therapy, namely that cognitive (e.g. language) and other behaviorally-mediated skills gradually provide the framework within which feelings are interpreted and regulated (Thompson and Hollon, 2007, pg.145).
References
Calkins, SD and Fox, NA. (2002) Self-regulatory processes in early personality development: a multilevel approach to the study of childhood social withdrawal and aggression. Dev Psychopathol.14(3): 477-98.
Gutstein, SE and Sheely, RK (2002) Relationship Development Intervention with Young Children: Social and Emotional Development Activities for Asperger Syndrome, Autism, PDD and NLD. Jessica Kingsley Publishers.
Kernberg, OF and Michels, R. (2009) Borderline personality disorders. Am J Psychiatry 166: 505-8.
Koegel, RL, Openden,DF, Freeden, RM, Koegel, LK (2006) The Basics of Pivotal Response Treatment. In Koegel, RL and Koegel, LK. Pivotal Response Treatments for Autism. Brookes Publishing Co.
Lord, CE and McGee, J. (2001) Educating children with autism. Committee on Educational Interventions for Children with Autism, National Research Council. National Academies Press, Washington, DC
Lovaas, OI (1987)Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol 1987. 55: 3-9.
Mesibov, GB., Shea, V, Schopler, E (2004) The TEACCH Approach to Autism Spectrum Disorders. Springer.
Montessori, M. (1966) The Secret of Childhood. Fides Publishers.
National Scientific Council on the Developing Child. Children's Emotional Development is Built into the Architecture of their Brains: Working Paper No. 2. http://developing child.Harvard.edu
Piaget, J, (1955) Construction of reality in the child. Routledge and Kegan Paul
Prizant BM Wetherby, A. et. al (2005) The Scerts Model: A Comprehensive Educational Approach for Children With Autism Spectrum Disorders (2 volume set). Brookes Publishing Company, Baltimore.
Thompson,T. and Hollon, SH (2008) Behavioral and Cognitive Behavioral Interventions. Chapter 10. Pg. 139
* Thompson T. (in preparation) Blended Autism Interventions (tentative title). Paul H. Brookes Publishing Co.
Vygotsky, L. (1978) Mind in society: The development of higher psychological processes. Harvard Univ Press, Cambridge, MA.