a critical review of asd interventions

7/30/2019 A Critical Review of ASD Interventions

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A Critical Review of ASD Interventions Used With Primary School

Children In The New Zealand Setting

Retrieved fromhttp://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtml

The graph above, produced by American Interagency Autism Coordinating Committee (IACC)

(2012) represents the exponential growth in research publications based on seven

sub-categories of ASD interventions and treatments. This rapid increase mirrors the improved

accuracy in the recognition and diagnosis of Autism following the identification of the ASD Triad

of Impairments by Lorna Wing in 1979. This explosion is represented on The Research Autism

website which lists 1081 ASD interventions. These interventions range from the now

discredited psychoanalytical theories of Bettelheim, through a continuum of behavioural and

developmental interventions supported by various level of evidence based research, to

interventions with only anecdotal evidence to support them such as the increasingly popular

dietary interventions.

This paper discusses 7 ASD interventions chosen to represent the current New Zealand setting

as reflected by the NZ ASD Guidelines (Ministry of Health, 2008, p. 298-300) interventions used

in the authors current school and local special school, and interventions used by ASD

professionals interviewed for the Specialist Teaching PGDip Core Assignment 2. These

interventions cover all the categories identified by the IACC graph above with the exception of

medical/pharmacological interventions which will be looked at in Domain 5.

The interventions examined are:

SCERTS: Social Communication, Emotional Regulation, Transactional Support Framework

ABA: Applied Behaviour Analysis

Video Modelling
http://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtmlhttp://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtmlhttp://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtmlhttp://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtml


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Social Stories

PECS: Picture Exchange Communication System

Weighted blankets/vests/collars

Gluten Free and Casein Free diet

The following categories were looked at for each intervention:

Theoretical Perspective

Purpose

Practice

Evaluation

Research

Evaluation

Individual with ASD

Culture

Ethics

SCERTS:

Social Communication, Emotional Regulation, Transactional Support Framework

Theoretical Perspective:

SCERTS is based on behavioural and developmental social-pragmatic theory and allows forinterventions to be drawn from a wide range of theoretical backgrounds.

Purpose:

SCERTS is a framework addressing the core deficits of ASD. It allows for a comprehensive,

multidisciplinary approach, combining techniques and strategies from different perspectives to

be used to meet the specific needs of the individual child, their family, and the professionals

working with the child. The acronym stands for:

SC - social communication - development of functional communication and emotional

expression.

ER - emotional regulation - development of regulated emotions and ability to cope with stress.

TS - transactional support - implementation of supports to help families, educators and

therapists respond to children's needs, adapt the environment and provide resources for

learning.


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Practice:

1. A SCERTS Worksheet for determining Communication Stage is completed by the parents and

after discussion with the professional a communication stage is established for the child.

2. A SCERTS Assessment Process (SAP) is made, involving observations at home and school,

using video and reports from parents and teachers. A variety of observations are made

including; structured/unstructured, adult directed/child directed, must do/free choice and

busy/calm.

3. The Information collected is scored on the SAP-Observation Forms at the relevant

communication stage using the following categories:

Social Communication

Joint Attention

Symbol Use

Emotional Regulation

Mutual Regulation Self-Regulation

Transactional Support

Interpersonal Support

Learning Support

The childs strengths are identified and goals set to build on these. The whole team is involved

in the choice of interventions to achieve these goals.

Evaluation:

SCERTS has a structured assessment procedure that allows for regular, 3 monthly, evaluation of

the interventions used. Information is collected through observations and scored on the

SAP-Observation Forms at the relevant communication stage using each of the six categories.

Progress, appropriateness of the intervention and next steps can then be identified. This data is

collected by at least 2 members of the childs team.

Research:

SCERTS is unrated by the Australian Raising Children Network and Research Autism website

who have not identified any peer-reviewed research on its effectiveness. However, peer

reviewed, longitudinal studies of large group and single case design from a variety of

perspectives support the specific interventions applied using SCERTS (Ministry of Education,

Hand-out 1.7). ONeill (2010) positively evaluates the implementation of SCERTs in a primary,

special needs, school.

NZ Setting:

SCERTS fulfils the Ministry of Education Specialist Service requirements for assessment and

intervention within natural settings and routines using measurable, outcomes based success


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criteria. An adapted model of SCERTS has been successfully trialled in New Zealand Early

Childhood (Ministry of Education, The Early Intervention Autism Project in Action 2006-2010).

The following table shows how SCERTS aligns with Te Whariki and the NZ Curriculum:

Te Whariki

Strands

NZC key

Competencies SCERTS framework

Exploration

Mana aotroa

Thinking SC: Understanding intentions; expressing preferences, needs & emotions

ER: Attend to the most relevant information in an activity or setting

Communication

Mama reo

Use of symbols

and Texts

SC: Sharing ideas and playing with others

ER: Process verbal and non-verbal information

Well-being

Mana atua

Managing Self SC: Communicating for a variety of purposes

ER: Initiate interactions using appropriate communication strategies

Contribution

Mana tangata

Relating to

Others

SC: Initiating interactions, pretend play

ER: Remain socially engaged with others. Respond in reciprocal interaction

Belonging

Mana whenua

Participating &

Contributing

SC: Relating to peers, understanding routines and expectations

ER: Actively participate in everyday activities

(Ministry of Education, Hand-out 1.4)

Individual with ASD:

The SCERTS Assessment Process looks at what the child can already do and what the next

logical goal would be. On the SAP-Report form parents are asked to list strengths they see in

their child. The interventions selected are specific to the needs of the individual child and

address a range of skills that can be generalised to multiple settings. This intervention allows for

a combination of child and adult initiation and the inclusion of peers and siblings.

Culture:

SCERTS provides a person-centred planning approach where the needs and goals of the family

are given high priority. The family has the opportunity to be involved in every stage of the

process including assessment, identification, implementation, evaluation and review of the

interventions used. The complexity of the SCERTS framework needs to be clearly explained to

the parents to allow them to fully participate in the childs team.


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Ethics

The integrated nature of SCERTS makes it flexible to the needs of the individual whilst

empowering the parents. The SCERTS assessment looks at what the child can do and builds on

these strengths. When assessing the child with ASD a number of team members are involved in

observation and data collection ensuring an accurate picture of the childs strengths and needs.The multi-intervention nature of SCERTS allows professionals to draw on interventions from a

range of perspectives relevant to the childs core ASD needs.

ABA: Applied Behaviour Analysis


Early forms of ABA interventions were firmly grounded in traditional behaviour and learning

theories that separated behaviours into discrete components. These theories proposed that

undesirable behaviours were learnt and could therefore be unlearnt. Over time contemporary

ABA approaches have included a developmental component as well as taking a more

naturalistic approach.

Purpose:

ABA aims to identify and eliminate, or reduce, individual components of the childs behaviour

that are considered to be undesirable whilst simultaneously strengthening or maintaining

desirable behaviours. Behaviours targeted by ABA include: following commands, use of

expressive language, responding to requests or questions, and participating in conversation.

Practice:

Appropriate behaviour is reinforced and non-desirable behaviour is ignored. Parents are trainedby a therapist to deliver the intervention in a home setting. The 3 phases of ABA are:

1. Systematic analysis of the childs behaviours

2. Selecting a technique to change frequency or intensity of target behaviours

3. Assessment of the intervention effectiveness and modification required

More contemporary forms of ABA include Incidental Teaching and Pivotal Response Training.

Evaluation:

ABA success is measured precisely using the following dimensions:

Repeatability: how many times the behaviour occurs

Temporal extent: how long the behaviour lasts for on each occasion

Temporal locus: when the behaviour occurred


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Response latency: time elapsed between the stimulus and the response

Inter-response time: time between two consecutive occurrences of a response

Derivative measures: measures unrelated to specific dimensions

Trials-to-criterion: the number of response opportunities needed to achieve the targeted levelof change in behaviour

Research:

Since 1980 ABA based research has provided much evidence to support the success of this

intervention. However, there is also contradictory evidence suggesting that outcomes of ABA

produce no more change than standard child care and that some children may show little

change over many years of work or even regress (Research Autism, n.d.).

NZ Setting:

Appendix 8 of the NZASD Guidelines lists Incidental Teaching and Pivotal Response Training as

interventions that are currently being used in the New Zealand Setting (Ministry of Health,

2008, p.298).

The following table shows how ABA aligns with Te Whariki and the NZ Curriculum:

Te Whariki Strands NZ Curriculum Key Competencies

Well-being /Mana atua Managing Self

Contribution/Mana tangata Relating to Others

Belonging/Mana whenua Participating and Contributing

Individual with Autism:

ABA can be delivered across a home/school setting providing consistency and a natural

environment for the individual. ABA provides many opportunities for the child to demonstrate a

target behaviour and receive positive reinforcement. There is concern that ABA can make the

child reliant on a particular learned behaviour in a particular environment making it difficult for

them to generalise their learning.

Culture:

Parents are trained to deliver the intervention in their home so allowing a natural setting for

this work and a high level of parent involvement. Interventions can be targeted towards

culturally acceptable behaviour but is must be considered if these are also the high priority

behaviours for the childs to overcome problems and reach their full potential.


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Ethics:

A number of ethical questions are raised by the ABA approach:

This approach addresses the symptoms shown by the child rather than the underlying cause of

the behaviours. Are the behaviours targeted by the therapist or parents fundamentally wrong,

or based on what the adults see as socially acceptable? Are the behaviours that are damaging

to the child or others being targeted? If these assumptions are true how is the modification of

these behaviours affecting the childs emotional and social regulation and their overall

well-being? In ABA behaviour is modified by external prompts, does this allow for

internalisation of these behaviours by the child?

In addition, a theory founded on the belief that behaviours are a result of faulty learning, that

needs to be un-done, does not take into account the growing body of compelling research

supporting the genetic and organic aetiology of ASD

Finally ABA involves a big time commitment, up to 40 hours week and strong emotional

resilience is required by already stressed parents.

Video Modelling


Video modelling comes from a combined behavioural/developmental approach focusing on

social learning.

Purpose:

Video modelling is designed to teach a range of new social and functional skills, how to adapt

current behaviours and how to apply behaviours to new situations. Video modelling can be

used to target a range off behaviours:

social interaction behaviours

academic and functional skills

communication skills

daily living skills

play skills

social initiations

perception of emotion

spontaneous requesting

perspective taking

Practice:

The video features someone else, or the child themselves, modelling appropriate behaviour in a

target situation and the child learns this behaviour by watching the video. The video clip should

be between 30-40 seconds with the numbers of behaviours included adjusted to the childs

needs. The setting should initially be the same setting in which the child will be demonstrating


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the behaviour. The video clip must be watched at least once before attempting the behaviour

and up to 3 times if needed. The video can be revisited after the childs attempts to refine the

skill. Video modelling can take the form of:

Imitation language skills

Role playing- social skills e.g. alternative responses to a situation rather than a tantrum

Let the camera roll to capture rare behaviours - typically used when individuals cannot

imitate or follow directions. A child can be filmed during several lunch periods and good

examples of them eating appropriately are combined into a video.

Evaluation:

Real time observations made initially in the target setting and later in other settings to check

for generalisation.

Research:

Much evidence supports the effectiveness of video modelling for teaching new skills to adults

and children with ASD. Research Autism reported positive results from 50 studies. However,

much of this research lacks efficacy underlining the need for high-quality research around this

intervention.

NZ Setting:

The use and interest in video modelling in New Zealand has generated research in this field,

including this study by A.M.Dekker (2008) from Waikato University: Comparing Wrong/Right

with Right/Right Exemplars in Video Modelling to Teach Social Skills to Children with Autism.

The following table shows how Video Modelling aligns with Te Whariki and the NZ Curriculum:

Te Whariki Strands NZC key Competencies

Exploration/Mana aotroa Thinking

Communication/Mama reo Use of symbols and Texts

Well-being/Mana atua Managing Self


Belonging/Mana whenua Participating & Contributing


Corbet et. al. (2005) suggest the following contributing factors to the high levels of motivation

shown by some children with ASD when using video-modelling:

over-selective attention and easily distracted in a real life situation
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restricted field of focus

preference for visual stimuli and instructions e.g. TV/video

avoidance of face-to-face interactions

the ability to process visual information more easily than verbal information

Other factors may include:

The predictability of the video when it is played over and over

Learning without having to go into a crowded, noisy environment initially

Videos can be personalised by using self-modelling allowing the child to see themselves

succeeding and in turn increasing their self-efficacy

Videos can be made more relevant to the child by using peers, parents or siblings.

However, this intervention does require the child to be able to watch TV for at least 1 or 2

minutes.

Culture:

The use of videos/DVDs is extremely common in todays culture but it is still important not toassume the family have the resources of knowledge to use this intervention method at home.

The use of video is beneficial in training and educating parents without the added pressures of

literacy demands.

Videos can be made in the home as well as school providing the opportunity to model the

cultural values and practices of the family.

Ethics:

Care must be taken not to use behaviour on the video that is currently beyond the childs skill

level as this can cause frustration and anxiety. Professionals need to be consulted when skillswithin their specialist areas are being targeted by video modelling.

Social Stories


Social Stories have a multiple theoretical background developing from

behavioural-developmental and cognitive social theory including lack of Theory of Mind and

Weak Central Coherence.

Purpose:

Social Stories are individualized stories written to describe social situations in terms of relevant

cues in order to explain appropriate responses or behaviours. They aim to describe what people

do, why they do something and how they might react. Social stories help children with ASD to

develop an awareness and understanding of the others in a social situations.


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Practice:

Share the social story with the child when everyone is calm and relaxed.

Use a straightforward approach when introducing the story.

Stay positive, reassuring and patient sharing the story.

Use a calm and friendly tone of voice

Involve others in sharing the story e.g. peers or siblings

Introduce one story at a time to maximise learning

Review the story as often as needed.

Gradually fade' the social story

Evaluation:

Outcome Measures used in a meta-analysis by Mogensen (2007), used the following criteria to

compare earlier studies

Frequency of social interactions

Duration of social interactions Frequency of inappropriate social interactions or behaviours

Frequency and duration of challenging, obsessive or disruptive behaviours

Duration of on-task behaviour

Research:

Social stories are widely used and many resources are available to support those wishing to use

this intervention. However, there are very few research studies in this area. Research Autism

lists Social Stories as having limited positive evidence due to the limited number of research

studies. A 2009 study reported 51% teachers rating social stories as very effective (Reynhout &

Carter, 2009). Given the positive results so far, Social Stories appear to be a promising

intervention for children with ASD, but more outcome studies are needed to replicate theseresults

NZ Setting:

Social Stories have been used successfully for many years in New Zealand schools.

The following table shows how Social Stories aligns with Te Whariki and the NZ Curriculum:








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To understand the story, the child with ASD must have well-developed reading or visual

comprehension and be able to translate the visual story into action. From that, the child must

understand the social situation and recall the story when appropriate.

Social Stories can be highly motivating through:

Personalising them to include the child, peers, parents, siblings, or favourite TV/movie

characters.

Shared ownership of the story through the child being involved in what the text will say

and taking photos for the book.

Taking the book home to share with family and friends

Being aware of the childs learning style when making the book e.g. preferences for

symbols, photos, or text

Culture:

Social stories made by parents offer the opportunity to share the familys cultural values and

practices and could can be written in their native language.

Ethics:

Social stories should always be positive providing information about preferred behaviours,

never threatening the childs self-esteem or emotional safety. Using a word like must is setting

a child up to fail, alternative words like, sometimes, usually, often, occasionally, most are much

less threatening. The goal of the story needs to be achievable and at least 50% of the stories

developed should celebrate the childs achievements (Carol Gray, n.d.).

PECS: Picture Exchange Communication System


PECS is based on a mix of behavioural and developmental approaches based on Skinners

operant learning theory.

Purpose:

PECS provides an alternative augmentative communication package to teach individuals to

initiate communication and express their needs building on the strong visual learning and

thinking styles characteristic of ASD. PECS aims to:

develop understanding of the world around them

develop understanding of the expectations of others.

increase motivation by anticipation of preferred activities, tasks, or classes

develop understanding of time and the ability to predict change

increase self-management and independent on-task behaviour

improve appropriate behaviour around transitions


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improve communication and daily living skills

improve play skills and physical activity

decrease disruptive behaviour including aggression, tantrums, and destruction of

property

Practice:

The adult teaches the child to exchange a picture of an item he wants (usually a symbol e.g.

Boardmaker). Initially, two trainers work with the child with one of them prompting the child to

exchange the symbol for the items he wants. The first trainer then hands the requested item to

the child. When the child can make the exchange independently only one adult is needed.

PECS involves six phases of training, building the childs independence and understanding that

communication is a two way process which can achieve desired goals.

Phase 1: Basic exchange with a wide range of pictures

Phase 2: Persists in getting anothers attention over increasing distances

Phase 3: Discriminates between a number of pictures Phase 4: Forms sentences using pictures

Phase 5: Answers questions using pictures

Phase 6: Expands on previous success

It is recommended that PECS be used alongside other interventions.

Evaluation:

The childs progress can be tracked using the 6 phases of the PECS program.

Research:

Research on PECS shows that it improves communication skills through exchanging pictures and

in some cases the individual learns to talk spontaneously.

Research Autism rates PECS as having very strong positive evidence, with 16/21 studies

showing positive improvements.

NZ Setting:

The following table shows how PECS aligns with Te Whariki and the NZ Curriculum:







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PECS is widely used across New Zealand schools. Both PECS training and resources are available

within New Zealand. A Picture Exchange Communication System (PECS) Basic TrainingWorkshop is offered by Autism New Zealand and PECS resources are available from Spectronics

NZ.


PECS assesses the preferences of the child and the program is initially develop around these.

The child is given a voice, is able to make choices and have more understanding and control

around the structure of a given period of time and their environment.

Culture:

PECS can be used across the home/school settings, affording the family a high level ofinvolvement and allowing them to use pictures that reflect their culture alongside their first

language.

Ethics:

Some other communication training systems, require the child to learn prerequisite skills, such

as get ready position, motor imitation or eye contact. These additional learning requirements

do not exist with PECS.

There is an ethical question around how long a child is left waiting for the desired object if they

do not use the card; no intervention should be causing unnecessary stress to the child.

Weighted Items


This intervention takes a sensory integrative approach. This is based on the theory that

perceptual, sensory and motor difficulties may result from poor integration of sensory

information and lead to the inability of the brain to regulate the bodys sensorimotor functions.

Deep pressure releases the chemical serotonin as well as endorphins. Serotonin has a calming

effect whilst the endorphins are mood enhancing. Serotonin also breaks down into melatonin

which aids sleep. The altering of their sensory system allows individuals with ASD to better feel

their movements and understand where their bodies are in space.


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Purpose:

The use of weighted items, such as blankets, vests or collars, is designed to help individuals with

ASD cope more effectively with a range of challenges, including poor motor skills, hyperactivity

and sleeplessness.

Practice:

Weighted items can be bought from specialist suppliers, second hand or made at home. They

are made heavier by stitching small weights into the fabric or putting them into special pockets.

Evaluation:

Evaluation of the effectiveness of such interventions can be made through observations to see

if the individual with ASD becomes less distressed in the target situation when using a weighted

item.

Research:

Currently there is no conclusive research about the effectiveness of weighted items as an

intervention for autism. However, researchers from Research Autism, motivated by the extent

to which disturbed sleep can impact on the wellbeing of children with autism are conducting a

clinical trial called Snuggledown. This will target children with ASD who suffer from poor

sleep.

NZ Setting:

Weighted products are available for purchase from a number of New Zealand websites

including Sensory Corner at http://www.sensorycorner.co.nz and My Diffability at

http://www.mydiffability.co.nz

The following table shows how use of weighted items aligns with Te Whariki and the NZ

Curriculum:






It is important that weighted items are not used on an individual if the person indicates they do

not want to use them. Care needs to be taken when selecting weighted items to make sure
http://www.sensorycorner.co.nz/http://www.mydiffability.co.nz/http://www.mydiffability.co.nz/http://www.sensorycorner.co.nz/


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they are appropriate for the individual. A weighted blanket should only be around 10% of the

individuals body weight.

The possibility of improved sleep means that many individuals with ASD are quite happy to use

weighted blankets.

Culture:

Many weighted vests are made to be worn under a layer of normal clothing to avoid attention

being drawn to the individual by wearing something different.

Ethics:

Weighted items should never be used for restraint or punishment and an occupational

therapist should be consulted before using this form of intervention. If the weighted item is

allowed to be worn for too long, the individual may become overly accustomed to it and so

reducing its, effectiveness. Although research states there is no risk of using weighted items, a

childs head must never be covered by a weighted blanket and they should be easily able to slipout from under the blanket.

Gluten Free-Casein Free Diets (GF-CF)


This is a complementary and alternative medicine therapy using dietary elimination. GF-CFdiets

are based on the theory that gluten and casein peptides leaking from the gut act as opioids

affecting neurotransmitters and causing ASD.

Some of the effects of opioids are the same as characteristics often seen in autism e.g.

abnormal immune system response, insensitivity to pain, repetitive movements and

hyper-sensitive or hypo-sensitive reactions to normal events.

Purpose:

The aim of a GF-CF free diet is to remove all gluten and casein intake from the individuals diet.

The gluten protein is found in some cereals such as wheat, oats, rye and barley. The Casein

protein is found in some dairy products such as milk, butter and yoghurt.

Practice:

Recommendations suggest that gluten and casein should be gradually eliminated from the dietover a period of about 4 weeks. It is important to check levels of vitamins and minerals

regularly to avoid any dietary deficiencies. Supplements may need to be taken.

Evaluation:

The individual is observed for any changes in behaviour in the core characteristics of ASD


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Research:

The theory behind the gluten-free casein-free diet is weak and unproven, with limited evidence

to support its effectiveness. Despite this lack of evidence dietary intervention is growing in

popularity and with anecdotal cases not uncommonly claiming a cure for the child (The GFCF

Diet Intervention, n.d.).

Research Autism has found limited positive evidence to support the claimed effects of GF-CF

diets on autism and strongly recommends that further large scale, high quality research is

needed.

NZ Setting:

A quick internet search brought up a number of New Zealand media items relating to GF-CF

diets and autism including a NZ Yahoo item entitled Can a gluten-free diet help treat autism?

Susan Lords book Getting your kid on a Gluten-Free Casein-Free Diet. This would indicate

that in New Zealand GF-CF diets are of interest to some families with children on the autistic

spectrum.

The selection of GF-CF food in New Zealand is more restricted than in America and the UK and

noticeably more expensive.

If claims that GF-CF diets can alleviate key behaviours across the core characteristics of ASD

then this would have an effect on the childs functioning and learning across all strand of Te

Whariki and all key competencies in the NZ Curriculum.


The child should be checked by a dietician before going onto a GF-CF free diet and the new dietshould be gradually introduced. The child will need to eat more often on this diet and should be

checked regularly by the dietician in case vitamin or mineral supplements are needed

Culture:

Having one person in a household on a GF-CF diet can mean huge changes, with extra time

being spent on food preparation, the extra cost of GF-CF food and the pressure of having to

adhere to the diet.

Ethics:

Individuals with ASD often have sensitivities to food items based on colour or texture and so arealready on a restricted diet. Adding a GF-CF diet to this would further restrict their food intake,

heightening the risk of dietary deficiencies.

If a child shows adverse changes in behaviour then the new diet must stop immediately.


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Discussion

Theoretical Perspectives:

Social Stories, PECS, Video Modelling and SCERTS are all developed from a multi-theoretical

basis thereby reducing the limitations of each of the individual theories. For example PECS has

the defined structure of a behavioural intervention but at the same time can target the childs

social-cognitive skills of observing, understanding and responding. This multi-faceted approach

lends itself well to working with children with ASD, allowing interventions to target social skills

and communication but at the same time ensuring that structured processes exist to achieve

outcomes that are measurable and can be replicated.

Purpose:

The purpose of behavioural interventions, such as ABA, is focused purely on eliminating the

undesirable behaviours shown by the individual. In contrast a developmental approach, such as

Social Stories, seeks to look at the underlying causes of these behaviours and work towards

developing theory of mind skills in order to facilitate underlying psychological change and social

modification.

Practice:

There appears to be a significant difference between the largely behavioural based, highly

structured interventions of ABA and PECS and the more developmental social-pragmatic

approaches of Social Stories and Video Modelling. The procedures for the social-pragmatic

interventions are more open to interpretation. A few guidelines were found for introducing the

video in the Video Modelling intervention but the majority of the guidelines for Social Stories

were directed more towards the social behaviour of the adults than any concrete steps in the

process. The practices around these interventions focused strongly on the individual with ASD

achieving success and maintaining a positive frame of mind e.g. 50% of social stories celebrating

the childs achievements and so improving self-efficacy. In contrast the behavioural approaches

of denying a child an object until they present the correct symbol or ignoring undesirable

behaviour has the potential to cause the child more anxiety and emotional dysregulation as

opposed to building self-esteem.

Evaluation:

SCERTS, ABA and PECS all have clearly identified, objective goals against which outcomes can be

measured, these can be attributed to the behavioural components of these interventions.

Evaluating the effectiveness of social stories, video modelling and even weighted items is less

clearly defined and more subjective in nature, making it more difficult to know when to move

onto a new goal or whether or not the intervention needs modifying. However, this broader

approach does allow for the acknowledgement of unexpected positives arising from the

intervention used.


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Research:

Social Stories, SCERTS, video modelling, weighted items and GF-CF interventions all have

anecdotal evidence to support their effectiveness, but lack peer reviewed evidence based

research confirming or disproving their effectiveness. PECS and ABA however, are support by

have good empirical, evidence based research. On the continuum of behavioural anddevelopmental interventions both ABA and PECS appear closer to the behavioural end than the

other interventions examined. The structure, precise focus and consistency of these more

behaviourally based approaches lend themselves to replication making confirmation of their

efficacy through quality research possible.


The role of the individual in behavioural interventions is to have the intervention done to

them, with very little consideration for their preferences or needs. For young children the

done to factor would also be true for GF-CF diets and possibly weighted items. However, these

approaches differ from the traditional behaviour approaches in that they are considering andresponding to possible causes of the behaviour rather than the behaviour itself. PECS

represents a slight shift from this approach in that the target items used are of high interest to

the child. In contrast Social Stories and Video Modelling allow the individual to be more actively

involved in the intervention and even take some ownership of it in an appropriate form e.g.

sharing the social story at home with family or selecting the next skill to target through video

modelling.

Ethics:

The behavioural based intervention of ABA focuses on the symptoms shown by the individual

rather than the causes underlying the behaviour. This raises the question as to whether

theories based mainly or exclusively on operant behaviour theory are targeting the behaviours

most relevant to the childs emotional and social regulation and well-being, or simply those

behaviours that the adults see as most undesirable. To what extent do these behavioural

interventions provide the child with coping strategies that can be generalised and retained and

to what extend are they simply teaching children to jump through hoops.

Multi-theoretical approaches such as SCERTS allow flexibility to meet the needs of the

individual, considers the individuals well-being and increases the parents sense of purpose and

value by including the parents in decision making and administering the interventions.

Summary

As every intervention offers its unique strengths treatment programmes should draw on these

strengths and be designed to provide the best fit for the needs of an individual whilst

facilitating learning in natural environments and through natural events. Although some

professionals still favour a specific behavioural or development approach, sometimes to the


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exclusion of others, there is a growing shift towards combined models drawing on both the

developmental understanding of social communication and the systematic progress measures

used by behaviourists. This approach is endorsed by the NZ ASD Guidelines in recommendation

3.1.2

There is no evidence that any single model is effective for teaching every goal to allchildren with ASD. Models should be chosen to fit the characteristics of the child and the

learning situation.( Ministry of Health, 2008, p.87).

.

References

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a critical review of asd interventions

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