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发表于 2008-12-23 12:50:49
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re:Association for Scie...
Association for Science in Autism Treatment (http://www.asatonline.org)
The Association for Science in Autism Treatment has what I believe was the best scientific evaluations of learning interventions used in the USA in an attempt to treat autism. The Association appears to review available scientific data and make a conclusion of whether the learning intervention has (1) proof it works, (2) suggestion that it might work, (3) no data to say it might or might not work or (4) data that indicates it does not work.
I have cut/pasted from the website the Table of Contents that identifies which types of treatment they have reviewed. After reading their reviews I then cut/pasted those treatments with likely merit. I ignored the (drug) therapeutic approaches but you might want to check these yourself.
After the ASAT section I cut/paste what I thought were relevant abstracts from the last 200 abstracts (Aug 2007 to present) after searching the US National Library of Medicine with terms “autism” and “behavioral treatment”.
Table of Contents
Psychological, Educational, and Therapeutic Interventions
• Animal Therapy
o Therapeutic Horseback Riding
o Dolphin Therapy
o Pet Therapy
• Applied Behavior Analysis (ABA)
• Art Therapy
• Auditory Integration Therapy (AIT)
o Tomatis Method
o Berard Method
o Fast Forward
o Earobics
• Augmentative and Alternative Communication (AAC)
• Developmental Therapies
o Developmentally-based Individual-difference Relationship-based Intervention (DIR)
o Floor Time
o Greenspan Method
• Facilitated Communication
• Glasses
• Holding Therapy
• Music Therapy
• Oral-Motor Training/Therapy
o Kaufman Method
o Prompts for Restructuring Oral Muscular Targets (PROMPT)
o Rosenfeld-Johnson Method
• Patterning
• Picture Exchange Communication System (PECS)
• Project TEACCH (Treatment and Education of Autistic and related Communication-handicapped Children)
• Psychoanalytic and Humanistic Play Therapy
• Recreational Sports/Exercise
• Relationship Development Intervention (RDI)
• Sensory Integrative Therapy (Sensory Integration, SI, or SIT)
• Socialization related classes
• Social Skills Groups
• Social Stories
• Son Rise (Options)
• Video Modeling
• Vision Therapy
o Irlen lenses
o Glasses
o Eye exercises
o Rapid Eye Therapy
o Iridology
o Ambient lenses
o Yoked prisms
The following behavioral approaches were considered either possibly beneficial or beneficial:
1. Applied Behavior Analysis (ABA)
Description: Practitioners of applied behavior analysis (ABA) aim to improve socially important behavior by using interventions that are based upon principles of learning theory and that have been evaluated in experiments using reliable and objective measurement. ABA methods are intended to support persons with autism spectrum disorders in many ways:
• To increase behaviors (e.g. to increase on-task behavior, or social interactions) and to teach new skills (e.g., life skills, communication skills, or social skills);
• To maintain behaviors (e.g., self control and self monitoring procedures to maintain and generalize job-related social skills);
• To generalize or to transfer behavior from one situation or response to another (e.g., from completing assignments in the resource room to performing as well in the mainstream classroom);
• To restrict or narrow conditions under which interfering behaviors occur (e.g., modifying the learning environment); and
• To reduce interfering behaviors (e.g., self injury or stereotypy).
Research Summary: Many studies show that ABA is effective in increasing behaviors and teaching new skills (Goldstein, 2002; Odom et al., 2003; McConnell, 2002). In addition, many studies demonstrate that ABA is effective in reducing problem behavior (Horner et al., 2002). A number of studies also indicate that, when implemented intensively (more than 20 hours per week) and early in life (beginning prior to the age of 4 years), ABA may produce large gains in development and reductions in the need for special services (Smith, 1999); however, large studies with strong experimental designs are needed to confirm the results reported for intensive, early intervention.
The United States Surgeon General (1999) concluded, "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning and appropriate social behavior."
Recommendations: ABA is an effective intervention for many individuals with autism spectrum disorders. ABA interventions should be supervised by qualified behavior analysts. Because of the scientific support for ABA, professionals and families may wish to obtain additional information about this approach; resources are listed in the references below.
An important area for research is to conduct large studies with strong scientific designs to evaluate long-term outcomes of early, intensive ABA and other comprehensive ABA intervention programs.
Selected References:
Systematic reviews of scientific studies:
• Goldstein, H. (2002). Communication intervention for children with autism: A review of treatment efficacy. Journal of Autism and Developmental Disorders, 32, 373-396.
• Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K.(2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders. 32, 423-446.
• McConnell, S. (2002).Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351-372.
• Odom, S. L., Brown, W. H., Frey, T., Karasu, N., Smith-Canter, L. L., & Strain, P. S. (2003). Evidence-based practices for young children with autism: Contributions from single-subject design research. Focus on Autism and Other Developmental Disabilities, 18, 166-175.
• Smith, T. (1999). Outcome of early intervention for children with autism. Clinical Psychology: Science and Practice, 6, 33-49.
• United States Surgeon General (1998). Mental health: A report of the Surgeon General. Washington, DC: Author.
Position statements from professional organizations:
• Maine Administrators of Services for Children with Disabilities (MADSEC). (1999). Report of the MADSEC autism task force (revised ed.). Manchester, ME: Author.
• New York State Department of Health, Early Intervention Program. (1999). Clinical practice guideline: The guideline technical report. Autism/ pervasive developmental disorders, assessment and intervention for young children (Age 0-3 Years). Albany, NY: Author.
For additional information:
• Maurice, C. Green, G., & Luce, S. C. (Eds.). Behavioral intervention for young children with autism: A manual for parents and professionals. (pp. 45-67). Austin, TX: Pro-Ed.
• Maurice, C., Green, G., & Foxx, R. (Eds.). Making a difference: Behavioral intervention in autism. Austin, TX: Pro-Ed.
2. Augmentative and Alternative Communication (AAC)
Description: Refers to methods of communication to either enhance or replace conventional forms of communication (spoken language). Individuals with significant impairment in communication skills may rely on augmentative communication systems to express their needs, wants, and feelings. There are a variety of augmentative communication systems that are available including gestures, sign language, picture exchange (such as PECS), pointing to pictures, and electronic devices that include voice output. Each system has unique advantages and disadvantages so the ultimate choose of a system should be predicated on a complete evaluation. Such an evaluation should consider the individual’s existing skills, his/her communication needs, and the skills needed to interact with others.
Research Summary: Studies indicate that AAC may improve communication skills for children with autism spectrum disorders who have limited or no verbal communication skills when ABA teaching methods are used to teach AAC. However, benefits appear to be limited. “Children with good verbal imitation skills demonstrate better speech production than those with poor verbal imitation skills, with or without AAC” (National Research Council, 2001, p. 58). Regarding sign language, “It is important to note that simple signs may be a support for children learning to speak or an additional mode of communication for children who have no speech or limited speech. However, it is very rare to find a child with autism spectrum disorder who learns to sign fluently (in sentences) and flexibly. Signing is not generally an entry point into a complex, flexible system” (National Research Council, 2001, p. 58). Similar findings have been reported for the Picture Exchange Communication System (see the research summary for PECS). There are case reports of children with autism spectrum disorders becoming proficient with electronic voice-output devices, but studies with strong scientific design have not been conducted on the use of such devices for children with autism spectrum disorders.
(See also the section on the Picture Exchange Communication System)
Recommendations: The application of ABA methods to teach AAC is an appropriate intervention for children with autism who have limited or no communication skills. Because of the scientific support for AAC, professionals and families may wish to obtain additional information about this approach; resources are listed in the references below.
To increase the utility of this intervention, an important area for future research is to investigate AAC methods for promoting initiation of communication and acquisition of complex, flexible language.
Selected References:
Systematic reviews of scientific studies:
• Hourcade, J., Pilotte, T. E., West, E., & Parette, P. (2004). A history of augmentative and alternative communication for individuals with severe and profound disabilities. Focus on Autism and Other Developmental Disabilities, 19, 235-244.
• National Research Council (2001). Educating Children with Autism. Washington DC: National Academy Press.
For additional information:
• Beukelman, D. R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children and adults with complex communication needs (3rd ed.). Baltimore: Paul H. Brookes.
3. Developmentally-based Individual-difference Relationship-based intervention (DIR)/Floor Time
Description: Also called Greenspan Method. In Floor Time, the adult participates with the child in his/her space. The child’s actions set the lead for actions that the adult can extend or elaborate. For example, if the child wants to line up cars in a row, the parent or service provider may playfully intrude in this activity (e.g., moving one of the cars or blocking a car and asking where it’s going). Floor Time is usually provided by parents under the direction of psychologists. However, it may be an intervention strategy used by professionals in other disciplines such as speech therapy or special education.
Research Summary: DIR is widely considered to be a plausible intervention approach (i.e., one that could be effective), but it has not been evaluated in peer-reviewed studies with strong experimental designs (National Research Council, 2001).
Recommendations: An important area for future research is to evaluate DIR in studies with strong experimental designs. Professionals should present DIR as untested and encourage families who are considering this intervention to evaluate it carefully.
Selected References:
Systematic reviews of scientific studies:
• National Research Council (2001). Educating Children with Autism. Washington DC: National Academy Press.
4. Music Therapy
Description: Refers to the application of music with the intent to enhance functioning. It consists of using music therapeutically to address behavioral, social, psychological, communicative, physical, sensory-motor, and/or cognitive functioning. The music therapist involves clients in singing, listening, moving, playing instruments, and creative activities in a systematic, prescribed manner to influence change in targeted responses or behaviors and help clients meet individual goals and objectives.
Because musical activities may be highly preferred by an individual with autism spectrum disorder (e.g., listening to music, dancing, playing an instrument), access to such activities may be used as a reward. This is different from music therapy, in which the musical activities themselves are viewed as therapeutic.
Research Summary: Preliminary evidence suggests that music therapy could be effective in enhancing functioning (Kaplan & Steele, 2005; Whipple, 2004), but this approach has not been evaluated in studies with strong experimental designs.
Recommendations: Researchers may wish to conduct studies with strong scientific designs to evaluate music therapy. Professionals should present music therapy as untested and encourage families who are considering this intervention to evaluate it carefully.
Selected References:
Systematic reviews of scientific studies:
• Kaplan, R. S. & Steele, A. L. (2005) An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum. Journal of Music Therapy, 42(1), 2-19.
• Whipple, J. (2004). Music in intervention for children and adolescents with autism: A meta-analysis. Journal of Music Therapy, 41, 90-105.
5. Picture Exchange Communication System (PECS)
Description: One of the methods used under an ABA approach, PECS uses pictures and other symbols to develop a functional communication system. PECS teaches students to exchange a picture of a desired item for the actual item.
Research Summary: Studies show that PECS is effective in teaching communications that involve single words or short phrases, and that gains may generalize to everyday settings. Ongoing consultation from an expert in this approach is likely to be necessary to maintain these gains.
Recommendations:The application of ABA methods to teach PECS is an appropriate intervention for children with autism spectrum disorders who have limited or no communication skills. To increase the utility of this intervention, an important area for future research is to investigate PECS procedures for promoting initiation of communication and acquisition of complex, flexible language.
Selected References:
Selected scientific studies:
• Howlin, P., Gordon, R. K., Pasco, G., Wade, G., & Charman, T. (2007). Journal of Child Psychology & Psychiatry, 48, 473-481.
• Yoder, P., & Stone, W. L. (2006). Randomized comparison of two communication interventions for preschoolers with autism. Journal of Consulting and Clinical Psychology, 74, 426-425.
For additional information:
• Bondy, A. & Frost, L. (2001). The Picture Exchange Communication System. Behavior Modification, 25, 725-744.
6. Project TEACCH (Treatment and Education of Autistic and related Communication-handicapped CHildren)
Description : In TEACCH, children and adults with autism spectrum disorders receive individual classroom instruction designed to accommodate learning styles characteristic of autism spectrum disorders. For example, because visual skills tend to be more advanced than verbal skills, instructions may be presented in pictures rather than words, and tasks may have visual prompts (e.g., grooves to indicate where to place items, pictures of each step of the task, etc.). Because classroom noise or intrusions from peers may be distracting or aversive, individuals with autism spectrum disorders often work at their own workstations rather than with classmates, though small group instruction also occurs. Because transitions from one activity to another may be difficult, individuals with autism spectrum disorders may have a highly structured schedule placed at their workstations.
Research Summary: TEACCH is widely considered to be a plausible intervention approach (i.e., one that could be effective; National Research Council, 2001). One small but well-designed study indicated that parent training provided by TEACCH may accelerate the development of cognitive and self-help skills (Ozonoff & Cathcart, 1998). Another small study indicated that TEACCH workstations may increase on-task behavior and completion of assignments (Hume & Odom, 2007). Other aspects of TEACCH such as classroom instruction have support from preliminary studies (e.g., Lord & Schopler, 1989) but have not been evaluated in peer-reviewed studies with strong experimental designs.
Recommendations: An important area for future research is to evaluate TEACCH in studies with strong experimental designs. Professionals should present TEACCH as untested and encourage families who are considering this intervention to evaluate it carefully.
Selected References:
Selected scientific studies:
• Lord, C., & Schopler, E. (1989). The role of age at assessment, developmental level, and test in the stability of intelligence scores in young autistic children. Journal of Autism & Developmental Disorders. 19, 483-499.
• National Research Council (2001). Educating Children with Autism. Washington DC: National Academy Press.
• Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism & Developmental Disorders, 28, 25-32.
• Hume, K., & Odom, S. (2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism & Developmental Disorders, 37, 1166-1180.
Systematic Reviews:
• National Research Council (2001). Educating Children with Autism. Washington DC: National Academy Press.
7. Recreational Sports/Exercise
Description: Attendance at sports classes such as swimming, gymnastics, or martial arts to give the child opportunities to develop athletic skills and interact, participate in group activities, and interact with other children.
Research Summary: Recreational sports may be a healthy and enjoyable activity, affording opportunities to generalize skills learned in therapy or school programs. However, their effects have not been evaluated in scientific studies with strong experimental designs.
Antecedent exercise, in which an individual exercises on a regular schedule, may reduce aggression or repetitive behaviors for some individuals with autism spectrum disorders (Celiberti, Bobo, Kelly, Harris, & Handleman, 1997; Rosenthal-Malek & Mitchell, 1997).
Some studies suggest that simply placing children with autism spectrum disorders in settings with typical peers, without any other intervention, may increase their social interactions (Lord & Hopkins, 1986) and reduce their repetitive behaviors (McGee, Paradis, & Feldman, 1993), but other studies have not shown these effects (Strain, 1983). Thus, additional research is needed on whether simply placing children with autism spectrum disorders in settings with typical peers is effective. However, there is strong evidence from multiple studies that placing children with autism spectrum disorders in settings with typically developing peers who have been taught to serve as tutors or models is effective in increasing social interactions (McConnell, 2002).
Recommendations: Recreational sports may have health benefits, may be an enjoyable leisure activity for individuals with autism spectrum disorders, and, in some cases, may help prevent problem behavior such as aggression. Sports also may afford opportunities for socialization, particularly if peers who have been taught to serve as tutors or models are available during the activity.
Selected References:
Selected scientific studies:
• Lord, C., & Hopkins, J. M. (1986). The social behavior of autistic children with younger and same-age nonhandicapped peers. Journal of Autism and Developmental Disorders, 16, 249-262.
• Celiberti, D. A., Bobo, H. E., Kelly, K. S., Harris, S. L., & Handleman, J. L. (1997). The differential and temporal effects of antecedent exercise on the self-stimulatory behavior of a child with autism. Research in Developmental Disabilities, 18, 139-150.
• McGee, G. G., Paradis, T., & Feldman, R. S. (1993). Free effects of integration on levels of autistic behavior. Topics in Early Childhood Special Education, 13, 57-67.
• Rosenthal-Malek, A., & Mitchell, S. (1997). The effects of exercise on the self-stimulatory behaviors and positive responding of adolescents with autism. Journal of Autism and Developmental Disorders, 27, 193-202.
• Strain, P. S. (1983). Generalization of autistic children’s social behavior change: Effects of developmentally integrated and segregated settings. Analysis and Intervention in Developmental Disabilities, 3, 23-34.
Systematic reviews of scientific studies:
• McConnell, S. (2002). Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351-372.
8. Socialization related classes
Description: Attendance at classes in the community to give the child opportunities to participate in group activities and interact with other children. Socialization classes are different from an integrated preschool, where therapeutic and special education services are delivered in a typical educational classroom.
Examples: Mommy and Me class, Gymboree, or Private preschool
Research Summary: Socialization related classes may be an enjoyable recreational activity, affording opportunities to generalize skills learned in therapy or school programs. However, their effects have not been evaluated in scientific studies with strong experimental designs.
Some studies suggest that simply placing children with autism spectrum disorders in settings with typical peers, without any other intervention, may increase their social interactions (Lord & Hopkins, 1986) and reduce their repetitive behaviors (McGee, Paradis, & Feldman, 1993), but other studies have not shown these effects (Strain, 1983). Thus, additional research is needed on whether simply placing children with autism in settings with typical peers is effective. However, there is strong evidence from multiple studies that placing children with autism spectrum disorders in settings with typically developing peers who have been taught to serve as tutors or models is effective in increasing social interactions (McConnell, 2002).
Recommendations: Socialization-related classes may be an enjoyable leisure activity for individuals with autism spectrum disorders. They also may afford opportunities for socialization, particularly if peers who have been taught to serve as tutors or models are available during the activity.
Selected References:
Selected scientific studies:
• Lord, C., & Hopkins, J. M. (1986). The social behavior of autistic children with younger and same-age nonhandicapped peers. Journal of Autism and Developmental Disorders, 16, 249-262.
• McGee, G. G., Paradis, T., & Feldman, R. S. (1993). Free effects of integration on levels of autistic behavior. Topics in Early Childhood Special Education, 13, 57-67.
• Strain, P. S. (1983). Generalization of autistic children’s social behavior change: Effects of developmentally integrated and segregated settings. Analysis and Intervention in Developmental Disabilities, 3, 23-34.
Systematic reviews of scientific studies:
• McConnell, S. (2002). Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351-372. |
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发表于 2008-11-25 14:34:54
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