Evidence Based Practices
Evidence Based Practices in Autism
Lynetric Rivers
Liberty University
3-11-13
Abstract
Autism and ASD (Autism Spectrum Disorders) has been one of the biggest misunderstood and misdiagnosed disorders. Working with children with autism presents different obstacles in regards to dealing with emotional, aggressive and depressive behaviors. This paper will show how Evidence-Based Practices can be highly effective when dealing with children with autism in the classroom, community and in the home. Further the definition of autism, ASD and what constitutes a medical/mental health diagnosis will be investigated also certain behavior problems that plague this population will be identified. In addition, Evidence-Based Practices will be explored …show more content…
and explained in relation to its usefulness in treating behaviors in children with autism. Probing simple exercises to increase coordination, sensory processing and functional skills will also be addressed for its usefulness in conjunction to Evidence-Based Practices as it relates to autism.
Evidence Based Practices in Autism
Introduction
Evidence-Based Practices (EBP) have been in existence since the 1970s. These practices can address a variety of problems in order that a person 's life may have quality, consistency and structure. Evidence-Based Practices have been very effective when addressing autism in children. There are several types of EBP such as, ABA (applied behavior analysis) and pivotal response training just to name a couple. David Sackett one of the founders of EBP stated, "Evidence-Based Practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 312)
This paper will show empirical data supporting the effectiveness of EBP in children with autism. This author will define autism and ASD; identify behaviors that are problematic with in the classroom, home and the community. Further this author will explain EBP in the form of describing some of the practices it utilizes. By exploring practices within EBP studies will show practical, useful interventions for teachers, clinicians, and parents to help in social validation, reducing repetitive behaviors and increasing social skills. Having a working understanding of autism can help provide best case practice for the children who have been diagnosed with this disorder.
Evidence Based Practices in Autism
EBP
A few practices of EBP are Applied Behavior Analysis (ABA), Pivotal Response Treatment (PRT) and Verbal Behavior Therapy, “ABA is a scientific approach to understanding behavior and how this is affected by the environment. The science of behavior analysis focuses on principles about how behavior works, or how learning takes place.” (Shannon, 2011, p. 340) This approach was created by three theorists, Ivan Pavlov, John Watson and B.F Skinner and continues to be effective to this day. This also is effective when treating children with autism; it specifically deals with the behavior in relation to the environment, Boyd stated, “The field of ABA has made significant and long-lasting contributions to evidence-based for the treatment of repetitive behavior and ASD. Currently there is evidence to support both consequence an antecedent-based treatment approaches for this symptom domain.” (Boyd, McDonough, & Bodfish, 2012, p. 1236) Pivotal Response Treatment or PRT is another practice which is also founded on ABA. This treatment however, places emphasis on behavior being essential to social skills and learning. Volkmar stated, “An important goal of this intervention is generalization of skills use of same skills across settings with different people or materials. PRT procedures have been used to facilitate language, play, and social skills.” (Volkmar & Wiesner, 2009, p. 120) Verbal Behavior Therapy obviously focuses more on verbal communication in relation to ASD this can also take form in sign language as well. According to Coplan, “The power of Verbal Behavior Therapy stems from its ability to analyze the function of work and teach worth according to these functions.” (Coplan, 2010, p. 195) By utilizing VB, this can enhance the child 's awareness of communication and thus increase social skills, less than aggression, and create a comfortable space.
Defining Autism and ASD
Autism and Autism Spectrum Disorder (ASD) can be very confusing words to define. For some it elicits thoughts of children who are isolated, loners, mentally retarded, or spastic. These thoughts represent children in the autism spectrum, some thoughts that are negative, some neutral, and some positive. To understand how to best service children with autism and ASD, the words themselves must be defined. Autism according the Autism and Pervasive Developmental Disorder Sourcebook, “People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.” (Shannon, 2011, p. 572) Some other characteristics of autism also include self injurious behaviors, hypersensitivity, difficulty with eye contact, and problems with repetitive behavior.
Autism can be detected as early as three months old. Children can be tested by the pediatrician using an autism spectrum disorder specific developmental screenings at the child 's well check appointment. Physically, a child with autism will have a larger brain as opposed to their counterparts. Neuroscience is currently researching how certain genes may actually cause autism. According to Feldman, “The work of cognitive neurosciences is also providing clues to the cause of autism a major development disability that can produce profound language defects and self-injurious behaviors in young children. Identifying the genes that make one vulnerable to such disorders is the first step in genetic engineering in which gene therapy can reduce or even prevent disorder from occurring.” (Feldman, p. 21) According to the Centers for Disease Control and Prevention, “New data shows an average of one in 110 children have an autism spectrum disorder.” This information is centered on several different communities was about 8% of the American population of eight-year-olds. Autism spectrum disorder or ASD contains several pervasive disorders; children with ASD have problems in social relations, communication and also repetitive behaviors.
Pervasive disorders include: Classic Autism, Asperger Syndrome, Rhett Syndrome, and Pervasive Development Disorder NOS (not otherwise specified). Historically, autism was identified in the 1940s and was interconnected with schizophrenia. Dr. Coplan stated, “Prior to 1980, physicians use the term childhood schizophrenia to cover a vast range of disorders, from delusions and hallucinations to what we now call ASD.” (2010, p. 85) Children can be diagnosed with autism or ASD by a licensed professional such as a psychologist, psychiatrist, or therapist who can also identify and complete a multidisciplinary evaluation for children as well. These professionals utilize interviews with the child, parent/caregiver, observation and evaluations. Evaluations can include the use of the DSM-IV, the Social Communication Questionnaire, Autism Diagnostic Observation Schedule, Gilliam Autism Rating Scales, and Autism Diagnostic Interview-Revised. “These tests may take the form of either parent completing rating scales for interviews, or they may need to be based on actual work of the child.” (Volkmar & Wiesner, 2009, p. 68)The parents will usually be the first to notice something is not quite right in their child’s development, by noticing the child does not respond to their name, there is no ‘baby talk” or babbling, and …show more content…
also no social responsiveness which would then prompt the need for evaluation.
Problematic Behaviors
Autistic children can often times have behaviors that prove problematic at home, in the classroom, and in the community. Teachers and clinicians that provide services for this population need to be able to identify difficult behaviors in order to better serve as this population. Some of the problem behaviors that have been noted are, aggression, social impairment, self-abusive behaviors such as biting, head banging, rocking and twirling. In addition, there are also problems with aggression, teeth grinding, empathy and echolalia. According to Volkmar echolalia is, “A parrot like repetition of phrases or words just her or heard hours, days, weeks, or even months before.” (Volkmar & Wiesner, 2009, p. 430) For obvious reasons some of these behaviors can not only the dangerous to the child, but also to those around her. Teachers and parents can often find themselves very challenged by these behaviors. Teachers at times can be ill-prepared to deal with children who have autism Lerman stated, “Most teachers receive relatively little, if any, formal instruction evidence-based practices for children with autism. The scarcity of specialized preparation in autism at colleges of education may be attributable to the low incidence of the disorder relative to other disabilities.” (Lerman, Vorndran, Addison, & Kuhn, 2004, p. 510) Parents find them challenging while in social situations, such as being in the community, with family, or in new environments. One of the questions proposed by most parents and teachers concerns the effectiveness of medication. Would medication decrease the aggressiveness and the self-injurious behaviors that children with autism display? This is another aspect of autism in which licensed professionals would address with caregivers and other providers involved with the child.
In the classroom some of the more problematic behaviors include; repetitive behaviors such as echolalia, flapping arms, and self-injurious conduct. When children with autism are mainstreamed into regular education classes the teacher will have to be well-equipped to handle these behaviors in order to keep the classroom safe and continued educational process. “ When considering inclusion of the child with an ASD in mainstream settings, parents and the school must take into account the needs of the child, the context of inclusion, the need for adult supervision, the expectations of peers and so forth.” (Volkmar & Wiesner, 2009, p. 135) Using EBP in the classroom is a necessary part of educational process and demands a multidisciplinary team approach to achieve the best possible outcome, according to Odom, “Evidence-Based Practices are the basis on which teachers and other service providers are required to design educational programs for learners with autism spectrum disorder.” (Odom, Klingenberg, Rogers, & Hatton, 2010b, p. 275) Incorporating the multidisciplinary team approach ensures that no one is isolated from the planning process. This helps to ensure children with autism or ASD are receiving proper services in an educational setting. When parents experience problematic behaviors at home the child may react differently to certain stimuli and interventions, since this is a more familiar environment. The parents are also a disadvantage due to increasing stress and possibly financial strains due to the needs of the child. Frazee stated, “Children with ASD are significantly more likely than to have problems regarding access to care and unmet needs, and their families have greater financial, employment, and time burdens compared with other children with special health care needs.” (Frazee, Drahota, & Standnick, 2011, p. 1651)The community can provide different challenges for children with autism. Some of these challenges can include hypersensitivity, aggression and social awkwardness. With the assistance of Evidence-Based Practices (EBP) professionals can aid in the reduction of problematic behaviors in the classroom, home and community.
EBP Interventions
Interventions address the targeted behaviors identified by a parent, teacher or other licensed professional. Children who suffer from hypersensitivity may need adjustments while experiencing the stimuli. According to Coplan, “Modifications such as providing the hypersensitive child with earplugs or headphones to block out environmental noise, avoidance of rough clothing, removal of clothing tags, replacing the flickering fluorescent lights, and other strategies are common.” (Coplan, 2010, p. 222) Since there are some behaviors that deal with sensory processing which may hinder the learning process, assisting the child with their conception of a sensory environment will better enable the child to be more successful. In the book Everyday Activities to help your Young Child with Autism live life to the Full it states, “Being aware of all that is being asked of the child in terms of understanding sensory environment is a great step toward helping him adapt them feel comfortable in the world.” (Jacobs & Betts, 2012, p. 80) This will greatly reduce some of the self-soothing behaviors that can be problematic at times such as flapping arms, rocking, hiding or even becoming aggressive.
There are several other interventions that are used in relation to EBP such as peer mediated intervention, visual supports, positive behavior support, self-monitoring, videotape modeling, and family involvement. Peer mediated intervention involves promoting preferred use of social behaviors and communication skills. According to Odom et al, “Schaffer, taught peers three classes of behaviors to be directed to children with autism, which led to increases in communicative interaction.” (Odom, et al., 2003, p. 171) Concerning visual supports they are signals that encourage children to participate in a behavior to ready them for the next event or activity. Positive behavior support is a collection of procedures intended to tackle problematic behaviors of children with autism. Self-monitoring enables children to have ownership in their behavior by accessing information that reinforces a new learned skill.
Videotape modeling intervention affords the child the opportunity to view positive examples of either himself or his peers participating in a taught behavior. There has been videotape modeling that includes toilet training, and functional living skills. While family involvement may not sound like an intervention family definitely intervene on several levels. Families must be able to effectively handle the children for the well-being of the entire family. According to Odom et. al, “To promote the use of argument to communication in the home Stiebel use the problem-solving interventions based on home teams to teach peers for the child 's communication, this also involves siblings in play activities promote the play of the children with autism.” (Odom, et al., p. 171) With repetitive behaviors using Cognitive Behavioral Therapy (CBT) has also been proven effective by providing psycho education to reprogram the thought process in regards to the undesired behavior. This accompanied by recognizing the symptoms of the behavior and finally following through with homework assignments in regards to correcting the behavior with the child and family can prove useful in minimizing or eliminating the behaviors. This is particularly true in regards to dual diagnosis Boyd said, “Currently it appears that CBT could be a promising treatment for individuals with ASD who have a comorbid diagnosis.” (Boyd, McDonough, & Bodfish, 2012, p. 1242)
There are other activities which can improve daily life for a child with ASD. One activity that really stands out is play. Play can be encouraged in the home school and community. As stated previously children with ASD have problems with social interactions and playing alone is not the problem. Encouraging the child to engage with others in play can at times be problematic. Play fosters very many things in children such as building relationships, sharing, and communicating on different levels. According to Jacobs she stated, “It is during playing that the child will try various roles, learn how to relate with others, and work to make others understand him.” (Jacobs & Betts, 2012, p. 103) By providing a child with positive opportunities to engage with playmates in different situations will begin to equip the child with new social skills that will be invaluable as they continue to develop. Another activity is assisting the child in remaining calm when faced with stressful situations. Incorporating an expected routine lays the foundation for tranquility and peace. When the child has routine that is consistently followed this provides security and safety. Understanding how the five senses can affect the child on a daily basis is essential. Some children who suffer from ASD have problems with certain textures and clothing, or bright lights, loud noises, different smells and unexplored tastes. With this in mind any one of these examples could potentially be disastrous depending on the child, according to Jacobs, “the goal then is to find balance. Providing the child with sensory experiences he needs to feel more balanced and comfortable in the world.” (Jacobs & Betts, p. 78) Delivering positive sensory experiences will provoke more curiosity from the child and progress the child 's development.
Empirical Studies
There have been many empirical studies completed on the effectiveness of EBP in autism.
The studies have been able to rule out certain misconceptions about autism, and practices that are effective with this population. Mesibov was certain about the advances EBP has made in this field he stated, “Many years ago empiricism putting into psychodynamic speculations about parental pathology is the cause of autism. Empiricism continues to enable the field to move beyond testimonial and antecedents from family members and with autism has resulted.” (Mesibov & Shea, 2011, p. 114). He goes on to say also how EBP has acted as a counterbalance in educational settings and has been a great authority in how services will ultimately be provided for students with autism. Social validity also plays a part in empirical studies regarding EBP in autism. “Social validity refers to the social acceptability of the goals, procedures and outcomes of programs and interventions.” (Callahan, Henson, & Cowan, 2008, p. 678) This is according to Callahan hypothesizes that social validity is correlated with effectiveness. According to his outcomes this appears to be true he used “overall in group means and standard deviations and Omega squares for all surveyed items, ranked by overall mean from highest to lowest.” (Callahan, Henson, & Cowan, 2008, p. 680) Through these examinations is been proven EBP continues to be effective in children with autism. Studies continue to develop in order to
obtain the best possible practice available to properly service this population.
Conclusion
Training, resources, implementation and support are all keys to empowering teachers, parents and clinicians in regards to best practice concerning children with autism. EBP has been proven over several decades of its effectiveness with problematic behaviors with the autistic population. With supports to the family this can only increase the chances of successfully integrating the child in the classroom and community. It is a partnership between all involved in communication is vital. By implementing proven interventions children with autism as a community of providers the enhancement of self-care, social skills, and education can only provide a better quality of life and a better adjusted child.
References
Boyd, B., McDonough, S., & Bodfish, J. (2012). Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism. Journal Autism Developmental Disorders, 42, 1248.
Callahan, K., Henson, R., & Cowan, A. (2008). Social Validation of Evidence-Based Practices in Autism by Parents, Teachers, and Administrators. Journal Autism Developmental Disorders, 38, 692.
Coplan, J. (2010). Making sense of Autistic Spectrum Disorders (p. 85). New York, New York: Bantam Books.
Feldman, R. (2011). Development Across the Life Span (p. 21). Upper Saddle River, New Jersey: Prentice Hall.
Frazee, L., Drahota, A., & Standnick, N. (2011). Training Community Mental Health Therapists to Deliver a Package of Evidence-Based Practice Strategies for School-Aged Children with Autism Spectrum Disorders: A Pilot Study. Journal Autism Developmental Disorders, 42, 1661.
Jacobs, D., & Betts, D. (2012). Everyday Activities to help your Young Child with Autism live life to the Full (p. 80). Philadelphia, PA: Jessica Kingsley Publishers.
Leblanc, L., Richardson, W., & Burns, K. (2009). Autism Spectrum Disorder in the Inclusive Classroom and. Teacher Education and Special Education, 32(2), 179.
Lerman, D., Vorndran, C., Addison, L., & Kuhn, S. (2004). Preparing Teachers in Evidence-Based Practices for young children with Autism. School Psychology Review, 33(4), 526.
Mesibov, G., & Shea, V. (2011). Evidence-Based Practices and Autism. Autism, 15(1), 133.
Odom, S., Brown, W., Frey, T., Karasu, N., Canter, L., & Strain, P. (2003, Fall). Evidence-Based Practices for Young Children with Autism: Contributions for Single Subject Design Research. Focus on Autism and Other Developmental Disabilities, 18(3), 175.
Odom, S., Brown, W., Frey, T., Karasu, N., Canter, L., & Strain, P. (2003, Fall). Evidence-Based Practices for Young Children with Autism: Contributions for Single Subject Design Research. Focus on Autism and Other Developmental Disabilities, 18(3), 175.
Odom, S., Brown, W., Frey, T., Karasu, N., Canter, L., & Strain, P. (2003, Fall). Evidence-Based Practices for Young Children with Autism: Contributions for Single Subject Design Research. Focus on Autism and Other Developmental Disabilities, 18(3), 175.
Odom, S., Klingenberg, L., Rogers, S., & Hatton, D. (2010a). Evidence-Based Practices in Interventions for Children and Youth with Autism Spectrum Disorders. Preventing School Failure, 54(4), 282.
Reecho, B., & Volkmar, F. (2010). Social skills interventions for individuals with autism: evaluation for evidence-based practices within a best evidence synthesis framework. Journal Autism Developmental Discord, 40, 166.
Reichow, B., Volkmar, F., & Cicchetti, D. (2008). Development of Evaluative Method for Evaluating and Determining Evidence-Based Practices in Autism. Journal Autism Developmental Disorders, 38, 1319.
Sackett, D., Rosenberg, W., Gray, J. M., Haynes, B., & Richardson, S. (1996). Evidence based medicine: What it is and what it isn 't. BMJ, 371.
Shannon, J. (2011). Autism and Pervasive Developmental Disorders Sourcebook (p. 572). Detroit, MI: Omnigraphics.
Volkmar, F., & Wiesner, L. (2009). A Practical Guide to Autism (p. 68). Hoboken, New Jersey: Wiley.
Lynetric Rivers
Liberty University
3-11-13
Abstract
Autism and ASD (Autism Spectrum Disorders) has been one of the biggest misunderstood and misdiagnosed disorders. Working with children with autism presents different obstacles in regards to dealing with emotional, aggressive and depressive behaviors. This paper will show how Evidence-Based Practices can be highly effective when dealing with children with autism in the classroom, community and in the home. Further the definition of autism, ASD and what constitutes a medical/mental health diagnosis will be investigated also certain behavior problems that plague this population will be identified. In addition, Evidence-Based Practices will be explored …show more content…
and explained in relation to its usefulness in treating behaviors in children with autism. Probing simple exercises to increase coordination, sensory processing and functional skills will also be addressed for its usefulness in conjunction to Evidence-Based Practices as it relates to autism.
Evidence Based Practices in Autism
Introduction
Evidence-Based Practices (EBP) have been in existence since the 1970s. These practices can address a variety of problems in order that a person 's life may have quality, consistency and structure. Evidence-Based Practices have been very effective when addressing autism in children. There are several types of EBP such as, ABA (applied behavior analysis) and pivotal response training just to name a couple. David Sackett one of the founders of EBP stated, "Evidence-Based Practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 312)
This paper will show empirical data supporting the effectiveness of EBP in children with autism. This author will define autism and ASD; identify behaviors that are problematic with in the classroom, home and the community. Further this author will explain EBP in the form of describing some of the practices it utilizes. By exploring practices within EBP studies will show practical, useful interventions for teachers, clinicians, and parents to help in social validation, reducing repetitive behaviors and increasing social skills. Having a working understanding of autism can help provide best case practice for the children who have been diagnosed with this disorder.
Evidence Based Practices in Autism
EBP
A few practices of EBP are Applied Behavior Analysis (ABA), Pivotal Response Treatment (PRT) and Verbal Behavior Therapy, “ABA is a scientific approach to understanding behavior and how this is affected by the environment. The science of behavior analysis focuses on principles about how behavior works, or how learning takes place.” (Shannon, 2011, p. 340) This approach was created by three theorists, Ivan Pavlov, John Watson and B.F Skinner and continues to be effective to this day. This also is effective when treating children with autism; it specifically deals with the behavior in relation to the environment, Boyd stated, “The field of ABA has made significant and long-lasting contributions to evidence-based for the treatment of repetitive behavior and ASD. Currently there is evidence to support both consequence an antecedent-based treatment approaches for this symptom domain.” (Boyd, McDonough, & Bodfish, 2012, p. 1236) Pivotal Response Treatment or PRT is another practice which is also founded on ABA. This treatment however, places emphasis on behavior being essential to social skills and learning. Volkmar stated, “An important goal of this intervention is generalization of skills use of same skills across settings with different people or materials. PRT procedures have been used to facilitate language, play, and social skills.” (Volkmar & Wiesner, 2009, p. 120) Verbal Behavior Therapy obviously focuses more on verbal communication in relation to ASD this can also take form in sign language as well. According to Coplan, “The power of Verbal Behavior Therapy stems from its ability to analyze the function of work and teach worth according to these functions.” (Coplan, 2010, p. 195) By utilizing VB, this can enhance the child 's awareness of communication and thus increase social skills, less than aggression, and create a comfortable space.
Defining Autism and ASD
Autism and Autism Spectrum Disorder (ASD) can be very confusing words to define. For some it elicits thoughts of children who are isolated, loners, mentally retarded, or spastic. These thoughts represent children in the autism spectrum, some thoughts that are negative, some neutral, and some positive. To understand how to best service children with autism and ASD, the words themselves must be defined. Autism according the Autism and Pervasive Developmental Disorder Sourcebook, “People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.” (Shannon, 2011, p. 572) Some other characteristics of autism also include self injurious behaviors, hypersensitivity, difficulty with eye contact, and problems with repetitive behavior.
Autism can be detected as early as three months old. Children can be tested by the pediatrician using an autism spectrum disorder specific developmental screenings at the child 's well check appointment. Physically, a child with autism will have a larger brain as opposed to their counterparts. Neuroscience is currently researching how certain genes may actually cause autism. According to Feldman, “The work of cognitive neurosciences is also providing clues to the cause of autism a major development disability that can produce profound language defects and self-injurious behaviors in young children. Identifying the genes that make one vulnerable to such disorders is the first step in genetic engineering in which gene therapy can reduce or even prevent disorder from occurring.” (Feldman, p. 21) According to the Centers for Disease Control and Prevention, “New data shows an average of one in 110 children have an autism spectrum disorder.” This information is centered on several different communities was about 8% of the American population of eight-year-olds. Autism spectrum disorder or ASD contains several pervasive disorders; children with ASD have problems in social relations, communication and also repetitive behaviors.
Pervasive disorders include: Classic Autism, Asperger Syndrome, Rhett Syndrome, and Pervasive Development Disorder NOS (not otherwise specified). Historically, autism was identified in the 1940s and was interconnected with schizophrenia. Dr. Coplan stated, “Prior to 1980, physicians use the term childhood schizophrenia to cover a vast range of disorders, from delusions and hallucinations to what we now call ASD.” (2010, p. 85) Children can be diagnosed with autism or ASD by a licensed professional such as a psychologist, psychiatrist, or therapist who can also identify and complete a multidisciplinary evaluation for children as well. These professionals utilize interviews with the child, parent/caregiver, observation and evaluations. Evaluations can include the use of the DSM-IV, the Social Communication Questionnaire, Autism Diagnostic Observation Schedule, Gilliam Autism Rating Scales, and Autism Diagnostic Interview-Revised. “These tests may take the form of either parent completing rating scales for interviews, or they may need to be based on actual work of the child.” (Volkmar & Wiesner, 2009, p. 68)The parents will usually be the first to notice something is not quite right in their child’s development, by noticing the child does not respond to their name, there is no ‘baby talk” or babbling, and …show more content…
also no social responsiveness which would then prompt the need for evaluation.
Problematic Behaviors
Autistic children can often times have behaviors that prove problematic at home, in the classroom, and in the community. Teachers and clinicians that provide services for this population need to be able to identify difficult behaviors in order to better serve as this population. Some of the problem behaviors that have been noted are, aggression, social impairment, self-abusive behaviors such as biting, head banging, rocking and twirling. In addition, there are also problems with aggression, teeth grinding, empathy and echolalia. According to Volkmar echolalia is, “A parrot like repetition of phrases or words just her or heard hours, days, weeks, or even months before.” (Volkmar & Wiesner, 2009, p. 430) For obvious reasons some of these behaviors can not only the dangerous to the child, but also to those around her. Teachers and parents can often find themselves very challenged by these behaviors. Teachers at times can be ill-prepared to deal with children who have autism Lerman stated, “Most teachers receive relatively little, if any, formal instruction evidence-based practices for children with autism. The scarcity of specialized preparation in autism at colleges of education may be attributable to the low incidence of the disorder relative to other disabilities.” (Lerman, Vorndran, Addison, & Kuhn, 2004, p. 510) Parents find them challenging while in social situations, such as being in the community, with family, or in new environments. One of the questions proposed by most parents and teachers concerns the effectiveness of medication. Would medication decrease the aggressiveness and the self-injurious behaviors that children with autism display? This is another aspect of autism in which licensed professionals would address with caregivers and other providers involved with the child.
In the classroom some of the more problematic behaviors include; repetitive behaviors such as echolalia, flapping arms, and self-injurious conduct. When children with autism are mainstreamed into regular education classes the teacher will have to be well-equipped to handle these behaviors in order to keep the classroom safe and continued educational process. “ When considering inclusion of the child with an ASD in mainstream settings, parents and the school must take into account the needs of the child, the context of inclusion, the need for adult supervision, the expectations of peers and so forth.” (Volkmar & Wiesner, 2009, p. 135) Using EBP in the classroom is a necessary part of educational process and demands a multidisciplinary team approach to achieve the best possible outcome, according to Odom, “Evidence-Based Practices are the basis on which teachers and other service providers are required to design educational programs for learners with autism spectrum disorder.” (Odom, Klingenberg, Rogers, & Hatton, 2010b, p. 275) Incorporating the multidisciplinary team approach ensures that no one is isolated from the planning process. This helps to ensure children with autism or ASD are receiving proper services in an educational setting. When parents experience problematic behaviors at home the child may react differently to certain stimuli and interventions, since this is a more familiar environment. The parents are also a disadvantage due to increasing stress and possibly financial strains due to the needs of the child. Frazee stated, “Children with ASD are significantly more likely than to have problems regarding access to care and unmet needs, and their families have greater financial, employment, and time burdens compared with other children with special health care needs.” (Frazee, Drahota, & Standnick, 2011, p. 1651)The community can provide different challenges for children with autism. Some of these challenges can include hypersensitivity, aggression and social awkwardness. With the assistance of Evidence-Based Practices (EBP) professionals can aid in the reduction of problematic behaviors in the classroom, home and community.
EBP Interventions
Interventions address the targeted behaviors identified by a parent, teacher or other licensed professional. Children who suffer from hypersensitivity may need adjustments while experiencing the stimuli. According to Coplan, “Modifications such as providing the hypersensitive child with earplugs or headphones to block out environmental noise, avoidance of rough clothing, removal of clothing tags, replacing the flickering fluorescent lights, and other strategies are common.” (Coplan, 2010, p. 222) Since there are some behaviors that deal with sensory processing which may hinder the learning process, assisting the child with their conception of a sensory environment will better enable the child to be more successful. In the book Everyday Activities to help your Young Child with Autism live life to the Full it states, “Being aware of all that is being asked of the child in terms of understanding sensory environment is a great step toward helping him adapt them feel comfortable in the world.” (Jacobs & Betts, 2012, p. 80) This will greatly reduce some of the self-soothing behaviors that can be problematic at times such as flapping arms, rocking, hiding or even becoming aggressive.
There are several other interventions that are used in relation to EBP such as peer mediated intervention, visual supports, positive behavior support, self-monitoring, videotape modeling, and family involvement. Peer mediated intervention involves promoting preferred use of social behaviors and communication skills. According to Odom et al, “Schaffer, taught peers three classes of behaviors to be directed to children with autism, which led to increases in communicative interaction.” (Odom, et al., 2003, p. 171) Concerning visual supports they are signals that encourage children to participate in a behavior to ready them for the next event or activity. Positive behavior support is a collection of procedures intended to tackle problematic behaviors of children with autism. Self-monitoring enables children to have ownership in their behavior by accessing information that reinforces a new learned skill.
Videotape modeling intervention affords the child the opportunity to view positive examples of either himself or his peers participating in a taught behavior. There has been videotape modeling that includes toilet training, and functional living skills. While family involvement may not sound like an intervention family definitely intervene on several levels. Families must be able to effectively handle the children for the well-being of the entire family. According to Odom et. al, “To promote the use of argument to communication in the home Stiebel use the problem-solving interventions based on home teams to teach peers for the child 's communication, this also involves siblings in play activities promote the play of the children with autism.” (Odom, et al., p. 171) With repetitive behaviors using Cognitive Behavioral Therapy (CBT) has also been proven effective by providing psycho education to reprogram the thought process in regards to the undesired behavior. This accompanied by recognizing the symptoms of the behavior and finally following through with homework assignments in regards to correcting the behavior with the child and family can prove useful in minimizing or eliminating the behaviors. This is particularly true in regards to dual diagnosis Boyd said, “Currently it appears that CBT could be a promising treatment for individuals with ASD who have a comorbid diagnosis.” (Boyd, McDonough, & Bodfish, 2012, p. 1242)
There are other activities which can improve daily life for a child with ASD. One activity that really stands out is play. Play can be encouraged in the home school and community. As stated previously children with ASD have problems with social interactions and playing alone is not the problem. Encouraging the child to engage with others in play can at times be problematic. Play fosters very many things in children such as building relationships, sharing, and communicating on different levels. According to Jacobs she stated, “It is during playing that the child will try various roles, learn how to relate with others, and work to make others understand him.” (Jacobs & Betts, 2012, p. 103) By providing a child with positive opportunities to engage with playmates in different situations will begin to equip the child with new social skills that will be invaluable as they continue to develop. Another activity is assisting the child in remaining calm when faced with stressful situations. Incorporating an expected routine lays the foundation for tranquility and peace. When the child has routine that is consistently followed this provides security and safety. Understanding how the five senses can affect the child on a daily basis is essential. Some children who suffer from ASD have problems with certain textures and clothing, or bright lights, loud noises, different smells and unexplored tastes. With this in mind any one of these examples could potentially be disastrous depending on the child, according to Jacobs, “the goal then is to find balance. Providing the child with sensory experiences he needs to feel more balanced and comfortable in the world.” (Jacobs & Betts, p. 78) Delivering positive sensory experiences will provoke more curiosity from the child and progress the child 's development.
Empirical Studies
There have been many empirical studies completed on the effectiveness of EBP in autism.
The studies have been able to rule out certain misconceptions about autism, and practices that are effective with this population. Mesibov was certain about the advances EBP has made in this field he stated, “Many years ago empiricism putting into psychodynamic speculations about parental pathology is the cause of autism. Empiricism continues to enable the field to move beyond testimonial and antecedents from family members and with autism has resulted.” (Mesibov & Shea, 2011, p. 114). He goes on to say also how EBP has acted as a counterbalance in educational settings and has been a great authority in how services will ultimately be provided for students with autism. Social validity also plays a part in empirical studies regarding EBP in autism. “Social validity refers to the social acceptability of the goals, procedures and outcomes of programs and interventions.” (Callahan, Henson, & Cowan, 2008, p. 678) This is according to Callahan hypothesizes that social validity is correlated with effectiveness. According to his outcomes this appears to be true he used “overall in group means and standard deviations and Omega squares for all surveyed items, ranked by overall mean from highest to lowest.” (Callahan, Henson, & Cowan, 2008, p. 680) Through these examinations is been proven EBP continues to be effective in children with autism. Studies continue to develop in order to
obtain the best possible practice available to properly service this population.
Conclusion
Training, resources, implementation and support are all keys to empowering teachers, parents and clinicians in regards to best practice concerning children with autism. EBP has been proven over several decades of its effectiveness with problematic behaviors with the autistic population. With supports to the family this can only increase the chances of successfully integrating the child in the classroom and community. It is a partnership between all involved in communication is vital. By implementing proven interventions children with autism as a community of providers the enhancement of self-care, social skills, and education can only provide a better quality of life and a better adjusted child.
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