Does Early Intervention Help Improve the Language Barrier for Children with Autism?

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17th Jun 2020 Nursing Essay Reference this

Tags: autism

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Due to the rapid growth in Autism diagnoses, ABA clinics have dramatically increased in many states. Medical specialists are now treating ABA therapy as a treatment for obstacles individuals with Autism face. These treatments are intensive and parents are now seeing the importance of Early Intervention. With high demands for a solution, Autism has expanded outside a medical field to social and mental realms to address the issues individuals with Autism encounter in today’s society. As a result of this disorder, the lack of communication skills makes it extremely difficult for individuals with Autism to adapt and communicate with others in their surroundings, so ABA techniques and operants are desired.

“Autism Spectrum Disorder, also known as ASD, is a complex neurological developmental disability; signs typically appear during early childhood. Considering their neurological disabilities, it affects a person’s ability to communicate and interact with others and their environment” (Autism Society, 2016.) There is no known specific cause of Autism, yet increasing awareness for early diagnosis and intervention allows carriers to access the appropriate services and support needed to improve outcomes. Autism Spectrum Disorder is prevalent in all racial, ethnic, and socioeconomic groups, however, it’s about four times more common among boys than girls. According to the Center of Disease Control (2018), approximately “one in fifty-nine children are diagnosed with an Autism spectrum disorder. Commonly one in thirty-seven boys is diagnosed with Autism in comparison to one in every one hundred and fifty-one girls.” There is no cure for Autism but studies prove intervention during a child’s preschool years can help improve a child’s learning ability in social communication, functional and behavioral skills (Mayoclinic 2018.)

“Applied Behavioral Analysis also know as ABA is a method of autism treatment based on behavioral principles which, simply put, state that desired behaviors can be taught through a system of rewards and consequences” (Ruby 2019.) Majority of these therapy session are conducted by Registered Behavior Technicians or RBTs; these are paraprofessionals who are supervised under a Board Certified Behavior Analyst (BCBA), who implement treatment plans to assist Autistic individuals with their challenges. These therapeutic sessions are held at both in-home and center-based settings.  Home-based Applied Behavioral Analysis provides a great way to teach skills to children in a more holistic and familiar environment. For example, it may be more beneficial to teach daily skills such as bedtime routines, toileting, and bathing in a home-based environment. The therapist refers to this as a Natural Environment Teaching which allows the child to participate in an environment that is familiar while learning new skills. This method of teaching is less invasive for beginners. On the other hand, “Center-based ABA provides a child with a structured environment in which he or she learns a variety of important skills” (Trumpet Behavioral Health 2019 ). This method of teaching skills is implemented in very small steps inside a structured environment which is referred to as Discrete Trial Training allowing a child to follow the demands of someone in authority similar to a structured environment like school. ABA therapy allows us to understand the function of behaviors and what to do when undesired behaviors are present. The end goal is to increase socially appropriate behaviors while reducing undesired behaviors that are harmful or impair a child’s’ learning ability. Applied Behavioral Analysis aims to help increase language, communication between others, memory, and academics. Autism Speaks (2019) conducted research that proves using early intervention empowers the outcomes for many children with Autism Disorder, only if sessions are orchestrated using intensive and long time intervals approximately twenty to forty hours a week. Applied Behavioral Analysis is beneficial throughout any of the milestones, but early ABA interventions have a greater impact.

ABA Therapy uses many verbal operants to increase the vocabulary of children with autism. These strategies are based on intense scientific research studies that have proven successful outcome rate, such as:

●       Manding: This strategy is used to provoke a request for a desired behavior or item. For example, the therapist will have a child’s preferred toy in sight yet not close enough for him/her to gain it independently, so the child would ask verbally or manually gesture towards the preferred item. This will be reinforced by giving him/her the toy. Again, this teaches a child to ask for the item rather than tantrum for what he/she wants.

●       Echoic: The therapist delivers a discriminative stimulus (SD) or commands like “say cup” and the child says “cup.” These commands are delivered with the hopes a child would imitate sound or word. This is used for both non-verbal and verbal children to increase their vocabulary and work towards communication skills. Therapists highly recommend these strategies to be used in a clinical setting and conversation with parents to ensure the child’s pronunciation is generalized outside a clinical setting.

●       Tact: The therapists use a verbal label to familiarize clients with what’s being presented. For example, a therapist shows a picture of a car and asks “what is this?” and the child responds “car.” This technique is used to provoke words with the association of an object. The therapist encourages parents to label objects at home such as the kitchen sink, toilet, and bed then reinforce the child when he/she answers correctly. Allowing the child to gain a better understanding of tangible objects rather than only seeing pictures in a clinical setting.

●       Intraverbal: The therapist and clients practice the correct response when engaging in a conversation. For example, a therapist asks “what’s your name?” and the child replies “John.” This is one of the most empowering techniques to advance interaction with peers, parents, and others in society.

ABA treatment goals are based on the age and ability level of the person with Autism Disorder. Goals can include many different skill areas, such as: “social skills, self-care, motor skills, learning and academic skills” (Autism speaks 2019.) Most importantly communication and language are a prioritized targets when teaching children with Autism. Communication is the foundation of learning so the above operants are practice during many sessions within the home and clinical environment to provide a child with greater social skills.

Applied Behavioral Analysis includes techniques as well. Applied Behavioral Analysis includes Discrete Trial Training, Natural Environmental Teaching, Chaining, and  Extinction and many other teaching methods. Techniques differ from operants. Operants rely on reinforcers or prompts to increase the response of a child. Additionally, Techniques are teaching methods that rely on an ABCs method to understand the antecedent and consequences of behavior and/or response. ABC is broken down into three sections to understand targeted behavior. For example, “A” stands for antecedent which could be described as the action that occurs before a target behavior. “B” is defined as the behavior that occurs after the antecedent occurs. Lastly, “C,” defined as the consequence of the behavior. Many times the ABC methods result in a Behavior plan because Board Certified Behavior Analyst use this majority to properly handle undesired behaviors at large. Applied Behavioral Analysis techniques include Discrete Trial Training, Natural Environmental Teaching, Chaining, and Extinction.  As stated before, Discrete Trial Training allows a child to follow the demands of someone in authority similar to a structured environment like school this is similar to Errorless learning, in which the children can not make any mistake forcing a correct response or reaction. Natural Environment Teaching is conducted in generalized areas such as home, kitchen, and bathroom to prompt behavior or action that is essential to daily life. In addition to Chaining and Exctition all techniques play a role in teaching individuals with Autism. Channing is implemented through very small steps. Once small steps are mastered the next step is followed. Therapist utilized this in a backward and forward procedure. Backward Chaining is implemented by teaching the last step first. For example, a child gets a taste of a peanut and butter sandwich then the therapist and child reconstruct another sandwich step by step starting from the beginning. Forwards chaining is the opposite. Forward chaining is implemented by teaching the first stop then guide a child step by step to reach the finalized goal. Each technique is utilized based on a child’s abilities and skills. Both operations and techniques were taken advantage of to implement studies and justify the results of Early ABA intervention.

Prior research indicated that early ABA intervention increase the IQ by twenty points, increasing the scores of standardized testing and minimizing the aid needed for individuals with Autism in school settings. The results was colledcted with hopes that Early Intervection will “normalizie” children with Autistic disorder. Due to previous studies, early ABA interventions is in high demand for parents’ with autistic children today, yet the aid and resources needed to conduct these sessions are limited. Registered Behavior Technicians and Board Certified Behavior Analysts are numbered. Behavior technicians did not have adequate training and credentials to provide services to children as well as Behavior Analyst to individualize the plans need to increase a child’s social skills and appropriate behavior at this time. So, The University of California in Los Angeles famously known as UCLA studied the results of early intervention and transformed the dream of early intervention into reality as a pilot study. This pilot study was condomed after UCLA students saw the need for Early ABA and decided to execute the plan and study the impact early interventions have on children with autism and their providers. The study aimed to address three aspects of their study which included the progress of six children with a mental disorder, quality of treatment and the review of parents associated with this study. This research required intensive background knowledge and tracking of the kid’s activity for years. It was achieved by gaining the proper training from professionals and building a trustworthy relationship with parents and children. They realized that previous psychologists in the 1980s tested a child’s’ IQ and other standardized testing before conducted experiments. Despite the common gender denominator, undergraduates also investigated the families’ socioeconomic data. To qualify for this longing study, participants must have been diagnosed by a professional with Autism or PDD. After further investigation, researchers found all six participants were boys and shared more than a diagnosis. “They all lack of imaginary play and peer play, as well as high rates of stereotyped or ritualistic behaviors according to their parents” (Smith, T, et al. 2000:299) Although the children shared many similarities the parental background differed. All parents received a high school diploma or a form of equal education yet more than half of the mothers were married providing some of the children with more support while other parents were single parents, dominantly single-mothers,  altering the amount of support and time need to implement fair trials. We know socioeconomic backgrounds does not play a factor in the progress of an individual, but it was important to state all aspects of this study. All contributors, including students, were new to early intervention training so data was collected from professionals and training was contributed from paraprofessionals also. To begin the experiment Baseline data was collected. Baseline data is “collected to determine the needs and identify targeted behavior. Behaviors are collected under baseline when procedures have not been developed” (Brousseau, A, et al. n.d.) Behavior Analyst uses this information to implement a child’s intervention plan. For this study, the intervention plan included: “40 unmastered tasks, including 10 receptive actions, 10 nonverbal imitation tasks, 10 verbal imitation tasks, and 10 expressive object labels.” (Smith, T, et al. 2000:301). They also included an IQ and standardized test before implementing procedures and recording baseline data to created individualize assessment plans.  Individualized assesments were client based, but assessments involved all parents, students, and children. Therefore training for all of the above was fairly important. Licesended Psychologist, who was not associated with this study, conducted a “blind” study to prevent any bias results and ensure the reliability of the research. This was done by testing children not associated with the study with children associated with the study and their IQ ranking was surprisingly the same. After the research began, parents became significantly involved. Parents and students were able to provide quality treatments due to the professionals of UCLA that provided them with sampling videos to model and provide quality treatment. Parents were instructed to measure the number of therapy hours a child receives over the course of the years and undergraduated students proceed to track follow up for one year after initial start date. The therapy session was timely measuring thirty-five hours per week for one year. The results concluded “5 of the 6 children substantially increased their correct responding to receptive actions, nonverbal imitation, and verbal imitation,” and “ all attending first or second-grade classes for typically developing children and were all assisted in the classroom by an aide” (Smith, T, et al. 2000:303). This proved children who received early intervention resuted in the likelihood of living in today’s social environment is astonishing higher.

Thanks to all of the incredible research of psychologist, students, and medical professionals their has been great progress in Autism treatment, yet there is still much more to discovered. Experiments are now working towards a more progressive plan that will detect Autism earlier than 13 month to 3 years in age to improve the lives of autistic children more dramatically. If Autism is detected earlier, around infantry age, parents can begin therapy and working towards skills that will improve the outcome of early intervention therapy. Formal articles and blogs encourage parents to pay attention to their children’s actions and not fear autism testing. A call for action and findings are important! In spite of that, there is limited funding to support these studies and the families of Autistic kids. Dr. Bryna Siegel, a professor of child and adolescent psychology at the University of California at San Francisco, states “single most heavily funded area of autism research across the last 20-30 years has been autism genetics. Brain science also receives a significant portion of funds” (Valerie 2018.)  Throughout previous studies, there has been no proven statistics that Autism is a genetic mutation yet majority of  all funding is aimed towards the electrical wiring of children’s brains. These funds should be aimed to increase therapy awareness, parent training and providing Registered Behavior Technicians in public school setting to ensure challenged children are receiving the proper assistance in order to be a productive citizen in society. It is important for us to volunteer in community activities involving autism and join awareness groups to spread knowledge and educate everyone of the characteristics of autism. Again, there is no specific race or socioeconomic background dominantly affected with this disorder so testing is extremely important especially in young men. Remember early intervention and detection is the best method utilized to shape a young autisc individuals in a social environment.

References

  • “Applied Behavior Analysis (ABA).” Autism Speaks, Autism Speaks Inc., 2019, www.autismspeaks.org/applied-behavior-analysis-aba-0.
  • “Autism Spectrum Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Jan. 2018, www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/diagnosis-treatment/drc-20352934.
  • Brousseau, Amanda, and Jennifer Derderian. “Website.” Applied Behavior Analysis in the School Setting: Baseline to Intervention, 0AD, www.biama.org/pdfs/annual%20conference/AC2019/AC2019%20Handouts/Track%20A.%20Wkshp%201.%20Applied%20Behavior%20Analysis%20in%20School%20Setting.pdf.
  • “Home-Based vs Center-Based ABA Therapy.” ABA Treatment | Trumpet Behavioral Health, tbh.com/autism-therapy/home-based-vs-center-based-therapy/.
  • Rudy, Lisa Jo. “Get to Know the Language of ABA Autism Therapy.” Verywell Health, Verywell Health, 14 May 2019, www.verywellhealth.com/what-is-a-mand-in-autism-therapy-259923.
  • Smith, T, et al. “Parent-Directed, Intensive Early Intervention for Children with Pervasive Developmental Disorder.” Research in Developmental Disabilities, U.S. National Library of Medicine, 2000, www.ncbi.nlm.nih.gov/pubmed/10983784.
  • Strauss, Valerie. “The Huge Issue That Most Autism Research Funding Ignores.” The Washington Post, WP Company, 14 Dec. 2018, www.washingtonpost.com/education/2018/12/13/huge-issue-that-most-funding-autism-research-ignores/.
  • “What Is Autism Spectrum Disorder? | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 May 2018, www.cdc.gov/ncbddd/autism/facts.html.
  • “What Is Autism?” Autism Society, 2016, www.autism-society.org/what-is/.

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