Integrating Treatment Strategies for Children with Autism

Background: In practice, many practitioners integrate various treatment techniques into comprehensive treatment programs for children with autism. Indeed, researchers have hypothesized that incorporating multiple treatment methods into a comprehensive program and customizing it in terms of individual needs should increase overall treatment effectiveness. However, very little data are available to inform specific methods for integrating approaches. In particular, highly structured behavioral treatments (e.g., Discrete Trial Training; DTT) and naturalistic behavioral treatments (e.g., Pivotal Response Training; PRT) may be differentially effective at targeting different skill areas. Structured and naturalistic models have often been compared, but no studies have suggested empirically-tested methods for integrating them into comprehensive treatment programs. It may be that they accomplish different goals and are mutually beneficial, and that their effectiveness depends on individual child characteristics.

Objectives: To identify methods of tailoring comprehensive treatment programs to the individual needs of different children with autism.

Methods: Preliminary data for three children with autism (18-36 mos of age), who participated in a single-subject alternating treatments design, are presented. Expressive and receptive language targets were selected from the MacArthur CDI. Target items were subdivided according to form (i.e. noun, verb, adjective), developmental appropriateness, and child preference (for objects only). Words were then randomly assigned to treatment conditions. Children received three one-hour sessions of in-home treatment per week, including 30 minutes each of DTT and PRT. Order of teaching procedures was randomly determined on the first day of the study and counterbalanced across subjects. Data are reported on rate of learning, word acquisition and generalization, as well as child disruptive behavior.

Results: Preliminary data indicate that participants made gains in the acquisition and generalization of the target items taught via DTT and PRT. Children demonstrated distinct patterns of responding to DTT and PRT. Word acquisition and generalization, as well as rates of learning and disruptive behaviors during treatment sessions varied depending on the treatment method used and word form of focus. Potential predictor variables useful in deciding treatment appropriateness a priori will be discussed. Fidelity measures indicated that the interventions were implemented accurately.

Conclusions: These data corroborate with other studies emphasizing the importance of treatment individualization and begin to suggest specific methods for tailoring treatment programs to individual child needs. The strengths and weakness of DTT and PRT are not as explicit as previous research may suggest. Effectiveness may vary depending on child variables, as well as curriculum area focus. This line of research also offers a model for future research designed to establish an empirical basis for combining intervention methods into comprehensive treatment programs for children with autism.