Intervention, Education and Transition

Intervention

An intervention is a combination of program elements or strategies designed to produce

behavior changes or improve health status among individuals or an entire population.
Interventions may include educational programs, new or stronger policies, improvements
in the environment, or a health promotion campaign. Interventions that include multiple
strategies are typically the most effective in producing desired and lasting change.

Benefit of Early Intervention

The diagnosis of ASD is a difficult issue, not only for the child but also for the parents.
Parents of newly diagnosed children need time to understand what is happening.
Information is crucial, and it takes time to explain the global aspects of the disease and
the planned intervention. Parents are a key element in therapy, not only because they
spend the most time with the child and can generalize the new skills taught, but also
because a well-informed and supportive environment warrants a better prognosis than a
chaotic one.

Early intervention refers to doing things as early as possible to work on your child’s
autism spectrum disorder (ASD) characteristics. Early intervention for children with ASD
is made up of therapies a huge range of interventions for ASD. They range from those
based on behavior and development to those based on medicine or alternative therapy.
Some interventions combine several different types – for example, a mix of behavioral
and developmental approaches of therapies or interventions and services. Early
interventions occur at or before preschool age, as early as 2 or 3 years of age. In this
period, a young child's brain is still forming, meaning it is more "plastic" or changeable
than at older ages. Because of this plasticity, treatments have a better chance of being
effective in the longer term (Cervera, Romero, Mas and Delgado, 2011).

Goals of Intervention

 An interdisciplinary early diagnosis.

 The design and execution of specific intervention programs.
  The use of effective resources and methods.
 Communication and interrelation with all health, educational and social services
involving the child and his or her family.

Principles of intervention

 Early Intervention programs should be flexible and tailored to each child's

individuality and the uniqueness of his family.
 Each child shall be given a cognitive-behavioral and environmental intervention
process.
 The intervention has to address the child with ASD, the family and all the
environments in which the child develops.
 The intervention has to promote the welfare and quality of life of children with
ASD throughout their developmental process (Cervera, Romero, Mas and
Delgado, 2011).

Selection of Early Intervention Program

The selection of an early intervention program for ASD children should be mainly family
Focused, well-structured and should be constructed on decent evidence. Following are
some important points that should be kept in mind while choosing and early intervention:

 Family-centered

The intervention or service

1. Includes family members so you can work alongside the professionals and
learn how to help your child
2. Is flexible – it can be offered at home as well as in other settings like
kindergartens and early intervention centers
3. Provides your family with support and guidance.
 Well-structured
1. The intervention or service has staff who are specially trained in the
intervention and services they provide
 2. Develops an individual plan for your child and reviews the plan regularly
monitors your child’s progress with regular assessments is highly
structured, well organized, regular and predictable
3. Provides a supportive learning environment – your child feels comfortable
and supported
4. Prepares and supports your child for the move to school
5. Enables contact between your child and typically developing children
(ideally of the same age).
 Evidence-based

The intervention or service

1. Is designed for children with ASD

2. Focuses on developing attention, communication, listening, imitation,
language and social skills
3. Includes strategies to help your child learn new skills and use them in
different settings (sometimes called ‘generalizing’ skills)
4. Identifies what the ‘purpose’ of a difficult behavior is, and teaches your
child more appropriate alternative behavior to replace it.
(O’Reilly, & Wicks, 2016).

Making Intervention More Convenient

There are some ways through which we can make intervention more convenient for the
teachers and parents. Following are some of those convenient ways:

1. Reducing the cost of training requirements may help early acceptability,

possibility, specifically in the under-resourced communities.
2. ASD parents should be empowered with operative plans so that they can
provision their child learning and help in the development of their child which is a
key component of operative intervention (Casagrande and Ingersoll, 2017).
Different Interventions for Autism

Behavioral Interventions

Behavior-based approaches to autism spectrum disorder (ASD) focus on teaching

children new behaviors and skills by using specialized, structured techniques. These
techniques are the best teaching tools for developing skills and encouraging appropriate
behavior.

Behavior-based approaches are probably the most studied and best supported by evidence
and research. Therefore, they’re the most commonly used type of intervention for
children with ASD. Interventions using an Applied Behavior Analysis (ABA) approach
are particularly common and well supported (Anderson, 2012).

ABA is defined as the process of applying behavioral principles to change specific

behaviors and simultaneously evaluating the effectiveness of the intervention. ABA
emphasizes both prevention and remediation of problem behavior. Significant attention is
given to the social and physical environment, including the antecedent conditions and
consequences that elicit and maintain behavior. These interventions should typically be
provided under the supervision of a trained behavioral psychologist or behavior analyst
(Dobby & Lindgren, 2011).

Therapy-based Interventions

Therapy-based approaches to autism spectrum disorder (ASD) provide a specific therapy

that targets specific difficulties. Examples include using:

 Speech therapy to develop a child’s communication and social skills

 Occupational therapy to develop skills for daily life, including physical skills.

Cognitive-Behavioral Therapy

The scientific basis for the use of cognitive behavior therapy (CBT) with adolescents and
adults with mood or adjustment problems is extensive and diverse. In fact, CBT is one of
the most widely used non-pharmacologic treatments for individuals with mental and
emotional disorders, especially depression, and its use with individuals with autism
spectrum disorders is growing. CBT focuses on replacing negative or ineffective

patterns of thought and behavior with structured strategies that are effective in improving
mood and adaptive functioning.

In the autism research base, the scientific evidence for the effectiveness of "self-
management," a type of CBT, is described by the NPDC-ASD as follows: “Self-
management interventions help learners with ASD learn to independently regulate their
own behaviors and act appropriately in a variety of home, school, and community based
situations. With these interventions, learners with ASD are taught to discriminate
between appropriate and inappropriate behaviors, accurately monitor and record their
own behaviors, and reward themselves for behaving appropriately. As learners with ASD
become more fluent with the self-management, some of the implementation
responsibilities shift from teachers, families, and other practitioners to the learners
themselves” (Dobby & Lindgren, 2011).

Sensory Integration (SI)

The use of sensory integration (SI) therapy for treatment of ASD has been both popular
and controversial. Many children with ASD are believed to have a form of sensory
integration dysfunction, defined as neural dysfunction that causes the nervous system to
inefficiently receive and process incoming information, which may lead to
hypersensitivity or hyposensitivity to sensory input, unusually high or low activity levels,
coordination problems, delays in speech or motor skills, and/or behavior problems. In SI,
a child’s individual sensory needs are evaluated, and a program of sensory therapies (e.g.,
riding scooter boards, swinging, jumping on trampolines, wearing weighted vests,
wrapping in fabric) is developed and prescribed as a “sensory diet.” Most SI therapy is
implemented by occupational therapists. Proponents of this therapy argue that sensory
integration therapy results in improved mental processing and organization of sensations,
although this is difficult to measure objectively.
Picture Exchange Communication System (PECS)

Picture Exchange Communication System is an augmentative communication strategy

designed for individuals with expressive language deficits. Individuals are trained to
exchange picture cards for desired items, which the therapist pairs with a verbal label for
the item. In addition to targeting communication skills, PECS also reinforces attempts to
initiate social contact in children with ASD. Empirical studies have documented an
increase in functional communication following this intervention, especially when used
as part of ABA treatment. This therapy can be used at any ages and all ability levels.

Developmental Interventions

In developmental interventions, the environment is organized to encourage or facilitate

communicative and social interactions. Developmental approaches to autism spectrum
disorder (ASD) aim to help children form positive, meaningful relationships with other
people. The child initiates and the adult responds. They also aim to help children develop
skills for daily living. Developmental interventions are sometimes called ‘normalized’
interventions ( M.Corsello, 2005).

Auditory integration training (AIT)

AIT is a controversial intervention that purports to remediate problems with sound

sensitivity and auditory processing, with the result of improved behavior,
communication, and quality of life. Although several studies have been conducted, there
is currently no scientific evidence that AIT retrains auditory systems of individuals with
ASD with the result of improved functioning.

Family-based Interventions

Family-based interventions for autism spectrum disorder (ASD) emphasize the idea that
family involvement in therapy is central to meeting children’s developmental needs. In
particular, parents not only drive the decision-making about interventions, but they also
take a key role in delivering them.
These interventions are designed to provide guidance, training, information and support
to family members. The success of these interventions depends on having strong and
collaborative parent-professional relationships. Their effectiveness also relies on
addressing the needs of the whole family, so that everyone in the family benefits, not just
the child with ASD.

Nutritional Supplements

Megavitamin therapy is based on the hypothesis that symptoms of ASD may be related to
biochemical errors resulting in nutritional deficiencies. Typical supplements for this
population include vitamin B6, magnesium, vitamin C, and vitamin A. There are several
reports that megavitamin supplements may benefit some children with ASD, but this
treatment currently lacks scientific support through well-controlled research. Although
vitamins can be obtained over the counter, it is recommended that a physician be
involved if this intervention is being considered. There are significant questions about the
safety of large doses of certain vitamins.

Medication-based Intervention

The use of pharmacological treatments for symptoms of ASD is both common and
challenging. Several psychiatric disorders in children are successfully treated by
medications, and many of these disorders have symptoms that overlap with those seen in
children with ASD (e.g., hyperactivity, inattention, tics, obsessive-compulsive behaviors,
depression, anxiety, sleep problems, etc.). However, there are no medications that
directly treat the social and language impairments seen in individuals with ASD. The
medications used most frequently for children and adults with ASD include
antipsychotics (e.g., risperidone), selective serotonin reuptake inhibitors (SSRIs) to treat
mood and repetitive behaviors, and stimulants and other medications used to treat
attention deficits and hyperactivity. The evidence base is good for using atypical
antipsychotics (e.g., risperidone and aripiprazole) to treat challenging and repetitive
behaviors, but there are also significant side effects associated with the use of these
drugs. There are some well-designed studies supporting the use of SSRIs and stimulants
with patients with ASD, but the evidence base is not as strong as for the antipsychotic
medications.

Gluten- and Casein-Free Diet

Gluten is a protein found in plants including wheat, barley, oats, rye and their derivatives.
Casein is a protein found in cow’s milk. In some severe cases, an inability to properly
metabolize these proteins can lead to serious gastrointestinal or neurological problems. It
has been proposed that ASD symptomology may be associated with this process, and thus
a gluten- and casein-free diet has been suggested as a treatment for ASD. A few studies
have suggested that long-term elimination of gluten and casein from a diet may result in
behavioral improvements in children with ASD. It is strongly recommended that a
physician be consulted to test for possible food allergies prior to beginning this diet. This
type of intervention can be very stressful for the family and has yet to be established as
an empirically valid intervention (Dobby & Lindgren, 2011).