Can autism be cured permanently? What are the three forms of early intervention in autism?

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Autism is a neurodevelopmental disorder that affects social skills, language development, emotional development, or Physical coordination. Autism always presents with a certain set of characteristics related to the above four components. For example, the child might lack social skills but will be great at cognitive development. A cardinal and typical sign is that a child seems apart or aloof from others, even in the earliest stages of life. Few autistic children do not show any need for affection or attachment with anyone and they usually do not even seem to know or care who their parents are. The autistic child is thought to have ‘mind blindness’ an inability to take the attitude of others or to “see” things as others do. Hence few children lack social interactions with others. Self-stimulation is another characteristic of autistic children. It usually takes the form of such stereotypical movements as spinning, head-banging, hand flapping, rocking, and other such bizarre repetitive behaviour. Few autistic children show behaviours that tend to be under or over-responsive to sensory stimuli in the environment- this can be due to sensory processing deficits.

There have been many research studies indicating many theories related to the etiology/pathology of Autism- since no concrete information of the cause leading to Autism has been acquired hence an evidence-based treatment has not been formulated which is promising to cure Autism. As the famous saying goes “Better late than never” - an early intervention approach by a multidisciplinary team with an aim to make the child functionally age-appropriate will be beneficial to the child. The child would be examined by the professionals with clinical observations and standardized assessments which would help the child and the family to work on certain specific goals which the child is lacking.

The family would be briefed about his or her behaviour by the Behavioural Therapist. Recommendations are suggested to the parents as well as to the Kindergarten school teachers. Speech delay is often seen in autistic children. Hence to work on his communication skills, Speech therapists would be the best expertise. They will help the child to express his feelings through verbal and nonverbal communication skills which in turn will help Parents to reciprocate in the same manner. As play is an important occupation in the child’s early stages of life- Occupational Therapy comes into the picture. Through sensory integration therapy as the foundational approach- an Occupational Therapist design activities to improve their cognitive, motor, and social participation in play. Every child has the right to receive education either by the regular class teacher or by remedial therapy for their academic development.

Applied Behaviour Analysis (ABA) therapy is a newly emerging professional expertise in India, hence an ABA therapist is another important member of the multidisciplinary team. There are three forms of early interventions which is practiced by ABA therapists for autistic children based on the principles of ABA (Applied Behavior Analysis) which include Discrete Trial Training (DTT) or Early Intensive Behavioral Intervention (EIBI), Pivotal Response Training (PRT) and Analysis of Verbal Behaviour. Each intervention would be explained in brief for a better understanding.

Discrete trial training (DTT) or Early Intensive Behavioral Intervention (EIBI).
DTT is a structured teaching technique that is very useful to teach new behaviour. This method is used by breaking down behaviour into smallest functioning and it is seen repeated several times. The definition of DTT is presenting a learning opportunity in which the students' correct responses will be given positive reinforcement. DTT consists of three parts that correspond to the ABC of behaviour. These parts are the (Antecedent) discriminative stimulus or SD, (Behavior) Response, and Consequence Stimulus Reinforce. For example, the therapist will give instruction to the client to look at her with a firm loud voice and the child will respond to the therapist. When a correct response is given the therapist will give reinforcement at the same time. But if the client is not able to give a correct response the therapist will just say No but she will again ask the same questions to the client and will prompt the client to give a correct answer and then positive reinforcement is given. Various strategies have been used to build skills which the child is lacking and when they master the skills the child is rewarded by token economy. The skills have been mastered so that they are self-independent.

Pivotal Response Training (PRT) is a naturalistic and systematic teaching method for autism spectrum disorder. PRT focuses more on building the skills to develop verbal communication skills, responding to multiple cues, self-management, and self- initiations. PRT method can be taught at an early age of 5 years before the child enters the regular school. It helps the child to gain confidence to speak to other children in the classroom and build the ability to ask questions to the people around them.

As it has been said, “All fingers are not the same” and hence all children's brains function in a different manner, different learning styles thus we need to acknowledge it. Here we conclude that “If a child cannot learn in the way we teach, we must teach in the way the child learns”.

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Anita Atgamkar
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