Effective Early Intervention Programs for Children with Autism - Literature review Example

Introduction On account of my nephew with autism, I have become interested in early intervention programs for autistic individuals. Knowing that in some cases autism is for life, I pin my hope on these programs to help my nephew to know more than the basic survival skills in life that would render him independent in everyday living, thus minimizing his need for parental supervision. I likewise hope that early interventions would make my nephew – and anyone afflicted with autism, for this matter – to be more totally integrated within the society where he can have not only his existence, but more importantly a meaningful life. This paper is going to critique the articles written by Erba (2000) and Kasari (2002). Together, they voice out the need for more effective early intervention programs that would generally apply for children with autism. Summary of the Articles The two articles focus on early intervention programs for autistic children. Autism is developmental disorder that results to severe social, communicative and cognitive deficits. Afflicted with autism, a child is deprived of the usual interaction with and experience of the world. Autism is perplexing, variable and – for most individuals – life-long impairment (see Erba 2000, pp. 82; Kasari 2002, 447). And, while anyone may be born with it, the best step to address the affliction is by providing early interventions. Erba (2000) notes that, given the gains that have already been achieved in understanding the structural and behavioral nature of autism, there are now reports concerning positive results in young children receiving early intervention services (see pp. 82; see also pp. 82-83 for the four tenets supporting the efficacy of early interventions for young children with autism). And, so, he dwells on to examine four of these intervention programs – i.e., the Discrete-Trial Training (DTT), Learning Experiences… An Alternative Program for Preschoolers and Parents (LEAP), floor time, and Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH). He observes that the four programs have several common components; however, their theoretical frameworks naturally vary – and, with them, their strategies, evaluation methods and outcomes. He concludes by noting the conflict that surrounds the issue of the efficacy of the early intervention services occasioned by the multiplicity of the available models or approaches of treatment (Erba 2000, pp. 92). At the outset, Kasari (2002, see pp. 447) is cautiously pointing out that the variability of autism passes on to children’s response to interventions. However, while the response of autistic children to different interventions is not going to be homogeneous, Kasari (2002) believes there are minimum elements that make an intervention program efficacious. Accordingly, there must be random assignment (see p. 448-449) and comparison (cf. pp. 448) to an alternative, standard community practice or no-treatment control group with the measures of pre- and post-treatment (being) carefully selected to be valid for the population under study and to reflect the focus of the treatment (pp. 449-450). Similarly, there is a need for appropriate diagnosis and assessment of the sufficiently-sized samples (see pp. 449). With these elements as backdrop, Kasari (2002, 450; see also pp. 458-459) studies ten (10) studies that made use of different programs of interventions (carrying with them their varying philosophical approaches) and service delivery (that is, either one-to-one treatment at home or teacher-taught small-groups in center-based settings) and evaluated the results for young children with autism. Kasari (2002) finally concludes that while in general terms there are interventions that report success in terms of improving the lot of children with autism, there is yet an evidence of a well established treatment of autism (see pp. 453), leaving us with many unanswered questions (see pp. 454). Critique of the Articles At face value, the two articles are very much distinct – making a critique on them exigent. Erba (2000) is engrossed with particularly four (4) early intervention programs for autistic children. He dwells on each of these programs by summarizing their concepts of learning and development, outlining their intervention procedures, illustrating the connections between their theory and practice, and discussing the research outcomes for each of them. Erba’s intent in writing his article is to illustrate the structural framework apparent in each of four diverse early intervention models (pp. 83). Kasari (2002) takes note of the variability of autism and concerns herself with predicting which children will need what type and intensity of treatment for which developmental behaviors (pp. 447). With this theme, Kasari intends to consider elements of a well-designed treatment study and evaluate the state of knowledge about comprehensive treatment programs for children with autism and give several suggestions for improving future studies, including more rigorous designs, searching for active ingredients of treatment programs and measuring change (pp. 447). Be that as it may, there is no doubt that the two articles’ concern to determine and find an efficacious early intervention service for children with autism is a common ground from which a critique on the two articles may be done. We may begin with the most obvious observation that one may make from the two articles. Erba and Kasari do not mention about biological interventions for children with autism. Careful not to ascribe ideas that they do not in fact propose in their articles, the most that one may do is to point out our writers’ silence over this matter. Concomitantly, though, it is good to state the point – which Erba and Kasari may be sharing -- by Birnbrauer (1999) that behavioral treatment still has much more scientific support than any other intervention for children with autism. The truth is that behavioral treatment is still the best initial course of action rather than the use of biological interventions that may, at the outset, be helpful for managing disruptive behavior but will definitely have major side effects in the long run. In similar fashion, one may point out too that the elements of effective early intervention programs that Erba and Kasari mention in their articles are generally affirmed – as they are mentioned and emphasized, too -- in other similar writings. For instance, we have Robbins et al. (1996) mentioning about the elements of inclusion as the starting point, individualized programs, family support and collaboration, behavioral/educational approach, and effective data-based procedures as principal stuff of early treatment services for autistic children. In details, Robbins et al. (1996) hold that children with autism are best educated alongside typically growing children (pp. 68). They likewise maintain that all aspects of early intervention programs need to be specifically tailored to address the individual differences and meet the needs of each child (pp. 68). Further, Robbins et al. (1996) underline the necessity for the parents to be involved at practically all the levels of intervention programs for the optimal benefit of their autistic children, with the parents serving as teachers as among the possible approaches (pp. 68-70; Ozonoff & Cathcart 1998; see also Birkin et al. 2008). Stating the same line with Rudy (2007), Robbins et al (1996) behavioral or educational approach is currently acclaimed as the best first-line approach (pp. 70-71). Finally, Robbins et al (1996) emphasize the need for data-based procedures. When there is sufficient data to back up, any form of treatment will not be practiced without adequate evaluation (pp. 72; see also Akshoomoff & Stahmer 2006, pp. 120-124). Speaking of need for data-based procedures, especially in the context of profusion of treatment methodologies to date, one finds the suggested thrusts of future research by Erba and Sakari validated by Frea & McNerney (2008). The latter’s outlook is that the most important research question of the day is how to bring together the different intervention programs for children with autism (pp. 103). According to Frea & MacNerney (2008), the current challenge in the field of special education in general and early intervention program in particular is collaboration. Thus, they call for researchers and clinicians to pool their expertise and data together so there would be further advancement in the existing knowledge base and state-of-the-art treatments for children with autism (pp. 103). One may be led to think, then, that the variety of the intervention programs for children with autism is yet to offer complete hope. Erba finds conflicting the studies on the efficacy of these programs. In fact, he observes that, based principally on methodology and design, these conflicts among intervention programs give rise to absence of information about the relationship between the programs’ conceptual frameworks related to specific intervention techniques and child outcomes and to dearth of data particularly about how child and family characteristics correlate with intervention methods and whether these would result to meeting individualized goals (Erba 2000, pp. 92). Sakari echoes the same sentiment when she says that a way forward is to have a more rigorously designed comparative studies to judge whether one treatment approach is superior to another, an evaluation of the active ingredients of current treatment programs, and a better understanding of the growth trajectories of children with autism (pp. 454). Thus, we may say not without basis that Erba and Sakari are writing on what actually preoccupies the field of special education and are recognizing the same issues that authorities in their field encounter and try to address. Likewise, it is good not to be tied exclusively to the technicalities of early intervention programs about which the two articles are obviously focused on. They dwell exclusively on the intervention programs, and not on the children with autism. They delve into the technicalities, and not on the receiving end of the program. While there is no need to contest the articles’ choice of theme, it may serve the interest of objectivity to mention about the autistic children being determinants, too, of the interventions’ efficacy. Of course, one may put forward that precisely by the fact that early intervention programs are considered, so the autistic children – as objects and subjects of interventions – were actually considered by the writers. Now, it has been widely believed that, since the human brain quickly grows between the ages of zero and three, early intervention program results to optimal outcomes as its purpose is to help children establish a solid, functional communication system as early as possible. The purpose is not to make the children talk per se, but to ensure the possibility of a back-and-forth communication. And, communication is the key to learning – that is, the child who has this tool has the pathway through which he/she can learn. Lest we forget, however, children have their individual profile, abilities and challenges that would make each of them have his/her own outcomes. In fact, an instance of children’s peculiarities is, for some, their having a longer window of opportunity for growth. That means there are kids who start late and quickly catch up Thus, while early intervention is definitely and clearly a good idea, it is by no means clear that the earlier and more intensive the intervention, the better the result. The idiosyncrasies of the children need to be factored in. In this way, parents who rush for early treatment of their autistic children would not be disappointed should the latter show slow recovery (see Rudy 2007; Rudy 2009). Conclusion The review of the two articles brings to the fore the most immediately practical concern among special educators and parents of autistic children. While it is true that there are currently available multiple intervention options for children with autism, there is still no way to precisely determine which of these intervention programs are going to be effective for all individuals with autism. In this case, we realize that the multiplicity of intervention programs is not all boon. Besides, it is very significant not to lose sight of the human-ness of the autistic individual – i.e., one should not forget that autism neither takes away nor destroys the individuality or uniqueness of children with autism. The steps such as those taken by Erba and Sakari are gearted towards greater comprehension of intervention options. While we are yet to see the light at the end of the tunnel, particularly since the task remains daunting and complex, I who have an autistic nephew for one can keep my hope knowing that better and more efficacious interventions to address autism are on their way. References: Akshoomoff, NA & Stahmer, A 2006, ‘Early intervention programs and policies for children with autistic spectrum disorders’, in H.E. Fitzgerald et al. (eds.), The crisis in youth mental health: Critical issues and effective programs, vol. 1 Childhood disorders, Praeger, Westport, pp. 109-131. Birkin, C, Anderson, A, Seymour, F, & Moore, DW (2008) ‘A parent-focused early intervention program for autism: Who gets access?’, Journal of Intellectual and Developmental Disability, vol. 33(2), June, pp. 108-116. Birnbrauer, JS 1999, How to evaluate intervention programs, online, retrieved 12 August 2009, from http://www.behavior.org/autism/index.cfm?page=http%3A//www.behavior.org/autism/autism_evaluate_programs.cfm Erba, HW 2000, ‘Early intervention programs for children with autism: Conceptual frameworks for implementation,’ American Journal of Orthopsychiatry, 70(1), January, pp. 82-94. Frea, WD & McNerney, EK 2008, ‘Early intensive applied behavior analysis intervention for autism’, in JK Luiselli et al (eds.), Effective practices for children with autism: Educational and behavioral support interventions that work, Oxford University Press, New York, pp. 83-110. Kasari, C 2002, ‘Assessing change in early intervention programs for children with autism’, Journal of Autism and Developmental Disorders, vol. 32, no. 5, October, pp. 447-461. Ozonoff, S & Cathcart, K 1998, ‘Effectiveness of a home program intervention for young children with autism’, Journal of Autism and Developmental Disorders, vol. 28(1), February, pp. 25-32. Robbins, FR, Giordano, S, Rhoads, S, & Feldman, R 1996, ‘Preschool children with autism’, in R Feldman (ed.), The psychology of adversity, The University of Massachusetts Press, Amherst, pp. 63-90. Rudy, LJ 2007, Is early intervention important for children with autism?, online, retrieved 13 August 2009, from http://autism.about.com/od/childrenandautism/a/EIImportant.htm Rudy LJ 2009, What can early intervention do for your child with autism?, online, retrieved 14 August 2009, from http://autism.about.com/od/earlyinterventi2/f/earlycommunicat.htm Read More