Developmental and Autism Spectrum Disorder Interventions (Child & Adolescent)

AIM HI (An Individualized Mental Health Intervention for Autism) is a caregiver and child skill-building intervention and therapist training model for children 5 to 13 years old with autism receiving mental health services.

The AIM HI protocol includes identifying functional patterns of a target behavior and actively teaching (through modeling, behavioral rehearsal, and in-home practice) positive alternative skills for children and complementary strategies for caregivers to structure the environment to reduce the likelihood of interfering behaviors, as well as promote the child’s use of alternative skills (e.g., communication skills, emotion regulation, self-help skills).

AIM HI components include:

• Mental health therapists teach caregivers to identify functional patterns in their child’s behaviors and collaborate to develop a behavior plan
• Therapists actively teach positive alternative skills to children and complementary strategies to the caregiver to structure the environment to reduce the likelihood of interfering behaviors, as well as promote the child’s use of alternative skills
• Strategies designed to assist in adaptation of psychotherapy sessions to maximize engagement and skill building among children with autism:
• Inclusion of the child’s special interests in treatment sessions
• Maximization of in-session predictability through the use of schedules and visuals
• Delivery within the context of mental health/psychotherapy services with adaptation for telehealth, as needed

Research Units on Behavioral Intervention Parent Training (RUBI-PT) program consists of 11 sessions that are delivered from therapist to caregiver (1-on-1) in an outpatient setting. RUBI-PT teaches caregivers a range of skills, based on principles of applied behavior analysis, that are designed to support the building of a behavioral strategy toolbox. RUBI-PT emphasizes:

• Tailoring the intervention to the child
• Identifying behavioral function instead of topography to inform behavioral strategy choice
• Decreasing challenging behaviors as well as promoting core adaptive skills
• Using positive behavioral supports, such as antecedent management, reinforcement, and functional communication strategies as the means to address challenging behaviors

Typically, a session begins with a homework review from the previous week, followed by didactic instruction. RUBI-PT uses a behavioral skills-training approach, including direct instruction, modeling, role-play, video vignettes, and practice with feedback in order to train caregivers in the various RUBI-PT skills. These tools are helpful in reinforcing a new concept and identifying whether the parents understand the concepts. Every session ends with creation of a homework assignment where caregivers track their implementation of targeted strategies during the week.

DIRFloortime® is designed to help children with a wide range of emotional, sensory, regulatory, motor, learning, and developmental challenges including having an autism spectrum disorder. DIRFloortime® is an intervention that is used to promote an individual’s development through a respectful, playful, joyful, and engaging process. It is designed to use the power of relationships and human connections to promote the development of the capacities for self-regulation; engagement; communication; shared social problem solving; and creative, organized, and reflective thinking and reasoning. It is used by teachers, occupational therapists, speech therapists, mental health professionals, parents, and many others that care for individuals with developmental challenges or other related needs.

The Early Start Denver Model (ESDM) is a relationship-based intervention designed to help children with an autism spectrum disorder (ASD) that involves the parents and families. An Early Start for your Child with Autism, is a parent’s guide to using everyday activities to help kids connect, communicate, and learn. The aim of ESDM is to increase the rates of development in all domains for children with ASD as it simultaneously aims to decrease the symptoms of autism.

ESDM focuses on boosting children’s social-emotional, cognitive, and language abilities, as development in these domains is particularly affected by autism. ESDM fuses a behavioral, relationship-based approach with a more developmental, play-based one in order to create an integrated whole that is both individualized and standardized.

LEAP Preschool (also known as Learning Experiences: An Alternative Program for Preschoolers and Parents [LEAP]) is designed to be both a behaviorally and developmentally appropriate approach for teaching children with and without disabilities within an inclusive early childhood environment. Learning activities are selected based upon the needs, interests, and developmental levels of individual children within the classroom. An integrated curriculum approach (i.e., designing learning experiences that promote children's skill development across multiple domains) is used to provide learning opportunities across all areas of development (e.g., social/emotional, language, adaptive behavior, cognitive, and physical). Curricular activities are selected to encourage children's learning through active exploration with concrete materials and interactions with other children and adults. Individual children's progress towards identified goals and objectives are monitored on an ongoing, systematic basis. In addition, assessment of skill acquisition, maintenance, and generalization are conducted as a means of evaluating the effectiveness of instructional strategies.

The Lovaas Model of Applied Behavior Analysis is a behavioral treatment model typically starts with children between the ages of two and eight who have developmental delays. Children typically transition to different services as they progress through elementary school and no later than the age of twelve. While treatment is always based on the principles of applied behavior analysis, its implementation varies based on a child's unique needs.

The Lovaas Model was created as a comprehensive, integrated program in which skills complement and build upon each other. The intervention progresses systematically through stages of learning and emphasizes individualization of curriculum based on each child's strengths and weaknesses.

PECS is a unique alternative/augmentative communication system designed for preschool students diagnosed with autism. PECS is used with learners of all ages who have various cognitive, physical and communication challenges. Specific prompting and reinforcement strategies that are designed to lead to independent communication are used throughout the protocol. The protocol also includes systematic error correction procedures to promote learning if an error occurs. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency.

PECS consists of six phases and begins by teaching an individual to give a single picture of a desired item or action to a "communicative partner" who immediately honors the exchange as a request. The system goes on to teach discrimination of pictures and how to put them together in sentences. In the more advanced phases, individuals are taught to use modifiers, answer questions and comment.

The primary goal of PECS is to teach functional communication.

Pivotal Response Treatment® (PRT®) is a naturalistic intervention model derived from Applied Behavior Analysis (ABA) for children diagnosed with an autism spectrum disorder (ASD). PRT® is designed to target pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations. These skills are pivotal because they are the foundational behaviors upon which learners with ASD can make widespread and generalized improvements in many other areas. By targeting these critical behaviors, PRT® aims to result in widespread, collateral improvements in communication, social, and behavioral domains. Specific motivational procedures including child choice, task variation, interspersing maintenance and acquisition tasks, rewarding attempts, and the use of direct natural reinforcers, are incorporated. The goal of PRT® is to move the child with ASD towards a more typical developmental trajectory, through individualized intervention objectives based on the child's needs. PRT® targets each core area of development and focuses on increasing motivation to engage and learn for children with ASD. PRT® is implemented in the natural environments of the child (e.g., home, community, and school) and emphasizes parent education in an effort to empower family members to become agents of intervention, so that learning can ideally be embedded across daily routines.

Program for the Education and Enrichment of Relational Skills (PEERS®) for Adolescents is a 14-week social skills intervention designed for motivated teens in middle school or high school who are interested in learning ways to help them make and keep friends. During each group session, teens are taught important social skills and are given the opportunity to practice these skills in session during real play activities (e.g., playing sports, board games, etc.).

Parents are taught how to assist their teens in making and keeping friends by providing feedback through coaching during weekly socialization homework assignments.

Project ImPACT (Improving Parents As Communication Teachers) is a parent-mediated intervention for young children with autism spectrum disorder (ASD) and related social communication delays. Parent-mediated means that a Project ImPACT coach teaches the parent techniques to be used with their child. The Project ImPACT coach uses systematic instruction to increase the parent's responsiveness to the child's behavior and teaches the parent how to use prompting and reinforcement to teach the child to use new communication, imitation, and play skills within child-led interactions. It is a naturalistic developmental behavioral intervention (NDBI). An NDBI is a newer class of intervention that has been informed by the fields of developmental and communication sciences and applied behavior analysis (ABA). Project ImPACT can be implemented in an individual or group coaching model and can be adapted for telehealth.

SCERTS^® is an educational model for working with children with ASD and their families. SCERTS^® is designed to build competence in social communication, emotional regulation, and transactional support and can be used for individuals with a wide range of abilities and ages across home, school, and community settings. It provides specific guidelines designed to help a child become a competent and confident social communicator, while preventing problem behaviors that interfere with learning and the development of relationships. It also is designed to help families, educators, and therapists work cooperatively as a team, in a carefully coordinated manner, to maximize progress in supporting a child.