From ABA to Zones of Regulation, therapy programmes for autistic children can be confusing. It is important to understand the approach and to check that the programme you are being sold is based on scientifically proven evidence.
Some commonly used approaches are:
PECS (Picture Exchange Communication System)
What is PECS? Picture Exchange Communication System is a widely used systematic way to teach a child to communicate using pictures. It provides an alternative means of communication allowing children who cannot talk or write to share their thoughts and opinions. For example, in simple terms, if a child wants a drink, he will give a picture of 'drink' to the adult who will then give him a drink.
How can PECS help? Originally, some believed PECS could hinder any progress with speech development. However, in practice even those previously uninterested become more open to trying other forms of communication, like speech. It also helps to alleviate frustration, minimising tantrums and challenging behaviour. It can be especially helpful to encourage children to interact and socialise.
Who can PECS help? PECS was originally designed for children with Autism and related developmental disabilities but can be used for other non-verbal children as well as adolescents and users of augmentative communication devices.
Social Stories
What are social stories? Pioneered by Autism specialist Carol Gray, social stories use narrative to help children understand and respond to a range of situations, from joining in playground games to visiting the dentist or going shopping. Each story is unique. It’s written for and about the child concerned, taking an aspect of their lives they find challenging, terrifying or incomprehensible and presenting it in a fictionalised form that addresses the issue and gives the child a way of dealing with it.
How can social stories help? Social stories can be used to prepare a child for something new, introducing it well in advance so that, when encountered, they can be familiar with its more worrying aspects.
Who can social stories help?? Pre-school or school-aged children and young adults with Autism or poor social integration. They also provide in-class activities for the child’s peers.
PBS (Positive Behaviour Support)
What is Positive Behaviour Support? PBS is a behaviour management programme, founded on ABA behaviour strategies. It seeks to understand the reason for challenging behaviour. By assessing a person’s life history, physical health and emotional needs, it looks to minimise the triggers for this by making changes to the environment or to routines. So proactive strategies might be dimming the lights, tying hair back to stop it being pulled, giving rewards, or using a sign to confirm a task is finished. Reactive strategies include not responding to behaviour, distracting the child, giving reminders, or leaving the room. A good PBS plan has more proactive than reactive strategies.
How can Positive Behaviour Support help? PBS aims to reduce anxiety or confusion that can lead to challenging behaviour. Additionally, PBS teaches a child more appropriate ways of communicating and getting what they want - using words or signs for example.
Who can Positive Behaviour help? Anyone with behavioural difficulties, including children with Autism. PBS can also be used with people with learning, developmental and social difficulties.
NAS Earlybird, Earlybird Plus, Teen Life Programmes
What is NAS? A portfolio of programmes aimed at supporting families of preschool children (Earlybird), Primary aged 4-9 (Earlybird Plus) and older children 10-16 (Teen Life). Parents sign up for group training sessions and home visits, which help them to understand Autism, communicate with their child or young person, and manage behaviours.
Who can NAS help? Families who are coming to terms with an early diagnosis, or those who wish to establish a consistent use of strategies across settings. The Teen Life programme supports the families of young people with a later diagnosis, or those coping with stress, puberty and independence.
SCERTS (Social-Communication, Emotional Regulation and Transactional Support)
What is SCERTS? An educational model, SCERTS aims to teach children with Autism the core skills that are needed in order to have the best outcomes in later life, and to be able to apply functional skills in different settings. It focuses on social communication (functional communication and emotional expression) and emotional regulation (coping with everyday stress). It may involve modifying the environment or providing learning tools like picture communications, written schedules, or sensory supports.
How can SCERTS help? SCERTS provides a framework so that families, teachers, and therapists can all work on a child’s individual plan, which will cover goals and objectives for learning both at home and at school. It may work on basic communication, through a programme at ‘social partner’ level, or more developed communication, at the ‘language partner’ level, using individually motivating themes for each child.
Who can SCERTS help? Mainly children with Autism and their families, but the SCERTS model can also be used across a range of developmental abilities.
ABA (Applied Behaviour Analysis)
What is Applied Behaviour Analysis? ABA is a programme developed in the US, which incorporates intensive interaction and positive reinforcement to achieve its therapy outcomes. It looks at the causes and the consequences of behaviour. It then makes changes to what happens before the behaviour occurs (the antecedent) and what happens after the behaviour occurs (the consequence). An antecedent may be a change to the environment, or it could involve a demonstration, for example how to interact with other children.
Prompts (visual or verbal or both) may be used to indicate what should happen next. Any task, even things like ‘brush your teeth’ will be broken down into lots of smaller manageable steps. Over time the prompts and small steps will gradually disappear. The consequence is then a reward or positive reinforcement that helps the child to think, ‘When I do this, that enjoyable thing happens, so I’ll keep doing it.’
How can Applied Behaviour Analysis help? ABA aims to develop and increase the good behaviours, and to minimise the behaviours that interfere with learning or relationships, or those that could be harmful. It also claims help teach basic skills.
Who can Applied Behaviour Analysis help? ABA is designed to work with all age groups. But it is controversial – while some parents, particularly in the US, are firm fans, others consider it a form of operant conditioning.
TEACCH (Treatment and Education of Autistic and Communication-Handicapped Children)
What is TEACCH? In collaboration with parents, TEACCH looks to understand the whole child or adult, focusing on their skills, interests and needs. Individual plans are designed to make the most of their strengths within a structured environment. This is sometimes called ‘structured teaching’ and involves looking at the physical structure or the organisation of the room, visual schedules (where/when/what the activity will be), visual information (what can we do in this work or play area), and task information (visually clear information on what the task is about).
How can TEACCH help? The TEACCH programme helps to prepare people with Autism to live or work more effectively at home, at school and in the community by focusing on communication and social skills, independence, coping skills and skills for daily life. It provides a wide range of services including educational services, supported employment programmes, parent training and counselling and individualised treatment programmes.
Who can TEACCH help? Any child or adult with Autism. Some people may need some form of TEACCH in place throughout their whole life.
The Zones of Regulation
What is The Zones of Regulation? A cognitive behavioural programme to teach self-regulation and emotional control devised by an OT, Leah Kuypers, with the aim of increasing social functioning.
How can The Zones of Regulation help? The programme provides easily understood categories for different feelings and states of alertness: blue, green, yellow and red zones, similar to a traffic light coding. Students are taught to recognise and regulate their zone and manage it, according to the environment and social situation.
Who can The Zones of Regulation help? Children and young people with social, emotional and behavioural needs, particularly Autism and attention disorders.
Auditory Integration Training (AIT)
What is Auditory Integration Training? AIT is an educational music programme based on the idea that some people are hypersensitive (over-sensitive) or hyposensitive (under-sensitive) to certain frequencies of sound. This can cause issues with concentration, understanding or communication, and may lead to irritability, tantrums, slow responses and tiredness.
How can it Auditory Integration Training help? AIT involves a person listening to a selection of music that has been electronically modified so the frequencies have been changed. The programme’s claim is to reduce ‘distorted’ hearing and hypersensitivity of specific frequencies by ‘re-educating’ the brain, so that all frequencies can be heard equally well.
Who can Auditory Integration Training help? People who have ADHD, ADD, dyslexia, hearing sensitivities, Autism, developmental delays, poor concentration, speech and language problems as well as a variety of other special needs.
How schools can help with autism treatments and interventions
Clear routines and structure, including a timetable of what is happening, with pictures, showing the sequence of activities.
Explanations about why you are doing something, or why the child needs to follow instructions, which use their cause/effect understanding.
Extend attention with a sand timer or stopwatch to count down at the end of an activity, so that changing activity or focus does not come as a surprise.
Identifying crisis points, triggers and consequences of stress, to avoid future meltdowns.
Sensory breaks for a restless child, using stress balls, fiddle-toys or simply a short walk, to clear the head.
Talk about emotions, with pictures of facial expressions, to label the feelings the child is experiencing.
Create social stories to explain different perspectives and the need to respect and tolerate others.