By Sheryl A. Isaacs

Studies have shown that when early intervention occurs with children that experience developmental delays it will change the outcome for the child. In this article I will focus on the specific benefits of early intervention behavioral therapy (EIBT) for children that have autism. 

The signs of autism can be insidious and hard to recognize. In order to recognize the a-typical development that occurs with autism, it is important to know what typical development looks like.  This can be difficult, especially for first time parents. With an infant that has autism, it is a slight deviation from normal development. Many times it is the lack of or lessened occurrence of a typical pattern of development that occurs. Infants with Autism can be categorized as good babies that are not demanding. Many signs of autism can be seen before 2 years of age. 

Studies have shown that when early intervention behavioral therapy (EIBT) occurs before the age of two many
children can be mainstreamed in typical classrooms.  Intensive EIBT before the age of two has been shown to help “rewire” a child’s brain and in some cases reverse the signs of autism. When the deficient areas are targeted, such as imitation, joint attention and play skills, there is an increase in expressive and receptive language by the child who has autism. When imitation, joint attention and play skills increase it opens up a whole new world of interaction for the children. An increase in these areas enables the children to test better on developmental test and effectively can raise their IQ scores when tested.

The most effective EIBT program will increase the parent’s responsiveness to their child through therapy and in
home treatment.  Parents are given the tools to continue treatment on a daily basis with their child, which will
benefit the child and parent.  When a parent is taught to follow their child’s lead in communication, non-verbal communication will increase and possible verbal communications occur.  Parents will learn to require the child to vocalize during interactions and requests. At first these vocalization requests will be far from the targeted word, but in time closer approximations to the word will occur. As parents continue to utilize the skills that are learned through the EIBT program they will be more effective parents for their child with ASD.  

Parents must also learn to “scaffold” various skills. Scaffolding occurs when a larger skill is broken down
into smaller components. Help is provided to the child until they become familiar with the new items that have been introduced within the larger skill. Teaching continues in this manner until the child masters the task. This type of teaching will enable the parent to focus on their child’s level of learning and have the knowledge and ability to help their child reach the next level of learning, regardless of the present skill level.  This technique can increase many skills: play skills, self-help skills, language skills, motor skills and cognitive skills.  As parents continue to “scaffold” the child’s learning will solidify in these areas because they are always beginning the learning task at a level that is just above their acquired level, which increases success and a level of
mastery. 

Further research continues to be being done to increase recognition of autism at an earlier age. All research
points to early intervention being the key in providing the best outcomes for children with autism. One exciting study links weak head and neck muscles to ASD.  Here is a link to the video and information on the study.  This study was done the Kennedy Krieger Institute.

In this article EIBT was addressed as an early intervention for children that have autism.  It is important to remember that any child that is experiencing any delay in any developmental domain (physical, cognitive, social and emotional) should receive early intervention services. Below you will find warning signs for autism
and a list of links that can help determine what steps you can take in getting your child the help they need to succeed!

The following list was taken from helpguide.org:

 Early signs of autism in babies and toddlers

 

Doesn’t make eye contact  (e.g. look at you when being fed).
Doesn't smile when smiled at.
Doesn't respond to his or her name or to the sound of a familiar voice.
Doesn't follow objects visually.
Doesn't point or wave goodbye or use other gestures to communicate
Doesn't follow the gesture when you point things out
Doesn't make noises to get your attention
Doesn't initiate or respond to cuddling
Doesn't imitate your movements and facial expressions
Doesn't reach out to be picked up
Doesn't play with other people or show interest and enjoyment
Doesn't ask for help or make other basic requests

Physician guidelines:

No big smiles or other warm, joyful expressions by six months or thereafter
No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
No babbling by 12 months
No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
No words by 16 months
No meaningful, two-word phrases (not including imitating or repeating) by 24 months
Any loss of speech, babbling or social skills at any age

If these signs are seen in your child then it is important to get them to your Doctor for a thorough examination.

Helpful Web Sites:

Developmental milestones birth through 12+ months

Overview of what early intervention is and has many helps and information.
 
MCHAT will help you determine if a professional should evaluate your child

Autism Speaks 100 Day Kit for newly diagnosed families

By Sheryl A. Isaacs

Many people hear Applied Behavior Analysis (ABA) and think that it is "doggie style" training for children that have Autism.  It is definitely not.  While I was working at the Bay School in Santa Cruz, I was able to learn about ABA while working under a Board certified Behavior Analyst.  I worked primarily with children that were under five in the Early Intervention Classroom.

My experience was amazing.  I saw each child grow in all areas of development.  Children that were not verbal were able to begin to vocalize, those that could not reciprocate in relationships began to seek out attention.  It was at the Bay School that I became a firm believer in early intervention.

ABA principles are utilized everyday in many different circumstances.  The major premise of ABA is that each and every behavior is reinforced either by positive reinforcement or negative reinforcement.  Behavior is increased by the presentation (positive reinforcement) or removal (negative reinforcement) of an object.  The trick is to find something that is super motivating to the person that you are trying to increase behavior in when utilizing positive reinforcement. 

Let's say that you want to increase the likelihood that Timmy will complete his school work without fussing by using positive reinforcement.  What is the most important thing to Timmy, what is his "carrot."  You need a big enough carrot for him to comply.  Let's suppose that he loves his video games.  Now you link playing his video game to finishing his homework.  Little Timmy will be reinforced with video game play ONLY after he completes his homework.  The trick is to not let Timmy play too long, then you might weaken the reinforcer.  You also do not want to allow Little Timmy to play at other times.  That will increase the likelihood that he will STAY motivated for his video games. Be sure to amp up the verbal praise...get REALLY excited when there is compliance. Are you beginning to see the value of ABA principles?

What about negative reinforcement?  Well, let's say that Little Timmy throws a fit and screams when he has to put his shoes on.  Mom, who is embarrassed by this behavior, allows Timmy to not put on his shoes.  Here we can see that Mom has unwittingly utilized negative reinforcement with Little Timmy.  Timmy's screaming caused Mom to allow him to escape the demand to "put your shoes on." Timmy has learned that if he engages in this behavior he will NOT have to put the shoes on.

This is where it is important to understand the ABC's of ABA.  Collecting this data can help us see what the function of the behavior is. There are four main functions of behavior: escape, attention, access to something and sensory need. The A in ABC's of ABA stands for antecedent. Antecedent just means what happened BEFORE the behavior you are looking to change, by being specific we can see patterns that occur.  The B in the ABC's of ABA stands for behavior.  What is the specific, observable behavior? When we look at a behavior we have to look at it in a non-judgmental manner and describe what we see.  The C in the ABC's of ABA stands for consequence.  That means what happened right after the behavior.  It is important to be very specific here as well.

Let's talk about Timmy again.  Timmy's mother reports that he has been having increased "meltdowns." Mom begins to collect data on an ABC data form when the "meltdowns" occur.  Mom notices that every time before the "meltdown" she is doing something, talking on the phone, doing laundry or cooking.  She records Timmy's behavior in a non-judgmental, observable manner.  Timmy drops to the floor, kicks his legs, screams and rolls back and forth.  Now Mom can be clear about the specific behavior she wants to change.  The consequence that is noted, is that mom stops what she is doing and picks Timmy up. Hmmm...do you see what is going on here?  What type of function is this behavior serving for Timmy?  Yep, it is attention.

Every time Mom stops what she is doing she is negatively reinforcing Little Timmy.  He learns that when he engages in "meltdowns" that Mom will stop what she is doing and give him the attention that he desires. What is Mom to do?  This will not be easy.  Mom will need to continue to do what she is doing regardless of Timmy's meltdowns. She will need to be consistent to extinguish this behavior. What if Mom decides to give in to Timmy a few days a week?  Well, she is teaching Timmy that his behavior WORKS.  Now poor Mom will have to work even harder to extinguish the behavior.  If Mom allows Timmy to "meltdown" for five minutes and then give in, it will be at LEAST a five minute "meltdown" next time. 

Mom could, of course, choose to use punishment to decrease the behavior, such as timeouts.  Mom could also utilize positive reinforcement, making a chart or giving Timmy a treat for every five minutes he is quiet while she is busy.  I myself prefer to utilize positive reinforcement first, then negative reinforcement and finally punishment.

When you begin to think about how a behavior is reinforced you see many relevant situations where ABA principles could be utilized. What about behaviors that our spouse, girlfriend or boyfriend engage in?  Are we reinforcing their behaviors at times?  Looking at the function of behaviors help us to understand a need that is not being met.  How can we increase attention at other times with our children to help alleviate acting out behavior?

Of course there is much, much more to ABA than this. I hope that you have begun to see the daily implications that positive reinforcement, negative reinforcement and punishment have in our daily lives!