Emerging Milestones (EM) is a behavioral and educational treatment service; offering intervention plans for children from the Autism Spectrum Disorders and their families. Emerging Milestones has formed an alliance with specialists in the fields of: Psychology, Medicine, and Education. It is believed that this diversity enhances the ability to develop appropriate and successful treatment plans.
EM Educational interventions attempt to help children not only to learn academic subjects and gain traditional readiness skills, but also to communicate functionally and spontaneously, socialize with skills such as joint attention, gain cognitive skills such as symbolic play, reduce disruptive behavior, and generalize by applying learned skills to new situations. Several model programs have been developed, which in practice often overlap and share many features, including:
Several educational intervention methods are available, as discussed below. They can take place at home or school. A 2007 study found that program with weekly home visits by a special education teacher improved cognitive development and behavior. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by age two to three years is crucial are not substantiated.
ABA has demonstrated effectiveness in several controlled studies: children have been shown to make sustained gains in academic performance, adaptive behavior, and language, with outcomes significantly better than control groups. A 2008 review of educational interventions for children whose mean age was six years or less at intake found that the higher-quality studies all assessed ABA, that ABA is well-established and no other educational treatment is considered probably-efficacious, and that intensive ABA treatment carried out by trained therapists is demonstrated effective in enhancing global functioning in pre-school children. A 2008 evidence-based review of comprehensive treatment approaches found that ABA is well-established for improving intellectual performance of young children with ASD. A 2008 comprehensive synthesis of early intensive behavioral intervention (EIBI), a form of ABA treatment, found that EIBI produces strong effects, suggesting that it can be effective for some children with autism; it also found that the large effects might be an artifact of comparison groups with treatments that have yet to be empirically validated, and that no comparisons between EIBI and other widely recognized treatment programs have been published.
TEACCH "Treatment and Education of Autistic and Related Communication Handicapped Children," which has come to be called structured teaching, emphasizes structure by using organized physical environments, predictably sequenced activities, visual schedules and visually structured activities, and structured work/activity systems where each child can practice various tasks. Parents are taught to implement the treatment at home. A 1998 controlled trial found that children treated with a TEACCH-based home program improved significantly more than a control group.
It is a therapeutic approach mostly derived by the proposal that individuals with autism are more apt to use and comprehend visual cues. Picture schedules are heavily focused on to encourage independence by being able to distribute step-by-step tasks. By being able to perform a task independently the individual is able to comprehend at a higher level.
The goal of TEACCH is to help autistic children fully develop into adulthood with the maximum autonomy and understanding of the world around them. Children acquire communication skills that enable them to relate to others, make independent choice about their own life, and maximizing their potential. The strategies taught in TEACCH do not work directly on behavior as it does in behavior modification, but on the core conditions that facilitate a learning experience. Behavior excesses and deficits are not directly treated, rather we want to comprehend why these behavior occurred in the first place. What is the underlying reason? Is it that the child is anxious, physically in pain, having difficulty with the task, going threw unpredictable changes, or bored, etc... By giving a meaning to communication, the person can then comprehend and express capabilities which will allow him/her to understand better what is being told or asked and to express needs and feelings in more appropriate ways.
The core belief of RDI is that the fundamental basis to enhancing the quality of life for autistic individuals rests in developing self-motivated intelligence. Autistic individuals must be gradually and systematically exposed to authentic emotional relationships. This will steadily develop motivation and success while rectifying common autistic deficits.
Building social connections by making friends, developing empathy, and sharing ideas and views with others is the main focus of RDI.
Dr. Steven Gutstein is the founder of RDI. He identified 6 abilities in dynamic interactions as:
1) Emotional referencing- Emotional feedback system used to understand subjective experiences of others.
2) Social coordination- Participating in spontaneous relationships linking collaboration and exchange of emotions while observing and regulating behaviors.
3) Declarative language- Expressing curiosity, inviting interactions, sharing feeling and synchronize actions with others by using non-verbal and verbal language.
4) Flexible thinking- Quickly being able to adjust plans based on changing circumstances.
5) Relational informational processing- Attain meaning out of problems when looking at the big picture.
6) Foresight and hindsight-.Capacity to reflect on past and predict possible and realistic pictures of the future.
Floortime follows a developmental approach that works on helping children climb the developmental ladder to success. This is achieved by: creating experiences that promote the mastery of milestones, dealing with each child’s specific challenge and facilitate development, and finally maximizing interactions with children by creating a family pattern of emotional and intellectual support.
Floortime is simply spending a 20-to-30-minute period on the floor interacting and playing with the child.
Human relationships are vital to a child’s development. The brain and the mind do not fully develop without the presence of relationships. Self-esteem, initiative, creativity, logic, judgment, and abstract thinking all develop stronger with relationships.
By following the child’s interests and impulses, you as the adult, are able to capitalize on the child’s emotion. You can help him/her learn how to attend to you, engage in dialogue, and connect emotions and intent with appropriate behavior. By working this way you make it possible for your client to embark on relating in a more meaningful, spontaneous, and flexible way.
Each Floortime interaction is an opportunity to build the gap between emotion and behavior seen in autistic children. Follow your client’s interests and motivations and observe where he/she takes you.
Phase 1: Physical exchange: Child requests a card the has a picture of what he wants, therapists acknowledges this and exchanges picture for item.
Phase 2: Distance and Persistence: Therapists moves slightly away to have the child come closer.
Phase 3: Correspondence Checks: The child is given 2 cards and chooses what it is he/she really desires.
Phase 4: Sentence Structure: child is given a card reading “I want__” to encourage verbal communication along with the exchange.
Phase 5: Request: Therapists asks, “What do you want?” Child hand therapist the card saying “I want__”
Phase 6: Discrimination Between the Label and the Request: Generalize the new skill and add new reciprocal communication, “I see__”. Child will learn to communicate observations, experiences and needs.
How to capture an EO: take advantage of naturally occurring situations. ex: Child comes inside from the park and wants water, capture the opportunity for a request.
How to contrive an EO: setting up situations or manipulating the environment to increase communication. ex: Hold the child's reinforcer in your hand and make it look or seem more enticing. The child will then have a stronger desire to obtain the item and may ask “help” “my turn” or “can I have” or “item name.”
EO’s can be contrived further by setting up a desired toy in a high location and has to request permission to get it. You are setting up a context to manipulate the situation in a way to encourage communication
The IFSP is in writing and will concern statements regarding:
The child's present levels of physical development, cognitive development, communication development, social or emotional development, and adaptive development. The family's resources, priorities, and concerns relating to enhancing the development of the child with a disability; . The major outcomes to be achieved for the child and the family; the criteria, procedures, and timelines used to determine progress; and whether modifications or revisions of the outcomes or services are necessary; Specific early intervention services necessary to meet the unique needs of the child and the family, including the frequency, intensity, and the method of delivery; The natural environments in which services will be provided, including justification of the extent, if any, to which the services will not be provided in a natural environment; The projected dates for initiation of services and their anticipated duration; The name of the service provider who will be responsible for implementing the plan and coordinating with other agencies and persons; and Steps to support the child's transition to preschool or other appropriate services.
U.S. Department of Education rules (1993) require that non-Part C services needed by a child, including medical and other services, are also described in the IFSP, along with the funding sources for those services. The statute allows parents to be charged for some services. If a family will be charged, this should be noted in the IFSP.
The IEP must contain the clients present levels of educational performance. Personal information about the child's strengths and needs will be taken from those working closely with the child, comments will be considered from all associated with t he child, observations and results from special education evaluation and district wide tests will be analyzed, and any other concerns of the child's developmental level and behavior will be discussed.
Services that will be provided based on the child’s specific needs are outlined and addressed. Measurable goals that can realistically be accomplished in one year are written up. “Goals should help her be involved and progress in the general curriculum and may be academic, social, behavioral, self-help, or address other educational needs.”
The law now states that the child’s IEP must include “a description of how the child’s progress toward the annual goals … will be measured and when periodic reports on the progress the child is making toward annual goals will be provided” — for example, at the same time report cards are issued for all students.
Once issues have been agreed on and the document is written, and action plan is created. The school district is obligated to provide a free appropriate public education (FAPE) in the least restrictive environment (LRE). Special education is considered to be a set of services. Services, goals and objectives are identified.
Other issues discussed in an Autism specific IEP meeting are maters such as: When services will begin, where and how often they'll be provided, and how long they'll last, supports and strategies for behavior management, language and communication needs, and necessary modifications in the general education or special education setting that may be needed, etc.
An IEP team includes: Clients parents, General Education teacher(s), a special education teacher, an individual to interpret evaluation results, a representative of the school system, administrators and all other individual professionals who are involved in the goal to aide in progress to the child’s plan.
Second, social skills treatment attempts to increase social and communicative skills of autistic individuals, addressing a core deficit of autism. A wide range of intervention approaches is available, including modeling and reinforcement, adult and peer mediation strategies, peer tutoring, social games and stories, self-management, pivotal response therapy, video modeling, direct instruction, visual cuing, circle of friends, and social-skills groups. A 2007 meta-analysis of 55 studies of school-based social skills intervention found that they were minimally effective for children and adolescents with ASD, and a 2007 review found that social skills training has minimal empirical support for children with Asperger syndrome or high-functioning autism.