Article Review: A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations

Lee Ann Melchor

University of Central Florida

College of Education - Graduate Studies

A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations

Recently, the CDC announced that roughly 1 in 88 children are diagnosed with autism with boys 5 times more likely to develop autism than girls. These staggering numbers combined with the lack of identifiable cure or cause of autism, leaves many parents vulnerable to miracle cures and ineffective and unproven treatment options. Of all the treatment options available, several programs were identified as being the most cited and most visible autism programs available. These programs include: UCLA’s Young Autism Project (YAP), Project TEACCH, LEAP, ABA Therapy and the Denver Health Science Program.

While there is no documented cure for autism, autism can be managed effectively using a combination of behavioral, education and biological interventions. In reviewing treatment options, autism and school professionals should consider the following questions: (a) Are these treatment programs effective? (b) What are the common elements of these programs? (c) What steps need to be taken to improve treatment outcome research for children with autism? (d) What implications do the answers to the above 3 questions have for school psychologists? (Gresham, 2000). Two primary distinctions are made when evaluating a treatment option: the efficacy of the treatment or the reduction in the autism symptoms while increasing functional skills and effectiveness across the settings in which the treatment options will be used.

In 1996, Bristol and his colleagues released a report to the National Institute of Health (NIH) in which he raised issue with the methods and the statistical data in autism interventions that must be addressed in order to gain a better understanding of what autism interventions work. These findings include:

• Research studies should use experimental designs and treatment comparison models.
• Use of randomly assigned children to treatment conditions.
• Treatment should be conducted across a wide variety of natural and laboratory settings in which a wide variety of behaviors and skills are assessed.
• Outside evaluators who are not vested in outcomes of research should not be used.
• Procedural integrity of the interventions should be consistently assessed.
• Longevity studies should be used to evaluate the long term effects of treatment over time.

The Clinical Child and Pediatric Psychology / Division 12 of the American Psychological Association (APA), formed a task force to evaluate the efficacy and effectiveness of research on childhood five childhood disorders, including autism. The goals of the task force include identifying what treatments are most effective for individuals with autism and under what circumstances.

In evaluating several of the leading programs for children with autism, including UCLA’s Young Autism Project (YAP), Project TEACCH, LEAP, ABA Therapy and the Denver Health Science Program, several key flaws were found. In the YAP program, which relies primarily on discrete trial training, the research studies utilized to evaluate YAP’s effectiveness, failed to randomly assign children to the research groups. Further research studies, failed to replicate the exact outcomes in later studies. Project TEACCH uses collaboration, sharing of information, as well as education programs for both the child and the parent. Project TEACCH uses a framework that combines vocational, social skills, and living skills. Research studies have been completed on the effectiveness of TEACCH in the classroom, but not on the effectiveness of the interventions being used in the home setting. LEAP program is a federally funded model that was one of the first to utilize inclusive practices for young children with autism and their families. LEAP emphasizes the use of a home-school alliance to promote academic outcomes of children. There is little data to support that LEAP has more effective outcomes than other autism programs. ABA Therapy is considered one of the most effective interventions for children with autism as it focuses on the role of the child’s environment impact on the child’s behavior. This article, however, focused on two ABA programs: Rutgers University’s Douglas Developmental Center and Princeton’s Child Development Institute. This article criticized that the studies conducted at Rutgers failed to use a control group and a comparison group, thereby nullifying the validity of the data collected. Princeton’s study also had several flaws including failing to randomly assign children, neglecting to use a comparison group receiving another treatment, failing to identify the treatment program adequately and poorly defined outcomes.

From this article, it has become clear that the autism field is hampered by the lack of adequately proven interventions. The lack of documented proven interventions is centered around the lack of an established, uniform criteria for evaluating the effectiveness of treatment options in the field of autism. If professionals in the field cannot agree on an established method for evaluating programs, how can they determine the most effective intervention programs available? Furthermore, if professionals cannot agree on the most effective interventions available, how more confusing is it to parents of children with autism to determine which treatment options are most effective for their child?

In summary, it is clear that there is a high need for a uniform set of procedures and criteria to be established to evaluate the effectiveness of programs. It is imperative for this to be established for advances to be made in the autism field. This is critical for not only protecting parents and children with autism but the field of autism as well.

Gresham, F. et al (2000). A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations. School Psychology Review, 28(4), pp. 559-575.

Article Review: Evidence-Based Practices and Students with Autism Spectrum Disorders

by Lee Ann Melchor

University of Central Florida and

Middle School ASD Seclusion Teacher

note: A full copy of this article and the successful interventions referenced in the article can be found at https://depts.washington.edu/pdacent/Publications/Simpson/Simpson2.pdf

With the passing of both IDEA and NCLB, several restructuring efforts to identify the role of the parent and increase parental involvement have been made. In 2001, NCLB sought to ensure that children with disabilities have a fair and equal opportunity to participate in obtaining a high-quality education as that of their non-disabled peers. To measure this, providing standards-based curriculum and measuring annual yearly progress (AYP) became the expectation for all students.

For children with ASD, this is becoming increasingly challenging. In recent years, the increased prevalence of those diagnosed with ASD has increased. Unlike other disabilities, educators and parents of children with the life-long disability of ASD face the additional challenge of not knowing the root cause of the child's disability as well as no universally accepted course of successful treatment (Simpson, 2005). Parents of children with ASD, are often desperate to find both a cause of their child's disability and cure. Unfortunately, there are many individuals and companies that prey upon the vulnerability of the parents by promising extraordinary and often unproven results. These unproven methods have encouraged unhealthy, unrealistic and often improbable expectations and have impeded the field of ASD (Simpson, 2005).

Over the last decade, there has been little information available as to what works. This is greatly hampered by the lack of agreement between professionals and educators on how to best identify and effectively evaluate and measure effective practices. Under NCLB, an attempt has been made to identify programs that are scientifically based by research “that involves the application of rigorous, systematic and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs” (NCLB, 2002). Shortly thereafter, the U.S. Department of Education awarded $18.5 million to the What Works Clearinghouse to assess and identify effective programs.

Despite these measures, there has not been adequate progress made in the field of ASD. Primarily, the wide range of symptoms among those diagnosed with ASD make it difficult to pinpoint effective methods as a method that may work for one individual may not necessarily work for another. It is also difficult to define how results will be measured as many of the results are based upon the observer’s perception, rather than scientifically based data collected.

For parents, this can be very confusing. Websites, testimonials, vitamin makers, the media and even supposed educational and medical companies all promise miracle cures. Simpson recommends parents and professionals become better consumers of intervention methods for children of ASD by utilizing 3 important questions: (1) What are the efficacy and anticipated outcomes that align with a particular practice, and are the outcomes in harmony with the needs of the student? (2) What are the potential risks associated with the practice, and (3) What are the most effective means of evaluating a particular method or approach? (Simpson, 2005).

In short, Simpson encourages professionals and parents to identify the specific, individual needs of the child. Next, determine what common goal they hope to achieve. Like in an I.E.P., parents and professionals should identify goals that are realistic, clearly defined and able to measured and obtained. Parents and professionals should also evaluate the risk to the child and the emotional and financial risk to the family unit. Finally, parents and professionals should determine how results will be measured, rather than relying on their feelings and attitudes.

So, what does work? Simpson and his team identified several interventions and treatments for children with ASD. Within the skill based category: ABA therapy, discrete trial training, LEAP and pivotal response training all meet the standard of scientifically based practices. Medications and other medically based interventions were not included in the evaluations possibly as the medications primarily treat the symptoms such as behavioral disorders and aggression, rather than overall ASD disorder.

In summary, the field of ASD is dependent upon identifying effective methods, treatments and interventions. This is critical not only to the field of ASD, but also to reduce the amount children with ASD are exposed to questionable and ineffective treatments.

References:

Simpson, R., et al (2005). Evidence Based Practices and Students with Autism Spectrum Disorders. Focus on Autism and Other Developmental Disorders, 20(3), 140-149.

No Child Left Behind Act of 2001. 20 U.S.C. 70, 6301 (2002).

Article Review: Preparing General Education Teachers to Improve Outcomes for Students with Disabilities

Lee Ann Melchor
University of Central Florida
College of Education and Graduate Studies
Fall 2011

This publication by NCLD is a prime example of how teachers are continually working to improve student outcomes while working within state and federal frameworks and on limited resources.  The article reflects the amount of stress placed on teachers to meet annual yearly goals, improve test scores and ensure students are meeting the requirements under NCLB in order for the districts to receive federal funding. 

Teachers of exceptional students are under more pressure because exceptional students are required to achieve AYP at the same rate of their non-disabled peers, as well as being required to pass assessments at the same level as their non-disabled peers.  Not only must general education teachers ensure that this is achieved, but must be able to use reasonable accommodations and modifications to ensure students meet those goals. 

Many general education teachers have not been adequately trained to deal with the medical, physical, mental and other challenges of a special needs child.  There is a lot of stress on general education teachers to combine the special needs education into a general education setting, combining both disabled and non-disabled students, tailoring instructional strategies to meet each student’s individual needs, writing lesson plans, attending staff and parent meetings, administrative duties and other duties as required.  In addition, many programs and processes designed to assist students with special needs, such as the IEP process and RtI, require general education teachers to devote a large amount of time for data collection, research and documentation before the child can be referred for special education services.

With this, comes a huge burden for teachers.  Teachers must continually use their time and resources effectively to deliver the most effective level of instruction, in the most efficient manner possible.  Teachers need adequate training, professional and parental support and a strong knowledge of the resources and skills they have available.  Also, at the state, federal and district level, incentives must be provided for teachers to invest their time and energy into costly training programs to further their education and training.  It is one thing for state, federal and district requirements to be placed on teachers, but without adequate training and support, teachers simply will fail to meet expectations.

References:

Blanton, L., et al. (2011) Preparing General Education Teachers to Improve Outcomes for Students with Disabilities.  AACTE and NCLD Publication.  Retrieved from http://www.aacte.org/pdf/publications/reports_studies/aacte%20ncld%20policy%20brief%20may%202011.pdf

History of Specific Learning Disabilities (SLD)

 Lee Ann Melchor

University of Central Florida

Department of Education and Graduate Studies

The first learning disability was diagnosed in 1877 by German neurologist Adolf Kussamaul after diagnosing a child with “word blindness”-- "a complete text blindness…although the power of sight, the intellect and the powers of speech are intact."  Another German physician diagnosed the first known case of dyslexia in 1887, while W.E. Bruner diagnosed the first child with reading difficulties in the U.S. in 1905.

Despite these early known reports of learning disabilities and the prior works of psychoanalysts Skinner, Chomisky, Vygotosky and many others, legislation changes in the realm of special education to address learning disabilities did not take place until approx. the 1960s.  In 1963, Samuel A. Kirk uses the term “learning disabled”, marking the first time this term had been used.  The term “learning disability” clearly departs from the mental disorders as classified by early psychoanalysts.

Learning disabilities today, as defined by the federal definition includes perceptual disabilities, brain injury, dyslexia, minimal brain dysfunction and developmental aphasia.  Learning disabilities does not include any disorder that is the primary result of a vision, hearing, motor disability, mental retardation, emotional disturbance, or environmental, cultural or economic disadvantage. (IDEA Amendments, 1997, Sec. 602(26), p.13)

Today, the National Joint Committee on Learning Disabilities has created an alternative definition due to dissatisfaction of the federal definition for learning disability.  This alternative definition developed by the NJCLD encompasses including adults, those with self-regulation and social interaction issues, disorders of the central nervous system and to clarify ambiguous term under inclusion, exclusion, spelling and references to the psychological processes. 

In 1965, Congress under Title VI created the Bureau of Education for the Handicapped, now known as the Office of Special Education Programs (OSEP).  In 1969, Congress specifically addresses learning disabilities with the passing of the Children with Specific Learning Disabilities Act.  This was later included in the Education of the Handicapped Act of 1970 (PL 91-230).

The Civil Rights Movement of the late 1960s and 1970s marked a radical change in the perception of the disabled.  In 1973, Congress passed the Rehabilitation Act of 1973, to very little public interest.  This act protects the disabled from discrimination due to their disability.  This was followed shortly by the Family Educational Rights and Privacy Act (FERPA) which protects the rights of families. FERPA specifically gives parents access to all information collected, maintained, or used by a school district regarding their child.

In 1970, Congress passed the Education for All Handicapped Children Act (PL 94-142).  This law incorporated one of the major concepts still used today--free, appropriate public education for all students (FAPE). In 1990, this law was renamed as Individuals with Disabilities Education Act and later reauthorized in 1997 and 2004.  IDEA changed the use of the word “handicap”, replacing it with “disability” therefore changing the public perceptions and increased sensitivity toward those affected by a disability.  Also in 1990, the Americans with Disabilities (ADA) Act was passed which mandates that no one with a disability can be restricted from any activity programs or activities that are federally funded because of their disability.  ADA also utilizes the 504 plan which spells out what accommodations the child will receive in order for students to have the opportunity to perform as their non-disabled peers. 

IDEA (1990) also added in Autism and traumatic brain injury into eligibility categories.  In 1997, general education teachers were included in the IEP process, allowed disabled students access to general education curriculum and also mandated that disabled students would be tested in state-wide assessments.  ADHD also was added to the eligibility categories in 1997.  In 2004, IDEA and No Child Left Behind (NCLB) work together to ensure that students are educated in the least restrictive environment possible and that a child’s disability does not exclude him from promoting forward. 

With the passing of federal legislation, more information readily known about most learning disabilities and changes in perceptions toward the disabled, there has been significant change in moving from institutionalization, to normalization, deinstitutionalization and inclusion.  This radical change in the perceptions and attitudes toward the disabled has been the direct result of parents, advocates, agencies, legislation and other individuals toward improving the quality of life and respect toward those affected by a disability.  This also includes supports and sensitivity to families affected by a loved one with a disability. 

While many causes of disabilities are not known, we have made great strides in improving the knowledge base of environmental, hereditary and other factors that cause some disabilities.  In addition, our focus has shifted toward ensuring that anyone affected by a disability is provided every opportunity to participate in education, employment and other activities as that of their non-disabled peers.  The biggest change by far, is the overall attitudes, levels of acceptance and perceptions about people with disabilities.

References:

Hallahan, D. (2012) Exceptional Learners. Pearson: Upper Saddle River.

LD Online (2011) Timeline of Learning Disabilities. 

Retrieved from http://www.ldonline.org/

Teaching LD (2011).  Retrieved from http://teachingld.org/pages/DLD-history