Effective Treatments for Autistic Children

Autism is a pervasive developmental disorder (PDD) that is associated with impairments in social functioning, emotional processing, and communication. Children who have this disorder experience difficulty understanding and interacting with the social world around them. One of the most debilitating features of this disorder occurs in social interaction. Autistic children experience difficulty in verbally expressing themselves, sharing their focus of attention with others (shared attention), engaging in pretend play, imitating others, and adapting to the social environment. Autistic children also have difficulty in processing emotional information. Children with autism do not understand their emotions as well as those of others. For example, they may not recognize the body language, gestures, and facial expressions conveyed by anger, happiness, or sadness. In addition, they lack the ability to attribute meaning to objects and people. They may present greater attention to physical aspects of an object, instead of focusing on the more important aspects of that object. On the other hand, autistic children may focus on one specific aspect of someone's face, without paying attention to the person's face in its entirety. Impairments in language are common among autistic children as well. These children have trouble with pragmatics, which is defined as "the appropriate use of language in social and communicative contexts" (Mash & Wolfe, 2005). Pragmatic difficulties are evident in the children's lack of conversational initiations, restrictive quality of speech, and use of repetitive speech (as cited in Aldred, Green, & Adams, 1993). Another pragmatic difficulty that autistic children have concerns their tendency to attribute literal meaning to their speech and others' speech; this tendency contributes to their failure to adapt their language to suit social situations.

Autism can drastically impact a child's social functioning. Although there is no cure for autism at this moment, if an autistic child is given proper and effective treatment, he may improve his social functioning dramatically. One of the most common and effective treatments for autism are aimed at changing a child's behavior and/or thoughts. Treatments that focus on changing one's behavior are called behavioral treatments, whereas those aimed at changing one's thoughts are called cognitive treatments. Some treatments are integrative of both behavioral and cognitive treatments and are thus, called cognitive-behavioral treatments. Numerous research studies have examined the efficacy of cognitive and behavioral therapies or both. MacDonald, Clark, Garrigan, and Vangala (2005), Aldred, Green, and Adams (2004), and Bauminger (2002) are among many of the researchers who studied these treatments.

Unlike typically developing children, autistic children have a hard time engaging in pretend play. In their play, autistic children usually engage in repetitive actions and fail to attribute meaning to their play (as cited in MacDonald et al., 2000). Their inability to understand others' emotions and perspectives contribute to their failure to engage in pretend play. MacDonald, Clark, Garrigan and Vangala (2005) studied the effectiveness of how video modeling can improve an autistic child's ability to engage in pretend play. Video modeling is a behavioral technique which involves showing a videotape of people (the video itself and its contents are known as the video model) talking and acting out certain behaviors. As part of the procedure, the participants, which consists of a 4-year old boy and a 7-year old boy diagnosed with autism, were asked to play with several toy objects. The toy objects that they were presented to play with were also displayed in the video model, and include: a town, ship, house, and toy characters, such as a girl, cat, dog, captain, a boy, and a mother.

In order to assess their pretend play skills, the children were observed while holding each object and speaking on its behalf during several sessions: before the video was shown (baseline), after the video was shown (training), and during probe sessions in which no videos were shown. In each session, the children's play was observed for scripted actions and verbalizations (actions and verbalizations that matched the video models' actions and verbalizations), and unscripted actions and verbalizations (actions and verbalizations that were seen in the video model but occurred with a different character or actions that are contextually appropriate but were not shown on the video). The results of the study showed that video modeling was an effective technique for teaching autistic children how to improve their pretend play skills. Both of the children in the study were able to quickly learn the actions and verbalizations displayed by the video models, and maintain their mastery performance over the course of the sessions. The children's acquisition of these abilities demonstrates their mastery of imitating others, and understanding of other's emotions and perspectives.

One experiment study (Aldred, Green, and Adams, 2004) aimed to improve the quality of parents' adaptational skills and communication with their autistic children through a social communication intervention. The social communication intervention is a cognitive-behavioral treatment; it required parents to attend workshops in which they were trained in communication skills and communication intervention strategies, and educated about developmental psycholinguistics. Subsequently, parents and their child attended sessions with a therapist for six months, followed by another six months of maintenance sessions. During these sessions, the therapist observed the communication between the child and parents, and offered communication strategies that the parents and child must practice daily at home. The main focus of the communication strategies was to increase shared attention, children's expressive language and understanding of language, and the sensitivity and responsiveness of parents towards their autistic child.

The participants of this study were a clinical sample of 2-11-year old children who were diagnosed with autism. The study consisted of two groups: the treatment group and control group, with each group being further divided into four smaller subgroups on the basis of age (young and older) and the severity of the disorder (high-functioning and low-functioning). Routine care, which consisted of speech and language therapy, was given to both the treatment groups and control groups. Compared to the control groups which received routine care alone, the treatment groups received the social communication intervention in addition to routine care.

The study contained six measures for assessing communication, comprising of questionnaires and interviews for parents, and observations of the children during free play and during interaction with their parents. Overall, the measures assess communication in the domains of verbal and non verbal behavior, more specifically in the areas of verbal and nonverbal expression and comprehension, shared attention, parental demands and comments, and parental stress towards their child's autism. The results showed that the treatment groups improved in a greater number of areas and to a larger extent than the control groups. For one thing, the treatment groups improved in many areas, most significantly in reciprocal social interaction, expressive language, conversation initiation, comprehension, and parent-child interaction. Overall, the treatment groups declined in autistic symptoms across all ages and severity levels, with the most improvement coming from the young age subgroup. Compared to the control groups, the parents in the treatment groups showed a greater usage of positive comments as well as an increase in their child's communicative acts. Furthermore, there were no significant differences between the stress levels of parents before and after the intervention and between the treatment and control groups. The control groups demonstrated increases in comprehension, parental demands and intrusive language. Also, only the young low-functioning control subgroup showed a decrease in autistic symptoms, while the other control groups showed no change in autistic symptoms. Thus, the results seem to show that the treatments groups demonstrated a larger degree of improvement across a greater number of domains than the control groups.

In contrast to Aldred, Green, and Adams' study (2004) which involved only parents and therapists in the treatment of autistic children, Bauminger (2002) incorporated teachers, peers, as well as parents into the treatment of autistic children. In her study, Bauminger studied the efficacy of a cognitive-behavioral treatment that focused on teaching interpersonal problem solving, comprehension of emotions, and social interaction to children with high-functioning autism. In the intervention, the children were trained in two areas: social-interpersonal problem solving and affective education. In the social-interpersonal problem solving training, children were trained to recognize and correctly analyze external social cues (body language and facial expressions) and internal cues (emotions and thoughts). This type of training also focused on the awareness of possible social situations and their outcomes. The affective education training, on the other hand, placed emphasis on the ability for children to understand their emotions and those of others, and their ability to recognize which emotions are elicited by certain social situations.

The cognitive-behavioral treatment was conducted within the school and at home. The teacher provided social-interpersonal problem solving training and affective training to the children for a total of 3 hours a week within the classroom. The teachers taught the children about friendship (what friends are and why we listen to them), how to identify simple emotions in social situations through nonverbal cues (simple emotions include happy, sad, and angry), and how to initiate a conversation, console, and share thoughts with a friend. The teachers also informed the children's parents and designated peer about which social skills the autistic child needed to practice and improve on. The peer met with the autistic child 2 times a week: once during school recess and once after school, and engaged in social activities during their meetings. During their meetings, they practiced social skills, which may include talking on the phone and initiating conversations. The parent's responsibility was to help their child master the social skills that they lacked on, as reported by the teacher, with the assigned peer.

The participants in this study included 15 high-functioning children diagnosed with autism who are between the ages of 8 an 17. Several measures were used to assess the children's understanding of emotions, problem-solving, and social functioning; the assessment measures included an interview and questionnaire for parents, a questionnaire for teachers, and observations of children's social interaction and problem-solving skills. All assessments were administered before and after the intervention to determine if the children had improved in any of the domains being studied. The results demonstrated that the children showed improvement in all domains, which included problem-solving, understanding of emotions, and social interaction. The children gave more relevant solutions and less non-social solutions to the problem-solving tasks after the treatment, as opposed to before the treatment. In addition, the children were more likely to understand and give examples of the simple emotions after the treatment as opposed to before the treatment. The most notable improvements occurred in social interaction, especially in the areas of eye contact, sharing of experiences, and expression of interest in peers. The children also appeared to exhibit less repetitive behavior following the treatment. Overall, the study illustrated that autistic children can be trained in and improve in problem-solving, comprehension of emotions, and social interaction.

The previous studies have implemented behavioral and cognitive-behavioral strategies for treating autism in children. Each of these studies have used a different approach to improve the social functioning of autistic children, and succeeded in doing so. Overall, the treatments implemented in these studies have improved the autistic children's functioning in many different domains. MacDonald and her colleagues (2005) have shown that video modeling can help autistic children improve in their pretend play skills in the areas of understanding emotions and perspective taking. Aldred and her colleagues (2004) implemented a more elaborate treatment and included parents and therapists into the treatment of autistic children. Their study illustrated that when parents are taught proper communication strategies by therapists to use towards their autistic children, they could improve their children's language in many areas. The children in the study were able to improve in reciprocal social interaction, expressive language, conversation initiation, comprehension, and parent-child interaction. They were also able to decrease their autistic symptoms accordingly. Bauminger (2002) was able to incorporate not only parents, but teachers and peers as well, into the treatment of autistic children. Her study showed that given training from teachers, practice with peers, and support from parents, autistic children can improve in social skills, their understanding of other people's emotions and their own, and problem-solving.

Autistic children suffer from many impairments because of their disorder. Their most apparent impairments are in social interaction. They have difficulty in shared attention, expressing themselves, and imitating others. Another ability they lack in is in emotional understanding. They do not understand how to interpret their own emotions as well as those of others. They also lack in communication skills, evident in their repetitive language, and tendency to attribute literal meanings to speech. Although there is no cure for autism at this moment, autistic children should take advantage of the cognitive, behavioral, and cognitive-behavioral treatments that are available. By taking advantage of these treatments, autistic children can reduce the severity of their impairments. These treatments could dramatically improve the child's social functioning, and teach them to be more expressive, outgoing, and understanding towards other's emotions.