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Increasing numbers of parents of children on the autism spectrum are now following home-based programmes adapted specifically for the needs of children on the autism spectrum. For some this is done in preparation for entry into mainstream school. For others, home-based provision provides an alternative to the provision offered by the local authority which they may feel to be unsuitable for the needs of their child.
There is a wide range of programmes on offer, but few are backed by conclusive scientific research. Better evidence is available to support the effectiveness of programmes with an emphasis on early development of cognitive, social, play and communication skills. Research Autism, a charity dedicated to research into autism interventions, states that while core features of autism have been shown to be resistant to intervention by whatever means, “It has been shown that individualised and persistent structured help, focusing on autism features and communication, is helpful and can greatly improve adaptive behaviour, academic potential and reduce the disabling effects of the condition.”
Such home-based interventions can be costly, both financially and in the huge investment of time that many programmes require of parents. Most of these programmes require intensive intervention from trained therapists, and costs can be as high as £25,000 a year depending on the hours, the location of instruction and the qualifications and number of therapists used. Some local authorities however, may fund part or all of certain types of home-based support such as Early Intensive Behavioural Intervention (EIBI, sometimes known as Applied Behavioural Analysis - ABA). NAS estimates that around 100 local authorities in England and Wales are currently funding EIBI programmes.
There are also issues to consider regarding the training and supervision of those working in the home with the child, and with regards to how the home-based provision fits with the work of other agencies and with transition to school if that is wished.
Early Bird Programme
The EarlyBird Programme is a three month programme, developed by the NAS, for the parents/carers of pre-school children on the autism spectrum. It is delivered by licensed trainers who work with parents/carers on how to get the best out of their child, and aims to empower parents and help them facilitate their child's social communication and appropriate behaviour within the child's natural environment. It also helps parents establish good practice in managing their children’s behaviour at an early age.
The following programmes are home-based interventions that aim to modify the behaviour of children on the autism spectrum.
Early Intensive Behaviour Intervention
Early Intensive Behavioural Intervention (EIBI) is sometimes referred to as Applied Behavioural Analysis or the Lovaas method (it was originally developed in the 1960s by psychologist Dr Ivor Lovaas). EIBI is a highly structured and intense form of therapy which aims to teach linguistic, cognitive, social and self-help skills by breaking them down into small tasks. Discrete Trial Training (DTT) is the main strategy used within this programme whereby the trainer instructs the child using a series of learning opportunities or ‘trials’. Praise and rewards are used to reinforce good behaviour.
The programme recommends 40 hours a week of intensive therapy for at least two years. A consultant designs a programme for each child, and a team of at least three therapists is employed to work with the child, usually on a one to one basis. Because of the need to train and supervise such a team, costs can be high.
These programmes have been well evaluated, and while claims that they result in recovery from autism cannot be substantiated, there is good evidence that EIBI results in important improvements for many children on the autism spectrum.
The NAS has produced a briefing paper on this type of intervention. TreeHouse which uses the approach in its school has a briefing paper which sets out the key elements of the approach. Research Autism also reviews EIBI in detail.
Milieu training describes a form of teaching which makes use of the child’s interest in the things around him, the ‘milieu’ to provide learning opportunities. A review of this intervention can be found on the Research Autism website.
Pivotal response training (PRT)
A type of training which focuses on key pivotal aspects of a child’s development. These are motivation, self-management, self-initiation, and the ability to respond to multiple environmental cues. A review of this intervention can be found on the Research Autism website.
Relationship based programmes
These programmes aim to engender a sense of relatedness, encouraging affection, attachment and bonding.
Also known as Options, the Son-Rise programme is a home-based programme based on the premise that the best way to help a child with autism is to follow the child’s lead, so that the adult joins the child in his behaviour rather than trying to superimpose his own ideas on the child. The aim is to build trust so that the child feels accepted and loved rather than judged by his behaviour. As the relationship grows, so the adult can use the child’s own motivation to teach him new skills based around his own interests.
The programme uses parents and volunteers to work with the child, usually in a special playroom, for between 20 and 40 hours a week. Parents must receive training from the Autism Treatment Center of America before starting the course. The considerable input required from parents to run the programme may have a significant impact on the family as a whole. Moreover, it can be difficult to recruit and retain sufficient properly vetted volunteers to run the programme.
Research Autism reports considerable positive anecdotal evidence from people who have used the Son-Rise programme. However, there is no scientific evidence to demonstrate benefits, largely because the Option Institute has never allowed or carried out any formal research on the effectiveness of the programme.
The NAS offers a useful information sheet on this programme and Research Autism reviews it in full.
The DIR method aims to help children on the autism spectrum to master the building blocks of relating, communicating and thinking by employing a series of interactive ‘Floortime’ exercises in which the carer follows the child’s lead and plays at whatever has captured his interests, but in a way that encourages a two-person interaction. This intensive method requires considerable commitment from the parents and other carers. The Research Autism website offers a fuller review.
This highly controversial therapy consists of forced holding of a child by a therapist or parent until that child stops resisting or until a fixed period has passed. The child is required to ‘surrender’ and look into the carer’s eyes before the hold is released. In its review of this technique, Research Autism reports “There is no sound evidence for effectiveness and there are significant concerns about the use of forced physical contact with individuals who may find this profoundly distressing.”
This approach works with parents, training them to detect and respond appropriately to the individual child’s attempts to communicate, no matter how unusual. Communication strategies can then be devised based on what works for that individual child.
Programmes using this approach include:
• The ‘More Than Words’ programme, run by the Hanen Centre in Ontario, Canada.
• The Responsive Teaching programme, run by Responsive Teaching International Outreach.
• The ‘Child Talk’ programme, currently being evaluated by the University of Manchester.
Relationship Development Intervention
Relationship Development Intervention (RDI) focuses on the problems children on the autism spectrum have forming true social and emotional relationships with others. Having evaluated a child’s relationship skills, a consultant sets objectives for the child and equips the parents with techniques to achieve these objectives. The parents then introduce their child to emotional relationships in a gradual and systematic way. The Research Autism website offers further information.
Skills based interventions
These interventions aim to develop particular skills in a child on the autism spectrum.
Social Stories were developed by Carol Gray to assist children on the autism spectrum develop greater social understanding. They provide explanations around situations that may be challenging for a child on the autism spectrum. Social stories can be written on paper, audio recorded or filmed. They are usually written in the first person and in the present tense, focusing on an issue of importance to an individual, and looking at social cues, things that might happen and why, and what the individual may choose to do about it. There is good evidence that Social Stories can be effective in reducing unwanted behaviour in children on the autism spectrum and in helping in social interaction. The NAS has a useful information sheet on social stories.
Picture Exchange Communications System (PECS)
This widely used intervention was developed specifically for children on the autism spectrum. A child is taught to exchange a picture card for something he wants such as a toy or food. The picture reinforces the word spoken by the adult, who gives the child the thing they want. PECS is effective in establishing the basics of communication as the child is highly motivated to request a wanted item, and the system uses visual skills.
This approach is relatively straightforward, compared to some interventions, and does not use expensive equipment. However, properly trained individuals should be used to implement PECS to ensure its correct use.
The NAS offers an information sheet on PECS, and a further review of the system can be found on the Research Autism website.
Functional Communication takes as its premise the idea that people on the autism spectrum use challenging behaviours such as self-harm or throwing tantrums as a form of communication, and aims to teach them how to substitute other forms of communication to get the same message across. Each problem behaviour is assessed to identify its function or “message”, and the child is then taught how to communicate that message in a more acceptable form.
Research Autism has further information on this approach.
Facilitated Communication (FC)
This intervention is a form of Augmentative Alternative Communication (AAC), and involves a communication partner or facilitator, physically supporting the individual so that he can point to pictures, symbols, letters or words, thus communicating.
It is particularly controversial for children on the autism spectrum as it assumes that a movement disorder is at the root of the difficulties faced by people with autism, rather than social or communication disorders.
Research Autism reports a significant body of evidence to show that FC is ineffective for people on the autism spectrum. The NAS also produces an information sheet describing this method and concerns associated with it.
Theory of Mind
Theory of Mind training programmes are designed to teach individuals on the autism spectrum how to recognise mental states (thoughts, beliefs, desires, intentions, and emotions) in oneself or others, and to be able to make sense of and predict actions. See Research Autism’s review for further information.
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Teachernet provides a useful guide to good practice in home-based provision, particularly for those interested in a later transition to school.
The National Autistic Society provides comprehensive information for parents of children on the autistic spectrum on different forms of home-based provision.
Research Autism offers a comprehensive review of many forms of intervention for children on the autism spectrum.
Useful report from the Journal of the Royal Society of Medicine
Howlin, P. (2000). Autism and intellectual disability: diagnostic and treatment issues. Journal of the Royal Society of Medicine 93(7), pp. 351-355.
Useful review of autism interventions available:
Researching interventions in ASD and priorities for research – Surveying the membership of the NAS. Richard Mills and Lorna Wing 2005
Approaches to autism: an easy to use guide to many and varied approaches to autism. London: The National Autistic Society, 5th ed. 2003. 1899280561
A comprehensive guide to some of the many different approaches that are used in the education and care of children and adults with autism.
Available from the NAS Publications Department
Applied Behavioural Analysis (ABA) information sheet from the NAS
The NAS information sheet on Lovaas and his work
NAS Son-Rise information sheet
NAS information sheet on social stories
NAS information sheet on PECS
NAS information sheet on facilitated communication
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ABA Resources Limited
The Hanen Centre, Ontario
NAS EarlyBird Programme
PEACH (Parents for the Early Intervention of Autism in Children) is a charity set up by parents to promote early behavioural intervention for children on the autism spectrum.
Picture Exchange Communications System
Responsive Teaching International Outreach
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Teachernet provides a range of case studies providing good practice examples of home-based provision, particularly for those interested in a later transition to school.