Autism: Guide for Parents [Part 2]

By  Maryam Bachmeier
Psychologist, Counselor, Writer – U.S
 Coping With Autism


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Once you have learned that your child has a Pervasive Developmental Disorder (PDD), your next step to find an Early Intervention Programme that individually suited to the needs of your child. During the first three years of life, your child's brain rapidly goes through a process called pruning.



When your child is born, he or she has a brain that has many neurological synaptic connections. In fact, these connections are so many that they are simply not efficient or strong enough to create stable neural pathways. The process of 'pruning' (synaptic pruning) includes the pruning away of some of the neurological synaptic connections so that those remaining can develop into strong and useful neurological pathways through which information can be processed. The baby or toddler works on the integration of sensory information, and the brain works hard to create stable pathways for this information to pass through and be processed.



Early Intervention Programmes try to use this window of opportunity to shape the brain as it develops. Providing the brain with information in a systematic, intense manner increases its chances of functioning better. Most Early Intervention Programmes  for autistic children include both Intense Positive Behavioral sProgramming  and discrete trial training, which help with learning.



A child with autism or a PDD may be having difficulties learning basic skills, such as toileting, dressing, eating, etc. In addition to Early Intervention Programmes for autism, optimal learning opportunities should be continued using Programming Techniques should be used all throughout the child's development.



Therapies for autism are designed with the intention of

   1. Decreasing learning, behavioral, and functional deficits.
   2. Increasing the child's independence.
   3. Improving the child's ability to function in his or her environment.
   4. Supporting the family and lessening the discomfort. This in turn should increase the child's and the family's overall quality of life.

There is no single intervention that can be generalized. Most interventions include combinations of treatments, and they are highly individualized for the specific needs of the child and his or her family.

The following therapies are most commonly used because they are based on substantial research that supports their efficacy:

    * Applied behavior analysis (ABA)
    * Developmental models
    * Structured teaching
    * Speech and language therapy
    * Social skills therapy
    * Occupational therapy

Most regional centres in the US and Canada provide funding for these interventions. If you have a child with autism, Asperger's, or a PDD and you live in the US or Canada, you should call the nearest regional center and ask for an "intake and assessment" to see if your child is eligible to receive the services.

Also, call your school district immediately, as the school must provide intervention as well. Once the child becomes old enough to go to school, the school is obligated to provide him or her with a special educational program, in addition to any early intervention that the regional center might provide. The Regional Centre's Assessment team includes:

   1. A speech therapist
   2. An occupational therapist
   3. A behavior analyst
   4. A psychologist
   5. A psychiatrist

They will come to determine appropriate intervention in each respective area. The psychologist will actually examine the child to see whether he or she has autism, Asperger's, or a PDD. The psychologist will examine the child to asses the possibility of mental retardation if appropriate. The speech therapist might recommend a program for speech therapy, and the occupational therapist will recommend a  program for occupational therapy if the child's development is not adequate.

The psychiatrist might suggest a treatment based on and refer the child to a psychiatrist in the community. The Behavior Analyst will see if a behavioural intervention would be helpful; he or she will also recommend some providers of Early Intervention Programme who can develop educational and behavioral programmes for the child and his or her family.

The most common ABA (Applied Behavioural Analysis)  interventions are the discrete trial training and the trainer-to-trainer (Pyramid model) behavioral intervention. 



The best way to understand what discrete trial training and behavioral intervention are is to actually observe them. Your Regional Centre will contact a service provider who will show you how these program are put together. Usually they are home-based programmes. A specialist will assess your child and develop what is usually a 20-hour home-based program. The specialist will also conduct a structural and functional assessment to see what kinds of changes in the household routine and environment can be made, and what positive behaviors the child can be taught.



The specialist might also write a behavioral plan for the family and school to follow. Parents usually attend a parenting class on the principles of positive programming  as part of the overall programme. Then there is the discrete trial training, which helps the child learn and acquire skills. Discrete trials mean that there is a definite beginning and ending for each learning trial. They are very short, and they include schedules of positive reinforcement, which encourages the child to continue to learn.

The Early n specialist will determine the kind and extent of the program that should be provided during the 20-hour home-based training. He or she will also advise on what can be done by the parents. Those specialists work closely with the parents to develop unique and individual plans. They design their plans in such a way that the outcomes can be accurately measured and reviewed to assess the effectiveness of interventions.

If there is no progress, then the approaches and techniques used should be modified. If there is progress, then the specialist will determine if and when it is time to change the intervention to assist further development of the child. Thus, the program itself changes according to the needs of the family and the child. These early interventions usually last for about two years. They also require a lot of dedication on the part of the parents. If the child also receives occupational and speech therapy, there could be up to 40 hours of active treatment that the parents must participate in each week.

Once the child is ready to go into the school system of therapy, the school conducts an assessment to develop an individualized learning plan tailored to the needs of the child. At this time, it is common that the behavioral intervention may continue for a while, and then the intervention may be dispensed with as the family usually becomes able to utilize the acquired techniques. Once the child is around six years of age, the family can have access to most of the interventions  through the school system of therapy.

In addition to these traditional treatments, the family can utilize the medical system when appropriate if the child's behavior is too difficult to control through the traditional interventions. Psychoactive drugs or anticonvulsants — with the most common drug classes being the antidepressants, stimulants, and antipsychotics — are prescribed for many children with autism or a PDD.

Parents should proceed with caution when considering such intervention. Sometimes, however, there is a real need for additional help, and the only way to know if this kind of intervention will help is to give the medication an adequate trial period.

If you are considering using a medication to calm your child down or to alleviate a mood disorder that often coexists with a PDD, make sure to see a doctor who has expertise in autism and PDD. Wisely shop around for your doctor.

However, the future can still be beautiful. Adjusting to this change may be difficult at first. It is not something that you have been planning for. However, if you reach out to support groups and are willing to go with the changes, you will find that you can enjoy your family life with your child.

If you have an autistic young adult or a child who is stepping into adulthood, please read Part 3 of this series.

Dr. Maryam Bachmeier  has 11 years in the mental health field, and is currently a staff psychologist at the Napa State Hospital.