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Autism is a serious disorder affecting children. Thousands of parents in all parts of the world face the challenge of autism in their children. Much has been written and said about the nature and consequences of autism for children. Unfortunately, how to deal with autistic children remains a matter of intense professional debate. The complexity of the problem is associated with the fact that autism leads to the development of other, related disabilities, such as attention deficit disorder, language disorders, and even Tourette’s syndrome (Olney, 2000). Moreover, the complexity of autistic disorders mandates the development of unique, personalized approaches to individuals with autism. The current state of literature provides sufficient information to develop new and improve the existing interventions for individuals with autism. A combination of socio-emotional and behavioral approaches could become a valid response to the difficulties encountered by individuals with autism.
Interventions and Approaches to Individuals with Autism: Historical Background
Autism is rightly considered as one of the most complex and controversial neurological disorders affecting children. The history of autism research dates back to the beginning of the 20th century, when scientific interest in the physical and natural sciences, as well as professional interest in psychology and social sciences, rapidly increased (Schopler, 2001). Researchers in psychology and social sciences borrowed their research methods from physical sciences and scientific technologies (Schopler, 2001). More often than not, scientific methods were used to study complex cultural phenomena mediated by human and political changes (Schopler, 2001). At that time, the growing body of psychological literature was built on experimental studies and their results but could not predict complex behavioral patterns in humans (Schopler, 2001). Autism represented a rare case, when a previously unknown disorder was saved from “the untested assumptions of psychodynamic theories that had produced a widespread misunderstanding of autism as a social withdrawal from emotionally cold parenting” (Schopler, 2001, p.10).
The growing scope of the cognitive revolution and the rise of theoretical analyses brought renewed interest in the theoretical study of autism. Later researchers were no longer interested in autism as merely a stimulus-response mechanism, but tried to look deeper into the nature of mental actions in individuals with autism, such as attending, comprehending, thinking, and feeling (Scholer, 2001). In the latter half of the 20th century, the study of autism displayed a number of parallel developments, including behaviorism and neuro-biological specificity (Scholer, 2001). New directions, including cultural psychology, were developed (Scholer, 2001). In 1995, the American Psychological Association was required to develop guidelines for the selection of the most appropriate interventions and therapies for psychosocial aspects of physical disorders and mental disorders, and that was when autism came to the center of the research arena. Scholer (2001) writes that the APA tried to make a rigid distinction between the effectiveness and efficacy of various autism interventions. The APA also decided that, in order to determine the efficacy and effectiveness of autism interventions, all research subjects had to meet the same diagnostic criteria and be not confounded by dual diagnoses (Scholer, 2001). Unfortunately, in the case of autism, such cases are virtually nonexistent as individuals with autistic disorders are loaded with a number of other, related symptoms and complications. Moreover, not all researchers and organizations can meet these criteria; as a result, the gap between theory and clinical application of various autism interventions and approaches continues to persist (Scholer, 2001). Scholer (2001) concludes that professionals and parents of children with autism need to overcome the existing research-service gap and because autism is a lifelong disorder with no definite cure, the treatment and intervention techniques developed for this group of patients should not be overly intrusive but effective to the extent that alleviates the burden of cognitive and emotional symptoms in individuals with autism.
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Today’s research into autism and the development of interventions and treatment approaches for individuals with autism are associated with a number of serious issues. All these issues have been described by contemporary researchers. To begin with, the appropriateness and effectiveness of various interventions (including behavioral and socio-emotional) are profoundly influenced by a prodigious time delay between the development of autism and its diagnosis. Bowler (2010) suggests that the delay between the moment parents notice the first symptoms and become anxious about their children’s behaviors, and the moment the diagnosis is confirmed is a matter of continued concern for clinicians. Bowler (2010) is convinced that timely diagnosis is crucial for the provision of effective care strategies and interventions. Unfortunately, this delay between symptoms and diagnosis is characteristic of almost all countries of the developed world (Noterdaeme & Hutzelmeyer-Nickels, 2010). When exactly parents become anxious about their children’s health greatly depends upon the subvariety of autism (Bowler, 2010). Bowler (2010) is confident that the existing gap between the first symptoms and the differential diagnosis considerably complicates the provision of effective autism interventions and services. These difficulties are further coupled with the complexities posed by ASD assessment; the latter is often both time-consuming and complex, requiring professional expertise and experience (McClure, Mackay, Mamdami & McCaughey, 2010). McClure et al. (2010) are convinced that these are the main factors affecting the quality and effectiveness of the diagnosis.
Another difficulty is in how teachers and service providers deliver autism interventions and refine approaches to treatment in individuals with autism. Lerman, Vorndran, Addison and Kuhn (2004) write that “the demand for teachers who have expertise in applied behavior analysis will continue to grow as more young children with autism receive the majority of their education in regular public schools” (p.510). Compared to the beginning of the 1990s, the number of children with autism studying in public schools has increased from 5,000 to almost 95,000 (Lerman et al., 2004). Unfortunately, most teachers have little, if any, formal training and instruction to deal with children with autism (Lerman et al., 2004). Lerman et al. (2004) confirm the scarcity of specialized preparations in autism across education colleges and universities, which deprive future education professionals of an opportunity to prepare themselves for dealing with autistic children. Most probably, because autism is still characterized by low incidence relative to other disabilities, education colleges do not deem it as necessary to provide future teachers with specialized training in autism (Lerman et al., 2001). It is also possible that the lack of autism training in education reflects the long-standing theory and dogma rather than changes in practices and research (Lerman et al., 2001).
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Whatever the reason, the conclusions made by Lerman et al. (2001) provide the basis for understanding the results of Jennett, Harris and Mesibov’s (2003) research. The researchers discovered that teachers working with children with autism were more susceptible to the risks of stress and burnout than their colleagues working with healthy children (Jennett et al., 2003). The importance of these findings can hardly be overstated as both stress and burnout can directly influence the effectiveness of autism interventions in teachers. The situation is particularly difficult with education professionals who feel incompetent to work with difficult clients (Jennett et al., 2003). This, in turn, justifies the conclusions made by Lerman et al. (2001) and confirms the need to provide future teachers with specialized training in education colleges.
Finally, one of the key issues affecting present-day interventions for individuals with autism is failure to adequately assess the efficacy and implications of various interventions. Bowler (2010) notes, that many evaluations of autism interventions reveal serious methodological flaws and make it virtually impossible to draw valid conclusions as for the way these interventions can work in real-time environments. Good evaluation studies are equally problematic and rare, slowing down the provision of quality services and support to individuals with autism (Bowler, 2010).
Theoretical Basis for the Current Interventions for Individuals with Autism
Despite the growing body of literature on autism, few authors paid considerable attention to the theoretical foundations of various behavioral and socio-emotional interventions in individuals with autism. To a large extent, only Olney (2000), Carbone, Morgenstern, Zecchin-Tirri and Kolberg (2007) and Rieffe, Terwogt and Stockman (2000) provided a more or less systematic review of the theoretical premises behind the most popular interventions and treatment methods in autism. Beginning with Olney (2000), the researcher conducted a detailed analysis of the theoretical and historical models of dealing with autism. Olney (2000) asserts that proper understanding of autism has evolved significantly over the past 50 years, giving rise to numerous models of autism and, consequentially, treatment options and interventions. Olney (2000) discusses the neurobiological model, clinical behavioral model, dyspraxia model, and social model of autism, all of which deserve professional attention in the development of behavioral and socio-emotional approaches to autism. The neurobiological model of autism treats the disorder as primarily the result of brain dysfunction (Olney, 2000). Autistic perceptions, according to this model, arise from difficulties modulating attention and arousal, problems dealing with spatial attention, etc. (Olney, 2000). The neurobiological theory of autism reinterprets autism and related symptoms through dysfunctional changes in the central nervous system (Olney, 2000).
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Olney (2000) also described clinical behavioral and dyspraxia models. The former conceptualizes autism as a thematization disorder, whereas the latter is focused on the analysis of autism as a problem of communication (Olney, 2000). Based on the dyspraxia model, autism is a problem of praxis disorders rather than the problem of thought (Olney, 2000). Olney (2000) also describes the social model of autism, which treats autistic children and adults as simply different, not sick. Olney (2000) recognizes that none of these models is complete, and generally these models contribute to the current understanding of autism. Here, a brief discussion of motivation and emotions could complement the theoretical analysis of autism and its implications for autism interventions and treatment.
The topic of motivation was raised by Carbone et al. (2007). Carbone et al. (2007) suggest that the principle of motivation has been at the heart of most behavioral studies during the past 20 years. The growing interest toward motivation is justified by the expanding knowledge of motivational and learning needs of individuals with developmental disabilities (Carbone et al., 2007). However, the current understanding of motivation and its relation to autism is very poor, and Carbone et al. (2007) points to the need to conduct a systematic analysis of motivation and its implication for instructional methods used in autistic individuals. Despite these inconsistencies, Carbone et al. (2007) write that behavioral approaches have proved to be effective in individuals with autism, and they facilitate the integration of individuals with autism with healthy peers in education.
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For the purpose of understanding the importance of socio-emotional approaches in autism, the meaning of emotions has to be better understood. A brief discussion of emotions and their importance in the analysis of autism was provided by Rieffe et al. (2000). Rieffe et al. (2000) wrote that emotions played a pivotal role in daily contacts between individuals, and a well-known characteristic of autism is the absence of emotionally-explicit reactions to others. Rieffe et al. (2000) also made a distinction between typical and atypical emotions, which could further contribute to the analysis of behavioral interventions in individuals with autism. Unfortunately, theoretical discussions in the context of autism are rather rare. More frequent are the studies analyzing the effectiveness of various behavioral and socio-emotional approaches to autism.
Research-Based Interventions and Approaches
Theory matters, but in most instances, service providers and educators rely on the results of empirical studies and research-based strategies and interventions. The body of literature reporting the results of empirical studies constantly increases, and service providers and educators have access to numerous empirically-tested interventions and strategies. However, before these behavioral and socio-emotional interventions are discussed, it should be noted that intensive behavioral treatments can be extremely effective and cause significant behavioral improvements in individuals with autism (Schreibman, 2000). Furthermore, behavioral approaches to individuals with autism are effective only when used in carefully controlled learning situations (Schreibman, 2000). Finally, only when parents are trained to participate in the provision of behavioral interventions, these interventions can be particularly effective (Schreibman, 2000). These are the ideas and conclusions provided by Schreibman (2000), based on the extensive review of the literature.
Until present, only Simpson (2005) has been able to systematize and organize various interventions and treatment approaches in individuals with autism. The principal advantage of Simpson’s (2005) review is in that the researcher organizes his analysis around several key categories, such as the controversy and effectiveness of treatments, scientifically valid interventions and practical recommendations for parents and professionals. Simpson (2005) does not list any particular controversial interventions, but notes that these are treatment strategies that lack scientific support and cannot be considered valid. Moreover, Simpson (2005) writes that nowhere else controversial treatments and interventions are as numerous as in the autism field. Simultaneously, defining the efficacy and validity of various interventions is extremely problematic: Simpson (2005) recognizes that understanding the potential effects and implications of different interventions can be particularly problematic for parents, who may lack skills and knowledge to deal with research-based information. Even then, the researcher provides recommendations parents may follow in their analysis and choice of the most appropriate strategy.
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In terms of behavioral interventions, play is cited among the most popular approaches in individuals with autism (Stahmer, Ingersoll & Carter, 2003; Wieder & Greenspan, 2010). Student-directed and self-management behavioral solutions do have the potential to increase the efficacy of other strategies (Mithaug & Mithaug, 2003). Eikeseth, Smith, Jahr and Eldevik (2002) proposed and tested the efficacy of an intensive behavioral treatment, based on the use of manual and associated videotapes. The intervention supported children as they progressed to more complex tasks and proved to be a highly relevant mechanism of dealing with individuals with autism (Eikeseth et al., 2002). However, as always, Eikeseth et al. (2002) recognize that treatments cannot be effective, unless implemented as early as possible. Educators and service providers can also use discrete trial instruction, as recommended by Carbone et al. (2007): this type of instruction, and as an element of a comprehensive program, led many autistic children to develop their cognitive and emotional functioning. In terms of emotions, Rieffe et al. (2000) recommend using theory-of-mind strategies and solutions, to facilitate the development or improve cognitive and emotional skills in autistic individuals.
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Reflective Statement and Conclusion
Although autism is widely recognized as a serious and complex disorder affecting children, the current understanding of the disorder and its treatments is surrounded by controversy. Autism remains one of the poorly understood health disorders, and nowhere else have inadequate and controversial treatments been as numerous as in the autism field. Researchers generally agree that intensive behavioral and emotional treatments can be highly effective in individuals with autism, but what strategies and treatments should be used and in what conditions they are effective is difficult to determine. Therefore, future researchers should focus on the analysis of various behavioral and socio-emotional interventions and develop strategies that combine their benefits.