Behavioural Intervention for Autism -
Our Experience in the UK
[Contents]
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Behavioural Intervention for Autism -Our Experience in the UK[Contents]
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How Our Behavioural Therapy Programme is OrganisedI am very fortunate in that my wife is a home to take an active part in co-ordinating and organising Paul's programme! Paul is at present being given therapy for around 33 hours per week. We have found it vital to keep up the number of hours because there was a marked deterioration in progress around Christmas when the number of hours dropped. The therapy takes place in our home in one of two rooms. One room has most of the things needed and in the other room is the computer which is sometimes used as a reward (Paul is very keen on CD-ROM's like 'World of Nature','Winnie the Pooh',etc.). At present we have four tutors and they mostly come for three hour sessions. Once a week there is a meeting for all the tutors so that they can discuss progress and refine methods so that there is a consistent approach. My wife attends this and every fortnight our supervisor also attends. This fortnightly meeting seems to be very effective for considering the next step and ensuring the consistent approach which is so vital. The room where the therapy takes place has a children's table with two children's chairs. The tutor and Paul both sit in these chairs and start one of the programmes. Initially this lasted for less than a minute before Paul was allowed out of the chair to run about as a reward for an appropriate response. These programmes are all carefully specified with tutors doing the same thing in each programme and all saying exactly the same question, etc. so that Paul does not become confused. In this room there is a loose leaf file with all the programmes which Paul is doing and each tutor works through the current programmes recording the percentage success rate. When there is a 90 per cent success rate or more with at least two people, then after discussion at the weekly meeting the programme is put on maintenance and a new programme is started. Initially small pieces of sweets and biscuits were used as rewards accompanied by loud praise, tickles, hugs, etc. However the sweets and biscuits are now used much less (a matter of policy!) and the video, computer and playing are more often used - accompanied of course by the loud praise, tickles, hugs, etc. In our present toileting programme we have have prevented Paul from using the computer until he started to use the toilet properly.( It took about two weeks before we got an initial success although there are still major difficulties!).
We are now using a token board to help to re-inforce the programmes. Ten coins are stuck to Velcro which then stick on a board. When the board is filled up Paul is allowed to get up and play. Recently we have started to use this in conjunction with a board with the eight letters of the word 'computer'. The idea is that when the coin board is filled up it will equate to one or more letters on the computer board and when the computer board is filled up he will be allowed to use the computer (his strongest re-inforcement). Eventually as he gets used to it we hope to eventually get one full coin board to equate to one letter.
At the front of the file there is a list of the programmes which Paul follows and each tutor records the date at the top of the column and the percentage success rate for each programme. Paul's programmes are then listed under the following main sub-headings:- Attending Skills, Imitation, Receptive Language, Expressive Language, Social Questions, Expressive Labelling, Yes/No, Pre-Academic Skills, Play, and Independence Tasks. At the beginning of each section there are the exact details of the programme. For example in the Attending Skills section, the eye contact programme looks for an initial one second response using an edible reinforcer as the prompt. This is followed by a data sheet where ten trials are logged in small boxes with a plus or a minus, together with the date, tutor's initials, etc. However when Paul finds something very very easy the number of trials are reduced and the tutor goes on to the next programme. We now have a second very large folder containing all the old data sheets i.e. from programmes Paul has mastered and which are now on maintenance. We think it is extremely important if somebody keeps the files in order and up to date. This ensures that tutors know straight away what has been done and what they should be doing. We are currently trying out Damian Porcari's Developmental Checklist and Graph (available from the Recovery Zone Website -See Internet Links above) in order to obtain some idea of Paul's progress in relation to the 'Norm'. It has graphs showing 'normal' overall development, 'normal' social/emotional development and 'normal 'communications development in relation to age. It also has a checklist of development stages in relation to age for the 'normal' child at 12, 18, 24, 36, 48 and 60 months. The major areas include Social/Emotional, Motor(Fine), Motor(Gross), Communications and Vision. |
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