Therapy - MigrAVE

Therapy offers

After receiving the diagnosis, it is important to find out how the child’s development can be supported in the best possible way. Therefore, a scientifically based intervention method with proven effectiveness should be selected, which is oriented towards the child, the individual symptom expression and the associated impairments. Since the term “autism therapist” is not protected in Germany and basically anyone can use this term, it is important to check the seriousness of the offers and facilities. Also the qualifications of the therapists, the concepts of the providers and their therapy offers should be examined by parents and cost units. For the health care system, the AWMF has published a guideline for therapy, which should also be followed by therapy offers outside the health care system: à Link einfügen: https://www.awmf.org/leitlinien/detail/ll/028-047.html

Facilities for child and juvenile psychiatry, social pediatric centers and professional counseling facilities can assist in the selection of a suitable and reputable therapy offer.

Evidence-based interventions

Not all support options for people with autism spectrum disorders (ASD) meet scientific criteria. The term “evidence-based interventions” covers those interventions whose effectiveness is backed up by sufficient, empirical data. Therefore continuous updating is of particular importance in order to provide orientation, transparency and security (cf. Bölte 2009).

Depending on the type and number of scientific studies, so-called evidence grades are defined, which indicate how well a therapeutic procedure has been investigated. Evidence level 1 demonstrates the best and level 5 the least scientific basis (cf. Freitag et al. 2017, AWMF 2016, AWMF, 2021).

Since only methods with the best current empirical evidence should be used in therapy, methods with the highest levels of evidence form the basis for guidelines for diagnosis and therapy in ASD. à Link einfügen: https://www.awmf.org/leitlinien/detail/ll/028-047.html

Therapy methods

In general, a distinction is made between specific and non-specific therapy methods.

ATTENTION: Offers whose effectiveness has not been scientifically proven are usually ethically indefensible and can harm the health of your child directly or indirectly. Therefore, you should urgently avoid purported therapy approaches such as dolphin therapy, nutrition modification, supported communication and restraint therapy!

Autism-specific therapy methods

Specific therapy methods focus on autism-specific impairments and specifically promote communication, social interaction, daily living skills, emotion recognition, etc. These include, for example:

Autism-specific behavior therapy (AVT)

Autism-specific behavior therapy is an evidence-based type of therapy for autism spectrum disorders (ASD). In particular, it aims to teach daily living, practical life, and socio-emotional skills. These include language, social skills, autonomy and imitation. Behavioral excesses (behaviors that occur at a very high rate) that prevent the child from actively engaging with his or her environment and/or are dangerous to others and itself can be reduced or behavioral alternatives can be established with the help of AVT. Behavioral deficits (behaviors that occur to an insufficient degree but are necessary for a self-determined and independent life) can be built up with the help of AVT. Implementing AVT as an early intervention with young children (ages 2 and up) can significantly improve development and autonomy. Even in adulthood, AVT can still help improve quality of life.

Basic principles of AVT

AVT is based on behavioral therapy, a special form of psychotherapy. It is based on the theoretical principles of learning and assumes that behaviors and thought patterns can be learned or unlearned or relearned. Therefore, VT or AVT focuses on individual behavioral observation, the development of a learning plan based on this observation, and the implementation of exercises in order to train and learn a behavior. Likewise, work is done toward generalization of this behavior, i.e., transferring the learned behavior into everyday life across different contexts.

In the AVT, the areas in which the child has a developmental need are thoroughly determined. Accordingly, it is worked out which (constructive, developmentally beneficial) behaviors should be built up and which (problematic) behaviors should be reduced. This results in a learning plan over a long-term period. The sequence of the individual learning steps is precisely defined. This planned approach is important in order to teach behavior in a targeted and continuous manner and to build it up step by step. This learning plan is always adapted and developed according to the child’s development.

In addition to a precise approach within the AVT, which is tailored to the child, the parents are also strongly involved. In addition to theoretical content on the topic of ASD and therapy, they are also actively supported in becoming experts for their children themselves and in incorporating exercises into everyday life and actively influencing behavior. In addition, supervision is usually included, in which the approach, progress and development are continuously monitored.

Based on general learning psychology findings, other specific forms of intervention have been developed in addition to AVT as part of specific programs. These include:

TEACCH®

TEACCH® (Treatment and Education of Autistic and related Communication handicapped Children) is a holistic educational-therapeutic approach from the USA, which focuses on the development of individual aids to support learning as well as independent coping with everyday life (Häußler, 2000). The goal is to provide individuals with individualized ways to communicate effectively and thereby achieve the greatest possible independence and quality of life.

It was developed in the 1970s, as part of a state grant program anchored at the TEACCH Division of the University of North Carolina at Chapel Hill.

Since then, the approach has been continuously developed and implemented worldwide (cf. Symalla & Feilbach, 2009).

The concept is based on the following principles:

In-depth knowledge of autism spectrum disorders is required in order to understand difficulties arising from the special stimulus processing of autistic people and to be able to develop appropriate support possibilities

Assistance offered is individually tailored to the needs and abilities of the respective person
Here, strengths are used specifically to compensate for weaknesses
Active involvement of parents/families
Different evidence-based methods can be integrated into the framework if they are helpful for the respective person
Holistic view

Understanding a person’s difficulties and individual abilities through targeted formal and informal diagnostics

(cf. Symalla & Feilbach, 2009 & Häußler, 2000)

The Structured Teaching method is based on developmental psychology and behavioral therapy concepts. Building on the very good visual abilities of many people with autism, it focuses on structuring and visualization aids for everyday life in order to create predictable and understandable (learning) situations for those affected (Häußler, 2000).

The following aspects are the main focus:

Spatial structuring

Distractions can be minimized through low-stimulus design
Markings, signage or symbols can be used to clarify functions and/or boundaries within a space

Time structuring

Predictability of events can be achieved through the use of clocks/timers, start and end rituals, and schedules

Structuring of actions /design of working materials

To make it easier to plan and carry out everyday activities in a targeted manner, sequences of pictures or written instructions can be used, for example, to clarify sequences of actions

Organization of work

Visually designed “work plans” can be used to support the independent completion of tasks in a specific order, for instance

Practicing functional routines

Providing orientation and confidence through certain routine procedures and consistent action strategies (e.g. processing materials always from left to right) or “first-then” procedures (cf. Symalla & Feilbach, 2009)

In the course of therapy, individual plans are drawn up to support the child, which can be implemented both at home and in kindergarten or school.

PECS®

The intuitive understanding of communication is often limited in children with autism spectrum disorders (ASD), and in most cases the lack of speech cannot be compensated by gestures and facial expressions. Therefore, the initiation of communication is of particular importance in the support of autistic children with simultaneous speech disorders. Younger children in particular must first experience the function and benefit of communication as an opportunity for exchange with other people (cf. Lechmann et al, 2009).

To promote the initiation of communication, in the 1980s, Bondy and Frost developed the non-verbal Picture Exchange Communication System® (PECS®), which is based on behavioral therapy methods and proceeds in six phases (cf. Bondy & Frost, 1998).

In the first phase, children learn to express wishes and needs using picture cards, which they hand over to a communication partner who immediately fulfills the child’s wish.

In the further phases of the communication program, the children are enabled to distinguish pictures, use more complex sentence structures, respond to questions and make comments.

Originally developed for children with autism, PECS is also successfully used for many other disorders associated with communication problems. Some children also begin to speak in the course of the program (cf. Lechmann et al, 2009).

Important note: PECS® can provide additional support for verbal language development. Some parents are often reluctant to use PECS® because they are concerned that its use will replace verbal language. It can be stated that PECS® can indeed support verbal language development and does not necessarily serve as a substitute for verbal language.

DIR®Floor-Time

The approach of DIR® Floor-Time (for Developmental, Individual-Difference, Relationship-based) was developed by S. Greenspan and S. Wieder for the targeted, play-based support of children with various developmental problems, including autism spectrum disorders (Gundelfinger, 2009).

The approach primarily uses naturalistic learning situations (playful interaction on the floor= Floortime) based on a close relationship and is adapted to the child’s individual stage of development.

Greenspan and Wieder describe six successive developmental stages in which the complexity of interaction and communication is continuously increased (Gundelfinger, 2009).

The basic principles of the approach are:

Share and regulate attention
Building relationsship/bond
Affective reciprocity and gestural communication
Sharing complex, social pre-symbolic communication and solving problems

Symbolic and creative use of ideas as well as as-if play and pragmatic language
Logical and abstract use of ideas and thinking including expressing and reflecting on feelings; finding insight into own and others’ behavior/thinking

(Röttgers & Rentmeister, 2020)

In the support of autistic children, an intensive procedure is recommended. That includes application of the method several times a day with the involvement of parents and caregivers (Gundelfinger, 2009).

Further accompanying interventions

In contrast, nonspecific therapy procedures do not affect autism-specific symptomatology, but may be used concomitantly with specific procedures to promote general development and may serve to treat other disorders or comorbidities. Non-specific procedures include:

Logopedics

Logopedics is a medical-therapeutic field that deals with the functions and disorders of the speech and language tract. The articulation, the speech and the swallowing act are considered in particular. Speech therapy can therefore be used in support of specific forms of therapy.

Ergotherapy

The aim of ergotherapy is to support people with limited ability to act and to enable them to cope with everyday activities. People should learn to perceive themselves as capable of acting, they should improve their coordination of movement, sensory and emotional perception and develop skills that are necessary in everyday life. The goal is therefore to teach basic skills and abilities that allow people a self-determined life. Just like logopedics, ergotherapy can be used in a complementary way to teach and deepen motor as well as daily living skills and abilities.

Remedial Education

Remedial education is particularly concerned with the education, upbringing, support and therapy of children and adolescents who are affected by a handicap or physical, mental or emotional developmental impairment. The focus is on developing strategies for successful living with a handicap or developmental delay. This is intended to promote and enable a person’s autonomy, self-determination, and the development and shaping of his or her life. To do this, various approaches are combined to create an individualized work concept for the person(s) affected. Examples are: Curative painting, mobility training, biography work, supported communication, play therapy, curative riding. These approaches can also be used to support or accompany the therapy of ASD.

Autism spectrum disorder (ASD) therapy introduction

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