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One out of 68 individuals have a diagnosis of an Autism Spectrum Disorder.* The awareness of autism is growing, yet many families, medical doctors and professionals in the community are sometimes unsure about what to do after a diagnosis is given. Although a lot of information on different types of treatment is available, how do you know which type of treatment will be the best suited for your patient?
Treatment looks different for each patient. Following an initial evaluation where treatment level is determined, a recommendation will be made on what type of therapy is most appropriate for your patient.
Determining Appropriate Treatment Level
The diagnosing clinician will determine the level of support based on the amount of impairment and support the individual will need. Levels can differ for social communication and restrictive repetitive behaviors, depending on the level of severity for each category.
Assessments determine where your patient falls along the autism spectrum in terms of:
- Level 1 (requiring support)
- Level 2 (requiring substantial support)
- Level 3 (very substantial support)
Areas to consider when determining level of cognitive functioning:
- Language impairments
- Social impairments
- Aggression (Physical / verbal)
- Self- Injurious Behavior
- Restricted and repetitive behaviors
Therapy Options for ASD
Applied Behavior Analysis Therapy
Applied Behavior Analysis (ABA) therapy is a scientific approach to the treatment of autism focusing on the contingencies between the environment and behavior. ABA therapy determines the function of behavior, or what is maintaining the behavior, by analyzing environmental factors, antecedents and consequences. Sessions are delivered by behavioral technicians in a one-on-one format, supervised by a Board Certified Behavior Analyst (BCBA). This treatment can be used for all ages, but early intervention is key to better and more long term outcomes.
ABA addresses a magnitude of skill deficits in areas of social, communication and adaptive behaviors. It focuses on the reduction of problem behaviors, in addition to increasing functional behaviors that are socially acceptable. ABA uses positive reinforcement to strengthen and maintain desirable behaviors with an ultimate goal of improving the quality of life for the individual on the autism spectrum. It can be delivered in a clinic or in the naturalistic setting such as the home or community.
ABA is best fit for individuals who have Level 3 and Level 2 severities, with or without cognitive impairments, with or without language impairments, aggression, self-injurious behaviors and restrictive, repetitive behaviors.
A major component of ABA, parent skills training is delivered by the BCBA with the purpose to help parents understand ways to support and implement behavior goals outside of training sessions. Parent skills training is done weekly to monthly dependent upon the amount of support the individual needs.
Most insurance companies cover treatment up to individuals 18 to 21 years of age. ABA has two different treatment paths: Focused and Comprehensive. Focused ABA services deliver treatment 10-25 hours a week; whereas Comprehensive ABA services average 26-40 hours per week.
Social Skills Training
The focus on social skills training is to break down specific social skills to the most basic skills and assess the needs of the individual. Skills will build in difficulty and complexity over time. Some examples of basic skills include:
- How to take turns in a conversation
- How to greet someone
- Joining in a conversation
- How to make and maintain eye contact
Social skills training is appropriate for elementary-aged children and older with Level 2 and Level 1 severity, with or without cognitive impairments, without language impairments and restrictive, repetitive behaviors would be best fit for this type of treatment.
An individual who would benefit from this type of treatment may have difficulty processing social cues, have a limited understanding of non-verbal communication (gestures, body language, facial expressions in self or others), misinterpretation of others intentions and perspective taking. Social skills training can be done individually in the outpatient setting with a behavioral therapist or in a group format. A variety of therapeutic approaches that may be utilized are role playing, video modeling and the use of social stories. The benefit of a social skills training in a group is increased social opportunities to practice the skills with other participants.
Social skills training utilizes positive reinforcement delivered through positive praise to encourage, motivate and maintain skills learned.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) focuses on the relationships between an individual’s thoughts, feelings and behaviors by challenging and replacing negative thoughts with healthy ones. For an individual with ASD, visuals may be utilized when exploring emotions, as this tends to be an area that is more difficult. CBT can also incorporate the family in the treatment process, providing psychoeducation and understanding of the individual’s struggles.
CBT is best fit for Level 2 and Level 1 severity, with or without cognitive impairments, without language impairments and restrictive, repetitive behaviors. The age groups that benefit are late elementary-aged children up to adulthood.
Co-morbidity of anxiety and or depression is possible for someone with ASD. Primary care physicians and other professionals can make a referral for testing to provide diagnostic clarification for the treatment process.
Pine Rest Services for Autism Spectrum Disorder
Pine Rest offers all the treatment modes discussed above. A referral for these services can be made by calling Central Access at 866.852.4001.
- ABA Therapy: Psychological Consultation Center, Grand Rapids
- Social Skills Training: Primarily delivered in an individual model although periodically, social skills groups are available
- Cognitive Behavioral Therapy: Offered at all outpatient locations.
*NIMH, October 2016
Emily White, LMSW, BCBA is a Licensed Master Social Worker and Board Certified Behavior Analyst at the Pine Rest Psychological Consultation Center. She completed her bachelor’s degree in psychology from Grand Valley State University and Master’s in Social Work from Western Michigan University before completing her education through the Florida Institute of Technology and becoming a Board Certified Behavior Analyst.
Emily has worked at Pine Rest with individuals from two years of age and up since 2010. Emily specializes in utilizing behavioral interventions and parent training to address ADHD, anxiety, autism and depression.