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Several authors have comprehensively reviewed key programs available internationally for children with autism, (Dawson & Osterling, 1997; Howlin 1997; Marcus, Garfinkle & Wolery 2001; Rogers 1996). Based on their reviews of the research, these authors have all defined the common elements they consider necessary for effective intervention, regardless of the theoretical framework underlying any one particular approach. Dawson and Osterling (1997) found that the directors of the programs they reviewed agreed on many of the key elements they believed are essential for a program to be effective regardless of theoretical perspective. However the methods employed by different programs to address each of the elements listed below may vary due to differences in the philosophical approaches.

The key elements described in the literature for effective programs are:

Curriculum content: Within this element there are five basic skill domains; ability to attend to elements of the environment, ability to imitate others, ability to comprehend and use language (Howlin, 1997), ability to play appropriately with toys (Howlin, 1997), and ability to socially interact with others (Dawson & Osterling, 1997). Marcus, Garfinkle & Wolery (2001) suggest that effective programs utilise the following intervention

strategies based on the learning characteristics of children with autism: Clarifying meaningful information, organisation and scheduling, teaching across settings and

people, active directed instruction, individualisation of teaching materials and curriculum, provision of visual supports, teaching imitation at a developmentally appropriate level, using strengths and interests to help with weak areas of development.

Need for highly supportive teaching environments and generalisation strategies: The core skills outlined above are taught in a highly supportive teaching environment and are then systematically generalised to more complex, natural environments. Howlin (1997) stresses the need for behaviourally oriented strategies.

Need for predictability and routine. Research shows that children with autism become more socially responsive and attentive when information is provided in a highly

predictable manner and, conversely, that their behaviour is severely disruptive when the same stimuli are presented in an unpredictable manner.

A functional approach to problem behaviours:Most programs focus on the prevention

of problem behaviour by means of increasing the child’s interest and motivation, structuring the environment and increasing positive reinforcement for appropriate behaviour. Should the problem behaviour persist despite ecological management, the behaviour is analysed to determine what the function of the behaviour is for the child. The environment is then adapted in specific ways to avoid triggers and reinforcers for the problem behaviour and appropriate behaviour is taught to give the child an alternative more acceptable behaviour. Howlin (1997) stresses the importance of recognising the

communicative function of problem behaviour and the need to teach the child more appropriate alternative means of communication.

Transition from the preschool classroom:Most programs recognise that transition to school is a time when children with autism need a great deal of support. Effective

programs actively teach school skills to enable the child to be as independent as possible. Programs frequently take an active role in finding school placements that will best suit the child and then actively integrate the child with autism into the new setting.

Family involvement:Effective programs recognise that parents are a critical component in early intervention for children with autism. Most programs support parents to choose the type and intensity of their involvement in their child’s program. Effective programs are sensitive to the stresses encountered by families of children with autism and provide parent groups and other types of emotional support. (Dawson & Osterling, 1997)

In addition reviewers discuss important strategies or methods not utilised by all models but utilised by a significant number and worth noting:

Visual Supports

Dawson and Osterling (1997) note that the provision of augmentative communication methods is a characteristics of many programs reviewed. In addition both Howlin (1997) and Quill, (1997) stress the importance of visually cued instruction to provide the child with a predictable and readily understood environment.

Number of hours of treatment per week

Dawson and Osterling (1997) note that programs reviewed recommend a minimum of 15 hours of treatment per week. The authors stress the point that the concept of intensity as discussed in the research is complex and not necessarily conveyed solely by the ‘number of hours per week’. Focusing exclusively on the number of hours per week detracts from the amount of actual meaningful engagement, which is the key factor. Marcus, Garfinkle and Wolery (2001) suggest that while it is unfortunate that the early intervention

movement emphasises the number of hours per week, a lower limit of 15 hours minimum per week is sensible in that the focus should be on the importance of more relevant factors of curriculum and content of instruction rather than on hours of treatment alone (Marcus, Garfinkle & Wolery, 2001).

Occupational Therapy

Several programs provide occupational therapy services for those children who can benefit from them (Dawson & Osterling, 1997).

Inclusion of peers

Independent functioning

Marcus, Garfinkle and Wolery (2001) note that many programs emphasise child independence, initiative and choice making

Obsessions and rituals

Howlin (1997) suggests that a good program will recognise the importance of obsessions and rituals as underlying causes of many problem behaviours. However, these may have a vital role in reducing anxiety and may act as a powerful source of motivation and reward.

Individual Variation

It is important to account for the spectrum of autism disorders and to recognise that while the core characteristics of autism spectrum disorders are consistent, no one child with autism will have the same pattern of strengths and needs as another. In addition families differ in their goals and resources, strengths and needs. Therefore, there is no one program that will suit all children with autism and their families. Research suggests that there are substantial short and long term benefits from early, intensive, family-based treatment programs, whatever their theoretical basis, so long as these are appropriately adapted to the child’s pattern of strengths and weaknesses and take account of family circumstances (Webster, Webster & Feiler, 2002).

COST BENEFITS OF TREATMENT PROGRAMS