2. Autism Spectrum Disorders (ASDs)
ASDs include Autistic disorder, Asperger syndrome,
and Pervasive Developmental Disorder not otherwise
specified.
Based on research, behavioral therapies that help
children with ASDs provide structure, direction, and
organization for the child. Family participation in
therapy is also necessary for success.
Behavioral therapies for ASDs should start as early
as possible.
3. Behavioral therapies for ASDs
Behavioral therapies help children with ASDs build
language, social and play skills.
Applied behavioral analysis (ABA) is frequently used for
children with ASDs and research shows that it can be
very effective in helping children with ASDs.
ABA involves identifying the behaviors that need to be
reduced and the ones that need to be built.
In ABA the child practices skills repeatedly and the
therapist constantly provides positive reinforcements for
the child. The program is highly individualized based on
the child’s interests, abilities and behavior.
4. Applied Behavioral Analysis (ABA)
ABA is a general intervention approach that can be
adapted to different circumstances and settings. ABA
can be used in combination with other psycho-
educational and behavioral strategies.
In ABA, the skills and behavior of each child are
assessed, and appropriate functional skills to be
taught are chosen with respect to the child’s ability.
The teaching environment is is set up to emphasize
classroom structure, to adapt instructional activities,
and to develop meaningful curriculum.
5. Early Intensive Behavioral Intervention (EIBI)
Early intensive behavioral intervention (EIBI) in contrast to ABA, is
a much more prescriptive, manualized program that integrates
components of ABA.
Children in an EIBI program have therapy approximately 40 hours
per week over the course of up to two years.
It is recommended that the child start therapy before the age of
three.
Two manualized EIBI programs are the University of California, Los
Angeles (UCLA)/Lovaas model and the Early Start Denver Model
(ESDM). Both programs involve high intensity instruction using
ABA techniques but have several differences.
The UCLA/Lovaas method uses one-on-one therapy sessions and
discrete trial teaching.
The ESDM uses ABA principles with developmental and
relationship-based approaches for young children.
6. Other interventions for ASDs
Cognitive behavioral therapy- CBT is used to teach children with ASD to
monitor and manage their own behaviors through changing their
perceptions, self-understanding and beliefs. Change is more likely to take
place when a child is actively involved in their own behavior management.
CBT is only appropriate for children with some degree of self-
understanding and self- awareness and are therefore mostly used with
school-age children and adolescents with High Functioning Autism and
Asperger’s Disorder.
Social Skills Interventions – Peer-mediated intervention is used to
encourage specific social skills and to also encourage broader interactions
and relationships (Rogers, 2000; McConnell, 2002). In this type of
intervention, children without ASD are taught how to initiate, elicit,
prompt and reinforce social behaviors of children with ASD (Odom,
Chandler, Ostrosky, McConnell, & Reaney, 1992). Parents can also be
taught to train siblings to use peer-mediated approaches at home to
improve child-sibling interactions (Strain, Kohler, Storey & Danko, 1994).
7. Childhood Schizophrenia
Treatment should include family education and ongoing
family intervention so that the family is in the best position to
provide support to the child.
Individual treatment with the adolescent must take into
account the child’s developmental level.
Due to likely social skills deficits, social skills training should
be an integral part of the treatment.
These sessions teach kids the coping mechanisms and
communication skills that will help them go to school and
socialize with their peers.
Cognitive behavioral therapy is also commonly recommended
to help children manage their symptoms; it’s been shown to
reduce both severity of symptoms and the risk of relapse.
8. Psychoeducational Family Therapy
A psychoeducational approach helps families learn
skills and gain resiliency to handle chronic
problems/illnesses that affect a member of the
family.
Traditional family therapy techniques are used:
joining, establishing an alliance with family
members, maintaining neutrality, and assessing how
to gain positive outcomes.
9. Combining medication management and a family
psychoeducational intervention offers families a therapeutic
package aimed at reducing family stress and preventing
symptomatic relapse in the schizophrenic member.
When family members are not being blamed for the
development of the disorder in one of their members it is
easier to engage and retain them into treatment programs,
thus increasing the likelihood of improved treatment
compliance.
Their willingness to work with the therapist is also increased if
they understand that efforts will help them reduce the family’s
level of emotional intensity so that relapse in the
schizophrenic might be delayed or reduced in severity.
10. Because schizophrenia can be considered a chronic disorder, a
medical family therapy can also be utilized as an intervention.
Medical family therapy consists of a coordinated effort by an
interdisciplinary team to treat a disorder. The focus is helping
families to cope better with a chronic illness, manage medication,
communicate better with providers, and accept that the illness may
not be cured.
This model for family therapy replaces the traditional medical
model that focuses exclusively on a sick individual receiving care to
one in which the family becomes a key component to the caregiving
system.
It seeks to draw out the family’s strengths so as to enhance coping.
Therefore, both psychosocial factors and biological interventions
play an important role in improving outcomes for the family
member with schizophrenia and the family.
11. Childhood Eating Disorders-
Anorexia and Bulimia
Treatment includes: Adequate nutrition, reducing excessive exercise, and
stop-ping purging behaviors.
For less severe eating disorder cases individual therapy and medication are
effective for many eating disorders. However, in more chronic cases,
specific treatments have not yet been identified.
Treatment plans often are tailored to individual needs and may include one
or more of the following: 1. Individual, group, and/or family
psychotherapy, 2. Medical care and monitoring, 3. Nutritional counseling,
4. Medications.
Individual therapy should focus on resolution of distorted cognitions, body
image and self-image issues, and treatment of mood and anxiety disorders.
Family therapy should focus on education, addressing communication,
family relationships, and individuation issues.
Some patients may also need to be hospitalized to treat problems caused by
mal-nutrition or to ensure they eat enough if they are very underweight.
12. Anorexia Nervosa
Treating anorexia nervosa involves three components:
Restoring the person to a healthy weight, treating the
psychological issues related to the eating disorder,
reducing or eliminating behaviors or thoughts that lead
to insufficient eating and preventing relapse.
Different forms of psychotherapy, including individual,
group, and family-based, can help address the
psychological reasons for the illness.
In a therapy called the Maudsley approach, parents of
adolescents with anorexia nervosa assume responsibility
for feeding their child. This approach appears to be very
effective in helping people gain weight and improve
eating habits and moods.
13. Bulimia Nervosa
To reduce or eliminate binge-eating and purging
behaviors, nutritional counseling and CBT can be
effective.
CBT helps a patient focus on his or her current problems
and how to solve them. The therapist helps the patient
learn how to identify distorted or unhelpful thinking
patterns, recognize, and change inaccurate beliefs, relate
to others in more positive ways, and change behaviors
accordingly.
CBT that is tailored to treat bulimia nervosa is effective
in changing binge-eating and purging behaviors and
eating attitudes. CBT can be individual or group-based.
14. Behavioral Disorders- ADHD, Conduct Disorder
and Oppositional Defiant Disorder
Evidence-based Psychosocial Treatment for
ADHD - Treatment for ADHD should include a
psychosocial component.
Research on the treatment of ADHD supports that
there are two treatments that have scientific
evidence for short-term effectiveness: behavioral
psychosocial treatments—also called behavior
therapy or behavior modification—and stimulant
medication. Behavior modification is the only
nonmedical treatment for ADHD with a large
scientific evidence base.
15. Children with ADHD have problems in daily life functioning
in many areas including academic performance and behavior
at school, relationships with peers and siblings, disobedience
with adults, and relationships with their parents.
How a child with ADHD will do in adulthood is best predicted
by three things—(1) whether his or her parents use effective
parenting skills, (2) how he or she gets along with other
children, and (3) his or her success in school.
Behavioral treatments must focus on these things and teach
skills to parents, teachers, and children with ADHD.
ADHD is a chronic condition, therefore teaching skills that
will be valuable to the child as they get older is really critical.
16. Behavior Modification for ADHD
Behavior modification is a form of therapy in which parents, teachers, and
children are taught skills by a therapist.
Parents and teachers use those skills in their daily interactions with the
child with ADHD to improve the children’s functioning, the child with
ADHD uses the skills they learn in their interactions with other children.
Behavior modification can be thought of as the ABCs—Antecedents (things
that happen before behaviors that influence them), Behaviors (things the
child does that parents and teachers want to change), and Consequences
(things that happen after behaviors that influence them).
In behavioral programs, adults are taught to modify antecedents (e.g., how
they give commands to children) and consequences (e.g., how they follow-
up if a child obeys or disobeys a command) to change the child’s behavior
(that is, the child’s response to the command). By consistently changing the
ways that they respond to children’s behaviors, adults teach the children to
learn new ways of behaving.
17. There are three parts of effective behavioral
interventions for ADHD children—parenting
training, school interventions, and child-focused
treatments.
Teaching parents more effective ways of dealing with
their children is the most important aspect of
psychosocial treatment for ADHD.
Parent, teacher, and child interventions must occur
simultaneously in order to achieve the best results.
18. Parent Training
Behavioral approach
Focus on parenting skills, child behavior in the home and
neighborhood, and family relationships (e.g., getting along
with siblings, complying with parent requests)
Parents are taught skills by therapists and instructed to
implement them at home
Typically group-based, weekly sessions with therapist initially
(8 to 12 sessions); then faded to booster sessions
Continually evaluate and modify what is being done to
identify what works best
Plan for what will be done if parents or child regress
Reestablish contact with a therapist for major developmental
transitions (e.g. start of middle school)
19. School Intervention
Behavioral approach
Focus on classroom behavior, academic performance, and peer
relationships
Teachers are taught classroom management skills by a therapist,
school psychologist or counselor
Two to 10 hours of training are necessary depending on the
teacher’s prior knowledge and skills and the child’s severity and
responsiveness
Continually evaluate and modify what is being done to identify what
works best and maintain it as long as necessary
Plan for what to do if child and plan regress
Integrate with school-wide plans, and required, school-based
programs
Reestablish contact with therapist/counselor for major
developmental transitions ( entry to middle school)
20. Child Intervention
Behavioral approach
Focus on teaching academic, recreational, and
social/behavioral competencies, decreasing aggression,
developing close friendships, and building self-efficacy
Can include, individual sessions, clinic-based weekly group
sessions, after-school or Saturday sessions
Intensive treatment is necessary
Monitor and modify as needed based on what works best;
provide as long as necessary (multiple years or when
deterioration occurs)
Plan for what to do when child regresses
Integrate with school and parent treatments
Reestablish contact with therapist for major developmental
transitions ( middle school entry)
21. Conduct Disorder and ODD-Treatments
that have been shown to work
Multisystemic Therapy (MST)- an integrative,
family-based treatment for youth with serious
antisocial and delinquent behavior. Interventions
last 3-5 months and focus on improving psychosocial
functioning for youth and families.
CBT-emphasizes problem solving skills and anger
control/coping strategies.
Parent training programs- focus on teaching and
practicing parenting skills with parents or caregivers.
CBT & Parent Training combined
