Early Intervention Helps Children with Autism
Disponible en Español |
Anibal Gutierrez, Jr., Ph.D., BCBA-D, has a host of impressive credentials, but one of his favorite parts of his job is sitting on the floor with a two-year-old.
“With a bucket of toys between us, I use hand over hand to help them make the ‘more’ sign instead of crying when they want a toy,” Dr. Gutierrez says. It sounds simple; for a child diagnosed with Autism Spectrum Disorder (ASD), learning to speak or use hand signals is a milestone.
Through a process known as early intervention (EI), Dr. Gutierrez helps children with ASD communicate without “tantrums, crying, or hitting.” It’s one of many skills he teaches that helps children overcome the challenges of their behavioral disorders.
As a review of ASD studies noted, “Almost all disruptive behaviors exhibited by children with ASD have a communicative function and . . . are often avoided, reduced, or eliminated, with early intervention focused on teaching functionally-equivalent replacement behaviors.”
The aim of EI is to reduce or eliminate behaviors that negatively impact the child’s ability to make meaningful social connections and achieve independence.
EI helps some children overcome ASD symptoms so well that they “fit within the typical range,” according to research. The same study said that almost half of children who receive “intensive EI grow up to function without needing special support.”
Through early intervention, as many as 25% of children outgrow the diagnosis entirely.
The benefits of a head start
The earlier he works with children, the better, says Dr. Gutierrez, who serves as division director at the Center for Autism and Related Disabilities (CARD), director of the Intensive Behavioral Intervention Services Clinic (IBIS), and co-director of the Behavior Analysis Program. Part of the Psychology Department at the University of Miami-Nova Southeastern University Center, CARD provides training and consultation.
In the past, early intervention studies found that children with ASD who receive services before age four progress better than those who enter programs after that age. Today, the recommended time to intervene is age two.
“The primary driver behind the benefits of early intervention is neuroplasticity,” says Dr. Gutierrez.
The brain of an infant or toddler is still developing and, therefore, more malleable. That’s why it’s easier, Dr. Gutierrez says, for young children to learn a second language than adults. By intervening early, clinicians can be more effective in helping children with ASD overcome their brain disorders.
Another reason EI is so effective in small children is simplicity.
“Life is simpler for a two-year-old, so we target simpler skills,” says Dr. Gutierrez.
It’s also easier to control a child whose behaviors aren’t ingrained. “We can arrange the environment to overcome behavioral challenges.”
Using science to build skills
Dr. Gutierrez uses a method called Applied Behavioral Analysis (ABA).
“It is learning theory and science applied to the skill you need to learn. We want to prevent and replace problem behaviors. ABA uses a broad set of principles based on the basics of learning. It can be applied to different ages and levels of functioning.”
Examples of ABA in action include teaching children to maintain eye contact, a daunting social task for many autistic individuals. It’s not an all-or-nothing approach, Dr. Gutierrez says. “All we really need to achieve is a glance at the listener so that they are aware you are talking to them.”
Another intervention focuses on habituation. “Through exposure and desensitization, we help them adapt to things that cannot be avoided, such as noise.”
Most EI programs share similar components:
- Parental involvement
- Establishing a predictable environment for the child
- Integrating the child’s interests in the process
- Actively engaging the child
- Focusing on personalized developmental goals
Chasing the age down
As a research associate professor in the Psychology Department, Dr. Gutierrez keeps abreast of current developments in his field.
“Dr. Alesandri and I are involved in a lot of studies training parents to get involved in early intervention. We also collaborate on studies looking into earlier detection. We’re chasing that age down as far as it will go. We’re getting better at detecting it earlier,” says Michael Alesandri, Ph.D., the executive director of CARD.
Researchers are now studying how to diagnose ASD in infants, especially if there is a family history of autism.
“If you’re concerned about your child’s development, we can start working with them. We don’t need a diagnosis. I always tell parents, ‘Never give up. Just because your child isn’t two or three doesn’t mean early intervention won’t help. I’m excited if a six-year-old comes in, and we help adults, too,” Dr. Gutierrez says.
Experts recommend 20 to 25 hours of intervention per week.
“Going to school or having speech therapy can be part of those hours,” says Dr. Gutierrez.
A collaborative approach
Parents who work with the university-based IBIS clinic have distinct advantages. “You have a lot of experts to draw from. If I’m stumped or seeing something for the first time, there are experts who can help and opportunities to collaborate and consult,” Dr. Gutierrez says.
Likewise, “Our behavioral clinicians share data with UHealth neurologists. When a clinician sees improvement, they share that information.”
Data sharing often allows neurologists to fine-tune the child’s treatment and medication.
Families, Dr. Gutierrez says, “benefit tremendously” from working with a teaching clinic for other reasons, too. He uses the latest evidence-based methods to train his clinicians. Because students are completing their practicum experience at IBIS, “Our staff-to-child ratios are unmatched.”
Although his work is demanding, the rewards are great. Taking toys from a bucket over and over may be just the intervention a child needs to change his life forever.
Early Signs of Autism Spectrum Disorder
- Not responding to their name by 12 months of age
- Not pointing at objects to show interest by 14 months
- Not playing “pretend” games (pretending to “feed” a doll) by 18 months
- Avoiding eye contact
- Having trouble understanding other people’s feelings or talking about their own feelings
- Repeating words or phrases over and over
- Giving unrelated answers to questions
- Becoming upset by minor changes
- Having obsessive interests
- Flapping the hands, rocking the body, or spinning in circles
- Having unusual reactions to how things sound, smell, taste, look or feel
To make an appointment at CARD in Miami-Dade or Monroe County, call 305-284-6563 or email [email protected]. To make an appointment in Broward County, call 954-262-7111 or email [email protected].
Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.