Certain forms of treatment are standard for most children with Autism. Speech/language therapy, counselling (for higher-functioning children), occupational therapy, and interventions aimed at improving social skills are used to help Autistic kids develop the abilities they’ll need to thrive as adults. Beyond that, however, parents are often presented with numerous optional treatments to choose from. These treatments generally fit into one of two categories: relationship building programs and skill building programs. Understanding how these two different forms of treatment work can help parents pursue the best programs for their child and streamline the treatment process.
Relationship Building Programs
Relationship building programs focus on improving social and emotional skills through strengthening the parent-child bond. While there are many relationship building programs, some of the best known are the Early Start Denver Model, Relationship Development Intervention (RDI) therapy, Greenspan’s FloorTime, and the Son-Rise program. Research does not indicate that any one of these programs is inherently the best choice; most of them share overlapping techniques and operate on the same fundamental principles. Parents are advised to choose the program that they feel would work best for their child.
In most relationship building programs, the parent is taught how to administer therapy at home. In essence, the parent serves as the child’s primary therapist, while a trained therapist provides additional guidance, oversight, and support. The goal of this approach is to make the parent the primary object of the child’s attention, placing the parent directly within the child’s sphere of interest rather than outside it. This encourages engagement and attachment, laying the foundation for the development of social skills. Through interacting with his or her parent, the child naturally begins to learn how to mimic appropriate behaviours, understand other perspectives, adapt to changing conditions, and integrate complex sensory information into a cohesive understanding. As the child gets older, he or she is often paired with a peer who shares a similar level of social functioning. This encourages the child to develop more diverse social skills outside the home environment.
Relationship building programs focus on using the parent-child bond to encourage the formation of broader thinking and communication skills, in addition to social skills. In the RDI program, for example, the parent helps his or her child work on developing the following six abilities:
Social Coordination: Social coordination allows the child to observe social interactions and select an appropriate reaction. A socially coordinated child can control his behaviour in order to facilitate the formation of healthy relationships with others.
Emotional Referencing: This skill helps Autistic children successfully understand, and learn from, the emotions of others. Emotional referencing is necessary for the development of empathy.
Flexible Thinking: Flexible thinking permits the child to adapt to changing conditions more easily.
Declarative Language: Developing declarative language skills is integral to self-expression. Declarative language allows children to communicate their thoughts and feelings and participate in group activities.
Relational Information Processing: Relational information processing builds the child’s capacity to understand nuance. It helps Autistic children solve problems that lack a clear correct answer and avoid “black and white” thinking.
Foresight and Hindsight: Foresight and hindsight are necessary to learn from past experiences and anticipate what may happen in the future. Having this knowledge of potential consequences aids in impulse control.
To make these goals manageable, relationship building programs use a step by step approach that’s easy for both the parent and child to follow. These programs are also adjusted to reflect the child’s age and ability level, so younger or lower-functioning kids don’t end up struggling with unrealistic expectations.
Skill Building Programs
Skill building programs help Autistic children learn specific skills by breaking those skills down into small, easy-to-process components. These programs teach kids how to pay attention, follow instructions, control impulses, mimic appropriate behaviours, use more expressive language, improve motor skills, etc. Differential reinforcement—a system wherein positive behaviours are rewarded and unhelpful behaviours are ignored—is used to train children to use these new skills.
Discrete Trial Training (DTT) is the oldest and most widely utilized skill building program. It’s important to note that while DTT is based on Applied Behavioral Analysis (ABA), ABA and DTT are not the same thing. DTT is simpler and more structured than ABA; it’s also been designed to reflect the unique needs of kids with Autism, whereas ABA can be applied to a broad scope of behavioural issues.
DTT differs from relationship building programs in a couple of key areas: It’s more structured than programs like RDI; parents follow specific teaching protocols when administering DTT, whereas RDI is performed intuitively throughout the day. DTT also requires more time spent with a therapist, with an average of 20 to 40 hours of therapy being required every week. Some parents prefer this approach as they’re not expected to act as their child’s primary therapist, but others find it too inconvenient or costly to work with their lifestyle.
Hybrid Programs
Not everyone finds it easy to choose between skill building and relationship building programs. Parents often discover that elements of both forms of treatment appeal to them. If you find yourself in this position, you may want to look into hybrid programs that combine core aspects of each treatment modality, like Pivotal Response Teaching (PRT). PRT is a derivative of DTT that uses differential reinforcement techniques to encourage skill building, but it has a more naturalistic, flexible style of administration. PRT is closer to the skill building approach than it is to the relationship building approach, but it may provide an acceptable compromise, depending on your child’s needs. Alternately, you can combine both RDI and DTT techniques into a customized program that works for you; just be aware that this option will involve additional training, time, and research.
Ultimately, it’s essential to remember that relationship building programs and skill building programs can be equally effective, so the best treatment is the one you feel most comfortable with. If you’re not sure which program to choose, ask your child’s therapist for suggestions.
