What do we teach?
The intervention programme is aimed at the functional development of all the critical areas in the development of the child.
The method of tackling the difficulties is individualized depending on the main reasons that impede the child from learning in the fastest way possible. Some of these, such as self-stimulation, temper tantrums and other inappropriate behaviours – added to the slowness of learning new skills (verbal skills, imitation skills and so on) - exacerbate the divergence from the typically-developing child.
Based on standardized assessments of performance and the use of behavioural observation, a clinical focus is established that forms the centre of all the areas of work. The intention is thus none other than to try to establish firmly-grounded and consistent skills that enable progressively more complex skills to be taught, such as language and socialization.
The skills to be taught in the programme are broken down into learning units that are as small as needs dictate, thereby ensuring that the child develops within a framework of constant success and fun. This is the basis of all learning: hundreds of scientific studies underscore the efficacy of positive consequences as the chief element of learning.
To this end we use what is technically known as positive reinforcement. These reinforcements are no more than fun elements and activities such as: kisses, hugs, children’s games (hide and seek, chasing and so on) a favourite food, tickles, music, praise etc. This enables us to maintain an atmosphere of success where the child is much more likely to learn than in less motivating, tedious or repetitive situations.
How do we teach?
We teach the children by using procedures based on Applied Behaviour Analysis (ABA)
These intervention procedures and techniques have been and continue to be developed through research undertaken by thousands of professionals within the ABA field.
Some people elaborate arguments that are opposed to ABA, largely or frequently based on misunderstandings. Having a behavioural focus does not entail that the treatment concentrates exclusively on reducing behavioural problems. Nor does it mean that the type of training necessarily has to be "excessively strict or repetitive" in order for it to be followed by a small child.
These perceptions, each of which can easily be cleared up, are on many occasions the product of lack of knowledge and the absence of up-to-date information.
As with all professional practice, however – and naturally even more so within psychology – beyond the question or right or wrong approaches what really makes the difference and what really makes it effective, apart from being backed by research, is how it actually works in practice. The question of how it takes concrete form – how this idea, this approach, is implemented – is what truly gives added value to professional efforts and, of course, to the children and their families.
In all educational settings, the person doing the teaching aims to obtain behaviours that are adjusted to context on the part of the learner. Why? Because appropriate behaviour facilitates faster learning. Because it predisposes people to learning, because it makes life easier for whoever lives with those people. This is giving people no more than their due, including people with ASD.
All learning requires repetition, and children with ASD are no exception. We want the children in our programmes to learn as rapidly as possible, as rapidly as a typically-developing child can learn. We want to provide a foundation for learning in each child, which enables them to learn with the fewest repetitions possible. Some children will require more repetitions, others fewer – but the important thing is to provide only those that the children needs.
Our goal is for the child with ASD to be able to learn, just like the typically-developing child, in the most natural situations possible; this is why in we work in the child’s most immediate settings and with technical procedures that are empirically validated. This does not mean that we can achieve our goal with all children. What has been amply demonstrated however is this: simply by modifying any of the variables that may prove necessary, the child’s integration into those day-to-day settings can be maximized as much as possible and be the least restrictive for him and his family.
How is the child’s day structured?
During the intervention the child is taught in a one-to-one situation (therapist or parent – child).
Depending on the age of the child and the skills exhibited at the start and during the intervention, daily sessions are structured with a certain number of hours. These range from two to seven and a half hours every day, between five and six days a week. We always aim to work steadily towards a total of approximately 35 - 40 hours per week.
We ensure that the intensity of our intervention programme is manageable for the child, respecting his time and needs in accordance with his stage of development (breakfast, break times, outings to the community, to the park and so on).
Normally we work on a specific task for 2-5 minutes and then have a short rest (1-2 minutes). A longer break of 10-20 minutes is held every one and a half or two hours. This depends on each child, however.
Who carries out the intervention?
The greater part of the intervention is carried out by a team of between two and four therapists; these are graduate psychologists, educational psychologists and people trained in speech therapy or special educational needs.
The therapists are coached using the "UCLA Young Autism Project" training protocol and have to pass quality control assessments before undertaking sessions by themselves. After their initial training, they regularly undergo specific training in behavioural modification techniques and weekly practical supervision. These therapists are coordinated and guided by clinical supervisors with at least 3-4 years’ experience of applying the method. The child’s progress is reviewed each week in a session where the team of therapists, the case supervisor and the child’s parents are all present.
The Director and the supervisor for each case oversee each child’s programme and supervise every advance to ensure that the techniques are being applied in the most effective way. The parents are always kept informed of the procedures being used and by the same token they are offered the chance to suggest new aspects. For their part the parents apply the intervention techniques and procedures to the child’s day-to-day setting and they are equipped by the supervisors with the ability to address the daily challenges that their children present. This strategy of getting parents involved extends to training them directly with the child, with the aim of being able to provide the greatest possible consistency for the time outside the individual sessions.
Introduction to a school situation
The decision to introduce children to a school-type educational setting always depends on the skills each child displays at the start of the intervention programme or the skills that he or she displays throughout the intervention.
In order to be able to introduce the child into a school setting, we always recommend that the child has already acquired a series of skills. Some of these are, for example:
- Control over sphincters in the area of personal care and autonomous habits.
- Language comprehension skills, such as following simple instructions and recognising certain objects.
- Staying seated to perform a task for a minimal time and being able to manage certain aspects of play (such as jigsaw puzzles, fitting shapes into slots and so on).
- Some academic skills such as colouring with different materials.
- Complete or almost complete absence of inappropriate behaviours in the form of temper tantrums or aggressive behaviours.
In the introduction to the school setting we first check to see that the child is capable of generalizing habits already acquired in a less structured setting (featuring children, more noise, more natural instructions and so on). The objective of this is to ensure that the child is able to get the most out of his or her time with the group, just like any typically-developing child.
Nonetheless it is the parents who ultimately take the decisions, with our guidance. They are the ones who choose the school. If there is no school, we help them to find the ideal context for this integration. Sometimes the questions focus on what type of education is ideal, ordinary or special. Neither context is better than the other per se, since the best context will be the one that can attend and adapt itself to the needs of the child. One decisive factor is that, whatever the context, it ought to possess a sufficient degree of competence that the child will emerge better off.
In the process of integration an educational specialist accompanies the child to the school with the aim of smoothing the transition to the classroom routines and fostering socialization with the other children. School attendance is gradually increased over time. For example, there could be children who start their integration with 30 minutes a day, twice a week... until they achieve complete integration. Meanwhile the educational specialist who accompanies them will withdraw little by little, where possible. The school hours when the child is supported by an educational specialist are included within the total hours of weekly treatment. The parents, teachers and the Foundation staff keep a close eye on the child’s progress at school so as to maximize the chances of success and minimize the risk of being excluded from the group.
Potential benefits of intensive behavioural intervention
Research indicates that with early and intensive behavioural intervention 35- 47% of children with autism and pervasive developmental disorders have been able to reach a normalized level of intellectual and educational functioning by the age of 7 (Lovaas, 1987; McEachin, Smith, Lovaas, 1993).
These children were integrated into ordinary educational classes and have successfully advanced in the educational system without any kind of additional assistance. They exhibit considerable improvements in intellectual functioning and score in the normal ranges of standardized intelligent tests. They are also indistinguishable from their peers in their scores for social and emotional functioning.
Unfortunately, these levels of functioning do not extend to the majority of children with ASD. In spite of this, an intervention focused on the treatment variables mentioned above does, in the majority of cases, achieve such benefits as:
- A significant fall in inappropriate behaviours.
- The learning of more complex and functional skills within the environment.
- The development of different levels of play, depending on the child.
- Skills for communication as well as the acquisition of basic language.
- Greater and better integration into social, community and educational settings.
The children who receive our services
The programme is designed to offer treatment to children with a diagnosis within the autism spectrum at an early age.
They should be no more than 60 months old at the time of starting the treatment and not present any other severe alterations at the organic or physical level.
However, the Planeta Imaginario Foundation has recently broadened its range of services and now attends to children whose ages exceed 60 months. It must be borne in mind however that the younger the child, the greater the benefits and effectiveness of behavioural and intensive one-to-one treatment usually are.
The Foundation does not have specialist staff to treat children diagnosed with any other medical condition such as blindness, significant hearing loss, uncontrolled convulsions, Rett Syndrome or severe delays in motor movement.
How can this intervention be obtained?
The intervention offered by the Planeta Imaginario Foundation can be divided into two clearly differentiated services depending on the geographical location of the families wanting the treatment.
Intensive or semi-intensive intervention is offered to families living in Barcelona, and a consultancy service is offered to families who live beyond the Barcelona metropolitan area or whose residence is located in any of the Spanish provinces, with limited services offered to certain places outside Spain.
Families can be assured of receiving the same treatment independently of the geographical location of the child, but there are some areas in which the two services differ:
A. Service in Barcelona
A.1 - Intensive service (40 hours a week)
- Designed for children who start the treatment at early stages of development (3-5 years old).
- The team doing the home-based intervention comprises Foundation employees who are specially trained in behavioural modification techniques and theory of learning.
- One clinical supervisory session is offered per week.
A.2 - Semi-intensive service (20 hours a week)
- Depending on the case, the team may consist of Foundation employees or a team recruited and directed by the family itself.
- A fortnightly clinical supervision session is offered.
B. Service outside Barcelona
B.1 - Consultancy service (from 20 to 40 hours)
- The child’s educational team is made up entirely of personnel selected by the parents and external to the Foundation.
- Monthly supervision sessions are offered; it is usually the clinical supervisor who travels to the family home for these sessions, setting out the best guidelines for working and carrying out the subsequent training of the educational team.