In my previous post, I talked in great detail about how Early Intervention is conducted for Autistic children.
In this section, I will talk about what things you, as parents, need to keep in mind while selecting the best Early Intervention therapist for your child.
Here are 12 key criteria that every Early Intervention therapist should meet:
- The earliest possible start to intervention is essential. This is discussed at length in the previous post.
- Services must be individualized for children and families. The diagnosis of ASD does not predict the outcomes or which frequency and mix of services and supports best suit a particular child and family – these are driven by the needs of the child and family.
Early intervention services must be directed as much toward the caregivers as toward the child to ensure that families can and will use the same strategies throughout the child’s day. Even though the intervention may follow a specific curriculum, the infusion of intervention into daily activities and routines must be customized for each family.
- Family involvement and participation is critical. Infants and toddlers learn as they experience life with their families. In other words, toddlers do almost all their learning between early intervention visits! Families should be actively involved in identifying outcomes that are important to them, planning strategies for addressing those outcomes during daily routines, deciding on services, and evaluating progress.
- Families have a right to evidence-based services. Researchers have clearly spelled out the need for early intervention services that are appropriate and based on scientific research, to the maximum extent possible. Families should expect us to be able to explain the theory and science behind our interventions, and families should be confident that we have been trained in how to implement our interventions with fidelity.
- Intervention is based on a developmental curriculum designed to address the specialized needs of the child with ASD. The curriculum should be based on principles of child development and how all children learn; build on strengths while also addressing weaknesses; and address key areas such as engagement, imitation, initiation, communication, playing, reciprocal interactions, spontaneous interactions, making choices, and following routines/variation in routines.
- Intervention is planned and systematic. Systematic intervention means assessing, planning, intervening, and measuring. However, the guidelines urge us to remember that many indicators that are easiest to measure such as vocabulary, intelligibility of words, or duration of eye contact may not be as meaningful or important to the family as the sense of the child and family’s quality of life, such as reduced frequency of tantrums, ease of transition between home and other settings, or the ability of family members to spend quality time together.
- Infants and toddlers with ASD should have regular and deliberate exposure to typically developing peers. Children with ASD struggle with social relationships. During the early intervention years, the parent-child relationship is primary, and also serves as the foundation for other relationships in the child’s life, including relationships with other children: siblings, cousins, the children next door, children at child care. With some planning on our part, learning opportunities for children with ASD can be embedded within those other relationships as well.
- Challenging behaviors are addressed using positive behavioral supports. Many young children without delays and disabilities present challenging behavior. Many behavior problems in toddlers with ASD are similar to those seen in typically developing children, but with increased intensity, frequency, duration, or persistence – which means increased stress for families. If we can increase a child’s ways of interacting and communicating across settings, the child is likely to have fewer problem behaviors.
Intervention should focus on developing communication skills. Communication is much more than talking; it can help or hinder opportunities for interacting and learning. Toddlers with ASD may have large vocabularies or imitate language well, but they may lack joint attention and/or functional use of language – important skills that facilitate interactions with the people in their environment.
The development of a communication system increases the likelihood of a toddler’s success in social interactions. Alternative or augmentative communication systems can be used to improve communication, increase social interactions, provide structure – and facilitate the development of speech! (But always remember that the first step in addressing communication skills is to make sure that the child’s hearing has been tested if that did not happen during the diagnostic process.)
- The development of social relationships is integral to successful outcomes. Relationships, the key challenge that defines ASD, are the primary context for learning in early childhood. Again, social relationships begin with child-adult interactions, which then become the foundation for child-child interactions and friendships with others. Skills such as turn-taking and “social play” may have to be planned and “taught” through experiences across many settings, beginning with coaching parents on strategies to engage and interact with their child.
- The transition from the Birth to Three System to preschool special education and related services should be well planned. Transition planning for all children is important, but especially so for young children with ASD. Many toddlers with ASD struggle with changes and transitions – a source of frustration for families and professionals alike. Plan early, plan thoroughly, be creative and flexible, and remember that it’s not just the child who needs transition support – the family does, too.
- Getting to quality outcomes is not just about hours of direct services. Nor is it about advocating for one single intervention approach. No single approach has been shown to impact all areas of development across all children and all families. Different intervention models impact different skills and behaviors. Instead of a narrow focus on hours of service and a certain intervention model, other factors may be far more important, including:
- Intensity:For toddlers, “intensity” means something quite different than hours of service. Intensity means the amount of active and appropriate engagement across routines with the adult family members they love to spend time with (who have in turn been coached by early intervention professionals). Moreover, toddlers need “down time” to rest and sleep. Further, an over-emphasis on as many services and hours of professional intervention as possible can negatively impact family and child outcomes.
- Fidelity of intervention delivery:Those of us who are working with families need to understand our intervention well enough so that, as we explain it to families, they are able to implement it in ways that will make a difference.
- Social validity of goals:In other words, does the outcome really matter in the context of the child and family’s everyday life? The example used in the Connecticut guidelines compares teaching a child to correctly label 3×5 cards of different colors (low social validity) to being able to make a choice when Mom asks, “Red or blue pajamas tonight?” (high social validity).
- Comprehensiveness of intervention:Progress in one area doesn’t necessarily impact progress in other domains for children with ASD. Young children with Autism and their families often face many challenges, and the IFSP must respond to those.
- Data-based decision making:Great intervention requires a constant cycle of planning, implementing, and measuring. How else will we know if we’re making a difference?
I am Ash and I celebrate Neurodiversity! Growing up with an elder brother with severe Autism was tough – but it has also taught me essential life lessons. I don’t believe that people with Autism are necessarily or have any disorder (except in extreme cases). They are just different! And that is something to be proud of! I am passionate about helping other families who may have Autism conditions in their family. So please reach out and drop me a note. I will be glad to help 🙂
