People with autism spectrum conditions have a different pattern of brain development from the very beginning of their life. typically developing babies have an inbuilt intense interest in other humans and a desire to communicate. In contrast, babies with autistic conditions have little or no interest in people and find pleasure in physical sensations, movements and objects.

This lack of interest in people is associated with delayed or absence of development of understanding of other’s thoughts, feelings and needs, a lack of desire to please, and problems with communication. However, as with everyone there are changes with development. The years between two and five can be particularly difficult for children with autistic conditions and their families but things tend to become easier from five or six up to around ten years of age.

The teenage years are turbulent because of the physical changes of adolescence. The problem may continue into the twenties or thirties but, in later adulthood, many people with autistic conditions have settled into a niche in life that suits them. It is against this background of varying phases with a general tendency to slow improvement over many years that the effect of any approach has to be judged. Since most of the available approaches need time to work, evaluating them requires a long-term view in a situation in which parents are desperate for immediate solutions to pressing problems. The difficulties are compounded by the fact that there are large variations in levels of ability, patterns of skills, responses to sensory input and personality and temperament among people with autistic conditions. For these reasons there are enormous differences in individual needs.

The aims of different approaches to autism can be classified into four basic types

• Organisation of the environment.
• Modifying behaviour.
• Teaching skills.
• Attempts to cure (that is, to make more typical) the underlying neurological and psychological differences from the typical patterns.

Some approaches concentrate on one of these aims while others combine two or more. The research studies show that some of the approaches aim to make the environment more appropriate and/or to develop specialised educational techniques that help people with autism to adapt better to everyday life and to learn useful new skills.

The provision of a calm, structured and organised environment and a programme of education, occupation and leisure geared to the needs of each individual are the basic requirements for all those with autism spectrum disorders. Many approaches discussed below are ways of achieving such an environmental and educational programme.

The best-studied interventions include educational/behavioural medical interventions.

Educational/behvioural interventions: There are many schools of thought regarding the best ways to teach a child with autism. Some of the more popular methodology have been briefly outlined below. In India it is a common practice to inculcate principles of different methodology and these are combined to form an eclectic approach.

TEACCH:

Treatment and Education of Autistic and related Communication handicapped Children was developed by Eric Schopler for the State of North Carolina in the US. The primary focus of this methodology is Structure. TEACCH believes that mosat individuals with autism having difficulties dealing with unexpected occurrences and they tend to have high levels of anxiety. The approach helps reduce this anxiety by “structuring” the physical environment, providing visual schedules (timetables that make the routine clear) and making the work process explicit and clear. Alongside the environmental adaptations, TEACCH believes in developing the individual’s skills and cultivating their strengths and interests

Applied Behavioural Analysis (ABA):

This is an intensive, structured teaching programme that uses the principle of learning given by BF Skinner to teach skills or behaviours. The focus of ABA is increasing behavioural deficits such as lack of communication and decreasing behavioural excesses such as hyperactivity through a systematic use of rewards or rewards and punishment. The major teaching methodology that is an inherent part of the ABA Approach is the DTT (Discrete Trial Training), which was given by I Lovaas. DTT involves breaking a skill into smaller components and teaching a skill intensely until mastery. Prompts are used alongside to facilitate learning.

Sensory Integration Therapy (SIT):

The proponent of the SI theory Jean Ayres defined SI as “the neurological process that organizes sense from one’s own body and from the environment and makes it possible to use the body effectively within the environment”. SI Dysfunction occurs when the brain ineffectively processes sensory information from ones’ own body or from the environment. It may coexist with autism and some other developmental disorders. SIT involves providing activities to help develop sensory integration.

Picture Exchange Communication System (PECS):

Lori Frost and Andy Bondy developed PECS in 1985 in response to the difficulty in successfully using a variety of communication training programs with young students with autism. Children using PECS first learn to approach and give a picture of a desired item to a communicative partner in exchange for that item. By doing this, the child initiates a communicative act for a concrete outcome within a social context.

The PECS training protocol is based on research and practice in the principles of ABA. It first teaches a child “how” to communicate. The child first learns to communicate with single pictures. But later learn to combine pictures to learn a variety of grammatical structures, semantic relationships and communicative functions.

There are 6 phases in PECS training ranging from learning how to communicate to communicating in sentences.

Relationship Development Intervention (RDI):

Research indicates that people with autism can display affection when operating for instrumental purposes. But they have great difficulty sharing their experiences, which requires a unique form of information processing, referred to as Emotional Coordination.After several years of analysis and evaluation, Steven Gutstein has come up with an intervention model called Relationship Development Intervention (RDI) to address this deficit in autism.

RDI helps to bridge in understanding and treating social deficits in people with autism. It teaches you to enable a child with autism to develop Experience Sharing.

The programme consists of developmental graded exercises wherein the child with autism is guided through the stages of relationship development.

Art Therapy

Art in a therapeutic context can provide an insightful tool of communication, a statement in a non-verbal form. Art is a powerful instrument for individual expression and artwork can be bridges or ‘elastic locations’ where we can communicate our ideas. Art used in a therapeutic setting can support both the containment and release of feelings: there are no mistakes and each piece of artwork is received as a means of communication or expression. Not only does this encourage confidence, it can also foster greater independence of thought and expression. Through this there can be a development of interpersonal and communication skills as a way of connecting meaningfully with the outside world.

Auditory Integration Training

The philosophy behind this treatment is that children and adults with autism frequently have distorted hearing and this can block communication, limit speech and social interaction and cause temper tantrums. The treatment does not claim to cure autism but aims at retraining the hearing to disregard intrusive sounds