Therapeutic Programmes

The therapies described here are based on behaviourist principles and are particularly suitable for individuals with limited intellectual abilities, which is a characteristic of many autistic people.

1. Aversion therapy for self-injuring behaviour

An individual is given an unpleasant shock or some aversive stimulus each time they do something that is self-harmful. This results in an association between selfinjury and the unpleasant experience, reducing the likelihood of repeating the self-damaging behaviour.

• Before conditioning: UCS (shock) creates UCR (fear and aversive or avoidance behaviour).
• During conditioning: Shock and harmful behaviour are paired.
• After conditioning: Harmful behaviour becomes CS, producing CR (fear and aversive behaviour).

Aversion therapy is based on classical conditioning. Aversion means avoidance.

Evaluation:

• This is an unpleasant treatment and may result in psychological problems such as resentment. However, it may be the only way to prevent severe self-injury in children with limited mental ability, so the benefits may outweigh the costs.
• The method has been used with some success when treating alcoholics, smokers and sexual deviants.

2. Behaviour modification

There are a number of behaviour modification techniques, such as:

Shaping – Behaviour can be changed or modified through a system of progressive rewards. Initially, almost any behaviour is rewarded but gradually rewards are given for behaviours that are closer and closer to the target behaviour.

Token economy – Autistic people are given tokens for achieving target behaviours. The tokens can be exchanged for rewards such as sweets or special activities.

Behaviour modification is based on operant conditioning.

Evaluation:

• Behavioural techniques may not provide cures; once rewards are withdrawn, behaviours may relapse.
• Behavioural techniques are most effective when started in early childhood and when they are very structured. One danger is that rewards are given for peripheral behaviours (e.g. the child gets attention for being naughty, which acts as a kind of reinforcement) and this spoils the effectiveness of the target rewards.

3. Language training

The Lovaas technique (also called Applied Behaviour Analysis, ABA) was established by Lovaas (1987). It is a form of behaviour modification therapy and is appropriate for children.

The programme identifies a range of target behaviours that are causing difficulties, such as language problems, self-care skills and self-damaging behaviour. Lovaas originally used punishments (e.g. shocks) as well as rewards to modify behaviour.

Punishments are used less today, although some claim that this lessens the effectiveness of the method (Dawson, 2004).

Evaluation:

• There is considerable evidence of the success of the technique. For example, Anderson et al. (1987) found that even an average of 20 hours a week of one-to-one support over a period of a year brought about significant improvement in cognitive functioning in half the sample of children treated.
• The method relies on intensive interaction (Lovaas recommended 40 hours a week) which means high costs, and it may not be successful with all children.
• The research evidence has been criticised because of selective sampling (some autistic children were rejected as unsuitable) and also because the studies tend to be conducted by supporters of the technique and, therefore, lack objectivity.

4. Parental involvement

Special home programmes have been devised, such as the TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) model, where parents were advised about their children's particular cognitive strengths and needs. Division TEACCH started in 1966 as part of the Department of Psychiatry at the University of Carolina, USA.

Evaluation:

• Lovaas et al. (1973) found that children with autism tended to relapse at the end of treatment if they returned to an institutional setting rather than to their homes. No relapse was observed among those children who returned home to parents who had learned to implement behavioural techniques.