The Secrets of Multi-Treatment Intervention

Current research supports the idea that the factors contributing to the behaviour, communication and learning challenges of people on the autism spectrum are multifaceted; Therefore, I believe, treatment should be multi-faceted as well. Treatments such as Applied Behavioural Analysis and special diets are important and can contribute to positive development but they are simply not comprehensive enough to address all of the needs of all children with autism. How can any one single approach take into account the entire spectrum? They can’t.

Even though most parents figure this out pretty quickly, unfortunately, most current treatment models which they have to choose from are exclusive of other ideas and are uni-focused. In other words, parents figure out they need to draw from various different ideas but, unfortunately, most professionals don’t exactly show parents ways to fit their unique program strategies with other, sometimes opposite-style, programs.

Inevitably, I see parents trying to patch and cobble together as many different parts of the treatment puzzle as they can on their own without much direction on how to do so effectively, and end up having to play program coordinator juggling the different objectives, expectations, schedules, and regimes that each individual program recommends.

Over 20 years of working with families trying different models of treatment, I’ve discovered that without question the most effective programs combine a range of different strategies i.e., they aren’t limited by any one program model or theory. For example, in my own practice with the Intensive Multi-Treatment Intervention program (IMTI), I begin with a focus on 3 broad domains and then select the right-fit strategies for each individual child:

 

1) Biological Treatment

2) Behavioral training and cognitive education

3) Family and therapist “Attitudinal Fitness” training and support

The strength of what I call the “multi-treatment effect” comes from the interaction between the often diverse variety of strategies. “One plus one equals more than two” when one strategy acts as a catalyst to speed up or enhance another one, for example.

But there’s a very powerful and not ye twell understood consideration: order and timing.

You may know for example that you want to use some play-therapy and some peer-group experiences for socialization, and some behavioural training for life-skills but what order should you do them in? Which one is first and which is second or can they be done at the same time? If not at the same time, when (i.e., timing) should you end one and start the next? These are the secretes of order and timing that I’ve been studying to unlock for years.

 

Order and Timing of Treatment are Critical:

Last week, I sat on the edge of a fenced-in kindergarten playground area observing four-year old Curtis. He had responded extremely well to the home-based IMTI Program and was beginning an advanced phase in which we introduce peer play-dates, social groups, and generalization to public environments. I watched with delight as Curtis ran toward a small group of kids playing with a basketball. He stopped a foot away, watched them for a few seconds, smiled, and then ran away from them to a different part of the playground. For this young little bundle of energy, approaching and observing a group of kids without being prompted was a major milestone. Of course our next step was to teach him to actually introduce himself and ask to join the play. But for now, we were cheering him on.

Just two years earlier, Curtis had been diagnosed with PDD. He had a very limited vocabulary of just a few words and was ‘disconnected’ from his peers and family alike. He was unsettled, restless, and resisted interaction and learning. Since he didn’t display the more acute stereotypical behaviours of classic autism, the local autism services recommended he be placed into peer groups like school so he could socialize. His mother followed their advice but was disappointed after several months that he hadn’t improved a bit – it was wasting his precious early learning time. When Curtis’ parents discussed the situation with me, I explained that school and peer groups were definitely an important piece in his “treatment map” but that it was too early – it was in the wrong order and not the right timing.  Thinking about what the first steps to help him would be (i.e. what order do we present new challenges to him) it was clear that he was not ready for structured learning yet. He was simply too defensive and reactive. We would otherwise have to really force and control him to get him to ‘comply’ with table work and with sitting in circle time at school. This didn’t seem like the best choice. For some children the first step is ABA-style adult-directed structured learning, but for Curtis’s development needs a more playful and less stressful relationship-based approach made sense. He thrived with our facilitated fun and play as a first step. More structured learning followed as a second step and peer-groups and school were steps three and four.

Once we had mapped out step one and steps two and three, the next most important  decision was to determine the timing of each strategy or step. In other words, we knew step two would come after step one but when should we start two and end one? Too often, parents, even guided by professionals, try to get as many services and programs combined all at once, thinking “the more the better.”  It’s critical to consider that some programs and approaches are counter-productive to each other; They cancel each other out. They may place opposing and confusing demands on the child (and sometimes on the parents too.)

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Before starting a new program, approach, strategy, or approach stop and ask two key questions:

1) Order: Where does this strategy fit in order with all of the others we are currently challenging our child with and that we plan to introduce in the near future? Are there any contra-indications for us to not begin it now?

2) Timing: When should we start a new strategy? You may have determined that it is the next best strategy to introduce to your child, but are you introducing it now simply because you just learned about it this month or more strategically because it is the right time in their development?

Multi-treatment programs designed with order and timing in mind can provide the most highly customized and comprehensive support for children with autism. If you have your own examples to share or advice on order and timing, please be in touch.