決定治療		行為治療		綜合治療

家長小心地選擇有效的治療方法十分關鍵,因為這不會浪費金錢和孩子寶貴的學習時間;更重要的是,適當的治療方案會來成果和進步的。在這過程中,第一步是要看一看什麼治療方法才是真正發生作用的。為你的孩子選擇一種奏效的治療方案正如醫生開處方藥物一樣,都需要仔細的判斷。所有合法的家庭醫生只會處方由FDA和經科學驗證可以改善你的身體狀態的藥物。身為家長,有責任選擇最科學可靠的和奏效的治療方法來改善你的孩子的狀況。

可惜,很多自稱有效的治療方法缺乏科學證據以支持其說。有些治療聲稱非常有效,但其後顯示對治療自閉症完全無效,例如,分泌激素(secretin)。有些治療進行一段時間後顯示對人體有害,例如: 氟苯丙胺(fenfloramine)。因此,當為孩子選擇治療時,任何時候家長都應獲得充分地資訊以及保持客觀,這十分重要。家長應該完全地獲知所有可供他們孩子用的現行的治療選擇。多一點了解治療如何幫助孩子固然重要,家長也應該評估那些自稱科學化的療效並且尋求其歷史。任何一種治療,無論得到如何廣泛地測試、採用甚至獲得科學研究驗證,它的歷史在確定治療成果上還是極為重要的,請預備一份問題清單來幫助你建立對治療提供方的評估。然後,你應該探訪所有治療的提供方,察看每一種治療提供方的服務的全貌。

現時,應用行為分析法顯示是最具研究和獲科學驗證的治療方法。沒有其他治療顯示比它更有效、或者獲相同的科學證據來支持。因此,建基於ABA原理上密集式早期培療課程成為美國的金牌治療。

「三十年的研究證實了應用行為分析法的療效:減少不恰當的行為,提高溝通、學習能力以及正確的社交行為。」

心理健康: 一般外科報告1999 (A Report of the Surgeon General)

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Applied Behavior Analysis

Applied Behavior Analysis is based on Learning Theory, which was formulated almost 100 years ago by the founding fathers of Behaviorism: John B. Watson and Ivan Pavlov. The foundations of ABA are: socially and emotionally inappropriate behavior Therefore, behaviors can be unlearned. Skills are taught through systematic and positive teaching methods. Reliance on scientific methodology. ABA is a methodology used to decrease problematic behaviors and to teach skills to children, adolescents and adults of ALL functioning levels. It is a very individualized approach. ABA is sometimes only recognized as an approach to get autistic children to behave or sit in a chair. This is simply not the case.

ABA is used to assist companies and organizations to evaluate their performance and efficiency. It is also used to look at a myriad of problems faced by adults e.g. Dr Phil. It can help with fears and phobias and couples facing problems in their relationships. It is a very wide-ranging approach!

When treating a child with ASD, we would assess all their strengths and weaknesses in all areas. We then come up with a treatment plan to address their needs. Often this focuses on behavioral skills, communication and language, play and social skills. The programs are highly individualized in terms of the teaching method, curriculum and settings.

The priority or the targets for individuals is different for different age groups and also for different level of functioning. While the focus of programming for a 5-year-old with adequate verbal and intellectual abilities might be adapting and adjusting to a mainstream school placement, the focus of programming for another 5-year-old who has no language skills or play skills might be to develop more means to communicate functionally with people around him and to develop play skills appropriate to his age. On the other hand, the focus of a 15-year-old teenager in a mainstream school setting might be more relating to social-emotional and introspective skills while another 15-year-old teenager in a special school setting might have programs focusing more on community living skills and functional life skills.

ABA is a scientific approach to learning. We take lots of data to show that what we are doing is working or not working. If the teaching is not helping the student to learn skills then we modify our teaching program. By constantly reviewing and adjusting our treatment programs the program will always be working at the most optimal level for the child.

Contemporary Behavioral Therapy
One would think that all applications of ABA would be quite similar.  However, there is tremendous diversity!  Although our foundations are the same, there are extraordinary differences in how ABA is applied.  There is a broad continuum of applied styles and approaches. In the extremes, approaches range from those that are dogmatic and rigid to those that are loosely, inexactly and unsystematically applied.  Additionally, many claim to provide ABA, when in fact they only implement a single procedure of the field (e.g. Discrete Trial Teaching). 

Behaviorists are often pigeonholed as rigid, narrow, and punitive.  The fact is that many behaviorists employ methodology of ABA (including DTT) with much flexibility and are quite natural in its application.  Perhaps because of the stereotype of ABA, many professionals seem to have distanced themselves from ABA and have come up with other names and variations of teaching strategies that would aptly be conceptualized as ABA!

Prizant and Wetherby (1998) suggested that more “contemporary” behavioral treatment differed from “traditional” approaches in that teaching occurs in more natural learning environments, that there is more emphasis on individualization of curriculum and “the use of more natural and balanced social transactions in which learning opportunities are initiated by the child”.  They specifically, identified the methodology and strategies utilized by Autism Partnership as an example of a contemporary approach.

We concur that Autism Partnership’s approach to ABA treatment of autism greatly differs in many fundamental ways from those who have a more rigid application of ABA. Further, our model incorporates a variety of ABA methodologies (e.g. DTT, Token Economies, Systematic Desensitization, Teaching Interactions) appropriate for the treatment of persons with autism. Therefore, to distinguish our approach we identify ours it as “Contemporary Behavior Therapy”.

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綜合治療

One of the most common treatment approaches is to adopt an eclectic approach. This approach involves running around all over town to see a multitude of different professionals, usually for one-hour sessions, to try to do all the different kinds of treatments. The hope is that by doing everything that something will stick. By doing this kind of approach, it also alleviates feelings of guilt that you are not doing a particular kind of treatment that might be the “magic bullet”.

However, there are many problems with this kind of approach.

• By seeing so many different people, it is unlikely that the intervention will be very consistent. Everyone will be doing different things, which may result in confusion on the part of the parent and the child. With no team meetings and little communication, it is nearly impossible to formulate a comprehensive plan that everyone is following.
  
• It is also impossible to evaluate which of the treatments is really helping your child. Many treatments that are ineffective may be continued because progress has been made that might have been wrongly attributed. This does not only waste the child’s learning time but also the parent’s money. In addition, the ineffective treatments also take time away from the interventions that are helping your child. In other words, you may be giving less time to the treatment that helps your child progress.
  
• Different approaches have very different underlying philosophies about autism and its treatment. Some of these approaches are in direct contradiction of each other. One approach may see the intervention as harmful and the other may see it as necessary and beneficial. Often parents may be told that the different approaches are used to individualize to the needs of different children, without understanding that some underlying philosophies are quite different. Just like going on a diet, you could try an eclectic approach too with a diet. Having heard that good results can be gained from a low fat diet and the Atkins diet, you decide to do both to cover all your basics. Clearly, this would not work as they are in direct contradiction of each other.
  
• The research shows clearly that adopting an eclectic approach does not result in the best outcome. Three recent comparative studies in California showed that doing ABA on its own was far superior in treatment gains than children doing the same number of hours of a mixture of approaches.
  
•  It is unlikely that practitioners who adopt a whole host of different approaches are masters of all interventions just as the old saying goes, “Jack of all trades, master of none”. It often rings true in this regard. To be able to design a curriculum and implement effective ABA programming often takes more than 5 years of ongoing training and hard work in just this area. If it is also necessary to be trained in the use of TEEACH, Floortime and other approaches, it is unlikely that staff will be able to receive the necessary focus and training necessary to implement all programs with the right level of treatment integrity. This often leads to a hodge podge of different ideas and interventions without a true depth of understanding of any of them. It is often not uncommon for people to attend 2-day workshops on different interventions and then proclaim that they are now adopting that approach without any real training in that area.