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Stanley I. Greenspan, MD, T. Berry Brazelton, MD, José Cordero, MD, MPH, Richard Solomon, MD, MPH, FAAP, Margaret L. Bauman, MD, FAANP, Ricki Robinson, MD, MPH, FAAP, Stuart Shanker, DPhil and Cecilia Breinbauer, MD, MPH
Congratulations to the American Academy of Pediatrics (AAP). Two of their recent clinical reports published in Pediatrics, "Identification and Evaluation of Children With Autism Spectrum Disorders"1 and "Management of Children With Autism Spectrum Disorders,"2 will enable pediatricians to address parent concerns sooner, facilitating the early identification of children with autism spectrum disorders (ASDs). As physicians and developmentalists with decades of accumulated experience in working with children with developmental challenges, we applaud and welcome these publications. However, we would like to expand on these reports. In this commentary we (1) describe a broader functional/developmental framework for screening for ASDs, (2) provide a critique of the current trend toward behavioral treatments as primary intervention strategies, and (3) present research evidence for functional/developmental approaches.
To read the complete article please click here (please be aware that you must click the link titled "Full Text PDF" to the right of the page to access full article)
by Richard Solomon, Jonathan Nechels, Courtney Ferch & David Bruckman Autism © 2007 SAGE Publications and The National Autistic Society Vol 11(3) 205–224
Sixty-eight children completed the 8–12 month program. Parents were encouraged to deliver 15 hours per week of 1:1 interaction. Pre/post ratings of videotapes by blind raters using the Functional Emotional Assessment Scale (FEAS) showed significant increases (p ≤ 0.0001) in child subscale scores. Translated clinically, 45.5 percent of children made good to very good functional developmental progress. There were no significant differences between parents in the FEAS subscale scores at either preor post intervention and all parents scored at levels suggesting they would be effective in working with their children. Overall satisfaction with PPHC was 90 percent. Average cost of intervention was $2500/year. Despite important limitations, this pilot study of The PLAY Project Home Consulting model suggests that the model has potential to be a cost-effective intervention for young children with autism.
To read the complete article please click here.
Excerpts from Engaging Autism Using the Floortime Approach to Help Children Relate, Communicate, and Think by Stanley I. Greenspan, M.D., Serena Wieder, Ph.D. A Merloyd Lawrence Book Da Capo Lifelong Books A Member of the Perseus Books Group
The National Academy of Sciences (NAS), in its report“ Educating Children with Autism” (National Academy of Sciences, Committee on Educational Interventions for Children with Autism, NRC, 2001), states that there is research support for a number of approaches, including DIR/Floortime and behavioral interventions, but that there are no proven “relationships between any particular intervention and children’s progress” (page 5) and “no adequate comparisons of different comprehensive treatments” (page 8). The report concludes that effective interventions vary depending on an individual child’s and family’s needs. The NAS analysis further indicates that behavioral interventions are moving toward naturalistic, spontaneous types of learning situations that follow the child’s interests, and note that “studies have reported that naturalistic approaches are more effective than traditional discrete trial at leading to generalization of language gains to natural contexts: (Koegel, Camarata, Valdez Menchaca, and Koegel, 1998; McGee, Krantz, and McClannahan, 1985).
To read the rest complete article please click here.
By Dr. Stanley I. Greenspan & Dr. Serena Wieder
A follow-up study of 16 children diagnosed with an autistic spectrum disorder (ASD) revealed that with the DIR/Floortime approach, a subgroup of children with ASD can become empathetic, creative, and reflective, with healthy peer relationships and solid academic skills. This suggests that some children with ASD can master the core deficits and reach levels of development formerly thought unattainable with a family-oriented approach that focuses on the building blocks of relating, communicating, and thinking.
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Suggested citation: Greenspan, S.I. and Wieder, S. (2005) Can Children with Autism Master the Core Deficits and Become Empathetic, Creative and Reflective? A Ten to Fifteen Year Follow-up of a Subgroup of Children with Autism Spectrum Disorders (ASD) Who Received a Comprehensive Developmental, Individual-Difference, Relationship-Based (DIR) Approach. The Journal of Developmental and Learning Disorders 9.
By Gerald Mahoney, Ph.D & Frida Perales, M.Ed.
This study compares the effects of relationship-focused early intervention on toddlers and preschool-age children who were classified as having either pervasive developmental disorders (PDDs) (N = 20) or developmental disabilities (DDs) (N = 30). The intervention was conducted over a 1-year period through weekly individual parent-child sessions. It focused on helping parents use responsive teaching strategies to encourage their children to acquire and use pivotal developmental behaviors that addressed their individualized developmental needs. Before and after comparisons indicated significant increases in parents’ responsiveness and children’s pivotal behavior. Both groups of children made significant improvements in their cognitive, communication, and socioemotional functioning. However, children with PDDs made statistically greater improvements on the developmental measures than children with DDs. On several developmental measures, children’s improvements were related to increases in both their parents’ responsiveness and their own pivotal behavior. J Dev Behav Pediatr 26:77–85, 2005. Index terms: early intervention, pervasive developmental disorders, relationship focused intervention.
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by Stanley I. Greenspan, M.D., & Serena Wieder, Ph.D.
Charts of 200 children who were diagnosed with autistic spectrum disorder were reviewed. The goal of the review was to reveal patterns in presenting symptoms, underlying processing difficulties, early development and response to intervention in order to generate hypotheses for future studies. The chart review suggests that a number of children with autistic spectrum diagnoses are, with an appropriate intervention program, capable of empathy, affective reciprocity, creative thinking, and healthy peer relationships; that an intervention approach that focuses on individual differences, developmental level, and affective interaction may be especially promising; and that there are different underlying processing patterns with a difficulty in connecting affect and sequencing capacities as a possible common denominator. It also suggests that there is an early marker, the difficulty in engaging in complex purposeful gestural communication, and that contrary to traditional beliefs, a significant number of children may have relatively better functioning in the first year with a regression in the second and third years. This review also suggest that difficulties with relating and intimacy are often secondary to underlying processing disturbances. Many children can become quite loving and caring, thoughtful, and creative, suggesting a need to change the criteria for diagnosing these disorders.
To read the complete article please click here.
Suggested citation: Greenspan, S.I. and Wieder, S. (1997) Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders 1:87-141.
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