Transactional
Developmental Approaches
Literature review
Autism is a disorder that affects
neural development. The disorder is typified by impairment of social interaction
and communication. Some other characteristics of the disorder include limited
or repetitive behavior (Dawson, Rogers, and Munson, eta al 2010). All the signs
of aurums become evident before three years of age. It affects the part of the
brain that processes information. How the alteration of the nerve cells as well
as well as how their synapses join and organize takes place has not been known
in spite of the vast research that has been carried out on the disorder (Fombonne, 2009). Researchers have identified three
disorders in what they have referred to as autism spectrum. Besides autism, the
other two are Asperger Syndrome and Pervasive Developmental Disorder-Not
Otherwise Specified. Asperger syndrome lacks delays in development of cognition
and language. Pervasive Developmental Disorder-Not Otherwise Specified,
commonly known as PDD-NOS, is identified when the criteria for the other two
cannot be met. Signs of autism are normally noticed by parents when their
children are two because this is the time they are supposed to begin to communicate.
These signs normally develop at a gradual rate, but some of the children
suffering from the disorder initially develop normally, and at some point start
to regress (Bertoglio and Hendren, 2009).
Care and intervention have been
noted to be very helpful in children with autism. As a result, various
intervention approaches that range from educational to medical to biomedical
have been developed. In the area of educational and medical interventions, efforts
in increasing socio-emotional and communication skills have been the major
focus. Early cognitive or behavioral intervention has been known to help these
children in gaining self-care, communication and social skills (Wing and Potter, 2002). Although there is no known cure
of the disorder, there have been cases of children who have recovered from it
due to early intervention and care. However, majority of the people with this
disorder are not able to live an independent life even as adults, although a
few are normally successful. The issue of intervention has been a controversial
one, with some people believing in helping children with autism, and others
arguing that children with autism should be treated differently and that the
problem should not be considered a disorder (Levy and
Hyman, 2008). Different approaches to intervention have been developed
and used in the care for these children and some have been known to be
effective. Some researchers have acknowledged applied behavioral analysis as
the most effective intervention approach for the disorder. Due to this
argument, this approach has generally been referred by its supporters as
“recovery.” The basis for this argument is a research carried out by McEachin,
Smith and Lovaas (1993). As a result, the term “recovery” has been used in
reference to the intervention approach. Most of the proponents who use the term
depend so much on the discrete trial method (Bertoglio and
Hendren, 2009).
The discrete trial method has
gained a lot of popularity as an intervention approach for children with
autism. The discrete trial method is based on applied behavior analysis. The
method is generally the one that come to mind when speaking about applied
behavior analysis intervention to autism. This intervention has been applied in
teaching children with autism (Francis, 2005). It works by breaking down subjects into lesser
and teachable parts. The method is generally based on a study by Dr. Ivar
Lovaas that began in the 1980s. In an article Using Discrete Trial Teaching within a Public Preschool Program to
Facilitate Skill Development in Students with Developmental Disabilities by
Downs, Downs, Johansen and Fossum (2007), there is a suggestion that the
utilization of discrete trial method can improve learning of communication,
cognitive, social, self-help and play skills. In another article, The "Discrete Trials" of Applied
Behavior Analysis for Children with Autism: Outcome-Related Factors in the Case
Law by Choutka, Doloughty and Zirkel (2004), there is a list of five
approaches that are utilized in discrete trial method. They are: breaking down abilities into constituent parts;
teaching of these parts until they are completely mastered; intensive teaching
sessions; and utilization of prompts as required and fading them as necessary (Schlosser and Wendt, 2008).
It is worth noting that the
supporters of the modern applied behavioral interventions that borrow from many
of the practices and principles from socio-pragmatic and developmental
approaches do not view them as superior or refer to them as “recovery.” Based
on extensive review of literature, Prizart and Wetherby (1998) claims that it
is misinformation and premature to claim that one approach is more superior to the
other. Their claim is based on various reasons. One of the reasons is that
literature has supported the helpfulness of a range of interventions in both
fundamental practice and principle. The second reason is that there is no
sufficient evidence proving that an approach is more helpful compared to
another. There is no sufficient research in comparing these approaches. The
third reason is that there is no single approach that is applicable to all
cases of autism. The fourth reason is that the prevailing research has
methodology limitations. The fifth reason is that researches have emphasized only
on child variable and outcome. The sixth is that there is no agreement on the
definition of the intensity of treatment. The seventh reason is that there is a
lot of overlapping in intervention methods that are recognized as having dissimilar
basic principles and practical use (Happé and Frith,
2006). The eighth reason is that the fidelity of treatment has not been
adequately measured. The last reason is that researches have not recorded and
accounted for variables that are outside the approach package that is the
object of the research. From this point of view, claims of an effective
intervention approach should be left alone. However, this does not mean that
there are no approaches that work in care and treatment for children with
autism. However, approaches should be customized to the needs of the client.
Interventions should be developed and applied on the basis of conventional
understanding of child development. The approaches should have a rational
consistency between the long term goals and education protocols. They should
also be gotten from different sources (Rao, Beidel and
Murray, 2008).
Developmental therapies or
socio-pragmatic interventions are aimed at promoting social interaction and
communication. This is because this is generally the part of child development
that is impaired in children with autism. These interventions generally make
highly motivating activities for the child and seek to be responsive to the
needs of the child. Interactions are made around the developed activities. Some
examples of developmental approaches are: “Denver Model; Responsive Prelinguistic Milieu
Teaching (RPMT), Social Communication, Emotional Regulation, and Transactional
Support (SCERTS)” (Miller-Kuhaneck,
2004: 56). Literature has investigated the use of developmental
interventions and realized that they work in development of social
communication and interaction. Nevertheless, not many researches have focused
on developmental interventions as on applied behavioral analysis. A transactional
developmental approach views a child development as a transactional process that
entails a developmental interaction and communication (Yoder and Stone, 2006). Developmental
results as any point are viewed as an ongoing dynamic interplay behavior of the
child, the parent’s reaction to this behavior and the environmental factors
that may have an influence on the parent and the child. As time passes, when
the interpretation or reading of the behavior of the child can be correctly
done by the parent or caregiver, and the caregiver can respond to the behavior in
a way that the needs of the child are adequately met or in a way that supports
social exchange, both of them develop a feeling of efficiency (Kasari, Freeman and Paparella, 2006). The effect of
positive dependent responsiveness is that interactions can be positively
predicted as expectations as well as contingencies increase. The transactional
developmental perspective focuses on the reciprocal, bidirectional impact of
the social environment of the child, the reaction of responsive caregivers and
the development of interaction and communication skills of the child (Zafeiriou,
Ververi and Vargiami, 2007).
The emotional and mental regulation
of the child that is fundamental to the ability to be able to learn and
particulate actively in social activities is viewed as a basic foundation in
the transactional developmental interventions to children with autism (Fitzpatrick, 2008). The influence to development is the
ability of the child to uphold some level of emotional and mental regulation
and to generate more decipherable and predictable signs, and the ability of the
caregiver to react effectively to the signals generated by the child and to
incorporate reciprocal and equally satisfying transactions in daily activities
and schedules. It is argued that the nature of the impairment in social, interaction,
communication and language in autistic children can be well understood through
reflection on the process of acquisition from a transactional developmental
point of view (Dawson, Mottron and Gernsbacher, 2008).
Social Communication, Emotional
Regulation, and Transactional Support, commonly known as the SCERTS model, is a
common example of transactional developmental perspective in autism
intervention. This model was developed as an answer to the intervention
approaches that focus on a single impairment. The brains behind the development
of this model are Barry Prizant, Amy Wetherby, Emily Rubin and Amy Laurant (Prizant, Wetherby, Rubin and Laurent, 2003). This model
is highly effective for it borrows from most of the other intervention
approaches such as applied behavioral analysis in the form of PRT, Floortime,
TEACCH and RDI. Howver, it differs from these other intervention approaches due
to its emphasis on promotion of child-initiated communication in daily
activities and routines. The acronym, SCERTS, generally refer to its emphasis
on Social Communication (SC): this is the development of unprompted, practical
interaction, emotional expression and trusting relations with other people. Emotional
Regulation (ER): this is the development of the capacity to uphold a
well-regulated emotional state so as to cope with daily stress and to be ready
to learn and interact with other people. Transactional Support (TS): this is the development and implementation of
support to assist partners in responding to the needs and interests of the
child, as well as to adjust and adapt the settings and avail tools and
equipments for enhancing the learning process. Some of the tools in question
include: picture communication charts, schedules and sensory support tools
(National Research Council, 2001). Implantation and use of the model also means
development of particular plans in providing emotional and educational support
to families. Within each of the development areas, goals, objectives and
activities are developed in accordance to the needs of the child. Learning
activities are tailor-made to the experiences of the child as well as the
expectations of the patents or caregivers (Prizant,
Wetherby, Rubin and Laurent, 2003).
SCERTS is a multidimensional model
for enhancing communication and socio-emotional skills of children with autism.
This model emphasizes on social interaction, emotional regulation, as well as
transactional support. This is a comprehensive support program developed for
support and care of children with this disorder (Bryson,
Rogers and Fombonne, 2003). This model takes care of the fundamental
impairments and challenges that characterize autism. This means that the model
can be used in a wide range of children with ASD (Rogers
and Vismara, 2008). The model emanates from over two decades of research
and is in line with suggested doctrines of evidence-based practice advocated by
researchers as well as medical scholars in autism and other related disorders. This
model is also influenced by other developmental works in psychology and out of
ASD. A relationship is noted from research between communication, socio-emotional
development and psychological regulation. The model also offers a basis for
other intervention models focusing on developmental relational point of view (Prizant, Wetherby, Rubin and Laurent, 2003).
Researchers have identified three
major characteristics in the model. The first characteristic is that the model
is systematic, semi-structured and flexible to suit the individual needs of the
user. The second one is that it deals with the fundamental abilities in the
development of functional abilities. The last characteristic is that it
incorporates practices from different intervention approaches and learning
methods (Miller-Kuhaneck, 2004).
The development of unprompted, functional communication skills and emotional
regulation are the main priorities in treatment and educational efforts. As
already noted, the model is not exclusive to other intervention methods, but
instead offers an effective framework for those seeking to implement treatment
or educational plan that is founded on the knowledge of the basic developmental
difficulties that children with autism face. Family-centered care is an
effective way of developing and implementing such a plan (Ospina,
Krebs Seida & Clark, et al. 2008).
The idea behind the use of developmental
transactional intervention approaches for children with autism is help in
development through the stages of achieving effective communication skills. This
is by targeting the very area that is affected by the disorder, which is
communication and social interaction. It is also aimed at helping parents and
caregivers in the understanding of the most effective way of supporting
children with autism (Kidd, 2002). Through
the use of the model, it is possible to develop the goals, objectives and
activities that are focused on supporting the child develop social and communication
skills. They are also able to identify basic interpersonal modification,
environmental settings, and visual supports and the way these can be included
in natural, practical and significant contexts (Dawson, Mottron and Gernsbacher, 2008).
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