Tuesday, February 5, 2013

Transactional Developmental Approaches



 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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