Emerging Minds - The principles of our approach

The Emerging Minds model for intervention

The principles of our approach | The behavioural basis of intervention | An overiew of intervention

The principles of our approach

Our approach is formed by naturalistic behavioural, developmental, and social/relationship-based therapies. We draw from a variety of evidence-based approaches and from a range of therapy disciplines (including psychology, speech and language pathology, occupational therapy, behaviour analysis, and education). We rely on ongoing data collection and monitoring of individualized programs. The following key concepts guide our approach:

Parents, family members and others involved in a child’s care are integral to the success of any intervention program. Parent’s goals, values, and dreams for their child are important in determining the direction that therapy takes. Family members are key partners in establishing, implementing and evaluating the intervention plan for their child.

While early learners with autism benefit intensive intervention, therapy that is intensive in nature can take place in many environments and can be carried out in diverse ways.

Evaluation of the effectiveness of an intervention should be based on broad and relevant indicators of a child’s functioning in everyday life. The primary goal of intervention is to see the child interface with the world in increasingly socially rich ways.

Intervention should promote the child’s intentionality, self-direction, and choice-making. This should through play, social experiences, and positive emotional exchanges.

Learning should be enjoyable. A positive, warm relationship between therapist and child is not only inherently worthwhile, but essential to an outcome of greater social connectedness.

The behavioural basis of intervention

Many beneficial therapies for ASDs have a “behavioural” basis, where learning is understood to be a growing understanding of the relationship between cause and effect. Within the behavioural perspective, the full range of simple to complex human behaviour, from simple actions like reaching for an object, to deeper social gestures like giving a hug, is conceptualized as behaviours that are “reinforced” by their effects. So, a wide range of objectives can be taught as a series of specific, learned behaviours.

Evidence-based intervention

Since behavioural approaches are, by design, based on visible and definable actions, their degree of effectiveness is amenable to empirical measurement. And, some behavioural approaches have indeed demonstrated effectiveness in some domains of development.

Didactic approaches

Didactic therapies (didactic: directed style of instruction) such as Intensive Behavioural Intervention (IBI) are very specifically designed and directed by the instructor/therapist. Their content is often formulated by established skill progressions, with a “map” of specific, isolated skills that are necessary for the acquisition of new and more complex skill sets.

For example, a child who is learning the concepts of “big” and “small” will be prompted to choose between big and small items, and rewarded for successful attempts. These activities, called “trials”, are repeated in a systematic and intensive way, until the skill can be shown to have been mastered. Then, the goal is to “generalize” the use of these newly acquired words by systematically introducing a variety of prompts.

Naturalistic approaches

Naturalistic therapies tend to formulate strategies by drawing from the child’s individual interests, environment, and family context, with less emphasis on established and standardized sequences of skills. They can be carried out by a variety of people, including therapists, parents, grandparents, care providers, and teachers. Naturalistic approaches tend to include some of these characteristics:

Consequences are the natural outcomes of behaviour. For example, approximate vocalization of the word “ball” results in play with a ball.

Behaviour and skills goals are taught in as many contexts as possible.

Interests and motivation contribute to intervention goals.

Parents, siblings, and peers are co-contributors to therapy and learning opportunities.

From didactic to naturalistic

Contemporary therapy models have endeavored to expand the scope of both outcome goals, and therapy settings. While preserving the important characteristic of empiricism by way of a behavioural framework, these approaches are thought of as more “naturalistic” than didactic in their content, their learner-therapist relationships, and their settings.

Bringing the two methods together

For some children, and for some skills, didactic teaching can be a powerful strategy for teaching specific skills directly and intensively. At Emerging Minds, skills taught in this way are also taught in naturalistic ways, and in the child’s environments.

Ultimately, new skills are considered meaningfully “learned” when their associated behaviours occur in a variety of settings, and with multiple social partners.

An overview of intervention

Bringing the two methods together

Our interventions are designed to meet the goals of the whole child across diverse learning contexts. Supported social and learning opportunities in a full range of contexts help the child live a rich, connected life – an end in itself that all children deserve.

For instance, a child who enjoys active and boisterous play with siblings might have difficulty using meaningful, communicative language to participate fully. Relevant, functional words and phrases that give rise to, or facilitate social play (for example, “my turn!”, “your turn!”, or, “Can I have a piggyback?”) would be included in speech and language goals. Those goals would be found in other programs, such as the child’s one-to-one intensive intervention program. Subsequently, data from therapists, as well as feedback from parents and siblings, would give insight into the progress towards, and the importance of, the particular language goal.

The following is an overview of how our approach is carried out.

The interdisciplinary team

Autism is a complex neurological condition that requires the input from the range of professional domains, including psychology, speech and language pathology, occupational therapy, behaviour analysis, and early childhood education. Additional input may come from other care providers, including pediatricians, neurologists, physiotherapists, and social workers.

The team typically consists of parents and other family members, a psychologist, a speech and language pathologist, an occupational therapist, a behaviour specialist, and trained “front-line” therapists (with backgrounds in autism intervention, early childhood education, education, or psychology). As well, a team member is assigned the role of therapy coordinator, which at Emerging Minds, is a key to truly coordinated intervention.

The family

It is no less true for a child on the Autism spectrum that the family is a primary author of aspirations for present and future contexts. Close collaboration with the family then, is critical to ensure a good alignment with family goals.

It’s also important that parents and other caregivers receive meaningful, ongoing instruction on how to implement therapy strategies in the home setting.

In short, family members are integral to establishing, implementing and evaluating the intervention for their child.

Integration of strategies

The child’s individualized treatment plan (ITP) is a set of strategies and goals emerging from a broad assessment of developmental skills, functioning, and environment. The ITP is a “living document” which fulfills two functions: it’s an accessible source of current data from which to drive program goals, and it’s an information hub which facilitates collaboration and communication between all team members.

The ITP content areas

1. the diagnostic assessment

While the primary inquiry of this assessment is diagnostic, it also provides valuable information on cognitive, adaptive, and social functioning.

2. interdisciplinary assessments

The assessments of the major disciplines (Psychology, Speech and Language, Occupational Therapy, Behaviour Analysis), provide information on a broad range of developmental areas: receptive language, expressive language, joint attention, social interaction, fine motor, gross motor, imitation, cognition, play, personal independence (eating, dressing grooming, chores).

3. the family context

Through interviews, observation, and direct involvement in intervention from the outset, the concerns, challenges, and goals of the family are very much a fundamental basis for the ITP.

4. the community context

The community context includes extra-curricular activities, school, and interaction with friends in peers in community settings. These represent significant social and learning opportunities that are represented in
the ITP.

Intervention

WIth the ITP in place, intervention is carried out largely by instructor therapists. These are supported in an ongoing way by the professionals through periodic team meetings. The psychologist oversees the program and consults to the team, and speech and occupational therapists provide ongoing input into the development of specific intervention strategies. They may also provide individual one-on-one therapy.

Jacob is a five year old child with a diagnosis of autism. He has problem behaviours that have made integration into mainstream programs impossible. Along with information from parents, Jacob’s diagnostic assessment and Speech and Language assessment indicate that his receptive language is significantly delayed, and that he has virtually no expressive language. At home, he has two older brothers, seven and nine years old, who are active and engaged with Jacob, but who nonetheless have difficulty playing with him.

Goal derived from diagnostic and interdisciplinary assessments:

Initiate language and communication program

Jacob’s Speech and Language Pathologist has established daily language therapy that is incorporated into daily sessions. Also, family routines incorporate activities and structures that give rise to language opportunities throughout the day. For example, Jacob participates in a table-setting routine before supper-time that includes language and social opportunities.

Goal derived from the family context:

Increase social connectedness at home

Jacob’s therapists schedule part of their sessions to include supported play activities with siblings. Component skills required for play activities are brought to targeted, intensive therapy.

Goal derived from the community context:

Prepare Jacob for half-day daycare (supported with attending therapist)

Focus on problem behaviours. Jacob’s program includes a behaviour program, with the goal of replacing problem behaviours with functional, appropriate behaviours. Parents are taught the principles and strategies of the program, with direct support as necessary. Special attention is given to strategies that are most relevant in a daycare setting.

Jacob's comprehensive therapy

Full-day programs (25 to 35 hours per week), consist of intensive interventions and supported routines occurring throughout the child’s contexts.

Our interventions are designed to meet the goals of the whole child across diverse learning contexts. Supported social and learning opportunities in a full range of contexts help the child live a rich, connected life – an end in itself that all children deserve.

For instance, a child who enjoys active and boisterous play with siblings might have difficulty using meaningful, communicative language to participate fully. Relevant, functional words and phrases that give rise to, or facilitate social play (for example, “my turn!”, “your turn!”, or, “Can I have a piggyback?”) would be included in speech and language goals. Those goals would be found in other programs, such as the child’s one-to-one intensive intervention program. Subsequently, data from therapists, as well as feedback from parents and siblings, would give insight into the progress towards, and the importance of, the particular language goal.

The following is an overview of how our approach is carried out.

The interdisciplinary team

The team typically consists of parents and other family members, a psychologist, a speech and language pathologist, an occupational therapist, a behaviour specialist, and trained “front-line” therapists (with backgrounds in autism intervention, early childhood education, education, or psychology). As well, a team member is assigned the role of therapy coordinator, which at Emerging Minds, is a key to truly coordinated intervention.

The family

It’s also important that parents and other caregivers receive meaningful, ongoing instruction on how to implement therapy strategies in the home setting.

In short, family members are integral to establishing, implementing and evaluating the intervention for their child.