Therapeutic Interventions
 
Several different types of interventions are available that are specific to your child's needs.   Therapies prescribed for single domain vulnerabilities are generally straightforward in nature. For example, if your child is delayed in his or her language development, Speech and Language Therapy will likely be prescribed; for motor delays, Physical Therapy or Occupational Therapy may be prescribed. In children who show complex, multi-system vulnerabilities such as those in Autism Spectrum Disorder, therapeutic options are more diverse, and include therapies with acronyms such as OT/SI, ABA, DTT, RDI, and PVT.  Each will be described briefly below.  Dr. Benveniste helps each family to understand and choose the specific type of intervention that will be most beneficial for special needs children and their families specific to each child's development over time.  Dr. Benveniste's emphasizes including parents and siblings in therapy sessions so that "therapeutic interventions" become an integral part of daily family life.
 
What is Occupational Therapy/Sensory Integration Therapy (OT/SI)?
The central nervous system (brain) processes all the sensory information sent from various sensory systems in the body and helps to organize, prioritize and understand the information.  Ayres (1979, in Smith Myles et al, 2000) defined sensory integration as 'the organization of sensation for use.  It involves turning sensation into perception.”  Organization of sensory information allows an individual to formulate responses:  these may be thoughts, feelings, motor responses (behavior) or a combination.  Throughout our bodies sensory receptors pick up sensory stimuli, and most of the time the processing of sensory information is automatic.  Seven sensory systems are commonly recognized:  1) vestibular (balance); 2) proprioceptive (awareness of body in space); 3) olifactory (scent; 4) visual (sight); 5) gustatory (taste ); 6) auditory (hearing); 7) tactile (touch).  Dysfunction in these systems can manifest as hyper- (high) sensitivity, hypo- (low) sensitivity, and / or difficulties with integrating multiple simultaneous stimuli. Delacato first described  Sensory Integration Therapy in 1974 as involving titrated (gentle and progressive) exposure to various sensory stimuli. The purpose of sensory integration therapy is to strengthen, balance and develop the central nervous systems processing of sensory stimuli, and thereby facilitate the attainment of an optimal state of arousal (the “quiet alert state”) to allow for bodily comfort and efficient learning.
 
What is Applied Behavior Analysis (ABA)?
Applied Behavior Analysis is described as applying, for therapeutic purposes, information gained from the careful examination (analysis) of what a person says or does (behavior) in a given situation or set of circumstances. Learning Theory has demonstrated that how a person behaves is largely determined by various factors (called antecedents) involved in the situation in which he or she is, and the results (called "consequences") of his or her behavior on previous occasions. By knowing and understanding what these antecedents and consequences are, strategies can be put in place to change them, and thus change the person's behavior.  Applied Behavior Analysis involves a systematic process of studying and modifying observable behavior through a manipulation of the environment. Its principles can be applied to virtually anything capable of learning, but generally is applied in humans to individuals with autism and other developmental disorders.  The components of any behavior are often given the acronym “ABC’s” as follows:
1.    Antecedent: a verbal or physical stimulus such as a command or request. This may come from the environment or from another person, or even internal to the subject.
2.    Behavior: the student's response
3.   Consequence: What happens conditional to the behavior. In controlled situations the consequence is that the student receives something motivational to him/her: commonly food, rewards, praise, a toy, etc. Consequence could also include correction (or punishment, but this is rarely used).
    
What is Discrete Trail Training (DTT) or the Lovaas Method?
Discrete trial training (DTT) as having four components: (1) the presentation of a stimulus, (2) the child's response, (3) the consequence, and (4) a short pause between the consequence and the next instruction (between interval trials). The primary difference among discrete trial training programs is found in what they teach, rather than how they teach. For example, the UCLA Young Autism Project (aka Lovaas Method) is one treatment program directed mainly at pre-school aged children with autism. It uses discrete trials as its main instructional method and follows a fairly set progression of instructional programs beginning with early receptive language and ‘terminating’ with programs focused on achieving skills in self help, community and school situations. Not all programs using DTT follow the same program sequences or curriculum as the UCLA project… There is often confusion between an informal or periodic use of this teaching model and "doing discrete trial training." What distinguishes DTT programs is the intensity and duration of the training and the primary role of the discrete trial method for instruction. DTT programs generally involve several hours of direct 1:1 instruction per day (including high rates of discrete trials) over many months or years. Though the basic model for DTT appears relatively straightforward, applying the model effectively requires training and skill.
 
What is Pivotal Response Training (PRT)?
Pivotal response training (PRT) is a behavioral treatment intervention based on the principles of applied behavior analysis (ABA) and derived from the work of Koegel, Schreibman, Dunlap, Horner, and other researchers based at the University of California in Santa Barbara.  It is a composite of the research on task interspersal, direct reinforcement, and role of choice. Key pivotal behaviors have been identified for children with autism: motivation and responsivity to multiple cues (Koegel & Koegel). PRT has demonstrated positive changes in these "pivotal behaviors" exhibiting widespread effects on many other behaviors associated with language and social interaction. Pivotal Response Training (PRT) provides a guideline for teaching skills and has been most successful for language, play and social interaction skills in children with autism.
The main components of PRT include:
1.    Choice (shared control to increase motivation)
2.    Clear and uninterrupted instructions or opportunities (make sure child is attending)
3.    Reinforcement of approximations/attempts
4. Reinforcement has a specific relationship to the desired behavior natural reinforcement ("ball" gets ball, not praise. Child chooses object for instruction and that object is used. This is done to increase motivation)
5.   Multiple examples or multiple components presented (e.g., use two different objects but same verb such as "roll car" and then "roll ball" then "throw ball." Multiple components also means using "new pants" or "red suite" versus just "pants" or "suit." This is done to increase responsiveness to multiple cues
 
What is Relationship Development Intervention (RDI)?
Relationship Development Intervention (RDI) is a trademarked treatment program for autism spectrum disorders (ASD). The program's philosophy is that individuals with autism can participate in social relationships if they are exposed to them in a gradual, systematic way, and thereby engage in authentic emotional and social reciprocity. The goal of treatment is to systematically build up the motivation and tools for successfully interacting in social relationships, and ameliorate deficits in this area that are characteristic of children, adolescents, and adults with Autism Spectrum Disorder.  RDI focuses on helping children develop the building blocks of social connection -- such as visual referencing, experience sharing, and emotional sharing -- that, in typical children, develop naturally in infancy and early childhood. RDI begins by assessing a child's level of social skill, and designing and implementing an individualized program for each child.
 
If you have questions contact Dr. Val at 310-597-9322 or BabyAnswers@gmail.com