Should we change targets and methods of early intervention in autism, in favor of a strengths-based education?

Abstract

Early intensive behavioral intervention (EIBI) and its recent variant, naturalist developmental behavioral intervention (NDBI) aim to increase socialization and communication, and to decrease repetitive and challenging behaviors in preschool age autistic children. These behaviorist techniques are based on the precocity and intensity of the intervention, face-to-face interaction, errorless learning, and information fragmentation. Once considered to be “scientifically proven”, the efficacy of these approaches has been called into question in the last decade due to poor-quality data, small effects, low cost-efficiency, and the evolution of ethical and societal standards. Grounded on a reappraisal of the genetic and cognitive neuroscience of autism, we question three aspects of EIBI/NDBI: their focus on prerequisites for typical socio-communicative behaviors, their lack of consideration of autistic language development and learning modes, and their negative view of repetitive behaviors and restricted interests. We propose alternative predictions for empirical validation, based on the strengths of prototypical autistic children: (a) their non-verbal intelligence should be normally distributed and within the normal range; (b) improving access to non-communicative verbal and written auditory language material should favor their subsequent speech development and (c) decrease their problematic behavior; (d) lateral tutorship should increase the well-being of children and parents to a greater extent than personalized, face-to-face interventions by professionals; (e) admission to regular, but supervised daycare centers, combined with parental support and on-site crisis solving, represents a more cost-effective educational intervention than EIBI/NDBI.

Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects

“…Similar patterns are seen in established autism as well as in other developmental disabilities (Blacher, Baker, & Kaladjian, ; Doussard‐Roosevelt, Joe, Bazhenova, & Porges, ). We cannot of course assume that such patterns of PCI are responsible for autism outcomes; it could be in theory that these different PCI trajectories are incidental or even adaptive (Mottron, ). Nevertheless, a transactional account (Sameroff, ) of the early reciprocal interplay between intrinsic developmental atypicalities in autism and the early social environment would suggest that evoked perturbations in interaction can indeed serve to amplify social impairments and symptom impact over time; on this basis, reversing these deficits and optimising (‘normalising’) social interaction could in theory improve social functioning or reduce symptoms in autistic children.…”

Evidence-based support for autistic people across the lifespan: Maximizing potential, minimizing barriers, and optimizing the person-environment fit

“…The creation of inclusive and autism-friendly sensory, physical and social environments requires ongoing effort and collaboration across parties. Scientific inquiry into novel evidence-based support to foster autistic strengths is still needed (Mottron, 2017 2. Cover the mental health needs of autistic children, teenagers and adults, including older adults.…”

“…Clinically, if a behaviour is viewed as part of the person's make-up and difference but is not interfering with the person's functioning or life (except perhaps leading to non-conformity), this may simply be the child's way of learning and stepping stone into cognitive development (eg, RRBIs related to information processing and seeking such as intense interests or hyperlexical behaviours) (Baron-Cohen et al, 2009, Mottron, 2017. A treatment that tried to reduce this behaviour may inadvertently be depriving the child of how they learn.…”

“…It is still an open question whether eventual gains brought by EIBI/NDBI outweigh costs in the long run, especially considering wellbeing defined by autistic individuals themselves, which has not been well captured so far. Some argue that early interventions should be based on activities that build on the interests, strengths and unique developmental pathways of the autistic child (Mottron, 2017), and where the motivations are based on intrinsic rewards (eg, curiosity and pleasure at mastery, or a strong drive to systemise) but transposed into a more social and less individualistic context (Lindsay et al, 2017). On the other hand, survey data show that parents generally show positive attitudes towards autism research in early years, especially appreciating the inclusion of an 'intervention component' (Fletcher-Watson et al, 2017), reflecting high needs and expectation of early interventions.…”

“…Akin to sensory experiences, many ego-syntonic RRBI can be soothing, anxiety-relieving and self-regulating, or a reflection of the individual's learning style (eg, 'stimming', narrow interests) (Koenig and Williams, 2017), whereas others may be challenging if they contravene ordinary social-contextual expectations or interfere with the individual's ability to cope and function. Understanding the function of RRBI is the essential step to support an autistic individual, rather than treating RRBI as the sole target to be reduced (Mottron, 2017).OSF preprint first posted online July 19, 2018; https://dx.doi.org/10.31219/osf.io/8z5rvThe copyright holders for this preprint (which was not peer-reviewed) are the authors et al., 2012). For autistic adults, an optimal amount of special interests has positive impacts and is associated with higher subjective wellbeing and satisfaction across life domains including social contact and leisure (Grove et al, 2018).…”