Beyond Diagnosis: Applied Behavior Analysis Treatment of Moderate Autism Spectrum Disorder
Sam 's case, like many cases of Autism Spectrum Disorders (ASD), can challenge the usual approach to neuropsychological assessment. It illustrates one application of Applied Behavior Analysis (ABA) treatment and the incorporation of an assessment model different from the typical rigorous use of norm-referenced instruments. The criterion-referenced measure does not produce standard scores or age equivalents but, rather, identifies more fine-tuned, skill-specific targets for treatment as well as progress toward treatment goals through regular reevaluation. Such an approach can be a highly practical resource that is directly applicable to treatment, steering intervention by providing information not available from norm-referenced measures of broader ability areas.
Sam was the first child born to a loving family, who watched him respond to noises and speech as an infant and develop cooing, babbling, and jargon prior to age 2. His language development stopped, and he became less verbal and generally appeared less happy at the age of 19 months. He no longer laughed and giggled as he had previously, and he would engage in prolonged periods of staring or rolling toy trains or cars back and forth. He did not respond when called. His parents wondered whether these changes related to the coincident birth of his sister, with whom he would not interact at the time. Speech and language evaluation at age 2 years and 3 months noted extremely limited expressive (9 – 12 month age-range) and receptive (6 – 9 month age-range) language. Screening at that time indicated normal hearing. When Sam was aged 2 years and 6 months, speech therapy observations described the following as significant progress: he would leave the couch, allow a therapist to touch him, respond to his name by turning his head when called, and use one to two words. He preferred isolation. Although these observations were intended to communicate progress, they also reflected the severity of Sam 's troubling symptoms. Although the difficulties were considered communication-related at the time, the implication that he had not been responding when called by name was a meaningful clue of his impending broader ASD diagnosis. An Early Childhood educational evaluation conducted in Sam 's home when he was aged 2 years and 10 months indicated that he seemed aware of actions around him but that he had poor eye contact and spoke mainly with jargon and screeches. Particular delay in social and emotional skills was noted. Sam 's parents, attuned to developmental concerns, attempted biological interventions often advocated for children with his profile, including a casein (gluten) free diet and vitamin supplements, without obvious benefit.
KeywordsAutism Spectrum Disorder Autism Spectrum Disorder Apply Behavior Analysis Behavior Analyst Childhood Autism Spectrum Disorder
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