A Critical Review of ASD Interventions Used With Primary School Children In The New Zealand Setting

Retrieved from http://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtml

The graph above, produced by American Interagency Autism Coordinating Committee (IACC) (2012) represents the exponential growth in research publications based on seven sub-categories of ASD interventions and treatments. This rapid increase mirrors the improved accuracy in the recognition and diagnosis of Autism following the identification of the ASD Triad of Impairments by Lorna Wing in 1979. This explosion is represented on The Research Autism website which lists 1081 ASD interventions. These interventions range from the now discredited psychoanalytical theories of Bettelheim, through a continuum of behavioural and developmental interventions supported by various level of evidence based research, to interventions with only anecdotal evidence to support them such as the increasingly popular dietary interventions. This paper discusses 7 ASD interventions chosen to represent the current New Zealand setting as reflected by the NZ ASD Guidelines (Ministry of Health, 2008, p. 298-300) interventions used in the authors current school and local special school, and interventions used by ASD professionals interviewed for the Specialist Teaching PGDip Core Assignment 2. These interventions cover all the categories identified by the IACC graph above with the exception of medical/pharmacological interventions which will be looked at in Domain 5. The interventions examined are: SCERTS: Social Communication, Emotional Regulation, Transactional Support Framework ABA: Applied Behaviour Analysis Video Modelling

Social Stories PECS: Picture Exchange Communication System Weighted blankets/vests/collars Gluten Free and Casein Free diet

The following categories were looked at for each intervention: Theoretical Perspective Purpose Practice Evaluation Research Evaluation Individual with ASD Culture Ethics

SCERTS: Social Communication, Emotional Regulation, Transactional Support Framework

Theoretical Perspective: SCERTS is based on behavioural and developmental social-pragmatic theory and allows for interventions to be drawn from a wide range of theoretical backgrounds. Purpose: SCERTS is a framework addressing the core deficits of ASD. It allows for a comprehensive, multidisciplinary approach, combining techniques and strategies from different perspectives to be used to meet the specific needs of the individual child, their family, and the professionals working with the child. The acronym stands for: SC - social communication - development of functional communication and emotional expression. ER - emotional regulation - development of regulated emotions and ability to cope with stress. TS - transactional support - implementation of supports to help families, educators and therapists respond to children's needs, adapt the environment and provide resources for learning.

Practice: 1. A SCERTS Worksheet for determining Communication Stage is completed by the parents and after discussion with the professional a communication stage is established for the child. 2. A SCERTS Assessment Process (SAP) is made, involving observations at home and school, using video and reports from parents and teachers. A variety of observations are made including; structured/unstructured, adult directed/child directed, must do/free choice and busy/calm. 3. The Information collected is scored on the SAP-Observation Forms at the relevant communication stage using the following categories: Social Communication Joint Attention Symbol Use Emotional Regulation Mutual Regulation Self-Regulation Transactional Support Interpersonal Support Learning Support The childs strengths are identified and goals set to build on these. The whole team is involved in the choice of interventions to achieve these goals. Evaluation: SCERTS has a structured assessment procedure that allows for regular, 3 monthly, evaluation of the interventions used. Information is collected through observations and scored on the SAP-Observation Forms at the relevant communication stage using each of the six categories. Progress, appropriateness of the intervention and next steps can then be identified. This data is collected by at least 2 members of the childs team. Research: SCERTS is unrated by the Australian Raising Children Network and Research Autism website who have not identified any peer-reviewed research on its effectiveness. However, peer reviewed, longitudinal studies of large group and single case design from a variety of perspectives support the specific interventions applied using SCERTS (Ministry of Education, Hand-out 1.7). ONeill (2010) positively evaluates the implementation of SCERTs in a primary, special needs, school. NZ Setting: SCERTS fulfils the Ministry of Education Specialist Service requirements for assessment and intervention within natural settings and routines using measurable, outcomes based success

criteria. An adapted model of SCERTS has been successfully trialled in New Zealand Early Childhood (Ministry of Education, The Early Intervention Autism Project in Action 2006-2010). The following table shows how SCERTS aligns with Te Whariki and the NZ Curriculum: Te Whariki Strands Exploration Mana aotroa Communication Mama reo Well-being Mana atua Contribution Mana tangata Belonging Mana whenua Relating to Others Participating & Contributing Use of symbols and Texts Managing Self NZC key Competencies Thinking SCERTS framework SC: Understanding intentions; expressing preferences, needs & emotions ER: Attend to the most relevant information in an activity or setting SC: Sharing ideas and playing with others ER: Process verbal and non-verbal information SC: Communicating for a variety of purposes ER: Initiate interactions using appropriate communication strategies SC: Initiating interactions, pretend play ER: Remain socially engaged with others. Respond in reciprocal interaction SC: Relating to peers, understanding routines and expectations ER: Actively participate in everyday activities

(Ministry of Education, Hand-out 1.4) Individual with ASD: The SCERTS Assessment Process looks at what the child can already do and what the next logical goal would be. On the SAP-Report form parents are asked to list strengths they see in their child. The interventions selected are specific to the needs of the individual child and address a range of skills that can be generalised to multiple settings. This intervention allows for a combination of child and adult initiation and the inclusion of peers and siblings. Culture: SCERTS provides a person-centred planning approach where the needs and goals of the family are given high priority. The family has the opportunity to be involved in every stage of the process including assessment, identification, implementation, evaluation and review of the interventions used. The complexity of the SCERTS framework needs to be clearly explained to the parents to allow them to fully participate in the childs team.

Ethics The integrated nature of SCERTS makes it flexible to the needs of the individual whilst empowering the parents. The SCERTS assessment looks at what the child can do and builds on these strengths. When assessing the child with ASD a number of team members are involved in observation and data collection ensuring an accurate picture of the childs strengt hs and needs. The multi-intervention nature of SCERTS allows professionals to draw on interventions from a range of perspectives relevant to the childs core ASD needs.

ABA: Applied Behaviour Analysis

Theoretical Perspective: Early forms of ABA interventions were firmly grounded in traditional behaviour and learning theories that separated behaviours into discrete components. These theories proposed that undesirable behaviours were learnt and could therefore be unlearnt. Over time contemporary ABA approaches have included a developmental component as well as taking a more naturalistic approach. Purpose: ABA aims to identify and eliminate, or reduce, individual components of the childs behaviour that are considered to be undesirable whilst simultaneously strengthening or maintaining desirable behaviours. Behaviours targeted by ABA include: following commands, use of expressive language, responding to requests or questions, and participating in conversation. Practice: Appropriate behaviour is reinforced and non-desirable behaviour is ignored. Parents are trained by a therapist to deliver the intervention in a home setting. The 3 phases of ABA are: 1. Systematic analysis of the childs behaviours 2. Selecting a technique to change frequency or intensity of target behaviours 3. Assessment of the intervention effectiveness and modification required More contemporary forms of ABA include Incidental Teaching and Pivotal Response Training. Evaluation: ABA success is measured precisely using the following dimensions: Repeatability: how many times the behaviour occurs Temporal extent: how long the behaviour lasts for on each occasion Temporal locus: when the behaviour occurred

Response latency: time elapsed between the stimulus and the response Inter-response time: time between two consecutive occurrences of a response Derivative measures: measures unrelated to specific dimensions Trials-to-criterion: the number of response opportunities needed to achieve the targeted level of change in behaviour Research: Since 1980 ABA based research has provided much evidence to support the success of this intervention. However, there is also contradictory evidence suggesting that outcomes of ABA produce no more change than standard child care and that some children may show little change over many years of work or even regress (Research Autism, n.d.). NZ Setting: Appendix 8 of the NZASD Guidelines lists Incidental Teaching and Pivotal Response Training as interventions that are currently being used in the New Zealand Setting (Ministry of Health, 2008, p.298). The following table shows how ABA aligns with Te Whariki and the NZ Curriculum: Te Whariki Strands Well-being /Mana atua Contribution/Mana tangata Belonging/Mana whenua Individual with Autism: ABA can be delivered across a home/school setting providing consistency and a natural environment for the individual. ABA provides many opportunities for the child to demonstrate a target behaviour and receive positive reinforcement. There is concern that ABA can make the child reliant on a particular learned behaviour in a particular environment making it difficult for them to generalise their learning. Culture: Parents are trained to deliver the intervention in their home so allowing a natural setting for this work and a high level of parent involvement. Interventions can be targeted towards culturally acceptable behaviour but is must be considered if these are also the high priority behaviours for the childs to overcome problems and reach their full potential. NZ Curriculum Key Competencies Managing Self Relating to Others Participating and Contributing

Ethics: A number of ethical questions are raised by the ABA approach: This approach addresses the symptoms shown by the child rather than the underlying cause of the behaviours. Are the behaviours targeted by the therapist or parents fundamentally wrong, or based on what the adults see as socially acceptable? Are the behaviours that are damaging to the child or others being targeted? If these assumptions are true how is the modification of these behaviours affecting the childs emotional and social regulation and their overall well-being? In ABA behaviour is modified by external prompts, does this allow for internalisation of these behaviours by the child? In addition, a theory founded on the belief that behaviours are a result of faulty learning, that needs to be un-done, does not take into account the growing body of compelling research supporting the genetic and organic aetiology of ASD Finally ABA involves a big time commitment, up to 40 hours week and strong emotional resilience is required by already stressed parents.

Video Modelling
Theoretical Perspective: Video modelling comes from a combined behavioural/developmental approach focusing on social learning. Purpose: Video modelling is designed to teach a range of new social and functional skills, how to adapt current behaviours and how to apply behaviours to new situations. Video modelling can be used to target a range off behaviours:

social interaction behaviours academic and functional skills communication skills daily living skills play skills social initiations perception of emotion spontaneous requesting perspective taking

Practice: The video features someone else, or the child themselves, modelling appropriate behaviour in a target situation and the child learns this behaviour by watching the video. The video clip should be between 30-40 seconds with the numbers of behaviours included adjusted to the childs needs. The setting should initially be the same setting in which the child will be demonstrating

the behaviour. The video clip must be watched at least once before attempting the behaviour and up to 3 times if needed. The video can be revisited after the childs attempts to refine the skill. Video modelling can take the form of: Imitation language skills Role playing - social skills e.g. alternative responses to a situation rather than a tantrum Let the camera roll to capture rare behaviours - typically used when individuals cannot imitate or follow directions. A child can be filmed during several lunch periods and good examples of them eating appropriately are combined into a video.

Evaluation: Real time observations made initially in the target setting and later in other settings to check for generalisation. Research: Much evidence supports the effectiveness of video modelling for teaching new skills to adults and children with ASD. Research Autism reported positive results from 50 studies. However, much of this research lacks efficacy underlining the need for high-quality research around this intervention. NZ Setting: The use and interest in video modelling in New Zealand has generated research in this field, including this study by A.M.Dekker (2008) from Waikato University: Comparing Wrong/Right with Right/Right Exemplars in Video Modelling to Teach Social Skills to Children with Autism . The following table shows how Video Modelling aligns with Te Whariki and the NZ Curriculum: Te Whariki Strands Exploration/Mana aotroa Communication/Mama reo Well-being/Mana atua Contribution/Mana tangata Belonging/Mana whenua NZC key Competencies Thinking Use of symbols and Texts Managing Self Relating to Others Participating & Contributing

Individual with ASD: Corbet et. al. (2005) suggest the following contributing factors to the high levels of motivation shown by some children with ASD when using video-modelling:

over-selective attention and easily distracted in a real life situation

restricted field of focus preference for visual stimuli and instructions e.g. TV/video avoidance of face-to-face interactions the ability to process visual information more easily than verbal information The predictability of the video when it is played over and over Learning without having to go into a crowded, noisy environment initially Videos can be personalised by using self-modelling allowing the child to see themselves succeeding and in turn increasing their self-efficacy Videos can be made more relevant to the child by using peers, parents or siblings.

Other factors may include:

However, this intervention does require the child to be able to watch TV for at least 1 or 2 minutes. Culture: The use of videos/DVDs is extremely common in todays culture but it is still important not to assume the family have the resources of knowledge to use this intervention method at home. The use of video is beneficial in training and educating parents without the added pressures of literacy demands. Videos can be made in the home as well as school providing the opportunity to model the cultural values and practices of the family. Ethics: Care must be taken not to use behaviour on the video that is currently beyond the childs skill level as this can cause frustration and anxiety. Professionals need to be consulted when skills within their specialist areas are being targeted by video modelling.

Social Stories
Theoretical Perspective: Social Stories have a multiple theoretical background developing from behavioural-developmental and cognitive social theory including lack of Theory of Mind and Weak Central Coherence. Purpose: Social Stories are individualized stories written to describe social situations in terms of relevant cues in order to explain appropriate responses or behaviours. They aim to describe what people do, why they do something and how they might react. Social stories help children with ASD to develop an awareness and understanding of the others in a social situations.

Practice: Share the social story with the child when everyone is calm and relaxed. Use a straightforward approach when introducing the story. Stay positive, reassuring and patient sharing the story. Use a calm and friendly tone of voice Involve others in sharing the story e.g. peers or siblings Introduce one story at a time to maximise learning Review the story as often as needed. Gradually fade' the social story

Evaluation: Outcome Measures used in a meta-analysis by Mogensen (2007), used the following criteria to compare earlier studies Frequency of social interactions Duration of social interactions Frequency of inappropriate social interactions or behaviours Frequency and duration of challenging, obsessive or disruptive behaviours Duration of on-task behaviour Research: Social stories are widely used and many resources are available to support those wishing to use this intervention. However, there are very few research studies in this area. Research Autism lists Social Stories as having limited positive evidence due to the limited number of research studies. A 2009 study reported 51% teachers rating social stories as very effective (Reynhout & Carter, 2009). Given the positive results so far, Social Stories appear to be a promising intervention for children with ASD, but more outcome studies are needed to replicate these results NZ Setting: Social Stories have been used successfully for many years in New Zealand schools. The following table shows how Social Stories aligns with Te Whariki and the NZ Curriculum: Te Whariki Strands Exploration/Mana aotroa Communication/Mama reo Well-being/Mana atua Contribution/Mana tangata Belonging/Mana whenua NZC key Competencies Thinking Use of symbols and Texts Managing Self Relating to Others Participating & Contributing

Individual with ASD: To understand the story, the child with ASD must have well-developed reading or visual comprehension and be able to translate the visual story into action. From that, the child must understand the social situation and recall the story when appropriate. Social Stories can be highly motivating through: Personalising them to include the child, peers, parents, siblings, or favourite TV/movie characters. Shared ownership of the story through the child being involved in what the text will say and taking photos for the book. Taking the book home to share with family and friends Being aware of the childs learning style when making the book e.g. preferences for symbols, photos, or text

Culture: Social stories made by parents offer the opportunity to share the familys cultural values and practices and could can be written in their native language. Ethics: Social stories should always be positive providing information about preferred behaviours, never threatening the childs self-esteem or emotional safety. Using a word like must is setting a child up to fail, alternative words like, sometimes, usually, often, occasionally, most are much less threatening. The goal of the story needs to be achievable and at least 50% of the stories developed should celebrate the childs achievements (Carol Gray, n.d.).

PECS: Picture Exchange Communication System

Theoretical Perspective: PECS is based on a mix of behavioural and developmental approaches based on Skinners operant learning theory. Purpose: PECS provides an alternative augmentative communication package to teach individuals to initiate communication and express their needs building on the strong visual learning and thinking styles characteristic of ASD. PECS aims to: develop understanding of the world around them develop understanding of the expectations of others. increase motivation by anticipation of preferred activities, tasks, or classes develop understanding of time and the ability to predict change increase self-management and independent on-task behaviour improve appropriate behaviour around transitions

 improve communication and daily living skills improve play skills and physical activity decrease disruptive behaviour including aggression, tantrums, and destruction of property Practice: The adult teaches the child to exchange a picture of an item he wants (usually a symbol e.g. Boardmaker). Initially, two trainers work with the child with one of them prompting the child to exchange the symbol for the items he wants. The first trainer then hands the requested item to the child. When the child can make the exchange independently only one adult is needed. PECS involves six phases of training, building the childs independence and understanding that communication is a two way process which can achieve desired goals. Phase 1: Basic exchange with a wide range of pictures Phase 2: Persists in getting anothers attention over increasing distances Phase 3: Discriminates between a number of pictures Phase 4: Forms sentences using pictures Phase 5: Answers questions using pictures Phase 6: Expands on previous success

It is recommended that PECS be used alongside other interventions. Evaluation: The childs progress can be tracked using the 6 phases of the PECS program. Research: Research on PECS shows that it improves communication skills through exchanging pictures and in some cases the individual learns to talk spontaneously. Research Autism rates PECS as having very strong positive evidence, with 16/21 studies showing positive improvements. NZ Setting: The following table shows how PECS aligns with Te Whariki and the NZ Curriculum: Te Whariki Strands Exploration/Mana aotroa Communication/Mama reo Well-being/Mana atua Contribution/Mana tangata NZC key Competencies Thinking Use of symbols and Texts Managing Self Relating to Others

Belonging/Mana whenua

Participating & Contributing

PECS is widely used across New Zealand schools. Both PECS training and resources are available within New Zealand. A Picture Exchange Communication System (PECS) Basic Training Workshop is offered by Autism New Zealand and PECS resources are available from Spectronics NZ. Individual with ASD: PECS assesses the preferences of the child and the program is initially develop around these. The child is given a voice, is able to make choices and have more understanding and control around the structure of a given period of time and their environment. Culture: PECS can be used across the home/school settings, affording the family a high level of involvement and allowing them to use pictures that reflect their culture alongside their first language. Ethics: Some other communication training systems, require the child to learn prerequisite skills, such as get ready position, motor imitation or eye contact. These additional learning requirements do not exist with PECS. There is an ethical question around how long a child is left waiting for the desired object if they do not use the card; no intervention should be causing unnecessary stress to the child.

Weighted Items
Theoretical Perspective: This intervention takes a sensory integrative approach. This is based on the theory that perceptual, sensory and motor difficulties may result from poor integration of sensory information and lead to the inability of the brain to regulate the bodys sensorimotor functions. Deep pressure releases the chemical serotonin as well as endorphins. Serotonin has a calming effect whilst the endorphins are mood enhancing. Serotonin also breaks down into melatonin which aids sleep. The altering of their sensory system allows individuals with ASD to better feel their movements and understand where their bodies are in space.

Purpose: The use of weighted items, such as blankets, vests or collars, is designed to help individuals with ASD cope more effectively with a range of challenges, including poor motor skills, hyperactivity and sleeplessness. Practice: Weighted items can be bought from specialist suppliers, second hand or made at home. They are made heavier by stitching small weights into the fabric or putting them into special pockets. Evaluation: Evaluation of the effectiveness of such interventions can be made through observations to see if the individual with ASD becomes less distressed in the target situation when using a weighted item. Research: Currently there is no conclusive research about the effectiveness of weighted items as an intervention for autism. However, researchers from Research Autism, motivated by the extent to which disturbed sleep can impact on the wellbeing of children with autism are conducting a clinical trial called Snuggledown. This will target children with ASD who suffer from poor sleep. NZ Setting: Weighted products are available for purchase from a number of New Zealand websites including Sensory Corner at http://www.sensorycorner.co.nz and My Diffability at http://www.mydiffability.co.nz The following table shows how use of weighted items aligns with Te Whariki and the NZ Curriculum: Te Whariki Strands Well-being/Mana atua Contribution/Mana tangata Belonging/Mana whenua NZC key Competencies Managing Self Relating to Others Participating & Contributing

Individual with ASD: It is important that weighted items are not used on an individual if the person indicates they do not want to use them. Care needs to be taken when selecting weighted items to make sure

they are appropriate for the individual. A weighted blanket should only be around 10% of the individuals body weight. The possibility of improved sleep means that many individuals with ASD are quite happy to use weighted blankets. Culture: Many weighted vests are made to be worn under a layer of normal clothing to avoid attention being drawn to the individual by wearing something different. Ethics: Weighted items should never be used for restraint or punishment and an occupational therapist should be consulted before using this form of intervention. If the weighted item is allowed to be worn for too long, the individual may become overly accustomed to it and so reducing its, effectiveness. Although research states there is no risk of using weighted items, a childs head must never be covered by a weighted blanket and they should be easily able to slip out from under the blanket.

Gluten Free-Casein Free Diets (GF-CF)

Theoretical Perspective: This is a complementary and alternative medicine therapy using dietary elimination. GF-CF diets are based on the theory that gluten and casein peptides leaking from the gut act as opioids affecting neurotransmitters and causing ASD. Some of the effects of opioids are the same as characteristics often seen in autism e.g. abnormal immune system response, insensitivity to pain, repetitive movements and hyper-sensitive or hypo-sensitive reactions to normal events. Purpose: The aim of a GF-CF free diet is to remove all gluten and casein intake from the individuals diet. The gluten protein is found in some cereals such as wheat, oats, rye and barley. The Casein protein is found in some dairy products such as milk, butter and yoghurt. Practice: Recommendations suggest that gluten and casein should be gradually eliminated from the diet over a period of about 4 weeks. It is important to check levels of vitamins and minerals regularly to avoid any dietary deficiencies. Supplements may need to be taken. Evaluation: The individual is observed for any changes in behaviour in the core characteristics of ASD

Research: The theory behind the gluten-free casein-free diet is weak and unproven, with limited evidence to support its effectiveness. Despite this lack of evidence dietary intervention is growing in popularity and with anecdotal cases not uncommonly claiming a cure for the child (The GFCF Diet Intervention, n.d.). Research Autism has found limited positive evidence to support the claimed effects of GF-CF diets on autism and strongly recommends that further large scale, high quality research is needed. NZ Setting: A quick internet search brought up a number of New Zealand media items relating to GF-CF diets and autism including a NZ Yahoo item entitled Can a gluten-free diet help treat autism? Susan Lords book Getting your kid on a Gluten-Free Casein-Free Diet. This would indicate that in New Zealand GF-CF diets are of interest to some families with children on the autistic spectrum. The selection of GF-CF food in New Zealand is more restricted than in America and the UK and noticeably more expensive. If claims that GF-CF diets can alleviate key behaviours across the core characteristics of ASD then this would have an effect on the childs functioning and learning across all strand of Te Whariki and all key competencies in the NZ Curriculum. Individual with ASD: The child should be checked by a dietician before going onto a GF-CF free diet and the new diet should be gradually introduced. The child will need to eat more often on this diet and should be checked regularly by the dietician in case vitamin or mineral supplements are needed Culture: Having one person in a household on a GF-CF diet can mean huge changes, with extra time being spent on food preparation, the extra cost of GF-CF food and the pressure of having to adhere to the diet. Ethics: Individuals with ASD often have sensitivities to food items based on colour or texture and so are already on a restricted diet. Adding a GF-CF diet to this would further restrict their food intake, heightening the risk of dietary deficiencies. If a child shows adverse changes in behaviour then the new diet must stop immediately.

Discussion
Theoretical Perspectives: Social Stories, PECS, Video Modelling and SCERTS are all developed from a multi-theoretical basis thereby reducing the limitations of each of the individual theories. For example PECS has the defined structure of a behavioural intervention but at the same time can target the childs social-cognitive skills of observing, understanding and responding. This multi-faceted approach lends itself well to working with children with ASD, allowing interventions to target social skills and communication but at the same time ensuring that structured processes exist to achieve outcomes that are measurable and can be replicated. Purpose: The purpose of behavioural interventions, such as ABA, is focused purely on eliminating the undesirable behaviours shown by the individual. In contrast a developmental approach, such as Social Stories, seeks to look at the underlying causes of these behaviours and work towards developing theory of mind skills in order to facilitate underlying psychological change and social modification. Practice: There appears to be a significant difference between the largely behavioural based, highly structured interventions of ABA and PECS and the more developmental social-pragmatic approaches of Social Stories and Video Modelling. The procedures for the social-pragmatic interventions are more open to interpretation. A few guidelines were found for introducing the video in the Video Modelling intervention but the majority of the guidelines for Social Stories were directed more towards the social behaviour of the adults than any concrete steps in the process. The practices around these interventions focused strongly on the individual with ASD achieving success and maintaining a positive frame of mind e.g. 50% of social stories celebrating the childs achievements and so improving self-efficacy. In contrast the behavioural approaches of denying a child an object until they present the correct symbol or ignoring undesirable behaviour has the potential to cause the child more anxiety and emotional dysregulation as opposed to building self-esteem. Evaluation: SCERTS, ABA and PECS all have clearly identified, objective goals against which outcomes can be measured, these can be attributed to the behavioural components of these interventions. Evaluating the effectiveness of social stories, video modelling and even weighted items is less clearly defined and more subjective in nature, making it more difficult to know when to move onto a new goal or whether or not the intervention needs modifying. However, this broader approach does allow for the acknowledgement of unexpected positives arising from the intervention used.

Research: Social Stories, SCERTS, video modelling, weighted items and GF-CF interventions all have anecdotal evidence to support their effectiveness, but lack peer reviewed evidence based research confirming or disproving their effectiveness. PECS and ABA however, are support by have good empirical, evidence based research. On the continuum of behavioural and developmental interventions both ABA and PECS appear closer to the behavioural end than the other interventions examined. The structure, precise focus and consistency of these more behaviourally based approaches lend themselves to replication making confirmation of their efficacy through quality research possible. Individual with ASD: The role of the individual in behavioural interventions is to have the intervention done to them, with very little consideration for their preferences or needs. For young children the done to factor would also be true for GF-CF diets and possibly weighted items. However, these approaches differ from the traditional behaviour approaches in that they are considering and responding to possible causes of the behaviour rather than the behaviour itself. PECS represents a slight shift from this approach in that the target items used are of high interest to the child. In contrast Social Stories and Video Modelling allow the individual to be more actively involved in the intervention and even take some ownership of it in an appropriate form e.g. sharing the social story at home with family or selecting the next skill to target through video modelling. Ethics: The behavioural based intervention of ABA focuses on the symptoms shown by the individual rather than the causes underlying the behaviour. This raises the question as to whether theories based mainly or exclusively on operant behaviour theory are targeting the behaviours most relevant to the childs emotional and social regulation and well -being, or simply those behaviours that the adults see as most undesirable. To what extent do these behavioural interventions provide the child with coping strategies that can be generalised and retained and to what extend are they simply teaching children to jump through hoops. Multi-theoretical approaches such as SCERTS allow flexibility to meet the needs of the individual, considers the individuals well-being and increases the parents sense of purpose and value by including the parents in decision making and administering the interventions.

Summary
As every intervention offers its unique strengths treatment programmes should draw on these strengths and be designed to provide the best fit for the needs of an individual whilst facilitating learning in natural environments and through natural events. Although some professionals still favour a specific behavioural or development approach, sometimes to the

exclusion of others, there is a growing shift towards combined models drawing on both the developmental understanding of social communication and the systematic progress measures used by behaviourists. This approach is endorsed by the NZ ASD Guidelines in recommendation 3.1.2 There is no evidence that any single model is effective for teaching every goal to all children with ASD. Models should be chosen to fit the characteristics of the child and the learning situation. ( Ministry of Health, 2008, p.87). .

References
Beauchamp, M. (2010). Summary: Weighted Blankets and Vests: Safety, Efficacy and Issues Related to Their Use in Different Intervention Settings. Montreal: Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS), 6(5), 13-16. Retrieved from http://www.inesss.qc.ca/fileadmin/doc/AETMIS/Rapports/ServicesSociaux/2010_04_res_en.pdf Corbett, B. A., & Abdullah, M. (2005). Video modeling: Why does it work for children with Autism? Journal of Early and Intensive Behaviour Intervention, 2(1), 2-8. Dekker, A. M. (2008). Comparing Wrong/Right with Right/Right Exemplars in Video Modelling to Teach Social Skills to Children with Autism. The University of Waikato. Retrieved August 2013, from http://researchcommons.waikato.ac.nz/handle/10289/2501 Education, M. o. (2008). New Zealand Autism Spectrum Disorder Guideline. Ganz, J., Erales-Vollrath, T., & Cook, K. (2011). Video modeling: A visually based intervention for children with Autism Spectrum Disorder. Teaching Exceptional Children, 43(6), 8-19. Gluten-Free, Casein-Free Diet and Autism. (2013). Retrieved August 2013, from Research Autism: http://researchautism.net/autism_treatments_therapies_intervention.ikml?ra=1&infolevel=4 Gray, C. (n.d.). How to write Social Stories. Retrieved August 2013, from The Gray Centre: http://www.thegraycenter.org/social-stories/how-to-write-social-stories Gray, C. (Ed.). (Winter 2002). The SCERTS model: Enhancing communication and socioemotional attributes of children with autsim Spectrum disorder. Jenison Autism Journal, 1-32. Retrieved from http://www.amy-laurent.com/docs/publications/SCERTSJJ_RM.pdf Gray, C., & Garand, J. (1993). Social stories: Improving responses of students with autism with accurate social Information. Focus on Autism and Other Developmental Disabilities, 8, 1-10. doi:doi:10.1177/108835769300800101 Howlin, P., & Magiati, I. (2009). Systematic Review of Early Intensive Behavioral. American Association on Intellectual and Developmental Disabilities, 114(1), 23-41.

Interventions, Treatments and Therapies for Autism. (2013). Retrieved August 2013, from Research Autism: http://researchautism.net/pages/autism_treatments_therapies_interventions/ Introducing and using social stories. (n.d.). Retrieved August 2013, from The National Autistic Society: http://www.autism.org.uk/living-with-autism/strategies-and-approaches/social-stories-and-com ic-strip-conversations/introducing-and-using-social-stories.aspx Klaveness, J., Bigam, J., & Reichelt, K. (2013). The varied rate of response to dietary intervention in autistic children. Open Journal of Psychiatry, 3(2A), 56-60. doi:10.4236/ojpsych.2013.32A009 Lord, S. (n.d.). Getting your kid on a Gluten-Free Casein-Free Diet. Retrieved August 2013, from Autism New Zealand Inc: http://www.autismnz.org.nz/store/books/diet/getting_your_kid_on_a_gluten-free_casein-free_ diet Meyer, A. (2012). Can a gluten-free diet help treat autism? Retrieved August 2013, from Yahoo New Zealand: Lifestyle: http://nz.lifestyle.yahoo.com/health/wellbeing/article/-/15383371/can-a-gluten-free-diet-helptreat-autism/ Ministries of Health and Education. (2008). New Zealand autistic spectrum disorder guidelines. Wellington. Mogensen, L. L. (2005). There is preliminary evidence (level 4) that social stories are effective in decreasing challenging behaviours and may improve social interaction skills in children with Autism Spectrum Disorders. CATS Critically Acclaimed Topics Occupational Therapy. Retrieved August 2013, from http://www.otcats.com/topics/Lise%20Mogensen.html O'Neill, J. (2012). The SCERTS model: Implementaion and evaluation in a primary special school. Good Autism Practice, 11(1), 7-15. Prizant, B. M., & Wetherby, A. M. (1998). Understanding the continuum of discrete-trial traditional behavioural to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars In Speech and Language, 19(4), 329-358. Prizant, B., Wetherby, A., Rubin, E., & Laurent, A. (2010). The SCERTS Model and EvidenceBased Practice. Retrieved August 2013, from https://www.google.co.nz/webhp?source=search_app&gws_rd=cr#fp=b0dcde272bf0cdf2&q=% C2%AE+The+SCERTS+Model+and+Evidence%E2%80%90Based+Practice+TKI+(Prizant%2C+2010.) &safe=off Prizant, Wetherby, Rubin, Laurent, & Rydell. (2007). The Early Intervention Autism Spectrum Disorder Project in Action: A comprehensive educational approach for children with autism spectrum disorders. Retrieved August 2013, from http://www.asdev.org.nz/__data/assets/powerpoint_doc/0020/82163/100830-Autism-NZ-EI-AS D-project-final.ppt. Reynhout, G., & Carter, M. (2009). The use of social stories by teachers and their perceived efficacy. Reseasch in Autism Spectrun Discorders, 3, 232-251. doi:DOI:10.1016/j.rasd.2008.06.003

SCERTS Model and Autism. (2013). Retrieved from Research Autsim: http://researchautism.net/autism_treatments_therapies_intervention.ikml?ra=94 SCERTS model. (2011). Retrieved August 2013, from Raising Children Network: http://raisingchildren.net.au/articles/scerts_th.html Services, U. D. (2012). IACC/OARC Autism Spectrum Disorder Publications Analysis: The Global Landscape of Autism Research, July 2012. Retrieved August 2013, from The Interagency Autism Coordinating Committee: http://iacc.hhs.gov/publications-analysis/july2012/appendix-i.shtml Social Stories. (2012). Retrieved August 2013, from Raising Children Network: http://raisingchildren.net.au/articles/social_stories_th.html Spectronics. (n.d.). Retrieved July 2013, from http://www.spectronicsinoz.com/ Stephenson, J., & Carter, M. (n.d.). The use of weighted vests with children with autism spectrum disorders and other disabilities. Retrieved August 2013, from The York University Centre for Reviews and Dissemination: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12009102545#.UiD3uz bI2YE The GFCF diet intervention - Autism diet. (n.d.). Retrieved August 2013, from GFCF Diet: http://www.gfcfdiet.com/successstories.htm TKI. (n.d.). SCERTS in practice. Retrieved August 2013, from ASD in Education: http://seonline.tki.org.nz/ASD/Learning/SCERTS-in-practice Video Modeling Research Overview. (n.d.). (Social Skill Builder) Retrieved August 2013, from Autism and Special Needs Software: http://www.socialskillbuilder.com/articles/video-modeling-research.html