Therapies & interventions for neurodevelopmental conditions

Neurodevelopmental conditions

What we know so far:

Causes – genetic, environmental, unknown

Prevalence can be influenced by numerous factors

Different profiles

• Strengths

• Weaknesses

• Assessed using standardised tests & experimental designs

Interventions

William’s syndrome - strengths

Relative strengths:

• Speech production

• Fluency

• Syntax

• Grammar

Difficulties in pragmatics (understanding intended meanng of words)

Williams syndrome - weaknesses

Executive function

Numerous studies suggesting that individuals with William’s syndrome experience difficulties across several executive functions including

• inhibitory control

• planning

• workign memory

Visuospatial abilities

• eg. as measure by the WISC (standardised IQ test)

Autism - potential strengths

Excellent attention to detail & pattern recognition

• Strong systemising abilities = heightened attention to detail and advanced capabilities in pattern recognition

Superior visual serarch skills are consistently reported

Shirama, Kato & Kashino (2017) used two visual search tasks and increased the level of difficulty of each task:

• Conjunction search

• Feature search

Regardless of the difficulty of the task autistic individuals outperformed neurotypical individuals on every task

Visual search task real ligfe application

Autism - potential weaknesses

Executive function

Numerous studies suggesting that autistic individuals experience difficulties across executive functioning

• inhibitory control

• cognitive flexibility

• working memory

Theory of mind

Difficulties in understanding the emotions, thoughts and intentions of others?

Theory of mind and autism

Research showed children with autism struggled with these tasks

Now research is more equivocal

• Some will struggle, some won’t

Children who fail this in a few years are able to then pass it

Many different therapies and interventions

Speech & language therapy - PECS

Williams - can be delayed speech before it becomes a strength

Both Williams and Autism are associated with delays or difficulties in speech

Picture exchange communication system (PECS)

• a form of alternative communication

• Difficulty as a child as you know what you want but don’t know how to communicate it → lead to meltdowns and tantrums as you cannot communicate in the same way

PECS - does not rely on verbal communication

Very basic to open a window of communication

Helps build on verbal communication

Stages of PECS

Every stage builds on previous skill to build understanding of communication

Different children may develop and stop at certain stages that are most appropriate to them so they are still able to communicate in some manner

Some may never move beyond the initial stage and some may get to the end - developmental differences

Makaton

Uses symbols (pictures) uses symbols (pictures), signs (gestures) and speech to enable people to communicate

Supports the development of essential communication skill such as attention and listening, comprehension, memory, recall and organisation of language and expression

2 vocabularies (learned suquentially)

• A core vocab of essential words or concepts presented in stages of increasing complexity

• A much larger, open-ended, topic based resource vocab providing an enormous banks of further signs and symbols covering broader life experiences

Makaton and BSL are entirely distinct and are used by very different communities of people

• makaton is not a complete language

Makaton pahses out as speech develops naturally

• for some this will be useful their whole lives

Builds on attention, listening, learning how language is organised and memory

Play therapy

If a child doesn’t express themselves in an adult world, the therapist should join the child in their world, on their level

• cannot expect children to act as adults - communication gap

children learn to understand the world and their place in it through play

its where they’re free to act out their inner feelijngs and deepest emotions

toys can act as symbols and take on greater meaning - if you know what to look for

• use toys and play to guide the child to understand their own behaviours and emotions

Typically 30 mins - 1 hour once a week

Therapy can take place individually or in groups

Can be directive or non-directive

• Directive = therapist will take the lead by specifying the toys or games that’ll be used in the session

• Non-directive - less structured - the child is able to choose toys and games and play in their own way - the therapist will observe closely and participate as appropriate

Techniques include

• storytelling

• role playing

• toy phones

• puppets

• dolls and action figures

• arts and crafts

• blocks and construction toys and more

demonstrated to reduce behaviours associated with ADHD & social anxiety and to increase social emotional competency in autistic children

Music therapy

Music as an educational tool in William’s syndrome?

Two groups: those with music training, those without

Better verbal recall when the information was sung for those without lessons

• Generally children with William's who received formal music training their recall was better

Those with training showed good recall for spoken information

Music aids verbal working memory in WS?

Applied Behaviour Analysis (ABA)

ABA is a type of therapy that can improve social, communication, and learning skills through positive reinforcement

Originally developed to focus an autism, but is now used across a range of disorders / conditions

An intensive theray, it was originally recommended for 40hrs per week 1-1, although more recently this contact time has lowered

• Fall upon educators and parents to conduct this in day to day life now hours have dropped

Shown effectively to remove maladaptive behaviours behaviours such as tantrums

How does ABA work?

Positive conditioning – children are rewarded for showing a desired behaviour

First a therapist will observe the child, consult with the parents and make a plan to address certain behaviours e.g.

• Reducing tantrums or harmful behaviours

• Increasing or improving communication

The plan will include specific strategies caregivers, teachers, and the therapist can use to achieve treatment goals.

ABA relies on parents and caregivers to help reinforce desired behaviours outside of therapy.

Something the child values when a wanted behaviour is conducted - pavlovian 

• Forming association 

Withold the reward when they display a behaviour not desired 

Do not target loads of behaviours at once 

Researcher observes and plans what behaviours need to be targeted 

• Focus on one behaviour at a time 

Doesn't now just fall on the therapist, others (families and educators) now involved in reinforcing 

Understandable why it is controversial

Effectiveness of ABA

Peters-Scheffer, Didden, Korzilius & Sturmey (2011)

Meta analysis on effectiveness of Early Intensive Behavioural Intervention (a type of ABA)

11 studies with 344 children

Groups who received EIBI outperformed the control groups on IQ, non-verbal IQ, expressive and receptive language and adaptive behaviour. 

ABA discussion points

ABA - received a lot of backlash even though it is highly effective Intensive and expensive 

Big problem In the way it phrases autistic behaviours as being undesirable 

• Part of that person and you are trying to remove this  

Encouraging masking 

• Training them to be neurotypical 

Dehumanising 

• Training them to give a response we want them to show 

Stigmatising  

May suppress self-regulation behaviours such as stimming and this can cause them to dysregulate 

• Harmful by causing more distress

Can be useful in terms of behaviours which are damaging to them - stimming such as head banging