978-1572305441

142 A MIND APART
Neither do we know how to combine them most effectively into one
program, nor what type of intervention works best for what type of
child with ASD. There are no evidence-based principles by which to
choose interventions, and these types of treatment decisions are best
made through educated guesses by both parents and professionals based
on the individual characteristics of the child, the particular situation
and context of the child, and the child’s response to the intervention
(hence the need for an extended assessment time). Trial and error is
often warranted: “If it works, go with it!”
For some time, the therapeutic claims for discrete trial training
were exaggerated in the popular press and by some professionals given
the quality of the evidence so far published. The possible gains are now
understood to be more modest but are still clinically important. In fact,
the gains for children with autism who also have severe learning disability
are limited. The approach seems to work best with children who have
at least moderate degrees of learning disability. Social–communication
therapies may be just as effective, cost much less, and be more naturalistic
for some higher-functioning children who are able to benefit from
this form of intervention. Many experts feel this is the preferred treatment
for children with AS and even for children with high-functioning
autism who are verbal. The problem is that not all children with autism
or PDDNOS have the attentional, social, and communication skills to
make the best use of naturalistic settings. In these circumstances it may
be best to start with a program of discrete trial training and then move
on to more naturalistic and incidental teaching when the prerequisite
skills appear or alternatively to work on both approaches simultaneously.
Identifying essential skills needed for social interaction, teaching
them using discrete trial training, and then moving on to the social–
communication therapies is a useful strategy adopted by many professionals
who like to take the best of both approaches and combine them.
* * *
Because Trevor had a moderate degree of learning disability based
on cognitive testing and was just starting to communicate with pointing
and pulling, we decided to start working on some other pivotal skills
using discrete trial training. Attending is an important prerequisite skill
for many other social, communication, and play skills. We taught
Trevor to come sit, look at an object, and look at the therapist in response
to having his name called. Each time he did the correct action,