Treatment of pervasive developmental disorders

TGDs are a very complicated matter that requires the help of professionals, so from the moment we identify any possible symptom of these disorders it is advisable to go to doctors and psychologists to be able to identify if it is any of these problems or not. Next, in this PsychologyOnline article we explain treating pervasive developmental disorderssuch as Autistic Disorder, Rett's Disorder, Infantile Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder, unspecified

Index

1. Intervention programs in deficit skills - treatment for PDD
2.  The topic
3. Gather the information for the story
4. Consider the guidelines applied to writing for SA persons
5. The proportion of sentences
6. Incorporate student preferences and interests into a social story
7. Presentation, review and monitoring of a social story
8. The implementation of treatment programs for PDD
9. Skills enhancement intervention and treatment programs
10. Conclusions on Pervasive Developmental Disorders

The intervention programs where the greatest emphasis has been placed and whose research has been most fruitful has been mainly the development of training programs in social skills (Macintosh et al. 2006; Tse et al. 2007; Rao et al. 2007; Owens et al. 2008; Llaneza et al. 2010).

According to Llaneza et al. (2010), the basic objective of any social skills training program is to help the child who suffers some type of autism spectrum disorder to develop, improve or acquire a greater awareness and understanding of the perspective of the others. In this way, he will show greater competence in social skills such as conversation, relationships with peers, cooperative play, conflict mediation, self-regulation skills and problem solving. Sessions are often highly structured and begin with an assessment of the abilities of the individuals and end with brief reports of their progress.

Methods such as role-playing or simulation are widely used in this type of program, with the aim of to generalize the situations raised during the program with those that usually occur in life daily. Learning to play, share, negotiate, and compromise are crucial skills that must be taught through the combination of explicit teaching and everyday life experiences.

One of the widely used methods for teaching social skills in school children with AS has been that of social stories. This technique, developed by Gray (1998), is fundamentally based on the teaching of social skills through stories that objectively describe people, places, events and concepts or social situations, following a content and format specific. These stories must include the most important elements of the social situation: who, what, when, where and why (Sibón, 2010).

According to Gray (1998), develop, write and implement social storieseffective It requires six basic elements that we will see below.

The social stories theme It must be related to those fears and concerns of the child, that is, they must offer a solution to the events that present difficulty or concern the child. They should also be used to describe future situations or introduce new skills to the repertoire. of this, in order to prevent negative responses in the future and thus preserve the self-esteem of the boy.

The understanding of the situation to be described must go through a detailed study by the instructor through observation and interviews with relevant people. Observing the main clues to the situation will determine the plot of the final story. These play an essential role, since they define the situation and form the guide on which the child will base the understanding of the story. The keys are interpreted as predictable signs that will act as guides in the chaos of daily life. An example of a key would be the recess bell, which reflects that recess has ended and the children must return to class.

Social history should be developed based on the individual characteristics of those students being taught (eg. Age, reading ability, comprehension, attention level, etc.). The social history must convey relevant information, ignoring unimportant details and highlighting those guides that are key to understanding it. Stories should be written in the first or third person. The phraseological typology that should include the social stories developed are as follows:

• Descriptive: objectively describe where the action occurs, who is carrying it out, what is doing and why. These types of sentences describe the characteristics of the environment, which characters are involved in the plot, what role they play in it and the explanation of their behavior throughout the story.
• From Perspective: These sentences describe the internal states of people. These states can be: physical states, desires, thoughts, beliefs, motivations, etc.
• Directives: these types of sentences clearly define the behavior that is expected, carried out by a certain character in the face of a key or situation. These types of phrases guide behavior and directly influence the behavior of the child with AS, since their Learning is literal, which intensifies the influence of this type of directive sentence on the behavior of the same.
• Control: these types of sentences are written by children with the aim of identifying valid strategies, remembering information included in a social story, provide you with reassurance or give you the opportunity to test your own answers. These types of affirmations allow the child to identify those significant personal strategies to handle difficult situations.

The proportion of sentences in social history defines the relationship between the number of descriptive sentences, of perspective, directives, and control in the whole story: social stories should describe more than lead. The number is usually between 0 and 1 for directive or control sentences and between 2 and 5 for descriptive or perspective sentences.

The child's interests and preferences should directly influence the content, writing styles, format, or implementation of a social story. In this sense, the approach and motivation of the student in relation to learning will be much greater, thus improving the processing of information.

It is necessary to prepare a draft prior to the presentation of the social history to the child. This draft must be reviewed by parents and people directly involved in the child's learning in order to evaluate it and carry out the appropriate corrections. Once the corrections are established, the implementation plan is programmed, which includes the presentation schedules and instructional methods that accompany the story.

In the review carried out by Rao et al. (2007), a study carried out through the development and implementation of social stories is collected. These social stories were based on information provided by parents and teachers, in addition to information collected through direct information from children. Their content was based on the social skills that must be manifested during the practice of some team sport, the ability to maintain and start a conversation and participate in activities of group. The social stories were written in book format and parents had to take charge of reading them to their children twice a day, before and after school. The results obtained were significant, observing an improvement in the use of social skills in the participants.

Another method proposed by Sibón (2010) for teaching social skills is closely related to social stories and is what is called "Social Scripts". Social scripts are based on explicit descriptions of the sequence of steps to be taken in each of the specific social interactions. These can have different degrees of complexity. Social scripts can contain images, text, or, in most cases, both.

In a research carried out by Barry et al. (2003), cited in the review by Rao et al. (2008), social scripts were used as an intervention method to improve specific social skills. These specific skills consisted of managing conversation, greeting, and play. The program was established through a schedule of weekly sessions of 2 hours for 8 weeks. It should be noted that a group of typically developed peers, who had been trained to participate in the program, were included in the development of the sessions. Each child affected by ASD was paired with a trained child during the development of the sessions. The results showed an improvement in the handling of the greeting and of those skills that had to do with with the game, but no significant results were found in the skills related to the conversation.

According to the study carried out by Owens et al. (2008), there are other approaches in the training of social skills in children suffering from AS. Peer-mediated behavioral intervention has shown significant results, as we have just seen. In this approach, a typically developing child (the child's partner, designated as tutor) is in charge of teaching, promoting and reinforcing the social behavior of the child with an ASD. Despite the good proven results, these types of interventions are costly and time-consuming.

The training groups in social skills included in the curricula that are implemented in schools and institutes give the opportunity for adolescents with AS to observe role models in their peers typically developed. These intervention programs have shown high effectiveness, mainly in the initiation and development of interactions social skills, recognition of emotions and group problem solving, despite the fact that there are difficulties in generalization (Barry et al. 2003; Solomon et al. 2004 cited by Owens et al. 2008)

In a study carried out by Bauminger in 2002 (cited by Owens et al. 2008) combines both types of interventions, that is, an intervention program was applied inserted in the school curriculum where the figure of the fellow tutor existed during the development of the same. The skills that worked were social cognition, emotional understanding and social interaction. The intervention was carried out for 7 months with sessions of 3 hours per week. The results demonstrated a significant improvement in those individuals submitted to the intervention program in those skills that They had to do with eye contact, verbal expressions in relation to interest in the partner, cooperation and the ability to affirmation.

Another of the conceptions that the authors have in relation to the implementation of training programs in social skills in children suffering from AS lies in the closest possible approach to the interests and natural environment of the child (Owens et al. 2008). According to the authors, the use of the materials and activities carried out by the individual allows a greater generalization of the learned capacities, in addition to the increase that it entails in relation to motivation for learning and involvement in change behavioral.

In a study carried out by these authors, they compared the results obtained in two types of interventions for teaching social skills: one of them, based on an approach more focused on the interests of the child where the game "LEGO" was used as a mediating experience through which to insert the learning, and another based on a more traditional approach, called SULP (Social Use of Language Program), which is applied in schools with the aim of training in linguistic and communication skills for children with learning difficulties (for a comprehensive review of both learning methods consult LeGoff, 2004; Rinaldi, 2004, cited by Owens et al. 2008).

In the study, the subjects were divided into three groups: a group undergoing LEGO Therapy, another undergoing SULP Therapy, and another control group. The contents of both types of intervention are the following:

-LEGO therapy: the main objective of this type of program is to motivate the child to work together through building with LEGO pieces in pairs or small groups. Normally, during the tasks the children were divided according to the role they had to adopt: the engineer (described the instructions), the supplier (found the correct parts) and the builder (placed the pieces). This division of labor allows subjects to implement strategies of joint attention, speaking time, problem solving, in addition to promoting cooperative, listening, and social skills behaviors in general. Other modalities of intervention reside in free play, without guidelines set by the researcher, where the participants have the opportunity to practice engagement, the ability to express their ideas, as well as take perspective of the other. During the development of the activities, the therapist remains present with the group of children. The function of this is not directive nor does it provide specific solutions to problems that may arise, its work is based on highlighting the existence of a problem and helping individuals to find a solution for them themselves.

-SULP therapy: this type of intervention is based on direct teaching through social stories, group activities and games. The main objective of the intervention is based on teaching skills related to proxemics, prosody, listening, speaking turns and eye contact. Normally, the sessions usually start with a story where a character presents a social difficulty, which he solves through adaptive social skills or not. Later an adult model shows the good social skills that should be put in place in the situation and also the negative ones that should not appear. Children must assess the situation and ask questions as well as identify errors and propose solutions. Once this part of the session is over, the children proceed to put the skill into practice through a series of programmed games. This approach would be distinctive from more traditional approaches to social skills training, as it makes use of stories. social skills and methods such as role-playing or modeling, procedures that have been carried out in the training in social skills more traditional.

The results obtained, as expected, are uneven. Both LEGO Therapy and SULP Therapy significantly improved the social skills of the children. children, although in some aspects a typology of intervention produced greater effects compared to the other. Generally speaking, LEGO Therapy produced significantly higher results compared to SULP therapy (reduction of social difficulties specific to autism, greater generalization of the learning). However, it was seen how there were improvements in different aspects of communication depending on the type of intervention to which the children had been subjected, which makes the authors think that each type of program has different objectives to to get better.

In short, it seems that, although with disparate results, social skills training programs applied to children affected by ASD are effective. Despite the varied existing methodology in relation to the procedures to be carried out to improve the social capacities of this group, the results are encouraging. In the review by Rao et al. (2008), it was found that in 70% of the interventions carried out, the results were significant. In this review, as has been shown, numerous studies were evaluated that had led to carried out different types of intervention, not finding negative results in most of the cases.

This fact is a reliable indicator of the capacity of the different intervention programs to reduce the social deficits that these children present. Future research is necessary through multi-component interventions, where the programs of intervention include all those contents and procedures that have been shown to be effective in the different studies. In this way, the individual can be trained in a global way, through clinically proven, effective and reliable procedures. In this sense, works based on this orientation are already beginning to be developed, such as that carried out by Beaumont and Sofronoff (2008).

These authors developed a multi-component intervention program whose content consisted of a computer games, group work sessions, training for parents and handing out brochures to children. teachers. As expected, the results were encouraging. Those children who participated in the study notably improved their social skills, maintaining this improvement in the long term. In addition, they increased emotional self-regulation and their ability to recognize and identify emotions in others.

In this work, it is emphasized that the approach to the individual through her areas of interest, in this case, the video game, is a good strategy to induce the individual to practice in addition to significantly increasing her motivation, and therefore, her learning. On the other hand, the practice of group sessions where traditionally proven techniques such as role-playing, modeling or scripts are implemented. social skills provides a necessary complement to learning, allowing the individual to put into practice the skills learned and to observe appropriate models of conduct. These two lines of intervention reinforced together with training for parents and information for teachers, allowed the generalization of skills developed during the course in the child's environment, thus ensuring that they will be established in their habitual behavior pattern and, therefore, remain at long term.

One of the most important questions asked by all those researchers who have studied the special abilities presented by those individuals affected by an ASD, especially the geniuses called "Savants" has been Is it more important to correct the "defects" or to train the talent? The answer has been clear in most cases, train talent (Treffert, 2009). According to the author, in the way in which he trains in this type of skills, those weaknesses that have been presented throughout the work will disappear.

Clark in 2001 (cited by Treffert, 2009) developed an intervention program based on those educational strategies that are used to enhance the skills presented by individuals gifted. The contents of the school curriculum that the author adapted were based on a combination of those strategies that are used in the curricular contents of children with a giftedness (enrichment, acceleration and orientation), along with the intervention strategies specific to ASDs that have been explained above (visual aids and stories social). According to the author, the objective of combining both strategies lay in the possibility of reducing the behaviors misfits of this group and channel those strategies developed, for the sake of a potential development of their skills. As the author cites, this study program has been very successful in enhancing and channeling outstanding skills, but also in the behaviors typical of autism. These improvements have been related to the general behavior of individuals, their academic self-efficacy and social skills.

Donnelly and Altman (1994) have noticed a notable increase in recent times in the inclusion of a population characterized by some type of autism spectrum disorder in curricular programs adapted for gifted subjects without any disorder. The elements that characterize this type of program are the provision of a mentor specialized in the child's spotlight, individual counseling sessions, and group social skills training. This fact highlights the growing visibility that the group is having in the field school, including children with some autistic characteristic in this type of empowerment programs academic.

On the other hand, some emerging specialized schools are obtaining excellent results in this regard, applying specific educational strategies based on the needs of their students, characterized by some disorder of the growth. Here are some examples of specialized educational centers.

"Soundscape" in Surrey, England began operating in 2003 as the only specialized education center in the world dedicated exclusively to the needs of and possibilities for people with loss of vision and special musical abilities, including those individuals characterized by Savant Syndrome.

Orion Academy in California (United States) has specialized in developing a positive educational experience for high school students with AS. The school's educational program is based on meeting both the individual and social needs of the group, in addition to enhancing those outstanding academic abilities. According to the workers of the center, the program is designed based on a safe environment of learning, with a specific focus on improving motor, social, emotional or visuospatial. This program includes the inclusion of high-level academic specialists in these types of disorders, which enables specialized care. In general, what the school seeks to promote at all times the developed capacities that can present the individuals but without forgetting to improve those deficit skills related to interaction Social.

Hope University in California (United States), is a visual arts center for adults with developmental disabilities. Its mission is to train talents and reduce disability through the use of art therapy, such as visual arts, music, dance, theater and narrative. The programs carried out in this center are always based on the artistic conception of therapy, so that through the training of individuals in the different artistic disciplines mentioned, other types of capacities are developed such as social skills, problem solving, recognition of emotions in others or cognitive ability, among others many.

In Spain, to date, there are no educational centers that follow such a specific line as the centers described. In this sense, we can find special educational centers that work mainly on aspects that have to do with disability or centers that work with talents, but independently, there is no specific educational curriculum for those children who share both features. This educational gap limits in many ways the current and future capacities of these types of individuals. As the authors well say, special abilities can be a child's gateway to society, demonstrating that their diagnostic label It is nothing more than that, a label, so that they are capable of developing extraordinary skills if they have the necessary support from the society. But this fact cannot be given if this group is not taught how to start, maintain and end a conversation, in addition to enhancing their musical skills, for example.

Currently, autism spectrum disorders include a complex network of clinical characteristics that makes their understanding and treatment difficult. Numerous professionals, both on the basis of their clinical experience and their research, have developed studies with the aim of bringing the scientific community closer to understanding of this type of disorders. Its etiology remains unknown, although certain explanations are already appearing that allow a more reliable hypothesis of those causes that are at the base of the disorder. Leaving in this way, that psychoanalytic casuistry where the emotional rejection by the parents was the central cause of the child's pathology. Advances in this regard, together with the experience of professionals in relation to the diagnosis and treatment of these individuals are making the group of professionals rethink the functionality of a categorical division of disorders that are included within the sub-category of the spectrum autistic.

In this sense, the future statistical and diagnostic manual of mental disorders in its fifth edition will establish, almost irrefutably, a single disorder for categorize those individuals who present a common symptomatology referred to problems in social interaction and communication, as well as activities and interests restricted. In this way, under the name of "Autism Spectrum Disorder" will be included what was known in the DSM-IV as the Asperger's Syndrome, Autistic Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder, unspecified.

In this way, it is evident that the categorical difference of this type of pathology has not delimited a representation of reality, since as explained at the beginning of the In most of the investigations, the authors have found that the subjects diagnosed with a disorder within the spectrum met the criteria established by the the rest. Sometimes, the differentiating characteristic resided in the subjective judgment of the clinician, based on criteria that were not strictly derived from those proposed in the DSM-IV, such as severity. In this way, the diagnosed subjects faced labels that in most cases only served to differentiate in name the individual, since the symptoms are common, and therefore the intervention strategies, in my opinion, should also be, always maintaining the individualized nature of each therapeutic process, where these must be adapted to individual characteristics of the subject.

One of the fields that has not generated much work in this population has been the extraordinary capacities that they present. Despite the fact that research has been carried out, the greatest weight of the studies has resided in the analysis of those deficient behaviors, specifically communication and social interaction in AS.

This fact, adopted from the traditional medical orientation, has forced to put aside the study of the characteristics that allow the individual with ASD to present developed skills that are not found in the bulk of the population normal. And with this, the study of the usefulness that these capacities can have when establishing intervention programs to improve deficit skills has also been avoided.

As has been observed, the traditional development of research that studied those effective intervention programs in the training of social skills and The communicative studies of children with AS revolved around social histories and those traditional methods in psychology for the training of these capacities, such as modeling and training. role-playing. This led to the development and application of numerous programs that used this type of strategy as the main line of intervention. Although the results obtained with this type of program were significant, and in general, the individuals improved their communication skills, there were still limitations. Specifically, the results were not maintained in the long term in all the studies, there were problems in the generalization of the skills learned in the interventions and in some cases, different interventions were shown to work differently capacities, so there was no integrative program that will work on all those strategies in which subjects with ASD present difficulties. Currently an attempt is being made to remedy this fact, applying multi-modal intervention strategies, that is, intervention programs where each and every one of those strategies that have been shown to be significant in the studies carried out are collected traditionally. These strategies require a greater psychopedagogical approach, so that greater attention is paid to the special educational needs of these individuals, thus increasing their capacity for introjection of those contents and skills that are intended to be taught to the child, in addition to increasing their motivation and involvement in the process of learning.

This approach is achieved through educational strategies such as the inclusion of the interests of this group in teaching strategies (as seen previously, in those programs where the game was included as the main strategy for learning social skills), the inclusion of this type of program in the school curriculum or training for parents and teachers. It has been seen how this type of multi-modal interventions have obtained significant results, improving those aspects that presented difficulties in traditional programs such as maintaining long-term effects and greater generalization to the subject's daily life of skills learned.

However, despite the fact that these new approaches represent a great advance in the treatment of children suffering from this pathology, it continues neglecting in most cases the ability of the special abilities of these individuals to increase the effectiveness of the learnings. Despite the lack of conclusive data, some schools are using this type of skills as mediators of learning. As has been seen, artistic and musical abilities are setting the basis for specific treatments where the improvement of social interaction and communication skills, among many others, play a role fundamental. This fact shows that the use of those extraordinary abilities of which we spoke at the beginning of this Conclusion, they can be a very valuable tool when it comes to establishing or improving deficient behaviors in individuals with TEA. Although it is true that not all those individuals who present a pathology of these characteristics have developed skills that go out of the box. common, if there is a capacity for systematization, attention and developed sensitivity that in its maximum expression would be the origin of this type of capabilities. This form of processing must be taken into account in the implementation of intervention programs, since, as expected, it has serious implications in the learning process.

Therefore, the studies that should be launched in the future should revolve around the capacity of these developed skills to influence the learning those deficit skills, in addition to their ability to assume a mechanism of social integration for individuals, with all that this fact carries.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Treatment of pervasive developmental disorders, we recommend that you enter our category of Neurological disorders.

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