How much Therapy Do ASD Children Need?

Our research last year compared the intensity of therapy for autistic children of different severity. So there were 87 children over the span of a year. They put them into four groups, and groups one and two were doing something called discrete trial training. And they had 15 hours versus 25 hours. Right. The third and fourth group, the therapy was called naturalistic developmental behavioral intervention. Very long. I'll talk about that later. And they also did 15 hours versus 25 hours. Okay. My name is Ming from agents of speech.com. i'm a speech therapist. Today we'll talk about how much therapy does your autistic child need to thrive? Okay. So I'll link the study in the description box below. And let's talk about what is DTT with discrete trial training, we'll have a whole different video talking about exactly what types of intervention methods you can have for autistic children. Or like, just speech delay children. Okay, so the first thing. What's a discrete trial training? Training? Dtt. Right. Therapy that involves structured tasks and. And. And discrete trials. What. What I mean by discrete trials is. So, you know, this is a behavioral method. If you think about conditioning. All right. Using reward systems, using consequences to shape behavior. Right. This might sound a little inhumane, but that's the main method that we use in an intervention for. For children who are on the spectrum. Right. And children on the spectrum, they do learn well with structures and routines. And so that's why we create this DTT so that they know what's going to happen next. And they feel, once DCT is working, you can see that they're a lot more calmer. Okay, so what DCT Think about, like, ABA therapy and traditional early intervention. We use that method for a lot of things, and we also use DDT for speech abilities. Okay. It's not just for autistic children. All right. Second of all, what is naturalistic developmental behavioral intervention? NDBI just say that from now on, this is more naturalistic per se. There's not as much table time. And you can think about intervention methods like teach and big caps. You can search for that or dir. Floor time. Don't worry, we'll have a different video exploring all these type of intervention methods. Okay. Therapy isn't necessarily done at the table, is more naturalistic. So around the whole. The classroom, around the therapy. So center around the house, on the floor, on the mat. And there isn't as much structured learning. Okay. So these two methods, the researchers found that between 25 hours and 15 hours, mild to moderate cases of ASD actually benefited no matter what. Like if you increase from 25 hours to 15 hours, the, the 25 hour groups would perform better in a way that they call maturity of spontaneous communication growth. What was that mean? So you can see that they're starting to talk to people more spontaneously, meaning they will take initiative to talk to people better. Okay. And that's a good thing. Right? So it doesn't matter whether it was DCT or ndbi. Okay. Both methods work. And I think by now we should be established that both work, but we just don't know how, which one is better, which one is worse. Right. But at the same time, from this study, right. 25 hours, 50. There were no significant differences that were found between the two therapy types. But here's the big but. Okay. There were no significant differences between children with moderate to severe levels of impairment. What does that mean? Meaning if a child who has a moderate to severe type of autism, they. You don't, you don't see much difference between 25 hours and 15 hours. Okay? That is a letdown. And that doesn't mean that you should do less. Okay. The authors of this study does try to say amen. This doesn't refute the National Research council's recommendation of 25 hours per week for those children who are moderate to severe. And I really do agree with that. You know, don't. Just because there isn't much of a difference in a, in a small study of 87 children doesn't mean you should reduce the time in therapy if there's no significant difference. Okay, why do I say this? Because from my personal experience is that, you know, for moderate to severe cases, it's a long battle. Okay? It's really, really difficult. And you see that, that for milder cases, it's easier to get results no matter what kind of method you use. That's great. But for severe cases, you need to think about, oh, why is it that we cannot get them do what we want to teach them? Right? So there are usually just two things, right? Number one is that they have no motivation. They don't want to. Or number two, they, they cannot. Okay? There's always, always about these two things. So either of which, these two reasons is still our own responsibility as a therapist, as a teacher to actually go there and, and help them if they don't want, if they won't want to do something, motivate them by showing them some fun way or just straight ahead, give a reward, you know? Or second of all, the cannot part. Reduce, reduce, reduce, reduce to the lowest level that they can attain a skill. Okay. So for moderate to severe cases, maybe sometimes it takes. Not maybe. I'm pretty sure most of the time is about them understanding the task, understanding, like why they have to do it, number one and number two, how they're supposed to respond. Okay. And that's the most important part there. So it takes a lot more time for children to actually learn. Especially those are moderate to severe autism, you know, to learn how to communicate, to learn why, to learn exactly the response that they have to give. Okay. So after a whole year of therapy, you cannot really see much of a difference between like the therapy duration or the therapy type. Okay. And that's why you need to keep on going. Okay. So there's a lot more factors rather than like just solely time and therapy. There's something called responsiveness to therapy, stimulability towards different types. You might be using something like pecs, you know, picture exchange, communication systems. And the suitability. All right. Should be also taken into account. And you might ask me, right, Ming, dude, is there too much therapy? Is there? I know that, you know, if I have the resources, I should be. I'm talking in, in your voice, okay. I should be taking as many resources and putting my child in as, as many therapy as I can. Right? So remember in a different video I, I talked about not trying to go too many directions in one go. Like some parents will say, oh, I need my child to learn how to play piano, whatever, you know, like do different sorts of activities every day. Just fill the whole calendar up, the whole schedule up. That might not be the best idea from my perspective, but what your child really needs is a language rich environment and a very structured approach to let a child, from moderate to severe, to learn how to communicate, interact with people. And I'm saying this as a very like very general sense, right. What I mean is, is that the time in therapy is, is important. If you can get 25 hours a week of therapy, that's great, okay. Even if you don't see the results, what's happening is that maybe that therapy is maintaining your child's interaction, right? The communication, you're maintaining it. If you don't have as much, maybe if you don't give like 15 hours to 25 hours, what's happening is that they might regress as well. So that's also a risk. Right? So when is a good time for you to decide, oh, this is too much therapy is that when you visually see that the child is actually unhappy during therapy, feels forced going to therapy. Right. And they're just visually distressed before, during, after therapy. Okay. So then you have to think about how about cutting down on that therapy, number one. Number two, can you change the therapy type? Right. Although in the study it says either naturalistic or structured, either way, it doesn't matter for the children. But at the same time, it goes down to personal preference. The worst thing that will happen to a kid is that they become unhappy about therapy and it's very hard to get them back into a therapy setting. All right, I've seen multiple moderate to severe ASD children will become unhappy about, like a therapy setting, and we cannot get them to continue to learn from us. And that is one of the worst things that could happen. Because if they're already unhappy about it, they lose all motivation. They don't want to do it anymore. So you have to be careful about that. Okay? So, I mean, there's no clear cut answer for this. Obviously, the answer is the more the merrier, especially for those who are around, you know, like, mild symptoms of asd. And, you know, we did talk about ASD severity in a separate video last week. But at the same time, that type of severity may not be very representative of your child's whole language and communication profile. Right. Because we're only talking about how much assistance they need. Right. Not talking about what words they have at what times they would talk. What other communication methods do they use when they need something or in distress? You know, so it really comes down to the assessment and to look them as a whole. I look at them as a holistic person. Right. So that's very important. So my last point to you is to stick to one therapy method. Okay? And if your child is okay with it and you see results with it, just stick with it. Because every time you change a setting for autistic child or person per se, they need a lot more time to actually come back and feel safe at that moment. Okay? So you need to be careful. Okay, so that's it for this, this week's video. And if you haven't, please go to agents of Speech.com checklist to grab a list of tools and toys we recommend you to get when you start home therapy. All right, so that's it for today. I'll see you next week. Bye. Bye.