**3. Early intervention**

Early intervention (EI) is a system of services provided to children who are disabled, have delayed development or are at risk of delayed development, from birth until about five years of age. To help children with autism it is essential to focus on the earliest years of de‐ velopment, since this is a critically important time for early learning which powerfully af‐ fects the child's future life course.

Early intervention, also known as early childhood education, provides a support system for children with developmental disabilities and their families. Early intervention may start as soon as it is evident that the child has a developmental disability or is at risk of acquiring it. The early intervention services ensure that infants and pre-school children develop the core skills in physical, cognitive, communication, socio-emotional and self help domains. Early intervention (EI) services are coordinated so that they enable child's growth and develop‐ ment and support families during the critical early years. For the family, such services help in overcoming the feelings of isolation, stress and frustration, and reduce the cost of provid‐ ing for special education, rehabilitation and health care needs of the child. EI services follow a multidisciplinary approach, with a variety of therapists and teachers working in collabora‐ tion to improve the child's prognosis in every area of development.

To help children with autism it is essential to focus on the earliest years of development, since this is a critically important time for early learning which powerfully affects the child's future life course. The children are actively engaged in an instructional program three to five times a week, through the year. It involves planned intervention organized around rela‐ tively brief periods of time for the very young children so that they may receive sufficient adult attention. Since children with autism find it difficult to work in large groups, the EI services for them should follow a structured program of one-on-one training or training in small groups to help attain individual goals.

EI is the most dynamic and critical period in the treatment of autism for one very simple reason: the younger they are, the more 'elastic' their brains are [9]. Recognizing and diagnos‐ ing autism before pre-school age has been uncommon until the last few years. But increas‐ ingly autism is being identified very early in development. It has been shown that diagnosis can be valid and reliable at 2 years of age, and signs can be recognizable and predictive of autism even from early in the second year of life. In future it is likely that autism will be diagnosed for most children in the toddler age period [18 - 30 months). Very early therapeu‐ tic intervention is likely to improve developmental and adaptive outcomes. Trials of early intervention need to focus on training parents to work with their very young children in the key areas of social responsiveness, attention skills, early communication skills, and interac‐ tive play. The findings of a study by Ivar Lovaas [10] on early behavioral intervention of children with autism in 1987 showed a significant gain in IQ and that 49% of children who received EI were mainstreamed in regular classrooms.

stressed, they may not be able to let others know how they are feeling and may react vio‐ lently or aggressively. Additionally, appropriate social interaction in autism is hampered by a tendency to become fascinated by special interest that dominates the child's time and conversation, and the imposition of routines that must be completed. The interest is a soli‐ tary pursuit and not that evinced by age peers. A lack of completion of the activity in a routine can lead to distress and anxiety. Researches indicate that insistence on completing an activity in a particular way may be the child's attempt to find patterns and look for rules and organization within environment [8]. Once a pattern has emerged it must be maintained. Thus, establishment of a routine ensures that there is no opportunity for change. As social situations are inherently dynamic, this adherence to routine and limited interest deeply impacts the child's ability to be socially active in appropriate manner.

Early intervention (EI) is a system of services provided to children who are disabled, have delayed development or are at risk of delayed development, from birth until about five years of age. To help children with autism it is essential to focus on the earliest years of de‐ velopment, since this is a critically important time for early learning which powerfully af‐

Early intervention, also known as early childhood education, provides a support system for children with developmental disabilities and their families. Early intervention may start as soon as it is evident that the child has a developmental disability or is at risk of acquiring it. The early intervention services ensure that infants and pre-school children develop the core skills in physical, cognitive, communication, socio-emotional and self help domains. Early intervention (EI) services are coordinated so that they enable child's growth and develop‐ ment and support families during the critical early years. For the family, such services help in overcoming the feelings of isolation, stress and frustration, and reduce the cost of provid‐ ing for special education, rehabilitation and health care needs of the child. EI services follow a multidisciplinary approach, with a variety of therapists and teachers working in collabora‐

To help children with autism it is essential to focus on the earliest years of development, since this is a critically important time for early learning which powerfully affects the child's future life course. The children are actively engaged in an instructional program three to five times a week, through the year. It involves planned intervention organized around rela‐ tively brief periods of time for the very young children so that they may receive sufficient adult attention. Since children with autism find it difficult to work in large groups, the EI services for them should follow a structured program of one-on-one training or training in

EI is the most dynamic and critical period in the treatment of autism for one very simple reason: the younger they are, the more 'elastic' their brains are [9]. Recognizing and diagnos‐ ing autism before pre-school age has been uncommon until the last few years. But increas‐

tion to improve the child's prognosis in every area of development.

small groups to help attain individual goals.

**3. Early intervention**

fects the child's future life course.

694 Recent Advances in Autism Spectrum Disorders - Volume I

The guidelines for best practice in early intervention for children with autism [11] recom‐ mend the following:


with no disability enhances the quality but it should be done so that peer interaction is adequately supported.

used to determine the patterns of typical development. The skills that the child demon‐ strates are indicative of his or developmental level. The intervention goals are set for the skills the child failed or partially accomplished during assessment. A developmental ap‐ proach to intervention is also referred to as child centered approach in which the adult fol‐ lows the child's lead. It uses materials and activities that suit the child's level in a given area of development. The materials are provided to the child, and the adult facilitates the child' interaction with them so that the child moves towards achieving the pre-set developmental goal. But it is the child's initiative with the material or activities that serves as guideline for the adult's interaction. For example, if a child picks up a toy, the adult may show what can be done with it by demonstration and prompts. Child's preferences decide what should be selected as material, and the adult plays a supportive role to encourage the child's interac‐ tion with the material. Unlike the behavioral methods, developmental approach does not re‐ quire the child to interact with material or carry out an activity in a pre-specified structured manner. The consequences of such interactive behaviors are reinforcements that occur natu‐ rally in child's environment. The reinforcements may be internal, such as, happiness at being

Early Intervention of Autism: A Case for Floor Time Approach

http://dx.doi.org/10.5772/54378

697

The Developmental, Individual, Relationship-based (DIR) Model, designed by Stanley Greenspan in 1989, provides a framework to understand the functional emotional develop‐ ment and unique profile of every child, and a guide to create emotionally meaningful learn‐ ing interactions that promote critical functional emotional developmental capacities. The objectives of the DIR Model are to build healthy foundations for social, emotional, and intel‐ lectual capacities rather than focusing on skills and isolated behaviors [13]. The DIR de‐ scribes six milestones as crucial to a child's development. Parents and professionals involved with the child must comprehend how the milestones affect a child's emotional and intellec‐ tual growth. The six milestones, namely, Self regulation and interest, Intimacy, Two-way communication, Complex communication, Emotional ideas, and Emotional thinking, are ex‐ plained below. Individual difference is the unique biologically-based ways each child takes in, regulates, responds to, and comprehends sensations such as sound, touch, and the plan‐ ning and sequencing of actions and ideas. While children may be very hyper sensitive to touch and sound, others may be hypo sensitive, and still others seek out these sensations. Relationship is described as the learning relationships with caregivers, educators, therapists, peers, and others who tailor their affect based interactions to the child's individual differen‐ ces and developmental capacities to enable progress in mastering the essential foundations. Floor time, is central to the DIR model of early intervention. It enables professionals and pa‐ rents to assess and implement intervention programs that address the unique developmen‐ tal needs of children with autism. The major element of this approach entails that (a) professionals do floor time with the child (b) parents observe floor time being done with their child, and (c) parents change their style of relating to the child with regard to a given milestone. Floor time is a systematic way of working with a child with autism to help him or

able to complete a task successfully.

**5. The DIR model and floor time**


Collaboration with family or parents is a component of best EI practices. Parents of children who have autism play an important role; they are critical components of the intervention process, without whom gains are unlikely to be maintained. The involvement of parents in implementing intervention strategies designed to help their autistic children has a history stretching back at least three decades [12]. Parental involvement is an integral part of the success of early intervention programs for children with autism. The collaboration between the parent and the professional working with the child in the program is critical to the effec‐ tiveness of programs.

Traditionally, the EI for autism has been premised on the use of applied behavioral methods such as discrete trials. However, at times parents find the structure, organization and proto‐ col of behavioral intervention difficult to implement and maintain. Consequently, the pro‐ gram receives inadequate follow up in the child's home. There is a need for interventions that do not require a rigid structure and ensure parental involvement. Hence, in the recent years, EI practices for autism have seen a shift from behavioral methods to developmental approaches.
