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Question:            Why is it recommended that children not attend school during the first 6 to 12 months of in-home treatment?

Answer:  The main reason to place children in school is to improve their social skills.  Until children are verbal, however, or understand how to interact, they typically don’t interact even when provided with the opportunity to do so.  Placing a child who lacks these skills in school will result in some improvement as follows:

1. Learning to follow classroom routines.

2. Becoming more compliant.

3. Becoming more tolerant of other children being near by.

While children may seem to enjoy school because there are new toys there, school typically will not result in the child learning to speak or to interact with other children.  Some parents have attempted to compromise by sending their child to school for only a few hours per week.  However, this would make it hard for even a typically developing child to make friends. Furthermore, since school is usually in the morning when children are most alert, we lose the best time to work. Children are often tired after a morning in school, and trying to work with them in the afternoon therefore may result in slow progress.

Question:            How long does the treatment last?  What if a child isn’t ready to stop at the “typical time” that treatment is ended?

Answer:  Dr. Lovaas’ research utilised time limited treatment duration in order to test how much a child could improve prior to first grade.  He had already determined that younger children made the most rapid progress.  However, a large group of children are not ready to stop treatment at age five or six and will continue to make gradual progress over many years.

Question:  How many hours are necessary for the best progress?

Answer:  This is currently being studied by Dr. Lovaas and the Wisconsin Early Autism Project, S.C. is one of the sites involved in the study. Based on available data, 10 to 20 hours is probably not enough for most children, although some may do quite well with this level of intensity.  Unfortunately, we currently have no way of predicting which children will or won’t do well with 10 to 20 hours.  Based on our own research of our first group of children that have been in treatment for one year, it appears that children who averaged 30 hours per week progressed at twice the rate of children who received 20 hours per week.  Faster progress allows children to move into social interaction training at a younger age, and may therefore result in a better overall outcome. 

Children begin the programme at different ages, and the hours of therapy must be appropriate for each child’s developmental stage.  For instance, with a 2½-year-old, we might recommend a programme of 10 to 15 hours to begin with.  As the child ages, we would increase hours very gradually - building toward the optimal number of hours as recommended by the research.  Similarly, when we work with a 6-year-old child who is in school full-time, we would clearly not insist on 30 hours per week of in-home therapy.  We would most likely adjust the child’s hours to complement the work being done in school.  

The child’s supervisor will recommend the most appropriate number of hours required for best outcome.  Families who wish to work with us must be open to our recommendations and need to make all attempts to ensure that the hours be met.

Question:  What about other therapies?  Can children still receive speech or OT?

Answer:  Parents may implement any treatment they wish as long as we are able to deliver Lovaas treatment in an effective way.  It might be a problem for example if the speech therapist wanted to see a child several mornings each week, since we would then lose valuable time when the child is most alert.

We need to be informed of any dietary, vitamin, or medication treatments. If a child’s behaviour worsens, we may ask parents to stop such treatments or to change them in a programmatic way so that we can help determine their effectiveness and implement an informed approach to improving your child’s behaviour.  The Early Autism Projekt Stuttgart is aware of the potential benefits of adjunct therapies and would be happy to discuss them upon request.  If we feel there is a need for supplemental treatment, we will recommend this.

Question:  What are a parent’s responsibilities?  How can parents be involved in treatment?

Answer:                  Parents have an intuitive understanding of their child, which can be helpful in planning treatment.  There are several things they can do to make treatment more effective:

1.      Attend team meetings.  This is where the child’s progress is reviewed, problems are discussed, and new programmes are introduced.

2.      Do five hours per week of therapy.  This will allow parents to feel closer to the treatment process, to have an appreciation of their child’s progress and ability, and will provide them with the perspective necessary to know when therapy is going well and when a particular tutor is having trouble.

3.      Make the tutors feel happy that they are on their child’s team. Notice the positive things they do for their child and thank them for helping.  Remember that although tutors are paid, most do this kind of work out of a desire to help others.  They will work harder and be more committed to the child if they feel welcome and appreciated. 

4.      Help their child learn to generalise skills learned in therapy to other settings.  Check the data book for mastered items and work on these in other areas of the house or outside.  Talk with the Supervisors about how to generalise the SD’s. 

5.      Avoid the temptation to teach new skills that have not yet been addressed in therapy.  Doing so in effect increases the number of things the child is being asked to learn at the same time, and can result in stress, frustration, behaviour problems, and decreased effort. 

6.      Avoid the temptation to “rescue” the child if he/she is whining or tantrumming during therapy.  Supervisors are trained to deal with this.  They will reduce demands, increase rewards and play, and ignore misbehaviours.  No aversives or punishment of any kind will be used.  If a child becomes upset, the Supervisors will do everything possible to resolve the difficulty.  Rescuing a child may inadvertently reinforce and strengthen tantrumming and oppositionality, decrease the child’s willingness to attend during therapy, and damage the team’s sense that the parent supports and believes in them. 

Question:            What can parents do before therapy starts?  Are there some things that would be helpful?

Answer:            We do not recommend that parents start actual Lovaas programmes on their own.  Parents who have tried to do this after reading “The Me Book” or attending a lecture often run into difficulties.  Either they do the programming incorrectly, they don’t know when or how to advance the programme, or they lack experience to recognise when their child is having trouble and/or what to do about it.  As a result, several children were already in trouble when we arrived, and we had to work in a remedial way for several months before we could make progress.

Parents can help their child by playing with them.  Initially, the child will be disinterested, but with perseverance and physical guidance, parents can teach the child to play catch, chase, and use playground equipment.  Non-verbal, gross motor activities are the easiest.  Next, try toys such as the Fisher Price garage or a car racetrack with a hill to roll cars down.  Demonstrate how to use the toy one action at a time, and physically guide your child to do the same.  Turn taking toys are also good.  Teach the child to take turns stacking blocks, using pounding toys, a xylophone, or building a train track.  The idea of all these interventions is to increase the child’s responsiveness to social cues and people in general.  If the child resists or wants to leave, stop briefly, but then try again.  Children who have had this kind of interaction training have a head start in attending and often move more quickly through the initial phases of Lovaas treatment.

Question:            Can tutors help with child care tasks?

Answer:            We recommend that tutors be hired to provide Lovaas therapy only.  Therefore, in order to make the best use of the tutor’s time, parents can do the following: 

1.      Be present or hire an adult to be present whenever tutors are in the home (parents may leave to take other children to school, etc., but they must be back before the tutor is due to leave for the next child’s therapy session).

2.      Have the child awake, dressed and fed when tutors arrive.

3.      Have treats and reinforcers ready.

4.      Do not expect tutors to take on “child-care” roles such as changing nappies, feeding, babysitting, bathing, etc.

5.      Avoid asking tutors to transport the child.

6.      Avoid asking tutors to implement non-Lovaas treatment approaches (e.g. sensory integration therapy procedures, physical therapy procedures, administering medication, etc.).

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