Treatment of generalized developmental disorders

TGDs are a very complicated issue that requires the help of professionals, so since we identify some possible symptom of these disorders, it is convenient to go to doctors, and psychologists to be able to identify whether it is any of these problems or not. Next, in this psychology article we explain The treatment of generalized developmental disorders, As autistic disorder, RetT disorder, child disintegrative disorder, asperger disorder and generalized developmental development disorder.

1. Intervention programs in deficit skills - TGD treatment
2.  The topic
3. Gather information for history
4. Consider the guidelines applied to writing for people SA
5. The proportion of sentences
6. Incorporate the preferences and interests of the student in a social history
7. Presentation, review and monitoring of a social history
8. The implementation of TGD treatment programs
9. Intervention and Treatment Programs in Skills Power
10. CONCLUSIONS ON GENERALIZED DEVELOPMENT DISORDERS

Intervention programs in deficit skills - TGD treatment

The Intervention programs where greater emphasis has been placed and whose research has been more fruitful has been mainly the development of social skills training programs (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 skill training program lies in helping the child who suffers some type of disorder within the autistic spectrum to develop, improve or acquire greater awareness and understanding of the perspective of others. In this way, this will show greater competition in social skills such as conversation, equal relations, cooperative play, conflict mediation, self-regulation and problem solving skills. The sessions are usually highly structured and begin with an evaluation of the skills of individuals and end with brief reports of the progress carried out by these.

Methods such as Role-Playing or Simulation are widely used in this type of programs, with the aim of generalizing the situations raised during the program with those that usually occur in daily life. Learning to play, share, negotiate and commit themselves are crucial skills that must be taught through the combination of explicit teaching and the experiences of daily life.

One of the methods widely used for the teaching of social skills in children with schools has been that of social stories. This technique, developed by Gray (1998), is based primarily on the teaching of social skills through stories that objectively describe people, places, events and social concepts or concepts, following a specific content and format. 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 stories effective requires six basic elements that we will see below.

 The topic

He Theme of social stories 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 disturb the same. They should also be used to describe future situations or introduce new skills in the repertoire of this, with the aim of preventing negative responses in the future and thus preserving the child's self -esteem.

Gather information for history

The understanding of the situation to describe must go through a detailed study by the instructor through observation and interviews with relevant people. The observation of the main keys of the situation will determine the argument of the final history. These play an essential role, since they define the situation and make up 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 it has ended and children must return to class.

Consider the guidelines applied to writing for people SA

Social history must be developed according to the individual characteristics of those students being taught (eg. Age, reading capacity, understanding, attention level, etc.). Social history must transmit relevant information, ignoring unimportant details and highlighting those guides that are key to the understanding of the same. Stories should be written in the first or third person. The phraseological typology that must include the social stories developed are the following:

• Descriptive: objectively describes where the action occurs, who is doing it, 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 history.
• Of perspective: these prayers describe the internal states of people. These states can be: physical states, desires, thoughts, beliefs, motivations, etc.
• Directives: This type of sentences clearly define the behavior expected, a certain character is carried out before a key or situation. These types of phrases guide behavior and directly influence the behavior of the child with SA, since their learning is literal, which intensifies the influence of this type of directive sentences in its behavior.
• OF CONTROL: This type of sentences are written by children with the aim of identifying valid strategies, remembering information included in a social history, providing security or giving you the opportunity to test your own answers. These types of statements allow the child to identify those significant personal strategies to handle difficult situations.

The proportion of sentences

The proportion of social history prayers defines the relationship between the amount of descriptive, perspective, directives and control in complete history: social stories must describe more than direct. The number is usually between 0 and 1 for directive or control sentences and between 2 and 5 for descriptive or perspective sentences.

Incorporate the preferences and interests of the student in a social history

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

Presentation, review and monitoring of a social history

It is necessary to prepare a draft prior to the presentation of social history to the child. This draft must be reviewed by parents and people directly involved in the child's learning with the aim of evaluating it and carrying out the appropriate corrections. Once the corrections have been established, the implementation plan is programmed, which includes the presentation schedules and the instruction methods that accompany the story.

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

Another method proposed by Sibón (2010) for the teaching of 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 carried out in each of the specific social interactions. These may 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 of Rao et al. (2008), social scripts were used as a method of intervention for the improvement of specific social skills. These specific skills consisted of the management of conversation, greeting and game. The program was established through a weekly sessions of 2 hours for 8 weeks. It should be noted that a group of typically developed peers were included in the development of sessions, which had been trained for participation in the program. Each child affected by ASD was paired with a child trained during the development of the sessions. The results evidenced an improvement in the management of greeting and those skills that had to do with the game, but no significant results were found in the abilities related to conversation.

According to the study carried out by Owens et al. (2008), there are other approaches in training social skills in children suffering from SA. Behavioral intervention mediated by equals has shown significant results, as we have just seen. In this approach, a child with a typical development (child's companion, designated as a tutor) is responsible for teaching, promoting and strengthening the social behavior of the child who suffers from any ASD. Despite the good proven results, these types of interventions are expensive and consume too much time.

The training groups in social skills included in the curricula that are implanted in schools and institutes give the opportunity to those adolescents who suffer from observing behavior models in their typically developed classmates. These intervention programs have shown high effectiveness, mainly in the beginning and development of social interactions, recognition of emotions and resolution of group problems, although 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) both types of interventions are combined, that is, an intervention program inserted in the school curriculum was applied where the figure of fellow tutor existed during its development. 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 subject to the intervention program in those skills that had to do with eye contact, verbal expressions in relation to interest in the partner, cooperation and affirmation capacity.

The implementation of TGD treatment programs

Another of the conceptions that the authors have in relation to The implementation of training programs in social skills in children who suffer from SA resides in the greatest 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 greater generalization of the abilities learned, in addition to the increase that entails in relation to the motivation for learning and the involvement in behavioral change.

In a study carried out by these authors, they compare the results obtained in two types of interventions for the teaching of social skills: one of them, based on an approximation more focused on the interests of the child where the "Lego" game was used as mediating experience through which to insert learning, and another based on a more traditional approach, called Sulp (Social Use of Language Program), which is applied in schools with the objective of training in linguistic and communication capacities to those Children who present difficulties in learning (for an exhaustive 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 subject to Sulp therapy and another control group. The contents of both intervention typologies are as follows:

-Lego therapy: The main objective of this type of program lies in motivating the child for joint work through construction 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 right pieces) and the builder (placed the pieces). This division of labor allows subjects to launch joint care strategies, word resolution, problem solving, in addition to the promotion of cooperation, listening and social skills behaviors in general. Other intervention modalities lies in free game, without guidelines marked by the researcher, where participants have the opportunity to practice commitment, the ability to express their ideas, in addition to taking the perspective of the other. During the development of activities, the therapist remains present with the group of children. The function of this is not directive or provides specific solutions to the problems that may arise, their work is based on highlighting the existence of some problem and helping individuals seek a solution for 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 the teaching of skills related to proxemics, prosody, listening, word shift and eye contact. Normally, sessions usually begin with a story where a character presents a social difficulty, which solves through adaptive or not. Later an adult model shows the good social skills that must be launched in the situation and also the negatives that should not appear. Children should evaluate the situation and ask questions in addition to identifying errors and proposing solutions. Once this part of the session is finished, children proceed to put the ability into practice through a series of scheduled games. This approach would be distinctive of those more traditional approaches in social skills training, since it makes use of social stories and methods such as role-playing or modeling, procedures that have been carried out in training in more traditional social skills.

The results obtained, as expected, are disparate. Both Lego therapy and Sulp therapy significantly improved children's social skills, although in some aspects a typology of intervention produced greater effects compared to the other. Generalized, LEGO therapy produced major significant results compared to Sulp therapy (reduction of the specific social difficulties of autism, greater generalization of learning). However, improvements were seen in different aspects of communication based on the type of intervention to which children had been subjected, which makes the authors think that each type of program has different objectives to improve.

In short, it seems that, although with disparate results, social skills training programs applied in children affected by ASD are effective. Despite the varied 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 could be verified, numerous studies were evaluated that had carried out different types of intervention, not being negative results in most cases.

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

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

In this work, it is highlighted that the approach to the individual through their areas of interest, in this case, the video game, is a good strategy to induce the individual to practice in addition to significantly increasing their motivation, and therefore, and therefore His learning. On the other hand, the practice of group sessions where techniques traditionally proven such as role-playing, modeling or social scripts are launched provides a necessary complement to learning, allowing the individual to implement the learned skills and observe adequate models of conduct. These two reinforced intervention lines together with the training of parents and the information towards the teachers, allowed the generalization of the skills developed during the course in the child's environment, thus doing this way that they will be established in the usual behavior pattern of the same behavior of the same and therefore, they were maintained in the long term.

Intervention and Treatment Programs in Skills Power

One of the most important questions that all those researchers who have studied the special skills presented by those individuals affected by a ASD have been asked, especially the geniuses called "Savants" has been ¿It is more important to correct "defects" or train talent? The answer has been clear in most cases, train talent (Treffert, 2009). According to the author, in the way 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 gifted individuals. 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 gifted (enrichment, acceleration and guidance), together with the intervention strategies of the TEAs that are have explained previously (visual aid and social stories). According to the author, the objective of combining both strategies resided in the possibility of reducing the evil behaviors of this group and channeling those developed strategies, in order to a potential development of their skills. As the author quotes, this study program has been very successful in the empowerment and channeling of outstanding skills, but also in autism's own behaviors. These improvements have been related to the general behavior of individuals, their academic self -efficiency and social skills.

Donnelly and Altman (1994) They have warned a notable increase in recent times of population inclusion characterized by some type of autistic spectrum disorder in the curricular programs adapted for gifted subjects without any disorder. The elements that characterize this type of programs are the disposition of a specialized mentor in the leading field of the child, individual advice sessions and group training of social skills. This fact shows the growing visibility that the group is having in the school environment, including children with some autistic characteristic in this type of academic empowerment programs.

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

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

The Orion Academy in California (United States) has specialized in the development of a positive education experience for high school students with SA. The school's educational program is based on addressing both the individual and social needs of the group, in addition to enhancing those outstanding academic capabilities. According to center workers, the program is designed based on a safe learning environment, with a specific approach to improving motor, social, emotional or viso-spatial disabilities. This program includes the inclusion of high -level academics specialists in this type of disorders, which makes possible specialized attention. In general, what the school pursues in promoting at all times the developing capacities that individuals may present but without forgetting to improve those deficit skills related to social interaction.

Hope University in California (United States), It is an adult plastic arts center with developmental disabilities. Its mission is to train talents and reduce disability through the use of artistic 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 such as social skills are developed, the resolution of problems, the recognition of emotions in others or cognitive capacity, among many others.

In Spain, today, there are no educational centers that follow a line as specific as the described centers. In this sense we can find special educational centers that mainly work aspects that have to do with disability or centers that work with talents, but independently, there is not a determined educational curriculum for those children who share both characteristics. This educational vacuum limits in many ways the current and future capacities of this type of individuals. As the authors say, special skills can be a child entrance door to society, demonstrating that their diagnostic label is nothing more than that, a label, so that they are able to develop extraordinary skills if they have the necessary support for part of society. But this fact cannot be given if this group is not taught how to start, maintain and finish a conversation, in addition to enhancing their musical skills, for example.

CONCLUSIONS ON GENERALIZED DEVELOPMENT DISORDERS

Currently, autistic spectrum disorders contemplate a complex network of clinical characteristics that make its understanding and treatment difficult. Numerous professionals both based on their clinical experience and their research, have developed studies with the aim of bringing the understanding of this type of disorders closer to the scientific community. Its etiology still is known, although certain explanations that allow hypothesizing in a more reliable way those causes that are at the base of the disorder are already appearing. Leaving that psychoanalytic casuistry where emotional rejection by parents constituted the central cause of the child's pathology. The advances in this sense, together with the experience of professionals in relation to the diagnosis and treatment of these individuals are making the set of professionals rethink the functionality of a categorical division of the disorders included within the sub-Category of the Category of the Autistic spectrum.

In this sense, the future statistical manual and diagnosis of mental disorders in its fifth edition will establish, almost irrefutable, a single disorder to categorize those individuals who present a common symptomatology referring to problems in social interaction and communication, in addition to restricted activities and interests. In this way, under the name of "autistic spectrum disorder" what was included in the DSM-IV will be known as the Asperger Syndrome, Autistic Disorder, Child Disintegrative Disorder and Generalized Development Disorder.

In this way, it is highlighted that the categorical difference of this type of pathologies has not delimited a representation of reality, since as explained at the beginning of work, in most research, the authors have found that the subjects diagnosed with a disorder within the spectrum complied with the criteria established by others. Sometimes, the differentiating characteristic resided in the subjective trial of the clinic. In this way, the diagnosed subjects faced labels that in most cases only served to differentiate the individual in the name, since the symptomatology is common, and therefore the intervention strategies, in my opinion, must also be, always maintaining the individualized nature of each therapeutic process, where they must adapt to the individual characteristics of the subject.

One of the fields that has not raised much work in this population have been the extraordinary capabilities they present. Although research has been conducted, the greatest weight of studies has resided in the analysis of those deficit behaviors, specifically communication and social interaction in the SA.

This fact, adopted from the traditional medical orientation, has forced to neglect the study of the characteristics that allow the individual with tea to present developed skills that are not found in the bulk of the normal population. And with this, the study of the utility that these capacities can have when establishing intervention programs in the improvement of deficit skills has also been obvious.

As it has been observed, the traditional development of the research studied by those effective intervention programs in the training of social and communicative skills of children with SA revolved around social stories and those traditional methods in psychology for the training of these capacities , such as modeling and role-playing. This resulted in the development and application of numerous programs that used this type of strategies as the main intervention line. Although the results obtained with this type of programs were significant, and in general, individuals improved their communication capabilities, there were still limitations. Specifically, the results were not maintained in the long term in all studies, there were problems in the generalization of the skills learned in interventions and in some cases, it was shown that different interventions worked different capacities, so there was no integrating program that will work All those strategies in which subjects with ASD have difficulties. Currently, this fact is attempted, applying multi-modal intervention strategies, that is, intervention programs where each and every one of those strategies that have been significant in the studies carried out traditionally. These strategies require a greater psychopedagogical approach, so that more attention is given to the special educational needs of these individuals, thus increasing their ability to introjection of those contents and skills that are intended to teach the child, in addition to increasing their motivation and involvement in the learning process.

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

However, despite the fact that these new approaches represent a great advance in the treatment of children who suffer from this pathology, the capacity of the special skills of these individuals to increase the effectiveness of learning are obvious in most cases to increase the effectiveness of learning. Although there are no conclusive data, some educational centers are using this type of capacities such as learning mediators. As has been seen, artistic and musical capacities are configuring the specific treatments base where the improvement of social interaction and communication capacities among many others, play a fundamental role. This fact shows that the use of those extraordinary skills that we talked about at the beginning of this conclusion can be a very valuable tool when establishing or improving deficit behaviors in individuals with ASD with ASD. While it is true that not all those individuals who present a pathology of these characteristics have developed skills that come out of the ordinary, if there is a capacity for systematization, attention and sensitivity developed that at its expression would mean the origin of this type of capacities. This form of processing should be taken into account in the implementation of intervention programs, since as expected, it has serious implications in the learning process.

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

This article is merely informative, in psychology-online we have no power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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