The Autism Society Event and Education Recordings Archive

The LPDAC program is one of the most effective autism treatment therapies in South Korea for Children with ASD who have severe dysfunction in cognitive, language, and social abilities. The program has a total of 12 sequenced stages and each stage has 3 to 18 therapy sessions. It takes approximately 36 months for children to complete all 12 stages. The detail explanation of each stage and the long-term effects and outcomes of this program will be demonstrated. The LPDAC was originally developed by Moon-Hwan Yeo, a director of Korea Cognitive Research Institute for treatment of Children with ASD. It has been conducted as a longitudinal study and has been one of the most effective autism intervention programs in South Korea. The 7 nationwide clinics have provided intervention to children with classic and regressive autism for more than 20 years. The program is based on cognitive theory (Frith, 1987), which focuses on cognitive factors as the primary cause of autism.

This intervention program is mainly focused on the treatment of children with ASD who demonstrate severe deficits in communication, social skills, and cognitive development. Children with ASD receive the LPDAC therapy three times a week for 50 minutes per session. The program has a total of 12 sequenced stages and each stage has 3 to 18 therapy sessions. It takes approximately 36 months for children to complete all 12 stages.

The procedures for intervention, the Flowchart of Integrated Learning Structure, have been developed, and will be distributed at the presentation. The flowchart is made up of 3 parts: cognitive skill domain, language skill domain, and social skill domain. Each domain is sequenced in 12 stages and these three domains are intertwined. That is, the therapy is designed to treat the three areas simultaneously in a sequence of stages. Primarily, the cognitive domain is the one that combines all the other developmental stages and the growth of cognitive levels is the main measure for the progress of the participants’ developmental levels.

The therapy is comprised of intensive one-on-one individual and group therapy sessions. A typical therapy session breaks down multiple tasks into many small learnable steps. The decision of how many learnable small steps there are for one session is determined by the individual’s abilities and disabilities status, such as the level of cognitive impairment, language skills of both verbal and nonverbal capacities, and the severity of self-absorption. The severity of stereotypical or external behavior problems are not usually considered predictions of the child’s learning pace, but the severity of self-absorption is a more critical element predictor of how long the treatment will take for the child to reach the final stage.

Children with ASD receive individual therapy until stage six to seven and then they are strongly encouraged to join additional group therapy sessions three times a week starting from stage 7 to 12. As would be expected, to emphasize the importance of early childhood intervention, the most effective time to receive the treatment is around the age of three. By completing the 12 stages in the proposed 36 months, children with ASD usually begin schooling with their peers in a general education environment, usually without the need for special education services.

In the initial stage, Director Yeo evaluates the child and interviews parents prior to starting the therapy and the Head Teachers who mentor several teachers, assess the child’s progress and adjust the designed small steps to the child’s progress. Each therapy session consists of small sequenced steps with structured step-by-step modeling and prompts at the beginning of each new task. Gradually frequency of the modeling is reduced as the child performs the task independently. The teacher keeps running records after each session during the beginning stages and at least once a week during the later stages. This running record consists of the teacher’s general comments about how the child performed in the sessions and a description of child’s progress in three areas of language, cognition, and social development. The Head Teachers review the running records and give feedback to the teachers. These running records are also shared with the parents. 

After a 50 minute therapy session, the teacher meets with the parents for 10 minutes. The teacher explains what the child had worked on that day and discusses any concern either side may have. Parents are told not to replicate the therapy activities at home in an attempt to provide practice and enrichment.

The 12 stages are categorized into three types:  basic therapy (the stages 1 – 4), foundational therapy (stages 5 – 8), and main therapy (stages 9 – 12).  The basic therapy is focused on ‘the recovery of relationship and attention’, the foundational therapy is concentrated on ‘the development of concepts and visual perception’, and the main therapy is focused on ‘activating representation and mental imagination’.

Stages one and two are the most important stages for cultivating readiness skills for therapy, which manages the child’s inappropriate behaviors and ability to follow the oral directions. It may take several months for the child to master these two stages, but the child must thoroughly master them prior to engaging in subsequent therapies. In stage one and two, a teacher and the child will enhance social–emotional interaction and establish a strong trusting relationship. This is an example of an initial therapy session:

The teacher takes a child walk. The teacher has three courses to take a child to, walking to the convenience store, then to the playground, and coming back to the center. First, they walk in the street outside while holding the child’s hand and stop by the convenience store to buy the child’s favorite snack. The child may throw a tantrum or display inappropriate behaviors in the street and/or in the store. The teacher addresses the child’s behavior right away. The child may try to eat the snack they bought while they are walking to the playground, but the teacher stops him and makes him wait until they get to the playground. After buying the snack, they walk to the playground and let the child play for a while. When the child comes to the teacher, the teacher puts a piece of the snack into the child’s mouth. After coming back to the center, the teacher sits the child in a chair and gives him/her the rest of the snack.

The description of the activity in the first session seems simple and common as a normal outdoor activity routine, but its implication is significant on behalf of the teacher and child’s attachment and relationship. This simple activity may take a few months for some children to master due to the skills necessary for holding a teacher’s hand voluntarily, walking with the teacher without showing any behavior problems or resistance, and voluntarily stopping when showcasing inappropriate behaviors by teacher’s oral request.

When the teacher gives the child the snack, the teacher arranges about 10 small pieces of the snack in front of the child within an arm’s reach of the child. As the snack comes to the child’s mouth regularly after finishing a piece, the child understands that his or her teacher will give him or her another piece of the snack. As the child learns to wait until the snack is given, trust is building between the child and the teacher.  

Director Yeo calls this snack as Chin Hwa Je which means ‘a thing making close social-emotional relationship’. Through his method, a piece of cracker is a simple tool of delivering the teacher’s mind of approval and love for the child. How much the teacher takes care of and loves him or her is also delivered through the means of hugging, skinship, laughing, smiling warmly, complimenting and sharing. Through these positive interactive relationships, the child and teacher exchange their feelings and emotions and establish an entrusting relationship. The child’s trust of his or her teacher will induce the child to control and regulate his or her own behaviors.

Once the child trusts his or her teacher, he or she listens to the teacher and follows the oral directions the teacher gives. Stages one and two are designed to acquire the basic self behavior management skills necessary for the rest of the therapies. By the end of stage two, the child’s inappropriate behaviors are no longer shown and the ability of following oral directions is evidenced. When the teacher can manage and control the child’s behaviors consistently without prompts or difficulties, they can move to stage three.  

Stage three is critical as a first actual step for the treatment of cognitive deficits. Yeo calls this stage a Gak-Sung, ‘sensory arousal’ and it is the most critical stage for the development of cognitive function. Children with ASD have deficits in sensory perception and usually fail to perceive sensory stimulation from their environments. They fail to sustain attention long enough to transfer the sensory stimulation to perceptual level (cognitive level). That is, their short attention to the sensory stimulation does not sustain long enough for them to perceive and process the input. At this stage, the child recovers body sense through the feeling of tension and increasing arousal by various therapy activities which are designed to give children the feeling of tension and physical instability. For example, without warning, as the child is pushed to fall down on the sand repeatedly, the child will gradually sense the environment with awakening sense or tension, and will respond to show the anticipatory arousal reaction, of turning to the teacher at the moment of the teacher’s pushing and grabbing the teacher’s hands simultaneously in order to protect him or herself from falling. This child’s action is interpreted as a great change and improvement because the child perceived sensory stimulation through processing the sensory input and reacted to protect him or herself. When an unexpected event or piece of information is unpleasant, it produces arousal. This arousal is interpreted as both a cognitive and the physiological reaction to the stimuli (Brewer & Crano, 1994).

Stage four focuses on increasing and sustaining attention to the perceived sensory stimuli. The therapy activities of stage four focuses on increasing the length of eye contact, tracking moving objects, observing and imitating the teacher’s motion, moving objects with a balance, and other activities which require a great deal of children’s attention to master.

The therapy on recovering attention function continues through the subsequent therapy stages. Therapy activities gradually move towards to the development of children’s cognitive function and heavily focus on mental processing towards the final stages. 

Group therapy is another unique aspect of this program. It is critical for children to learn to sense and recognize peers around them, communicate with others, share emotion, and socialize with others. This group therapy is accompanied by with individual therapy.

Around stages 7 and 8, children are evaluated to see if they are able to receive group therapy. Yeo usually evaluates children for this. The main measure is the child’s level of mental processing (cognitive process). By this stage, most of the children’s external behavior problems should be under control, but mastery of it and other autistic related behaviors are not criteria for qualification of group therapy. 

Based on the evaluation, children are grouped heterogeneously. In this heterogeneous group, upper level children help lower level children to enhance their leadership skills and lower level children try to imitate upper level children. In group therapy, children are engaged in role-playing, discussions, games, and comparing each other’s drawing and writing, to develop social understanding and teamwork. Through this group therapy, they have the opportunity to share their emotions, learn about individual differences by comparing themselves with others, learn the feeling of cooperation, engage in competition, help their peers, socialize, and recognize interpersonal relationships.

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