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Review of a program for systematic intervention for children of preschool age with Autism Spectrum Disorder in Greece

Sotiris Kotsopoulos

Child psychiatrist in charge, Day Centre for Children with Developmental Disorders, Messolonghi, Greece

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

DOI: 10.15761/PD.1000213

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The long search for the nature and origin of the Autistic Spectrum Disorders (ASD) has in recent years settled with acceptance of the paradigm of neuro-developmental disorder, which according to the evidence often begins during the intrauterine development [1]. The clinical manifestations of the syndrome begin to become evident in the first year from birth and are distinct in the second year [2], when the clinical diagnosis may become clear. The distinguishing anomalies in the brain vary and so do the various symptoms that the child presents. The main signs, above the various symptoms of the disorder that characterize it, consist of the severe difficulty in the ability to communicate and the show of stereotypies. Present is also the difficulty in the development of language. Other symptoms that emerge early in childhood may subside as the child develops.

While a plethora of research problems draw the attention of clinicians and researchers on the child with ASD, the parents who have a child with this problem are greatly preoccupied with his/her management and his/her future development [3]. Depending on the capabilities of the family and the severity of the behavior problems of the child the dilemmas on his/her management may cause substantial strain on the family [4]. Specific etiological therapy of the ASD does not exist; however, therapeutic interventions that have been developed in recent years may limit the behavior difficulties of the child. It is not very long in the past that individuals with ASD remained depended on services and institutions for years due to incapacitation by the disorder. For example in Sweden, as reported by Gillberg [5] a sample of 66% individuals with autism were dependent for life, while Fernell [6] showed that despite treatment all children formerly diagnosed with autism continued to present with symptoms. The prospective for a positive development, however, began to change from the contribution by Lovaas et al., [7] of the Applied Behavior Analysis (ABA).

The Lovaas method consists of a detailed and systematic teaching of social capabilities and depends on the principles of ‘operant conditioning’ [8]. The results of the method ABA as applied by Lovaas and coworkers [7] in intense programs that are for 2 years were impressive: 40 hours per week, at home, school and community. Modifications of ABA with enrichment in theory and practice have been proposed by Koegel and Koegel [9] and Rogers and Dawson [10] and for academic application and usage the method TEACCH [11].

In Greece various ABA modes are offered individually or in small groups. A program that may apply to the whole of the country and may be supervised by the educational authorities for children of preschool age has not been developed yet. Programs in small scale are offered by groups organized by parents and specialists with the support of government services.

In 2003, within the frontiers of the government program ‘Psychargos’ for general psychiatric care, the minister K. Stefanis accepted a proposal for the creation of a specific unit for the early diagnosis and intervention for children of preschool age with autism, in Messolonghi Western Greece. A similar project did not exist at the time in any Greek province. The initiative at the time the effort began was at point zero. The project now seventeen years later has achieved its objectives according to the opinion of the workers involved in it. The program is financed by the state.

Day centre for children with developmental disorders

Settings up the Day Centre and the difficulties encountered in the first years of operation have been presented in a paper published in 2016 [12]. Now completing the operation of the program appears to have achieved a level of maturity. The community at large and the pediatricians in particular, informed about autism, refer children 2,8 yrs old on the average, suspecting severe developmental disorder for an expert assessment and possible therapy. The staff responds promptly and the child with the parents is assessed by the child psychiatrist. Children with ASD and severe language impairment are referred next to therapists of the program while those with other developmental disabilities are referred to other services in the province. Those referred to therapists complete the assessment program. The program runs with a capacity of 46 children with autism and 20 with severe language impairment per month.

The assessment program includes the administration of the tests: Cars, Vineland, Raven, and in certain cases ADOS-2. Therapy starts with one therapist and in about 3 weeks is joined by two other therapists from different disciplines who observe and play with the child. When observation is complete the therapists meet and complete EDALFA.

EDALFA is a tool that has been a product of the staff and consists of a scale with developmental steps of seven domains from birth to 6 years [4]. The tool was based on eight international scales of typical development of the child and on books of psychology, speech therapy, occupational therapy etc. When the EDALFA for each child is completed, it shows the developmental level at which the child stands and the steps lying ahead that the child has to conquer while in therapy. The therapists then focus jointly and work on helping the child to master the targets that come automatically after the completion of EDALFA. The treatment program is throughout based on behavior lines. The therapists improve continuously their skills on the ABA method. The work with the child is done in a pleasant environment and with the love of the therapists being evident and approving for the success of the child.

An analogous line is followed with the cases with severe Developmental Language Disorder. The speech –language therapists are using a method ‘Phoneme Touch and Say’ [13] that has been found effective in children with language delay and dyspraxia [14]. The method’s main characteristic consists in producing sounds of phonemes while touching parts of the face that are involved in the production of each sound. In occupation therapy the method ‘sensory integration’ has been in use introduced on the advice of the Association of Occupation Therapists. Consultative work with parents by the social worker has been systematic [14].

At the completion of two years of individual and group therapy and when the children reach kindergarten age, they enter a school preparation program that is of substantial help to those who would proceed to regular school classes. The program was developed at the Centre, it involves three disciplines: special education, occupation therapy, psychology with exercises on writing, phonological awareness and rules of school functions.

The results of systematic therapy are encouraging. Summing up the outcome of therapy 32 children with ASD, out of 52, reached a level of development that allowed them to enter regular classes in public schools near their homes. The remaining was directed to special schools of the region.

Social initiatives

The Day Centre took the initiative to organize the first three national conferences on ASD (2007, 2009, and 2011) in Greece contributing in the establishment of the National Association of Professionals who work with children with autism. The Association organizes national conferences on autism every two years and other activities. Research in a limited scale has been conducted by a few members of the staff and published locally or presented in international media. The Day Centre has accepted graduate students from the School of Speech-Language Therapy of the Technological Institute of Patras for six months on the job training.

The limits of the program

Despite its success as an institution dealing with very young children with ASD and the appreciation expressed by parents and a general view of a successful institution, the Day Centre is isolated in the local community of Messolonghi and the nearby region. Staff is seldom invited to present its work and offer expertise to others dealing with children with ASD. The Centre is particularly excluded from the primary and secondary education institutions of the region by a national law which aims to protect the schools from private initiative individuals possibly trying to exploit school activities for their own clients. Our efforts to change the law have failed so far. The Centre is still considered by individuals a private service regardless of its existence being totally supported by the government.


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Editorial Information


Michael A. Portman
University of Washington, USA

Article type


Publication History

Received: March 17, 2021
Accepted: March 24, 2021
Published: March 29, 2021


©2021 Kotsopoulos S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Kotsopoulos S (2020) Review of a program for systematic intervention for children of preschool age with Autism Spectrum Disorder in Greece. Pediatr Dimensions 6: DOI: 10.15761/PD.1000213.

Corresponding author

Sotiris Kotsopoulos

Child psychiatrist in charge, Day Centre for Children with Developmental Disorders, Messolonghi, Greece

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

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