The Son-Rise Program®: Is There Science Behind That?

Stacha C. Leslie, M.Ed., BCBA, LBA, Catherine L. McHugh, MA, BCBA, LBA,
and Thomas Zane, PhD, BCBA-D
Department of Applied Behavioral Science, University of Kansas

Is there science behind that Treatment for individuals with autism often involves a multidisciplinary team approach to address all aspects of an individual’s environment. Given this, advancements in autism treatment emphasize the inclusion of primary stakeholders (e.g., parents and family members) as an integral part of the multidisciplinary team, from initial diagnosis and assessments to delivery of recommended treatment. A program demonstrating long-standing popularity that emphasizes parents as primary clinicians is the Son-Rise Program®.

What is the Son-Rise Program®?

The Son-Rise Program® (SRP) was founded in 1983 by Barry and Samahria Kaufman. After receiving their son’s autism diagnosis, the Kaufmans found available treatment options to be unsatisfactory and developed their own method of autism treatment behind the precipice of “bonding through acceptance” (Autism Treatment Center of America, 2022). The group reported that the treatment cured “all symptoms of autism” for their son; thus, the Kaufmans began disseminating SRP procedures through training other parents and related service providers. SRP was designed to serve individuals ages 18 months to 60 years old with a diagnosis of autism and intellectual and developmental disabilities. It is reported to be defined as a child-centered, developmental approach to treatment for individuals with autism and developmental disabilities intended to be implemented in a home-based program by primary caregivers (Autism Treatment Center of America, 2022; Houghton et al., 2013). SRP is delivered in a child-adult dyad, in a distraction-free and naturalistic environment that emphasizes spontaneous, child-initiated interaction (Houghton et al., 2013; Thomas & Jenkins, 2016). Although SRP employs techniques found in other approaches like naturalistic teaching and pivotal response training (PRT; Koegel et al., 1999), SRP differs in that adults never initiate interactions with their child. Rather, the adult (i.e., parent or caregiver), engages in “parallel imitation” until the child initiates an interaction with them. For example, if a child is engaging in repetitive behaviors such as hand-flapping, rocking, or rolling a car the adult will imitate the child until the child initiates an interaction. Following child-initiated interactions, adults will provide general praise (e.g., “Nice job!”) and then “invite the child” to participate in additional interactions. That is, if a child is rolling a car and then makes eye contact with the adult, the adult may say, “We can also push the car up the ramp like this!” and provide a model of this interaction. The overall aim of SRP is to increase the frequency and duration of child-initiated social interactions, thereby increasing their overall social abilities (Kaufman & Kaufman, 1995).

How is The Son-Rise Program® Implemented with Children with Autism?

We direct your attention to the Autism Treatment Center for America’s website on the Son-Rise Autism Program®, which includes several informational tabs about SRP, including the SRP training sequence. A brief review is included here. Following enrollment in SRP, parents complete a five-day, intensive remote course focused on teaching the seven main principles of SRP. These principles include (1) joining – entering the child’s world; (2) utilizing motivation – unlocking unseen intelligence; (3) teaching through play – designing games to break through challenges; (4) creating meaningful relationships – prioritizing social goals over academic goals; (5) you hold the keys – parents are the most important ingredient; (6) a loving and respectful attitude – using a non-judgmental, welcoming, attitude to increase responsiveness; and (7) creating the optimal home environment – a distraction free work and play area to maximize growth (Autism Treatment Center of America, 2022). After this intensive course, parents are invited to attend the “maximum impact” course designed to practice attitudinal guidance to overcome setbacks and struggles they may experience while implementing treatment recommendations from the SRP program.

The SRP staff highlights three primary areas of focus for the treatment of individuals with autism including restricted and repetitive behaviors (referenced as “stims”), communication delays, and problem behavior. With respect to restricted and repetitive behaviors, SRP suggests these activities or behaviors are important to the child and may be useful to self-regulate, combat sensory overload, and gain a sense of internal control. Thus, treatment recommendations include parents joining their children in engaging in repetitive behaviors and refraining from initiating interactions or interrupting them. To address communication delays, SRP encourages caregivers to send the message that “every word matters,” placing emphasis on useful and fun language to increase motivation. Thus, treatment recommendations include responding quickly to any sound a child makes, showing that every spoken word results in an action by providing access to corresponding consequences (e.g., “If your child says “up,” pick them up.), and celebrating every attempt at communication. Finally, to address problem behaviors (e.g., screaming, crying, hitting, throwing items), SRP encourages caregivers to view problem behavior as a means of communication that may have been effective in the past. Thus, treatment recommendations include withholding reactions to problem behavior, explaining in a calm way that you are misunderstanding your child, minimizing personal reactions, and avoiding giving the child the “pay off” they want (Use the Son-Rise Program® to make an immediate impact on your magnificent child, 2019).

At first glance, SRP seems like it may be a socially valid treatment that, with enough training, can be implemented by parents in their homes without the need for additional professional support. Additionally, SRP seems to mitigate common barriers (e.g., costs of professional services, time allocation, proximity to professional services) that likely prevent caregivers from accessing treatment. But wait – is there science behind that?

Does Science Support the Son-Rise Program®?

Although caregiver testimonials are provided on the SRP website, most of the empirical research on SRP outcomes comes from two studies comparing the effects of SRP treatment groups (receiving 6-40 hours of SRP treatment per week) to control groups (receiving no or less amounts of treatment). Houghton et al. (2013) compared the effects of clinician-delivered SRP treatment (six children with autism) and a no treatment group (six children with autism) on the frequency of spontaneous social orienting (i.e., orienting head towards the clinician) and the use of communicative behaviors (i.e., vocalizations made with single words or utterances or gestures), as well as the duration of social engagement episodes (i.e., two more consecutive communication exchanges). For the SRP treatment group, baseline sessions consisted of direct observations of the child’s behavior over seven days. Treatment sessions consisted of 40 hours of intensive clinician-implemented SRP treatment across five days which included three basic techniques (a) joining or imitating the child’s activities or movements, (b) provision of immediate and naturalistic feedback to child-initiated interactions (i.e., praise and acknowledgement), and (c) prompts/expansions of child responses or suggestions for new activities. Results showed that clinician-implemented SRP resulted in increased frequency of social orienting (i.e., head orientations and gestures showing medium-large effect sizes; however, verbal behavior (i.e., communicative responses) and increased durations of social engagement episodes showed no clinical significance. There are some limitations of this study worth mentioning. First, treatment was delivered by SRP clinicians for only five days and parent training (beyond basic information about procedures) was not provided; thus, the generalization and maintenance of effects are unknown. Second, session durations used for data analysis only included a randomized selection of 60-minute segments of treatment across the five-day period. Finally, the control group in this study received no intervention which provides insufficient data to compare SRP outcomes to other treatments or varying degrees of SRP. Thus, the results suggesting the efficacy of SRP should be preliminary at best.

Thompson and Jenkins (2016) evaluated the effects of training 49 parents to deliver SRP treatment to their child diagnosed with autism. Following two, five-day parent training courses focused on SRP procedures, parents were asked to implement 40 hours of SRP procedures per week in their homes. A pre- and post- questionnaire was provided to evaluate the degree to which (a) speech, language, and communication, (b) sociability, (c) sensory and cognitive awareness, and (d) health and physical behavior changed for each of their children over time. Following parent implementation, results were divided among three groups based on parent-reported, weekly delivery time of SPR procedures. Groups included the “no SRP” group (0 hours), “lower intensity” group (6 to 20 hours), and “higher intensity” group (22 to 40 hours). Results showed parents reported more significant changes for children in low and high intensity groups as compared to those in the no treatment group. However, this study is not without limitations. First, researchers did not directly observe outcomes of children receiving treatments or administer any standardized assessments of the children’s cognitive, social, or communication abilities pre- or post-treatment. Although pre- and post- survey results were evaluated, these data do not sufficiently support a determination of intervention efficacy or child outcomes over time. That is, without direct observation of child outcomes throughout treatment, we are unable to determine how treatment changed or did not change child behavior. Second, there were no reliability or treatment integrity measures to evaluate the degree to which parents implemented procedures throughout the week; weekly delivery times were based on parent reports.

In addition to these two studies, a handful of studies have evaluated additional domains and compared SRP to other autism treatments. Williams and Wishart (2003) evaluated the social validity of SRP by investigating families’ experiences using SRP procedures. Researchers found SRP led to more drawbacks than benefits for families over time. Williams (2006) evaluated implementation patterns (i.e., procedural integrity) across caregivers and found recommended SRP procedures (40-hours per week by parents) to be inconsistent and often impossible to implement due to various external variables (e.g., time, competing contingencies in home, etc.). Most recently, Mirzakani (2022) compared the effects of SRP to Floortime (a non-evidence-based treatment for individuals with autism) and found Floortime programs to be more effective in increasing social interaction.

What Else Should We Consider?

In addition to the lack of quality research conducted on the effects of SRP, we must also consider the individuals that the SRP group reports to champion as the primary administrators of their procedures – parents and family members. It goes without saying that parents and family members are the most important change agents in the lives of individuals with autism, not only as their support system but as experts in their child’s growth and development. To ensure their effectiveness, parents should be trained by qualified professionals to implement evidence-based strategies and provided with ongoing monitoring to ensure strategies are implemented with high procedural integrity. We run the risk of hindering the progress of individuals with autism and their families when parents are provided with tools that lead to more drawbacks than benefits (Williams & Wishart, 2003) or tools that potentially add to the already existing barriers to accessing treatment (e.g., time, costs, and competing contingencies in the home; Borrell, 2017; Williams, 2006), especially when procedures are unclear and difficult to implement consistently (Williams, 2006).

Finally, it is worth noting that some aspects of SRP are implemented and supported in other evidence-based treatments for autism. For example, behavior-analytic interventions like functional communication training (FCT; Tiger, 2008) also support caregivers (or other relevant stakeholders) in teaching and reinforcing appropriate communication responses (i.e., providing access to desired items when requested without challenging behavior). Another example is the use of natural environment teaching methods (NET; Pisman & Luczynski, 2020), during which caregivers are encouraged to embed teaching opportunities into play and natural routines to make the environment a more fun and inviting place to learn. What differentiates these treatments from SRP? They are supported by years of repeated scientific studies demonstrating their efficacy and generalizability. Yet, despite the similarities between these treatments and those used in SRP, SRP continues to use their resources (i.e., websites, testimonials, etc.) to discredit their effectiveness. We implore our readers to be cautious of programs that focus their marketing methods on the discreditation of others without scientific evidence to support their claims. If an intervention or program aimed at improving the lives of individuals with autism and their families is effective, the results will speak for themselves – not just through client testimonials, but through scientific research demonstrating the generalizability and replicability of the program’s effectiveness across time. Further, SRP is marked by over 35 years of implementation. Yet, the lack of current research and recent diagnoses updates on the SRP website suggests staff are not abreast of current, evidence-based procedures used to support their clientele. This demonstrates a reluctance to adhere to what may be the most socially valid method of making meaningful differences in the lives of the families they serve.

Final Thoughts

Limited empirical research has been conducted on the impact of SRP and autism. Although parent and teacher testimonials suggest SRP may be effective for increasing social abilities, there is insufficient scientific evidence to suggest this as an effective treatment to mitigate potentially severe deficits in individuals with autism, including deficits in communication and the occurrence of challenging behavior. Comprehensive research is needed on both parent training and the effectiveness of parent implementation in children with autism. That is, research must first examine if there is a causal relationship between the use of SRP procedures and positive changes in autism symptomology and then replicate these positive results. They must then evaluate the use of caregivers as primary implementers of the procedures, followed by a closer examination of SRP time-delivery requirements based on autism symptom presentation or adaptive functioning levels. There is much research to be done before the widespread use of SRP should be supported. Therefore, caregivers and clinical professionals should not use or recommend the use of The Son-Rise Program® as a scientific treatment for autism at this time.

References

Borrell, B. (2017, September 22). Can you cure autism? For this non-evidence-based treatment center, the answer to that depends on how much you’re willing to pay. Slate Magazine. Retrieved March 10, 2023, from https://slate.com/technology/2017/09/an-in-depth-look-at-the-son-rise-program-an-autism-treatment-center.html

Houghton, K., Schuchard, J., Lewis, C., & Thompson, C. K. (2013). Promoting child-initiated social-communication in children with autism: Son-Rise Program intervention effects. Journal of Communication Disorders, 46(5-6), 495–506. https://doi.org/10.1016/j.jcomdis.2013.09.004

Koegel, L. K., Koegel, R. L., Harrower, J. K., & Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24(3), 174–185. https://doi.org/10.2511/rpsd.24.3.174

Mirzakhani, N., Asadzandi, S., Ahmadi, M. S., Saei, S., & Pashmdarfard, M. (2022). The effect of son-rise and floor-time programs on social interaction skills and stereotyped behaviors of children with autism spectrum disorders: A clinical trial. Cadernos Brasileiros De Terapia Ocupacional, 30. https://doi.org/10.1590/2526-8910.ctoao248732532

Pisman, M. D., & Luczynski, K. C. (2020). Caregivers can implement play-based instruction without disrupting child preference. Journal of Applied Behavior Analysis, 53(3), 1702-1725. https://doi.org/10.1002/jaba.05

Thompson, C. K., & Jenkins, T. (2016). Training parents to promote communication and social behavior in children with autism: The Son-Rise Program®. Journal of Communication Disorders, Deaf Studies & Hearing Aids, 4(1). https://doi.org/10.4172/2375-4427.1000147

Tiger, J. H., Hanley, G. P., & Bruzek, J. (2008). Functional communication training: A review and practical guide. Behavior Analysis in Practice, 1(1), 16–23. https://doi.org/10.1007/BF03391716

Use The Son-Rise Program® to make an immediate impact on your magnificent child. https://www.autismtreatmentcenterforamerica.org. (2019). Retrieved from https://autismtreatmentcenter.org/wp-content/uploads/2019/06/SR.001.KS_.FINALchart.pdf

What is the son-rise program? Autism Treatment Center of America. (2022, March 25). Retrieved March 10, 2023, from https://autismtreatmentcenter.org/what-is-the-son-rise-program/

Williams, K. R. (2006). The Son-Rise Program® intervention for autism: Prerequisites for evaluation. Autism, 10(1), 86–102. https://doi.org/10.1177/1362361306062012

Williams, K. R., & Wishart, J. G. (2003). The Son-Rise Program® intervention for autism: An investigation into family experiences. Journal of Intellectual Disability Research, 47(4), 291–299. https://doi.org/10.1046/j.1365-2788.2003.00491.x

Citation for this article:

Leslie, S. C., McHugh, C. L., & Zane, T. (2023). The Son-Rise Program®: Is there science behind that? Science in Autism Treatment, 20(6).

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