Autism
Instead of beginning with the usual statistics and definitions of the disorder at hand, I'd like to begin this page of the website with describing the picture above. The picture above is just one of many that attempts to encompass Autism between Elijah who has Autism and his father, Timothy Arhibald. Mr. Archibald is a professional photographer. The project's name is "Echolalilia" One day, he picked up the camera to take pictures of his son and the behaviors he couldn't understand and more so "bothered him". Unbeknownst to him, it turned into a non-verbal communication of sorts between the two and a project. Along the line, Archibald dabbled in other artistic things such as different types of music, painting and drawing; all the while bringing Elijah closer to him and his family, opening him up into his world and diminishing his The project continues and can be followed here on this website: http://timothyarchibald.com/
A diagnosis of autism spectrum disorder can be an overwhelming experience. As a caregiver you may have to come to terms that there is no known current cure. However there are now some very viable treatment options. Some approaches may reduce some of the challenges associated with your child’s condition. Others focus on embellishing your child’s existing abilities. One of those types of therapy plans is referred to as “follow their lead” also known as “child-directed therapy” and strongly encourages parent/caregiver involvement in therapy sessions. Whatever approach you choose, you shouldn't choose it b/c it's the next best thing, but it's the thing that will work for your child.
There are many different treatment approaches for children with autism. Some of them include:
Child – directed therapies ensures child participation rather than the Clinician trying to motivate the child in what they are interested in implementing. They are considered to be “functional” therapies that can be transferable to “real life” situations. Providing the child with the language for what you are doing such as commenting on the toy or action offers a natural language model rather than some of the drill approaches where the product has been described as “robot sounding” language. It’s important to meet them at their linguistic level one ahead; expanding and adding the next linguistic step from where they are currently (ie if a child only says one words, we comment two to three words back in conversation and so on).
Dr. Stanley Greenspan’s (Founder of the DIR/Floortime Approach) http://www.icdl.com/ encourages following the child’s lead throughout therapy. To practice DIR therapy, the therapist must be certified in the DIR/Floortime Approach. DIR represents:
· Developmental - meeting your child where they are developmentally in treatment
· Individual Differences - following an individuality treatment approach via developmental ladder.
· Relationships - focuses not only on relationship building with the therapist, but most importantly engaging the parent with their child. Greenspan strongly believes that once relationships evolve, “the child can then move up the symbolic developmental ladder”.
Below are Greenspan’s definitions of six (6) phases of development and descriptive assessment checklist in his book Engaging Autism (2006).
It's very important to note that DIR is just one example of a relationship engaging Developmental focusing therapy.
There are many different treatment approaches for children with autism. Some of them include:
- Direct Therapy (i.e., Speech, Occupational, and Applied Behavior Analysis
- Medication
- Dietary InterventionsVitamins and Minerals
- Animal Therapy
- Music and Art Therapy
- Immune Globulin Therapy
- Secretin Injections
- Chelation Therapy
- Auditory integration training (AIT)
- Multi-approach between Speech and language, Gross and fine motor Daily living, & Social Community Classroom.
Child – directed therapies ensures child participation rather than the Clinician trying to motivate the child in what they are interested in implementing. They are considered to be “functional” therapies that can be transferable to “real life” situations. Providing the child with the language for what you are doing such as commenting on the toy or action offers a natural language model rather than some of the drill approaches where the product has been described as “robot sounding” language. It’s important to meet them at their linguistic level one ahead; expanding and adding the next linguistic step from where they are currently (ie if a child only says one words, we comment two to three words back in conversation and so on).
Dr. Stanley Greenspan’s (Founder of the DIR/Floortime Approach) http://www.icdl.com/ encourages following the child’s lead throughout therapy. To practice DIR therapy, the therapist must be certified in the DIR/Floortime Approach. DIR represents:
· Developmental - meeting your child where they are developmentally in treatment
· Individual Differences - following an individuality treatment approach via developmental ladder.
· Relationships - focuses not only on relationship building with the therapist, but most importantly engaging the parent with their child. Greenspan strongly believes that once relationships evolve, “the child can then move up the symbolic developmental ladder”.
Below are Greenspan’s definitions of six (6) phases of development and descriptive assessment checklist in his book Engaging Autism (2006).
It's very important to note that DIR is just one example of a relationship engaging Developmental focusing therapy.
Functional Emotional Developmental Levels (FEDL)
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Functional Emotional
Developmental Level DIR I Shared Attention & Regulation
DIR II Engaging & Relating DIR III – Purposeful Emotional Interactions DIR IV – Shared Social Problem Solving & Emergence of Sense of Self DIR V – Creating Symbols & Ideas DIR VI – Building Logical Bridges between ideas |
Emotional, Social and Intellectual Capacities
Following their lead via gaining eye gaze, joint attention (doing an activity together ie, book reading). Experiencing affective interest in sights, sound, touch, movement and other sensory experiences. Modulating affects (i.e., calming down).
Entering into your child’s world through what they are doing will demonstrate acknowledgment and acceptance. Response will hopefully be engagement, interacting, and relationship building. Children will tell us verbally or non verbally via various gesturing, eye gaze, body movements, vocalizations or just picking up what they want. It’s our job as therapists and parents to listen. Then further our responsibilities by affirming their interests; letting them know that yes, we hear them. Think about it. There is nothing better in the world than having someone acknowledge you and say verbally or non verbally, I hear you; I’m listening.
Also sometimes referred to as Intentional Two-Way Communication or “circles of communication” (Ex provided below).
It is important to enter in some challenges or obstacles in order for them to think and become creative about how to overcome simple problem solving. Critical thinking, creativity, and spontaneity should all be practiced and encouraged. Example: Your child is rolling his or her car back and forth. Put a hand there to create a boundary for them to figure out how to go around.
Your child will begin to use pretend play in order to explore their feelings, world around them and make sense of this world. Some children on the spectrum tend to have aggression and as a parent your first intention may want to be to cease these emotions. The follow the child’s lead model would instead encourage you to listen to your child, acknowledge their feelings, then model how you or I would instead express them.
Children link their ideas learned through play and relationships to comprehend their world in a logical and real way.
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DIR assumes that all of your child’s actions are purposeful and have meaning no matter how unusual, different or considered "bad" by some. DIR invites the parent/caregiver to follow along in therapy with the guidance of the therapist (follow their lead) by mimicking the same behavior as a means of captivated the child’s interest through the interaction while deciphering meaning to the action. Example:
Your child is playing cars. He/she loses interest and runs over to the shiny doorknob and begins tapping on it repetitively. To follow their lead, I would follow them to the doorknob, bend down to their literal level DIR I and bang on the doorknob right back at them DIR II. If they continue to bang back at you, you are now entering what Greenspan refers to as “circles of communication” – DIR III (nonverbal acts of back and forth). For every time he/she bangs on the doorknob in whatever rhythm, as soon as they break, the adult should bang on that doorknob right back at the child, and be as silly as possible! Engaging, affirmation, and hopefully as many back and forth circles of communication as possible. Had they moved onto another activity and not responded to your banging, follow them to that next toy/object and try to engage them beginning at DIR I again.
A common misconception with child - centered therapy is that it can only be done through spontaneous play. Any good therapist will individualize treatment which can possibly include integrating different types of therapies. Focusing on and enhancing what they have by promoting their self – esteem so they are willing to trust, build self-confidence, and a willingness to interact. Child-directed therapy, though maybe more difficult for the parent, is more functional and transferable to real life situations rather than academic or Clinician- directed therapy. The basis for choosing any treatment plan should come from a comprehensive evaluation of the strengths and weaknesses observed in the child. Therapy is important to match your child's potential and specific developmental and/or social & emotional needs with treatments that are likely to be effective in moving him/her closer to established goals and abilities.
Integrating therapies would mean coming in with a session goal, a language plan to meet for that day for the child while still being able to follow the child’s lead. Example:
While working in a more stricter TEACCH (Treatment and Education of Autistic and related Communication Handicapped Children) school I was working on PECS (Picture Exchange Communication System) goals with a child during structured play. During every PECS session, no matter what we were working on, the child would go under the table and remain there. I finally decided to follow him under the table. Using this train of thought, I also needed to find out why he was going under the table, rather than correcting it. First I worked on brief sensory integration DIR I, thinking he was seeking self-regulation. I then engaged him DIR II by doing something silly and quickly reached on top of the table and brought below what we were working on DIR III (In this case, the communication was verbal and non-verbal using PECS - Communication Boards). I partially achieved the session goals by following the his lead, integrating therapies rather than giving up or trying to force, bringing the session to a negative place and not accomplishing anything.
Emotional, social, and intellectual development is cultivated through the Floortime approach. Foundations for relationship building leads to critical thinking and communication which are fundamental for building problem solving skills which increase intelligence. For some higher functioning children, a lot of children on the spectrum usually have concomitant problems with either Executive Functioning Difficulties or an Auditory Processing Disorder. However, it's not the other way around. If a child has an Executive Functioning Disorder or an Auditory Processing Disorder, it does not mean they also have Autism. That said, a child with Autism can also associate a whole host of additional health an disorders.
Throughout the stages, commenting on what you are doing is important as it is providing the language for what you are doing. However, it does not be constant and depending on their linguistic level, most likely should not be lengthy (one or two words). When ready, enhance their interests by expanding linguistically and adding the next linguistic step from where they are currently (ie if a child only says one words, we comment two to three words back in conversation and so on). Use simple language.
Parents as well as professionals have been confounded by conflicting messages regarding what is and what is not appropriate treatment approaches for children and adults on the autism spectrum. Doctors are trying to profit on the next new thing!
Not all of them are like that thankfully. However, take caution. Before deciding what treatment protocol is right for you, the parent or caregiver to investigate and read all of the research, educate yourself, and if needed, talk to as many therapists that you can. Try out some different therapists or therapies you're interested in with a few caveats. First, do not, I repeat, do not do any therapy that is new- there is no research under the AMA publishing. If you need to travel to another country to get a drug infused or entered in any way into your beloved child's body, think TEN times before you book that ticket. You have the right to change therapists and therapies if you are not satisfied with what you are currently working with. However, I suggest first approaching said therapist with your concerns to see if they can be resolved. Remember, you are the advocate for your child, most likely in this case, the only advocate. Speak up for them, care for them, as you would for yourself. Therapy needs to be an enjoyable experience for all involved.
WORKS CITED
Greenspan, Stanley I.; Wieder, Serena (2006), Engaging autism: Using the floortime approach to help children relate, communicate, and think, Cambridge, MA, US: Da Capo Press.
Your child is playing cars. He/she loses interest and runs over to the shiny doorknob and begins tapping on it repetitively. To follow their lead, I would follow them to the doorknob, bend down to their literal level DIR I and bang on the doorknob right back at them DIR II. If they continue to bang back at you, you are now entering what Greenspan refers to as “circles of communication” – DIR III (nonverbal acts of back and forth). For every time he/she bangs on the doorknob in whatever rhythm, as soon as they break, the adult should bang on that doorknob right back at the child, and be as silly as possible! Engaging, affirmation, and hopefully as many back and forth circles of communication as possible. Had they moved onto another activity and not responded to your banging, follow them to that next toy/object and try to engage them beginning at DIR I again.
A common misconception with child - centered therapy is that it can only be done through spontaneous play. Any good therapist will individualize treatment which can possibly include integrating different types of therapies. Focusing on and enhancing what they have by promoting their self – esteem so they are willing to trust, build self-confidence, and a willingness to interact. Child-directed therapy, though maybe more difficult for the parent, is more functional and transferable to real life situations rather than academic or Clinician- directed therapy. The basis for choosing any treatment plan should come from a comprehensive evaluation of the strengths and weaknesses observed in the child. Therapy is important to match your child's potential and specific developmental and/or social & emotional needs with treatments that are likely to be effective in moving him/her closer to established goals and abilities.
Integrating therapies would mean coming in with a session goal, a language plan to meet for that day for the child while still being able to follow the child’s lead. Example:
While working in a more stricter TEACCH (Treatment and Education of Autistic and related Communication Handicapped Children) school I was working on PECS (Picture Exchange Communication System) goals with a child during structured play. During every PECS session, no matter what we were working on, the child would go under the table and remain there. I finally decided to follow him under the table. Using this train of thought, I also needed to find out why he was going under the table, rather than correcting it. First I worked on brief sensory integration DIR I, thinking he was seeking self-regulation. I then engaged him DIR II by doing something silly and quickly reached on top of the table and brought below what we were working on DIR III (In this case, the communication was verbal and non-verbal using PECS - Communication Boards). I partially achieved the session goals by following the his lead, integrating therapies rather than giving up or trying to force, bringing the session to a negative place and not accomplishing anything.
Emotional, social, and intellectual development is cultivated through the Floortime approach. Foundations for relationship building leads to critical thinking and communication which are fundamental for building problem solving skills which increase intelligence. For some higher functioning children, a lot of children on the spectrum usually have concomitant problems with either Executive Functioning Difficulties or an Auditory Processing Disorder. However, it's not the other way around. If a child has an Executive Functioning Disorder or an Auditory Processing Disorder, it does not mean they also have Autism. That said, a child with Autism can also associate a whole host of additional health an disorders.
Throughout the stages, commenting on what you are doing is important as it is providing the language for what you are doing. However, it does not be constant and depending on their linguistic level, most likely should not be lengthy (one or two words). When ready, enhance their interests by expanding linguistically and adding the next linguistic step from where they are currently (ie if a child only says one words, we comment two to three words back in conversation and so on). Use simple language.
Parents as well as professionals have been confounded by conflicting messages regarding what is and what is not appropriate treatment approaches for children and adults on the autism spectrum. Doctors are trying to profit on the next new thing!
Not all of them are like that thankfully. However, take caution. Before deciding what treatment protocol is right for you, the parent or caregiver to investigate and read all of the research, educate yourself, and if needed, talk to as many therapists that you can. Try out some different therapists or therapies you're interested in with a few caveats. First, do not, I repeat, do not do any therapy that is new- there is no research under the AMA publishing. If you need to travel to another country to get a drug infused or entered in any way into your beloved child's body, think TEN times before you book that ticket. You have the right to change therapists and therapies if you are not satisfied with what you are currently working with. However, I suggest first approaching said therapist with your concerns to see if they can be resolved. Remember, you are the advocate for your child, most likely in this case, the only advocate. Speak up for them, care for them, as you would for yourself. Therapy needs to be an enjoyable experience for all involved.
WORKS CITED
Greenspan, Stanley I.; Wieder, Serena (2006), Engaging autism: Using the floortime approach to help children relate, communicate, and think, Cambridge, MA, US: Da Capo Press.
