As an autism consultant, I have observed that families struggle with the overwhelming amount of information and treatment options recommended for their children. While I don’t believe that any one approach addresses all the needs of a child or family, I have seen the effects (both positive and negative) of enough approaches to appreciate the principles that seem to lead to the best results. In my quest to get to the ‘root’ of obstacles to my client’s advancement, I have trained and become certified in various complementary modalities over the past few years. This list is a summary of some of my observations about what is most helpful in working with families through a variety of developmental approaches:
1. Treatment is Heart Centered: All caregivers (parents, nannies, therapists) and service providers should ideally come from a place of loving and supportive energy. (Not to be confused with celebrating for no reason.)
2. Family priorities are established in the intake process to guide treatment goals.
3. Treatment goals are directly related to functional improvements in the Quality of Life of the child and family. (A kid in Florida doesn’t need to know what a sheep is when he doesn’t know there’s another person in the same room as him.)
4. Spontaneous independent display of skills and behavior is the way progress should be measured: it doesn’t matter what a child is doing when prompted if we don’t see spontaneous generalization and use of skills.
5. Instill in parents that they do not have to do everything at once, nor do they have to do everything before the child turns 5 years old. The medical establishment unnecessarily stresses parents by instilling this false notion into their psyche. People grow and develop throughout their lives. Otherwise none of us would have learned to drive a car.
6. Don’t believe “conventional wisdom.” Science is important and critical thinking is imperative. Keep in mind, however, that it takes decades before cutting-edge research becomes textbooks used to train the next generation of therapists. Most professionals who diagnose autism and make treatment recommendations have little real-world experience in the homes of families living with an autistic child. Furthermore, it is rare to find a diagnostic professional who has a good idea of the pros and cons of various treatment modalities. Just because a PhD or MD says that ABA is the ‘only’ effective therapy for autism doesn’t mean it’s true (it isn’t). It just means it’s the one they’ve heard a lot about and probably learned about in their PhD program or medical school in a continuing education seminar.
7. Autism can be thought of as a regulation disorder; therefore, treatment priorities should emphasize “bottom-up” and “top-down” processing modalities that support regulation of the brain and nervous system. Self-regulation and coregulation can be addressed through a combination of various mind-body (ie, HANDLE® and MNRI®) and cognitive development (ie, RDI® and Miller Method®) approaches that are very successful in get to the root of many of the processing problems that children with autism often have.
8. Teaching skills (ie academics, ABA, etc.) should be addressed after Self-regulation and Co-regulation are in progress or under development. (Self-regulation is not to be confused with “Compliance,” which often happens in place of mindfulness and self-regulation.)
9. Parents should be taught as soon as possible about the concepts of regulation, co-regulation, and communication to share experiences. Co-regulation is rarely discussed in most autism therapies, other than RDI®. It is critical that families understand this concept, because it is the foundation for communication and independent functioning, and is often lacking in people with ASD. Instead, a compensation pattern develops and ‘pseudo-coordination’ or ‘pseudo-conversation’ ensues.
10. Beware of the tendency to ‘over-therapy’ the child with autism. Remember that children with autism are children first. It is not ‘normal’ for a child to spend dozens of hours each week in one-sided therapeutic interactions (which much of autism treatment can be without understanding co-regulation, which is mentioned in #9). It is important that children with ASD are provided with competent roles and participate in family life like their siblings. We expect children with autism to become ‘normal’ as adults when much of their childhood does not provide for ‘normal’ experiences if they receive too much therapy.
11. Pay attention to how the child spends his time. The brain changes and organizes itself through experience. This means that every hour that he is awake, the child with autism is practicing and rehearsing the construction of neural pathways, digging “grooves” deeper and deeper. Think about the child’s interests and how much time is spent engaging in repetitive and “mindless” activities (to refer to Dr. Steve Gutstein), how much time is spent watching TV or playing video games. Parents can significantly alter the course of a child’s brain development by educating themselves about autism deficits and making simple adjustments to daily interactions to create opportunities for mindfulness, social engagement, and creative thinking. The brain doesn’t stop self-organizing after age 5, and parents can make a significant difference in brain development by knowing a few key strategies.