- After the Diagnosis: what to do?
- Instructional and developmental Therapies
After the Diagnosis: What do do?
The diagnosis in overwhelming as is the information regarding Autism parents will find online. It will require time to be able to process it all and even more skills and doubt to be able to choose the best approach.
My recommendation is not to rush into one single approach, thinking it will be The Cure. No cure has really be found but many things can help your child reach his potential. As you are trying to decipher all this information, keep in mind it is wise to have your child receive a thorough evaluation in a specialized hospital unit ( i.e. pediatric neurology unit, or developmental pediatrics unit) with a staff familiar with the disorder and its numerous expressions. It will give you a more complete picture of your child's needs and impairments and allow to rule out any seizure activity.
If you suspect your child as a developmental delay , but have not been able to have your child assessed, contact the local Public school system and the state Public health system which should be able to evaluate your child.
Instructional and developmental Therapies
Autism being such a complex disorder, is better approached through as many angles a possible. Keep a very open mind but reappraise constantly your child’s needs and monitor the progress and the regression closely. A team approach is much more effective than many parallel approaches. Target the need of your child that seems to be the direst and ask the therapist to develop a strategy for it, which has to be shared with all other therapists. Do not set goals to high, trust yourself and your partner, if any, as being the one who knows your child best but take into consideration your child's teacher and therapists' input.
Whatever the therapist, the theory, the child should be engaged in social interaction as much as possible throughout the day. Joint attention has proven extremely effective to increase availability for learning, and social awareness. Due to the brain plasticity of young children , very early intervention is highly recommended..
However, remain wary of therapies that could jeopardize your child's health, therapies that have not been subjected to any independent and scientific evaluation, and overall of extremely expensive therapies. If they had proven useful, their use would have become more generalized and their cost would have diminished. Take the time to evaluate the efficiency of the therapy and the therapists.
Intensive, early intervention during the toddler and preschool years improves behavioral and cognitive outcomes for most young children with autism. But, It is never too late to help a child and an adult with Autism progress. Developmental therapy should be targeting the child's needs and strengths through a systematic instruction which main target should be enhancing and facilitating the child's motivation to learn and relate. It should be aiming at building a positive relation with the child, allowing him to own and derive pleasure from his experience with another person and with his environment. It should include gross motor, fine motor, communication and attention building activities as well as sensory integration techniques through playful, reciprocal activities
Early diagnoses and early intervention show very encouraging results. Autism can be diagnosed by the age of 10 months. It is hoped that in most cases, with very early and proactive interventions, it is possible to alter the course of the disorder due to the brain plasticity of the child.
Interventions are behaviorally oriented rather than medically. Most of the older therapies aim at “reshapping” the impaired behaviors caused by neurological impairment. Other newer therapies aim at rebuilding the fundamental motivation to relate and helping the child internalize his personal experience.
Most commonly used Behavioral ( re-shaping) therapies
Applied Behavior Analysis( ABA), verbal behavior (VB), have been , in the last 20 years, the most commonly implemented therapies. ABA and VB are very systematic approaches, based on repetitive delivering of tasks and consequences and on the theory that behaviors can be shaped by consequences, that behaviors that are reinforced will reoccur and behaviors that have been discouraged or punished will disappear. Both methods stem from Pavlov 's work about classical conditioning. ( Russian scientist, 1849-1936).
Play therapy has started to develop in the 80's, it is not a conditioning behavioral therapy.
Applied Behavioral Analysis (ABA)[1]-is a method inducing behavior modification. It consists in the delivery of systematic instructions that elicit responses from the child which are followed by consistent reinforcement. For a long time aversive consequences have been used to shape appropriate responses. Aversive are either unpleasant or painful experiences. I.e. a child is presented with a cup and a teddy bear, then asked to touch the cup , prompted physically to do so after 2 verbal commands , then given a candy. The child is then subjected to "mass trials" which are repeated exercises in the exact same format. The child is rewarded for "good answers" and ignored or given something he does not like for "bad answers". Aversive approaches are less and less used. I truly think it does not help build communication and relatedness, to the contrary. The theory is that behavior that is reinforced will reoccur and that behavior is shaped by consequences. It is the product of a research conducted by O.I. Lovaas, a Californian clinical psychologist , very famous in the years 1970. This method was supposedly aiming at reducing or extinguishing self stimulatory behaviors and building imitation capacity for Children with Autism. Lovass was , at the time, using slapping or screaming as aversive consequence for "bad answers"..
I believe the only positive contribution Lovaas made for Children with Autism was to demonstrate that they had the potential to learn and progress, therefore other option than institutionalization existed. It was at the time an important step forward.
Verbal behavior [2] Behavioral therapy whose main target is the acquisition of expressive language. This therapy is based on presenting the child with reinforcing situations and materials, labeling the material for the child with the use of a sign form the American Sign Language repertoire ( or an adaptation of the sign), prompting the child, in a systematic and automatic manner, to use the sign in order to access the rewarding material which is placed in front of him. The exercise is to be repeated dozen of times along the day.
The child 's focus is maintained on the reward , speech is linked to the object or the reinforcing action . Communication is not dynamic nor internalized as a tool for sharing interest with another human being. It derives from the work of B.F Skinner, a famous American psychologist and one of the first "behaviorist" whose research work occurred in the 1950's.
To my knowledge and experience both these techniques do not help the child internalizing his experiences and acquisition nor do they help build motivation and pleasure to relate. Autism being a disorder of relating it is important to establish, as a foundation, the desire and pleasure to relate.
New and promising therapeutic approaches have recently emerged.. They are more centered on building relatedness and affective based behaviors.
Relationship Development Interventions or RDI consist in social and emotional development activities aiming at enhancing the child's capacity to connect and co-regulate with another person and derive pleasure from these experiences. RDI was coined by Steven E. Gutstein MD. He developed a program, "that opens door to lifelong social and emotional growth" to quote his own words, teaching parents how to interact with their children with Autism. Some of his recommended activities can be found in his book: Relationship Development Intervention with Young Children. Jessica Kingsley Publishers. Gutstein gives many conferences around the country. Attending one could be a good start for understanding what you can do with your child at home. Signing up with his program is costly . It is always an option to look in your area for skilled therapist working along this approach while not pertaining to the school.
Play therapy targets the development of engagement, shared attention, imitation skills and language through play. Play promotes the development of social-emotional skills.
Play has been recognized as important since the time of Plato (429-347 B.C.) who reportedly observed: “you can discover more about a person in an hour of play than in a year of conversation”. Psychiatrists and clinical psychologists have increasingly introduced play in there therapy with children since 1930. Play is used as a diagnosis tool and as a therapeutic tool. To name a few : Melanie Klein, ( 1955), David Levy,( 1938) ‘s release therapy, Carl Rogers ( 1942) Client centered therapy.
In 1982 The Association for Play Therapy (APT) was established marking not only the desire to promote the advancement of play therapy, but to acknowledge the extensive growth of play therapy. In 2006 the APT has almost 5,000 members in twenty-six countries. One of the most prevalent play therapy targeting children with Autism is Floor time.
Floor Time
The Floor Time program, developed by Dr. Stanley Greenspan, Clinical Professor of Psychiatry, established in Bethesda Maryland. It involves working directly with autistic children's interests. Instead of requiring the child to engage in a structured activity, the therapist enters the child's play and introduces variation to it. The basic theory Floor time is that Children with Autism will learn skills form the relationships they develop with their caregivers.
Greenspan created a whole method addressing the needs of children with deficits in relating and communicating. This method is known as Developmental Individual Difference Relationship Model (DIR Model). Floor time, which is a specific therapeutic technique also developed by Greenspan, is often confused with the DIR Model.
As these approaches have been developed in the 1980’s , trained therapists are available in most states. Following the whole program is, one more time, very costly.
Sensory integration therapy: Children with ASD often have a dysfunctional sensory system in which one or more senses overreact or under react to stimuli from the environment and from their internal milieu. Therapy for a better sensory integration provides sensory ( massages, exposition to various textures ) and motor activities, often in the form of play, to help the child process and integrate sensory information. This therapy should be included in the developmental therapy offering sensory breaks and experience to better the quality to the child's attention.
Higashi Principles, Daily life therapy:
1)
Vigorous physical exercise: helps regulate the biological rhythm of
life such as sleep and food intake. It also greatly improve
eye/motion coordination and relatedness and awareness of one's
surrounding
2) Emotional stability: is extremely important to eliminate the stress
linked to a poor understanding of one' surrounding. Instructors
are encouraged to develop a trusting bond with the child and to
dynamically take part, with the child, in each therapeutic
activity.
3) Intellectual stimulation ; providing the child with novel and enjoyable
experiences in order to foster his motivation for
learning
Autism primarily being a disorder of relating , I would advice that the main target of any therapy be to engage the child in a dynamic and interactive manner.
These strategies are often coupled with occupational therapy which addresses the sensory deficiencies and with speech therapy . Children with severe apraxia do poorly with traditional speech therapy and their language improves through play, songs, rhythmic activities. Children with severe dyspraxia might need physical therapy as well.
Communication, whether verbal (speech) or through signs, pictures, gestures, computerized devices and social skills should be targeted through all therapies.
Psychotropic drugs such as mood stabilizers (they also are anti seizure medicines such as Depakode, Keppra, Lamictal ) and anti psychotic drugs like Risperdal are given to children with Autism exhibiting aggressive and self injurious behaviors, or suffering from very short attention span with hyperactivity and extremely unstable moods. Antidepressants are also often prescribed later in life.
Remember that, as for typical children, there are no two children alike and in spite of an Autism Disorder your child is first of all a child and needs your support and love.
He is the one suffering from a disability and he needs even more than a typical child that you become his facilitator to access and comprehend the outside world. It is important that you trust him to be able to grow, learn, adapt. His disability is why he is is acting strangely and in a challenging manner. He cannot be blamed for his disability neither can you. He can be helped in order to reach his potential. Children with Autism have to be shown in a very explicit way how to behave. This can be done addressing their various needs and capacities, steps by steps. Try to identify your child's strengths and build on them, never against them.
Words and names are most of the time meaningless for a child with ASD. Use few of them, make few demands. They should be followed by clear, consistent and predictable consequences.
Do not repeat a command more than twice, then help your child comply with it and praise him when it is completed no matter how much you both struggled to do it.
Associate the child’s name with something enticing, do not use it in a repetitive manner. He will then start to pay more attention to it being called.
Children with Autism often have amazing and unusual visual processing’s skills. They may appear to have a tunnel-like vision but they often scan their environment very methodically , though not as a whole but as a succession of details . They use small and not relevant details to recognize an object or a person. The child might be fixated to a very small detail to identify the safe food or environment. Always teach your child in a variety of environment to allow him/her to generalize the use of an acquired skill. and to help diminish his anxiety.
Eyes have a very aversive quality for children with autism. Accordingly eye contact is painful to sustain, or make the children uncomfortable, which hinder their ability to learn language and social codes through observation and imitation. Better to ask them to focus on somebody’s nose., or chin.
The best way to extinguish an oppositional or disruptive behavior is to (pretend! to) ignore it. For example: Give no eye contact, no word, while you stop your child from climbing the window sill. Redirect him/her to an appropriate activity and then praise him/her for being engaged in something appropriate.
Try to be consistent! Celebrate every victory. You sometimes might feel helpless as children with Autism (as well as typical children) grow with regression, plateau, challenging behaviors, but remember they also have wonderful breakthrough, a unique quality of love and they offer another view of the world , of life.
Used to remove heavy metals from the body that might be damaging the brain. Chelating agents were introduced into medicine as a result of the use of poison gas in World war I. Chelation therapy is used as a treatment for acute mercury, iron (including in cases of Thalassemia), arsenic, lead, uranium, plutonium and other forms of toxic metal poisoning.
Chelation therapy in Autism
The efficacy, safety, and much of the theory behind these alternative practices are disputed by the medical community. Based on speculation that mercury may trigger the symptoms of autism, chelation therapy is used to treat autism, with some surveys suggesting 2–8% of children with autism have had the therapy. Parents either have a doctor use a treatment for lead poisoning, or buy unregulated supplements. Chelation therapy can be hazardous, even conducted with the FDA-approved chelation agents. In August 2005, botched chelation therapy conducted by an ACAM member killed a 5-year-old autistic boy. A 3-year-old non autistic girl died in February 2005, and a non autistic adult died in August 2003. These deaths were due to cardiac arrest. Only the 3-year-old girl had been medically assessed and found to have a elevated blood lead level and resulting low iron levels and anemia, a proper medical cause for chelation therapy to be conducted.
Hyperbaric Oxygen Therapy
Is an oxygen therapy (HBOT) . It refers to intermittent treatment of the entire body with 100-percent oxygen at greater than normal atmospheric pressures.
Hyperbaric oxygen therapy (HBOT) has been utilized to treat Autism in many countries throughout the globe. The rationale behind using hyperbaric for Autism is that the treatments increase cerebral blood flow and thus oxygen is delivered to areas of the brain, which are thought to be oxygen deficient.
The theory is still disputed by the medical community and few positive results have been reported..
Dietary approach
The 2 following diets, Dairy-free diet ( Or lactose free diet) and Gluten free diet are frequently used with children with Autism. Their results vary greatly according to the children. It seems that some of the children with prior digestive problems and allergy improve. It has been reported that some children were more able to engage in eye contact, their skin rashes disappeared, and their sleep quality improved only a few days into one of these diets.
Another diet , less widely used, is aiming at eliminating yeast in the digestive track with specific carbohydrates .
Dietary supplements
Melatonine is used to aid sleep ( with some good results) , calcium, coenzyme Q-10, L-carnitine, taurine, zinc, magnesium, molybdenum, selenium and Nystatin (for yeast), fish oils, curcumin , milk thistle and many more are often administered daily.. Homeopathy is also widely used. Some of the supplements are supposed to “detoxify” the body.
None ,so far, have proven very effective and many can be quite costly. I would here repeat the advice of using caution when offered a new and costly therapy . Never take the risk to jeopardize your child's health. Therapies that have not been subjected to any independent and scientific evaluation, and overall are extremely expensive should be thoroughly evaluated before you throw yourself and your child in. Remember that had they proven effective they most likely would have become generalized and their cost would have diminished. Take the time to evaluate the efficiency of the therapy and the therapists.
[1] Lovaas. 1904.1980
[2] Verbal behavior . BF Skinner, 1957
[3] The affect based language Curriculum , S. Greenspan, D. Lewis,
[4] Early social games and the acquisition of language, British Journal of developmental psychology Ciamoni.L, Laicardi .C..
Contact Information
- Véronique Buré (more information attached here)
- Telephone (301) 588 5113
- Cell:(202) 375-4443
