Monday, September 10, 2012

Principles Of Excellent Autism Care And Treatment

As an autism consultant I've observed families struggle with the overwhelming amount of information and treatment options recommended for their child. While I don't believe that any approach addresses all of a child or family's needs, 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 my client's obstacles to progress, I've trained and achieved certification in several complementary modalities over the past several years. This list is a summary of some of my observations of what is most helpful working with families through a variety of developmental approaches:
1. Treatment is Heart-Centered - all caregivers (parents, babysitters, therapists) and service providers should ideally be coming from a place of supportive, loving energy. (Not to be confused with celebrating for no reason).
2. Family Priorities are established in the intake process to guide treatment objectives.
3. Treatment goals are directly related to functional improvements in Quality of Life for the child and the family. (A child in Florida does not need to know what a sheep is when he doesn't know another person is in the same room with him.)
4. Spontaneous independent demonstration of skills and behavior is how progress should be measured - it does not 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 don't 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 drilling this false notion into their psyche. People grow and develop throughout their whole 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. However, be aware that it takes decades before the cutting edge research is distilled into textbooks which are used to train the next generation of therapists. The majority of professionals diagnosing autism and making treatment recommendations have little real-world experience in the homes of families who live with an autistic child. In addition, it is rare to find a diagnosing professional who has a good idea of the pros and cons of various treatment modalities. Just because a PhD or MD says ABA is the 'only' effective autism therapy does not mean it is true (it is not). It just means it is the only one they have heard much about and they probably learned about it in their doctoral or medical school program at a continuing education seminar.
7. Autism can be thought of as a disorder of Regulation - therefore, treatment priorities should emphasize 'bottom-up' as well as 'top-down' processing modalities that support regulation of the brain and nervous system. Self-regulation and Co-regulation can be addressed through a combination of various body-mind (i.e. HANDLE® and MNRI®) and cognitive-developmental approaches (i.e. RDI® and Miller Method®) that are very successful at getting to the root of many of the processing challenges children with autism tend to have.
8. Teaching skills (i.e. academics, ABA, etc.) should be addressed after Self-Regulation and Co-regulation are in progress or developing. (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 experience-sharing communication. Co-regulation is rarely talked about in most autism therapies, aside from RDI®. It is critical that families understand this concept, because it is a foundation to communication and independent functioning, and is often non-existent with individuals with ASD. Instead a pattern of compensation develops and 'pseudo-coordination' or 'pseudo-conversation' ensue.
10. Watch out for the tendency to 'over-therapize' 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 hope for children with autism to turn out 'normal' as adults when much of their childhood does not provide 'normal' experiences if they are over-therapized.
11. Pay attention to how the child spends his time. The brain changes itself and organizes itself through experience. This means every waking hour the child with autism is practicing and rehearsing building neural pathways, digging 'grooves' deeper and deeper. Think about the child's interests and how much time he spends engaging in repetitive, "mindless" activities (to reference Dr. Steve Gutstein), how much time he spends watching television or playing a video game. Parents can significantly alter the course of the child's brain development by becoming educated on autism deficits, and making simple adjustments to daily interactions to build opportunities for mindfulness, social engagement and creative thinking. The brain does not stop self-organizing after age 5, and parents can make a significant difference in brain development if they are aware of a few key strategies.
April Choulat from Pathways Developmental Learning Center, Inc. For useful tips and information on educational programs for autism remediation, visit us today at
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