At two-and-a-half, my autistic son spoke more often than several other kids in his regional center-funded speech and language class. Two years later, several of those kids talked non-stop, whereas my son continued to speak only occasionally, and mostly kept his own counsel.
We parents of those kids constantly compared notes, as parents of autistic kids often do, about the differences in our kids' speaking abilities. Which different therapies and interventions were our kids receiving? How did they make a difference, and why?
My son is 15 now. In hindsight, I believe the differences in those kids' spoken language development had more to do with their individual autistic developmental paths than with specific therapies or programs. For those kids subjected to non-science-based approaches like GFCF diets, or chelation, it seemed like some of the kids were developing despite, rather than because, of their treatment.
So, what are good therapies for autistic kids?
Photo Credit: Shannon Des Roches Rosa via Flickr.
There’s no one answer, because of our inability to predict how autistic kids develop. Sometimes our kids spontaneously start speaking at three, five, eight, or older. Sometimes they seemingly spontaneously start reading. Or are suddenly able to type to communicate.
Some may never develop any these skills (and that's okay, that's who they are, and they deserve the supports they need). Still others never have their abilities perceived due to improperly or un-diagnosed motor, communication, sensory, processing, or other disabilities. Such a diverse group of autistic kids couldn't possibly all benefit from the same "interventions."
So I'd like to caution parents of autistic kids to give themselves time to really think over the approaches they consider using. I'd especially like them to consider not overdoing therapies or interventions, as per Suburban Autistics:
"I feel as though many of our autistic kids can never escape from this idea that they must always be being corrected; must always be being taught; must always be building on skills; must always be attending therapies and classes; must always be being “consistently disciplined”; must always remember every second of every day that they are autistic and that they have so much to learn, so far to go, so much more that they need to be."
Autistic kids can benefit from specific supports, but we need to be cautious and mindful of our kids' personalities, interests, tolerances, and needs when settling on those supports. We need to be especially careful about not putting our kids in therapies just because they are touted as "gold standards for all autistic kids."
Where to start? There are some excellent general guidelines for approaching therapeutic supports for autistic people, like Sparrow Rose Jones' article What Does Helpful vs. Harmful Therapy Look Like. But before anything else, I believe an autistic child's communication profile needs to be evaluated. I believe this whether an autistic child is non-speaking or a hyper verbal, hyperlexic language decoder. As Deanne Shoyer writes:
"In my opinion, any strategy that does not prioritize communication skills is not only bound to fail but it is also doing a huge disservice to the autistic person. How can an autistic child socialize with his peers if he can’t communicate with them? Why are we spending so much time suppressing behaviours instead of giving a child the means to tell us how she feels?"
Kids with no or limited speech need Assistive Augmentative Communication (AAC) options. But parents once again have to be careful. Those considering symbol-to-speech apps or software programs need to know that not all programs are of equal quality, or follow the same language acquisition philosophy -- so do your research, work with an expert if you can, make sure the program suits your child, and choose wisely. (But don't be overcautious -- I'm guessing most AAC-using autistic people would rather have an imperfect communication system than none at all.)
Other AAC options include typing to communicate, using FC (facilitated communication,) or RPM (Rapid Prompting Method). I worry that kids who could benefit from these approaches are never exposed to them, due to concern over a few cases of fraud. But as many autistic people who previously had limited communication options are using these methods with great success, I don't understand why researchers aren't formally investigating why and how such approaches work, instead of dismissing them outright, and closing off these communication possibilities entirely.
Once an autistic child's communication needs have been assessed, it's time to decide how to best help them learn and interact with the world. Kids do need to gain these skills, but the paths need to be individualized, and parents need to be wary of holding autistic kids to non-autistic standards. Eye contact, for example, is more a social than a functional skill, and many autistic people find it difficult if not impossible -- especially if they're also expected to talk or pay attention at the same time.
Applied Behavioral Analysis (ABA) is an approach that definitely merits caution, due to its history, and the tendency of its practitioners to focus on compliance. Autistic writers including Julia Bascom have written about how traumatizing ABA approaches were for them as autistic children, how unnatural and soul-destroying.
Recent research indicates that the non-generalized repetitive learning often favored in ABA scenarios may actually hinder autistic learning. More evidence has emerged that many autistic people have motor planning disorders, and while able to comprehend ABA-type instructions, physically cannot comply with them and so are considered to not be learning at all. Other physical conditions, such as dyspraxia, or Tourette's, can also prevent autistic kids from complying with ABA-type directions. Of additional concern is echolalia -- repeating phrases -- being considered problematic within an ABA framework, when it can actually be a functional form of communication for autistic kids.
These common ABA pitfalls have misunderstanding autism, and autistic learning styles, at their core. Dusty Jones has described how ABA therapists can fall for the trap of misunderstanding aggressive or problematic behaviors, and trying to "extinguish" them -- without understanding why they happen in the first place:
"Why not take the aggressive, problematic behavior as a cue that the child, unable to express his needs with words, has suddenly encountered a situation he doesn’t understand and that exceeds his ability to respond effectively? Why not take the opportunity to help him find comfort and return to a state of contented equilibrium? [...] But -- and this is key -- we can only do that if we stop worrying so much about what the student does, and start worrying about what the child needs."
So how do we know when therapies are effective or beneficial? As Sara Luterman writes, at NOS Magazine:
"It’s pretty easy to tell if someone finds a therapy helpful or not, regardless of whether they are verbal. How is the person’s mood? Do they find therapy sessions distressing? If it’s the latter, maybe that kind of therapy isn’t the best fit. Being unable to speak and being unable to communicate at all are not the same thing. Listen to your clients, especially the ones who do not speak. They’re the ones who need you to listen the most."
There are some therapeutic approaches that most people agree are beneficial. Occupational Therapy (OT) is usually a favorite, because of the aforementioned high rate of motor issues, many of which OT can address. OT can also benefit autistic people's characteristic poor overall tone, or varied strength profiles like having a weak upper body. But, again, with the caution -- some autistic kids find writing by hand nearly impossible, and can communicate more effectively when allowed to type or use other AAC. Using OT for handwriting practice under these circumstances is a waste of time and resources.
Some other favored approaches: The services of a speech language pathologist (SLP) can be crucial, if the child's communication needs are properly identified and supported. Feeding therapy or nutritional consultations can be useful if respectful and non-coercive, and their aversions are noted and never overridden. Adaptive Physical Education (APE) can help your child to maintain their health and self-regulate.
Even when appropriate therapies have been identified, they're not always available locally. And there are limited options for kids whose parents can't pay for preferred therapies out of pocket, or who are limited to non-preferred therapeutic options. Those availabilities and options need to change, at the school district, county, regional, state, and federal policy level, because too many kids and their families simply aren't getting the services they need.
But even when formal therapeutic options are limited, parents can work to ensure their own attitudes and approaches, and home lives, are understanding-based. As Briannon Lee writes at Respectfully Connected:
"The target of intervention is not autistic children, but their social and physical environments. Autistic children [need to be] supported in families and communities to develop as unique and valued human beings, without conforming to the developmental trajectory of their neurotypical peers. "
Have you, or has your child, had particularly good or bad autism therapy experiences? Please leave a comment, so we can discuss best practices.
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