A New Look at Autism
A New Look at Autism
It is likely that many of you visiting this website know a friend or relative whose child has a developmental disorder. This is not surprising, as current estimates now place 1 out of every 36 children on the autism spectrum. This statistic has led many governments, communities, and institutions to launch new programs and autism focused initiatives. But if we are to truly change the outlook for these children, we must begin by changing our assumptions.
The following is from a website post written by Dr. Stanley Greenspan shortly before his death in 2010. Dr. Greenspan was a pioneer in the field of child development, the original mind behind DIR and DIRFloortime, and the founding president of Zero to Three and ICDL.
Past wisdom regarding the potential of children with autism was deeply pessimistic. The widely used behavioral approach to treatment teaches rote skills with the main goal of changing behaviors, the assumption being that these children’s difficulties in the areas of reading emotional cues, empathy, and creative thinking represent permanent limitations that can not be treated.
But they can. Children originally diagnosed with ASD can relate to others, love others very deeply, and can learn to communicate and think creatively and logically. In contrast to the older model, the new approach recognizes that each child has a unique path to the autism diagnosis, and therefore each child’s path to improvement must also be unique. In addition to overcoming symptoms, the goal of treatment in this new model is to help the child develop the core functional emotional developmental capacities that we now know are critical to learning. Building these foundations helps children overcome their symptoms more effectively than simply trying to change the symptoms alone.
Take the case of “David.” At 2 1/2 years old, David could not use language meaningfully, and made little eye contact with others. He engaged in repetitive behavior, lining up cars over and over again. David’s treatment program, based on the older model of treating symptoms, had enabled him to memorize more words, but he was not becoming more spontaneous or interactive with others.
It was clear that David was missing crucial pieces of early development. Our goal was to help him learn to enjoy true intimacy with his family, respond to social and emotional cues, and use language meaningfully. To do this, we had to figure out that he was very oversensitive to sound – the normal human voice was almost frightening to him – and he was confused by what he heard and saw, making it hard for him to enjoy intimacy, communicate or think. David also had a hard time figuring out how to carry out actions that required more than one step, such as running after the ball to bring it back. This made it hard for him to interact socially.
As we worked with the family on a comprehensive program to deal with the missing pieces in David’s development, gradually we were able to create experiences where he could take pleasure in a warm, close relationship with his family, and become engaged in the back-and-forth of natural communication with gestures and words.
By kindergarten, David was able to relate to others with real warmth; he had lots of friends and a mischievous sense of humor. He was in a mainstream classroom, and even had somewhat precocious reading and math skills. David, now fifteen, is warm, creative, and popular with peers – by any measure a typical teenager. While not all children with substantial developmental challenges will make this kind of progress, the majority of children using the modern approach to development are making significant strides in the areas of social and emotional as well as intellectual growth.
The modern model has the potential to revolutionize early identification and intervention. In a large health survey conducted by the National Center for Health Statistics, the addition of the functional emotional developmental capacities described in this new model resulted in the identification of 30% more children at risk for developmental problems. And in a review of 200 cases using this new model, a subgroup of children was observed to develop abilities formerly thought unobtainable for children diagnosed with ASD: intimacy with adults and peers, empathy, creative and logical thinking. Like David, these children participate in regular education programs and have made excellent academic progress.
Unfortunately, the new concepts are not yet widely used. In our review, more than 90% of clinics and medical centers spent less than ten minutes observing children spontaneously interacting with their caregivers when conducting developmental evaluations. This resulted in numerous misdiagnoses, underestimation of the children’s abilities, and treatment recommendations with insufficient emphasis on relationships and family strengths.
Families and clinicians need access to this modern approach to identification and treatment that is improving outcomes for children. With this new model, we can do a better job of identifying children at risk even earlier, rather than waiting for symptoms to appear. We can help children become warm, related and engaged. And we can define each child’s potential not by assumed limitations, but by his own growth.
Since Dr. Greenspan wrote the above excerpt, DIRFloortime has become much more available around the world and there is a strong body of research to support its effectiveness. But still today, ABA is the dominant treatment approach. All too often, professionals are telling parents that controlling behaviors and managing autism using behavioral techniques is the only option. It is simply not the case. There is so much we can do using DIRFloortime, which is a developmental approach, not a behavioral approach.