Why the 25 Year Old Approach Towards Autism No Longer Works

I was bowled over by his vivid imagination!

He talked excitedly about a dream in which he met Shahrukh Khan and Salman Khan. In it, he also he bought an aircraft model for only 2 Swiss Francs! He meandered between different thoughts and scenarios, each so detailed that I could easily visualize the scenes.

“The sad part is that I always wake up before the good stuff happens,” he ended.

Another youngster shared how he learned to navigate his way around relationships.

Initially he found it difficult to read others’ feelings and emotions. When he talked, people politely moved away. He was never able to figure out why. But eventually, he understood who value and respect him. He also figured out how to respond appropriately by stepping back or going ahead with a conversation.

What a long way he’s come. But he still struggles to be in touch with his feelings. Expressing them to others is difficult for him.

Here’s what’s interesting:

Both boys are 16.

Both are in the 10th grade.

And both have a diagnosis of Autism.

And both are as different from each other as chalk and cheese.

The first youngster feels things too much. He’s too close to his emotions. It might be good if he steps away from his feelings and views things objectively.

The second youngster needs to feel his emotions deeply and feel more connected to them.

Autism affects them both differently. The only thing common is that the brain is wired differently. And yet, the manifestation in each person is diverse.

Think about this:

Autism is a spectrum condition.

Some children and adults are more severely affected in terms language, social interaction and communication.

Others are less affected in above mentioned aspects, like the boys described above.

Question: How can we provide services suitable to the needs of each child, since each one of them is different?

Answer: By ensuring that treatment stays with up with research. But we can’t have a blanket treatment. One size certainly doesn’t fit all. Customization is the need of the hour.

Here’s a query that I received recently:

“My son is 9 years old and gets frustrated if he can’t have his iPad or computer. He watches some cartoons or Hindi movie songs repeatedly. How can we engage him in other activities? He is very hyper and tantrums a lot.”

My dear fellow professional, we put our minds and hearts into providing services for people on the Spectrum.

Imagine this scenario: This 9 year old described above has been coming for therapy to you for the last two years – three times a week. And yet, the problems of hyperactivity, rigidity and frustration persist. He has not been able to generalize what you taught him during therapy sessions. His parents are not happy about his behavior at home.

Autism spectrum disorder has been the most researched condition in the last decade. However, the treatment doesn’t reflect it. We state that each individual on the autism spectrum is unique. Yet, we offer the blanket treatment of speech therapy, sensory integration and special education to all children with autism. But neurologists and researchers show that autism is not a disability in learning static skills, but a differently wired brain. There is nothing wrong with it.

When Mohit was a child, I followed the same age-old treatment techniques for him – speech therapy, occupational therapy and special education… just like thousands of other parents. Because we didn’t know any better.

Today, however, we are equipped with data and research to shed light on how the brains of individuals on the autism spectrum truly function. Empowered with this data, we can design alternate ways to treat children with autism and make them independent. Isn’t it time that treatment evolves?

Over the last 23 years, I have discovered an alternate (and more effective) way to treat children with autism. It comprises of just 3 simple steps. But these 3 simple steps will ensure success with every student you work with.

1.a. Identify the 5 Core deficits

The core deficits are common across the population of ASD. These include – Difficulties with Co regulation, Social Referencing, Emotional Sharing, Episodic memories and Dynamic Problem Solving.

Take a look at how they affect your student (h/t Sarah Wayland for these definitions)

i.) Co regulation – Taking small adaptive actions based on the reactions of others to avoid communication breakdowns.

While playing back and forth games, does your student take actions based on what you do? Or does he take random actions?

ii.) Social Referencing – Managing uncertainty by evaluating the reaction of a trusted person.

If a stranger approaches you both, does your student check with you to see your reaction or is he oblivious to the situation?

iii.) Emotional Sharing – Experiencing what you have in common with others and where you are different.

Does your student share experiences with you? Even if he is non vocal, does he look for you to share his feelings?

iv.) Flexible dynamic thinking – Taking relevant factors into account and adapting as the situation evolves.

In dynamic situations, can your student solve problems which emerge? For instance, if you both are cooking and you’re out of salt, what does he do?

v.) Episodic Memory – Remembering what happened in the past and using this information when planning for the future.

After solving the salt problem in the previous experience, is he aware of where the other spices are stocked if he needs them?

Does your child use his experience (in any small way) from the past to apply it to a different scenario?

Irrespective of where your student stands on the autism spectrum, you will see these core deficits in him. He could have Aspergers’ Syndrome, High Functioning Autism or Classic autism. These core deficits are shared by all people on the Autism Spectrum.

1.b. Work on the Core Deficits

Think about how these core conditions are visible in each of your students. Note your findings in a tabulated document.

Involve the parent and train them to be your partner. Parents are wonderful guides for their children.

Under your guidance, their own relationship with their child could flourish. Also, your problems of generalization at home, and the inability to implement learned skills, will vanish over time.

2.a. Zero down on Co occurring conditions

Co occurring conditions occur side-by-side with the core deficits. Many times these problems are clubbed together with the autism. Parents are told that these are part of Autism Spectrum Disorders. They are not. These problems create speed breakers that slow down progress in your students.

One of my students experiences severe anxiety. So he tries to control his parents constantly. More than the core deficits, it is the anxiety that has affected the quality of his family life and limits him.

Mohit has had seizures since he was 14. It affects his progress.

This is certainly not ‘autism’. It needs proper medical attention under the supervision of a neurologist.

Too many times we throw co occurring conditions under the umbrella of autism.

But, to maximize progress, you need to be crystal clear about how the core deficits affect your students and how the co occurring conditions create obstacles.

2.b. Eliminate Co occurring Conditions

Collaborate with other specialists.

For example, for the youngster with anxiety, it’s important for the special educator and occupational therapist (if applicable) to set limits for the child. They should also work on the child’s regulation, and train his parents on the same. If the problem still persists, services of a mental health professional like a psychiatrist could be warranted.

When a collaborative team is set up, it is important for everyone on the team – parents and professionals – to talk to each other openly and share concerns. That is collaboration in the true sense of the word.

3.a. Address Communication Needs

Your student could be vocal or non vocal.

If he is vocal, does he share his thoughts and feelings?

Teaching him 500 words is not a marker for emotional sharing. A common parental concern is that their children don’t share emotionally with them.

This is frustrating because you’ve probably spent years trying to build up communication and speech. You wish that your goes home and tells his parents about school, what he did with this friends, isn’t it? And that he shares the same with you when he meets you.

If he is non vocal, how does he share his feelings with you in addition to letting you know what he feels?

At the end of the day, you want to feel fulfilled as professionals. The hard work you put in has to show up in daily life. You want to see ‘real improvement’ in all scenarios, right?

3.b. Strengthen the Foundations of Communication

I have witnessed meaningful language and emotional sharing develop in some students who were vocal, just by working on the core deficits.

Here are the words of Viji, mother of Vishal:

“Vishal developed language and communication as well as a neurotypical 4 year old. But he lost most of his speech and language when he regressed soon after being diagnosed with ASD at age 5. So imagine my happiness when Vishal by the time he was 15 had “ MASTERED” labeling more than 250 items. 
But it was all ‘rote’ with no understanding. Application and appropriate use of language was not happening without prompt and correction. But today, after 3 years by working on the core deficits, language is developing naturally, speech is clearer, application and usage is more appropriate. To state a recent instance – he came in from the balcony and told me how a balloon with a thread tied to it, entangled to a tree broke loose because of the wind, and had fallen to the ground. This is a far cry from the labeling days – balloon, tree etc.”

If your student is vocal, training parents to work on core deficits is the key to make your practice effective.

If your student is non vocal, working on core deficits is mandatory. But you also must look at the following: How does he learn? Is he a visual, auditory, kinesthetic learner?

Do ask yourself the following questions –

Does this child make any sound? How are gross and fine motor skills? What about motor imitations? What about visual skills? How proficient is he while using an iPad? Does he enjoy playing games on the computer? Is he inclined towards typing? Does he write?

All you wonderful Speech Language Pathologists out there, do lend a helping hand.

25 years ago, when Mohit was diagnosed, the prognosis for autism was bleak. I clearly remember the pediatricians words – “If it’s Autism, it’s going to be a downhill journey for him.”

Till today, I get that sinking feeling in the pit of my stomach when I think of that pronouncement. But I shake myself out of that feeling quickly – before it engulfs me.

Now when a family approaches me, I think of only 3 things.

1. How do the core deficits manifest in this beautiful child?

2. What co occurring conditions are creating road blocks and complications for this family?

3. How can we work on enhanced communication for the child? How can I empower these dedicated parents?

My experience over the years has shown me that we witness remarkable improvement. Parents become empowered, family lives get normalized, and most importantly, the youngsters achieve a good quality of life.

Isn’t that exactly what we want for each student and family?

Work on an effective plan – keeping the 3 above points in mind and create a better life for your students.

Individuals on the autism spectrum don’t want us to make them ‘normal’. They simply want us to help them navigate the world. In return, they will make the world a better place for us – with their intelligence, and their unconditional love.

Will you help in making this world a better place?