Good early intervention is a vital ingredient for the success of a child with autism. However if it is done badly it can have the opposite effect – it can make them, and you, feel like crap while having very little effect on their life skills. This is why it is vital to find a type of therapy that fits with you and your child, and it is even more important to find a good practitioner of that therapy to bring it to life for you.
I think that ‘shopping’ for therapies is a bit like shopping for clothes. Some people with standard figures can go almost everywhere, and as long as they know roughly what looks good on them they’ll be ok. I am pretty blessed that way – I can go online, buy a dress and as long as I look at the measurements 99% of the time it’ll be fine. In the same way, for some kids most of the therapies that are ‘promising’ or established in the autism field will help. It doesn’t really matter if you do Floortime, ABA therapy, or the Early Start Denver Model, they will improve. Some even do well with just a weekly visit from an occupational therapist, some speech therapy, and extra reading with mum and dad.
Michael was never one of those children. Most types of therapy for children on the spectrum are founded on the notion that you find an interest and work with it. Michael’s only interest is watching cartoons on his iPad. Since the introduction of our food program he also has a growing interest in food. In his free time he stims by waving his hands in front of his face, climbs things or runs back and forward.
We’ve tried everything to get him to be interested in toys. We tried ‘pairing’ them with cartoons. So he is sitting and watching a cartoon, and every now and then we stop it and he plays with a toy. Or we tried just getting really excited about toys and getting him to show what he’s interested in. Every other tip we have tried. Every toy. Loud toys. Shiny toys. Musical toys. Sensory toys. Balls. Blocks. Nothing works for more than about five seconds at a time.
This is why ABA therapy has been such a blessing for us. It is the only way to get him to engage with the world around him. We use the things that he does like (iPad and food) to reward him for doing things that he’s pretty indifferent to (looking at books or stacking blocks). Eventually he learns to enjoy some of these activities and we can use them as rewards for other things.
But ABA therapy does not work for everyone, and many other promising therapies exist. The Raising Children Network has a good list of them.
There is a spectrum of therapies, in the same way that autism is a spectrum. At one end is Floortime, where the child is left to do pretty much what they want to do and you insert yourself into their play. Its philosophy is that autism is something like a ‘broken bond’ between parents and child, so it involves rebuilding that bond. On the other end is ABA therapy. It is based on the philosophy that if a behavior is rewarded, it will be continued and if it is not rewarded, it will not continue. It involves a lot of structured activities where you encourage the child to do what you want them to do but reward them for it. Of course the rewards will be the little one doing what they want to do, so they still spend a lot of time on what they like.
There are many therapies in between. Some are more appropriate for children with high functioning autism, others are promising across the spectrum. Some common features of ‘good therapies’ do exist though and this is my list of what features should always be present, no matter what therapy you do with your little one.
Early Intervention Should Be Evidence-Based and Intensive
The most important thing about therapy is it should rest on a foundation of solid evidence. There are so many experimental therapies and ‘cures’ for children on the spectrum. It’s very easy as a parent to think that this particular thing you’re doing is helping, because we are pretty crappy observers. Human beings see exactly what they want to see. Your little one might be having a good week or a bad one. She might be sleeping particularly well. Or you might be traveling and he might be reacting badly to that. You don’t know what is really working so the important thing is to do no harm, and to find something that has evidence behind it.
Some ‘alternative therapies’ are harmless (although tend to be pretty expensive) and others can actually harm your child. Have a look at the Raising Children Network for a list of common autism therapies. Every one has a ‘research rating’ – only go for the ones that have a rating of ‘promising’ or ‘established’. And remember that research shows that whatever method you use should be done for at least 25 hours per week for best effect.
Your Child Should Enjoy Themselves
I know that the name ‘therapy’ sounds clinical, detached and painful. But since it is something you’re doing to a three year old it should involve a lot of stuff they like. They shouldn’t really know they’re doing therapy.
Let’s take ABA therapy as an example. It is the one that cops the most criticism for being robotic and totally not fun at all. Yet my little one loves therapy. The only time I have seen him throw a real meltdown is on a therapy free day. My explanation for this is that he likes the structure, he likes knowing what is going to happen. He likes the activities we do, like stacking blocks or sorting shapes. He just doesn’t seem to have the ability to calm himself down enough to sit down and do them on his own, without our help.
To be sure, the first three months were not enjoyable. He threw a lot of tantrums, because he wasn’t used to having any demands placed on him at all. But eventually he grew to like it. So give it time (three to six months) but after a while he should warm up to it.
There is crying sometimes during therapy. A lot less crying than outside therapy, but it does happen. He might not like a task. Something might be new, and hard, maybe frustrating. Unfortunately if I want him to be resilient, and to learn, he will sometimes need to do things he doesn’t like. That’s life. But usually the sounds from the room are laughter, giggling and ‘good boy, you’re so clever!’
There Should Be A Lot of Play
Little kids learn through play. Research has shown this over and over again, and most good preschools/childcare centers will base their activities on this concept. So whatever therapy you do, there should be a lot of toys, dirt, random wrestling matches, slides and swings.
If the therapy your child is doing involves them sitting at a table in front of a large amount of letters and numbers, and that is all they do, something is wrong. Now, this doesn’t mean that there shouldn’t be any letters and numbers. Obviously. And this will clearly change as they get older and move into school.
But at the start the way children learn language, reading and mathematics skills is through play. Activities like sorting things, matching games, building with blocks, pretend play. All of these things develop vital skills.
There Should Be Lots of Hugs
Any therapists that your child spends time with should love being with them. And showing affection is so important. I used hugs as an example in my heading, because that is what my son loves. We hug him every five minutes at least in therapy and out. But if your child is not a big hugger they will have other ways of showing affection and receiving it.
The important thing is that anyone spending time with them should enjoy it, and show this. My little one is, first and foremost, a child. He needs love like he needs oxygen. Often when I hear people complain about the therapy they received it was the love that was missing. Their therapist just didn’t click with their little one. Remember often it’s not the therapy that’s wrong for your family, just this particular person.
Give this bit time. A relationship with a child on the spectrum can take a few months to build up. Initially there may be very few hugs. If after six months though there is still nothing, then time for a change.
Early Intervention Should Be Flexible
Often in Michael’s therapy there will be a program that he has trouble with. No matter what we do and how long we do it for, he’s just stuck. We usually try something for a few months (sometimes it just takes time) and if it’s not working, we try a different approach.
A good therapist/supervisor will be able to give you ideas of different ways of teaching the same thing. They should not insist that this is the one and only way of teaching, and it has to be done in this order every single time. Don’t get me wrong, some things you can only teach a certain way. But most things there are several techniques for teaching and a well-educated, experienced therapist will know them or at least be able to find out about them.
It should also fit in around your little one’s current mood. My son is only two and a half at the moment. There is no way he’s going to spend five hours a day sitting in a chair, matching things or doing puzzles. A lot of his therapy is done outside, or running around. If he’s in a sitting mood, that’s what he does. If he’s in a restless mood, I do social play or teach him to kick a ball. Picture communication is good to practise if he wants to run around. He can run to the book, get the picture, come back to you, get his reward.
Early Intervention Should Be In Your Everyday Setting
All the research shows that early intervention should take place in your little one’s natural setting. A lot of it can happen at home, at the playground, at the shops. This is especially easy if the parents are therapists themselves.
If they’re in preschool, it can happen there. ABA therapy can be generalized by having the therapist accompany them to wherever they want to go. For example, in preschool my son will have a private shadow who will make sure he is included and learning with the others. Other types of therapy can also be integrated in preschools – for example the Early Start Denver Model is great for this.
Parents And Other Family Should Be Involved
Over and over all research shows that the more parents are involved in early intervention, the better the outcomes for the child. I can say for sure that Michael’s outcomes are better because my husband and I are involved. We are trained therapists, so we can do more hours with him. But also the overall approach is more consistent if we understand it.
I have written about why parents make the best therapists. We know our children better than anyone. A therapist/supervisor should always be asking parents for feedback and good approaches. If you consistently bring up concerns and they get ignored, then it is time to change therapists.
Other family members can be involved too. They don’t need to actually do the therapy (although it’s pretty great when they do). But they should understand what you’re trying to achieve and go along with it. With Michael, we always emphasise to everyone how important it is that everyone uses the same approach with him. It means he is less upset and he can see his family without getting overwhelmed.
Early Intervention Should Be Tailored To Your Child
Whatever you do in therapy, it should start with an assessment. There should be a plan for what your little one’s strengths and weaknesses are. Some skills they will be great at. Some they may be very delayed at. All should be addressed but of course the weaknesses will need more time. The strengths can be used as rewards or as a way to teach other things.
It is important that your therapist knows where your child is at in every facet of their development. They may not be delayed at all (or in fact ahead) in some things. For example they might have great gross motor skills, slightly delayed fine motor skills and very delayed communication skills. Their therapy should reflect this. There shouldn’t be a lot of gross motor skills activities and lots of communication skills ones. And the communication skills activities should be incredibly simple, whereas the gross motor skills ones can be more complex and geared to their age group.
There Should Be Measurable Results
One of my main issues with any kind of ‘treatment’ for autism (for lack of a better word) is that many of them are not based on any kind of evidence. You need to always measure the results of whatever therapy you try with your little one. It can’t be based on observation either. The therapist/supervisor should be counting specific results. How many words were said, how many pieces of the puzzle put in, how many times he made eye contact (or whatever your goals happen to be).
If you are doing therapy and nothing is happening, change therapies. Try it for three to six months because these things take time to work, but don’t waste precious years plugging away at something that just isn’t working. It will be frustrating for you and for your little one.
Therapy does take a long time to work sometimes and you need to be prepared for baby steps. We celebrate Michael learning to drink water from a cup by himself. But there needs to be progress. It can be magical when you find the right therapies and therapists for your little one. The progress they can make, over the years, is amazing. Working hard to find the right match to begin with, will pay off big time.