I have, since Michael’s diagnosis, seen the big autism controversies. There are so many I won’t list them all but one is this ongoing feud between different therapies – providers, schools, parents. I never did understand it. As long as you have an evidence based therapy that has been proven to work – you try it. If it works for you, you keep doing it. If there is something it isn’t addressing as well as you would like, find something else that will. We are always searching for different approaches to Michael within his ABA sessions, and looking for better ways to motivate him. I am always discovering new techniques that I can use with my son. And discarding a LOT on the way.
This week has been a week of discovery for us here. We took Michael to a special needs playgroup for the first time, and to occupational therapy. Now I don’t know how much Michael learned from these experiences but I have learned a few things very decisively
- I am very lucky we have ABA therapy
- ABA therapy is in no way harsher or more demanding than relationship based interventions
- The difference between all the interventions is so small you need a microscope to see it
- All therapy providers need to sit down with a psychologist in a nice office somewhere and work out their differences. Because see points one to three.
To start with, let me say that anyone that deliberately works with children with special needs is a hero in my eyes. I do it because I have to and because I am quite partial to this one child with special needs in particular. In my other life I was a soul-less lawyer who specialised in tax, which is about as far from a special needs teacher as you can get without actually becoming a vampire.
But this feud they have going with each other is immature and is harming our children.
How is it harmful?
Well, let me illustrate.
Michael’s new playgroup
We took Michael to a special needs playgroup. It was set in a big special school that goes all the way to year 12 and beyond. And you know the first thing these super supportive people did when they were talking to me about Michael and what we had been doing to help him? I mentioned ABA, their faces closed up and they said ‘well this approach is quite different and I suppose your centre told you that.’ I’m pretty sure they thought I spent my time with Michael slowly roasting him over a pit and then sacrificing him regularly to the full moon. And really I haven’t eaten a baby while laughing evilly in WEEKS. I would have argued with them but honestly by that point I had been up for five hours since 4:30 and I just hadn’t had enough wine or coffee to deal with it.
Anyway the rest of the day I spent watching these teachers for their approach. If it was so amazing I really wanted to see what it was so I could learn the error of my ways.
Their Special Approach
As far as I could see their approach with Michael mostly involved sticking toys at him while he ran backwards and forwards from room to room. They also suggested that maybe if I took him outside for a five minute run he might calm down and be ready to learn after that. Have they ever actually seen a child with ADHD you ask? Did they know what such children looked like? Did they understand that I had just taken him to the park for an hour and a half, but that irrespective of this yes he runs around. All the time. That is what he does. They assured us they had been teaching at this school for twenty years. So you’d hope.
Anyway they also suggested that maybe if we waited outside for a bit they might be able to do something with him then. You know what happened next? Yep, you guessed it, he ran out of the room within (I timed it) three minutes. He kept running backwards and forwards, while they taught the other kids. We looked after Michael as he ran up to one of the walls and started looking at a big red cross on the wall. He also enjoyed exploring one of their chairs.
What Works With Michael
You know the one time he sat down and learned something in that session? When I gave him a pop-up toy to play with, in return for a snack. That lasted for approximately five seconds before one of the teachers swooped in and told me that they don’t do that here. ‘No, God forbid you should do that here, one of your non high-functioning kids might actually learn something and not end up going to a special school for the rest of their lives’. I thought that but didn’t say it. I also considered how well they might teach my child if they paid half as much attention to his learning as they were to my teaching style. Since I may possibly know what works with my child just a bit better than they do.
This is not the first time I have tried this approach with Michael. I have done it with other OTs and other playgroups. And to be blunt he learns more in 10 minutes of ABA than in two hours of whatever-that-was.
Relationship Based Therapies
Now I am not claiming all relationship based therapies are like this. Some relationship development interventions have some very promising results – approaches like RDI. There is the Early Start Denver Model that combine elements of both relationship and behavioural models.
Which brings me to my next story. We also started occupational therapy with Michael this week. We are doing it primarily to help Michael with his sensory needs and it was a wonderful place.
Sure, we got that ‘oh you do ABA therapy, well this is very different here’ speech. They were nicer about it though, probably because we were about to pay them nearly $700 for a report and a sensory diet. It’s amazing what paying people money will do for their social skills.
Yes Relationship Based is Different. But not that different.
Anyway what’s funny is that what they did after that looked EXACTLY like one of Michael’s ABA therapy sessions. Except that we don’t have bolts in the ceiling and five different kinds of lycra swings at our house. Yet.
First, they tried different swings on him. They found one he liked. They put him in and got him enjoying himself. Then they stopped the swing and assessed what methods he would use to ask for more. They would then bounce him around for a bit, and stop. Wait for him to request more. Then go again.
It was ABA. They may have been using social reinforcement instead of tangibles, but our supervisor has told us many times that if we can run a session using mainly social reinforcement instead of tangibles she would kiss all of our feet. She gave us a list of ‘natural reinforcers’ to use in therapy. OT is just a really great way of finding more of these natural reinforcers – and yes, the bolts in the ceiling are going to be installed soon!
There were some key differences to be sure. One: in ABA we would have been very clear with Michael what we expected him to do to get his ‘reward’ and this therapist was not. So Michael started crying, because he got frustrated and didn’t know what they wanted from him. Two: ABA is about teaching skills, broken down into bits – the relationship building is always happening but it is happening during the rewards and throughout teaching the skills. In the OT’s approach it was about building the relationship and the skills got taught along the way. But you know what? It was absolutely so tremendously similar that for the life of me I could barely tell the difference between them.
Choose the Approach that Works for Your Child
The thing is though that these techniques are all valid. Not all completely – to be clear I am only talking about evidence based therapies. I am not saying that camel’s milk is valid. Or dolphin therapy, or holding therapy. Or many other things I will not list here.
But autistic children are very different. Some approaches will work fantastically with one and fail miserably with another. And some therapies are better at particular skills. No therapist or special ed teacher should ever completely dismiss another technique out of hand. And far too many of them are doing exactly that with ABA therapy.
Each technique has its strengths and weaknesses
For example ABA is great for (well almost everything) but especially things that require repetitive learning, or figuring things out. It is fantastic if your child doesn’t have much motivation to learn on their own.
Occupational Therapy is great for physical problems – gross motor skills, some fine motor skills, sensory diets etc. Relationship type therapies are great for teaching social skills, which is something ABA can be a bit weak on. If a child only struggles with social issues and has all the other skills, I can see how a relationship based therapy would be a better fit.
There are other types too. For example, we will very soon be starting music therapy with Michael because of how much he loves songs, musical instruments, and for social and communication skills.
If you have a therapy combination – make sure they are consistent
Yes these therapies do sometimes clash and in that case you do need an overarching framework – I go with ABA and if I think something is inconsistent with our ABA goals, I drop it. So I am not advocating doing 10 hours of each therapy and having a completely all over the place approach. It is a delicate balancing/pruning act.
My approach is rather to incorporate these other techniques into ABA. Others may use something else as their ‘umbrella’. We use the reinforcement that works so well in OT in ABA. What could be better than a reward that he loves, that requires other people, is quite easy to separate into little steps, and that calms and regulates his system at the same time?
I can use the music therapy to help with social skills and to teach my son to really listen to sounds (he has trouble distinguishing similar sounding words). And again I can find more reinforcers and ways of motivating him from his music therapist. Speech therapy also has obvious benefits and most children that I know that do ABA will also do speech.
Find the Right Therapy Combination For YOU
If you go to the Old City in Jerusalem you will see an important church – it is the church of the holy sepulchre. It contains many monuments important to Christianity including the place where Jesus was crucified and his tomb. It belongs to many denominations and ‘ownership’ of part of the church is determined partially by who ‘fixes’ that bit. I have family in Jerusalem and have visited it many times and I remember a few years ago seeing this ladder and buckets standing around. The tour guide told us that the denominations can’t decide on who would fix that bit. So the tradesmen have left and it just remained unfixed. I visited a couple of years later and it was still there. For real you could not make this stuff up.
I see the different therapies (again, I reiterate, the evidence based ones) as different denominations. Maybe this comes from a long time interest in history of religion, but it works. They are all trying to reach the same goal, they are all using similar ways of getting there, and many of them come from the same root. Some are more structured, some are more liberal. But doesn’t it sound a bit odd if one of them points to another and say the others are all going to Hell? It is waaaay more odd when it comes from autism therapy providers.
And yes I understand that some approaches are mutually exclusive (to be clear, not talking about religion in this paragraph – talking about autism therapies). Some will suit your child better than another. It is hard to coordinate different approaches that may be completely inconsistent and yes if you struggle with that it is definitely better to choose only one and not even look at any others. You need an ‘umbrella’ that it all comes back to. But many of the struggles with learning life skills for my son has been the need for lots of repetition, a lack of motivation, and sensory issues. Surely any tool that can help with these things is worth trying?