A Developmental Approach to Autism: Not ABA, but Building on Core Foundations. Everything You Need to Know.
The justification of therapy is hinged around the basis of viewing developmental gaps using purely behavioural lenses. For example, there are the following assumptions of ABA:
Behaviour can be affected by the environment;
Behaviour can be strengthened or weakened by consequences;
Behavioural changes are more effective to be changed with positive reinforcement rather than negative punishment;
Behaviour needs to be disciplined or reinforced for socially significant changes.
The trouble with this model is that it doesn’t consider the core deficits of autism itself. The neurological differences and neurological weaknesses where the underconnectivity theory is robust in scientific studies are hardly addressed by these tenets. Because they have been truly considered, one would start working on building and strengthening the pathways of connectivity. Logically speaking, one can’t think about correcting behavioural deviations when there is a lack of semblance to foundation patterns of interactions, to begin with. These patterns of interactions as developmental experts have pointed out, rely greatly on many minute moments of interactions established at the Infants’ early age by caregivers.
Daniel Stern in his “The Infant Years” tells you that from the get-on – the neural connectivity starts in vitro before the birth of the child. When the child is born, the usual “work” of the caregiver’s interactions (holding the baby, responding to the baby’s cries, adjusting the baby so that he gets to be comfortable, responding to the baby reaching out, the baby responding to his own body, etc), all play an important role when it comes to establishing the foundation and fundamentals of the Infant Self. The Infant Self soon develops and craves human interaction because of all this “work’ that has been done. This intricate work, within grounded developmental milestones, would soon pay off because the baby starts to develop cognitive senses, within the environment he is placed in. He starts to learn how to establish meaning, and he starts getting attuned to the caregiver, aligning his emotions with those of his caregiver. With that relationship, language blossoms because the child starts to absorb and use words for connections and communication. This puts focus on the very natural instinct of babies to develop through relationships.
Purely changing the behaviour of a child when he has not developed basic developmental milestones, whether its emotional milestones, cognitive, or physical, is very much missing the point.
Logically, intervention would have to start by thinking about the child from a developmental standpoint. This means taking a check of those milestones that are not intact and putting in place a programme that would suit the child. Typically, too, a bottom-up approach where foundational pre-linguistic skills would need to be looked at. So it is not a question of “Teaching the child to speak” – but of planning for intervention where small steps are met - so that the eventuality of speech and language (symptomatic of lots of milestones coming together in place) becomes evident.
Think of these small steps of interactive goals as a savings bank, in which good experiences build up in incremental strength when these experiences are properly coached and acquired.
These experiences are going to be “fuel” and motivation for the child to go on with new experiences. This is where resilience comes from.
This blog will cover the following:
Starting at the right point of development for intervention as Paramount
When treating children on autism spectrum disorder, it is important that we treat this as a whole child. This means taking into consideration the different milestones and starting intervention from where development has been arrested.
In a child who lacks joint attention, almost always, we have to start looking at creating remediation that provides small moments of success. This would be more replicating all those small steps needed to gain attention and regulation.
Sometimes this would involve having the child connect at a very tactile visceral level. Training parents to use important moments of connections where body movements are coordinated would be important.
Recognise the importance of Prelinguistic Goals
One of the key goals is for our therapist to work on establishing connectivity with the child. This can be carried out in a variety of ways with the principles of Guided Participation, slowing down, and establishing patterns of interaction that allow the child to recognise different forms of “status quo”. Having the child see an action in a continuous flow, instead of a disjointed form, would also be a key fundamental goal. It is from here, that we can work on emotional alignment, experience sharing, and creating suitable challenges so that the child can slowly acquire cumulative experiences of interactive successes. Successful acquisition of Prelinguistic skills would mean that naturalistic language and speech would follow.
Parents’ Role as Absolute, Non-negotiable, Primary Key Player
No one in this world would play as important a part in the child’s developmental growth as their parents. So it is a critical part of remediation to truly involve parents. Our experience has told us that this can sometimes be a daunting piece of news for parents, and that remediators cannot replace the value that parents bring into the equation. However, it need not be so, as we exist to guide you, as far as possible with the “how-tos”. Having access to a network of the best people in developmental remediation means that we can help you tap into vast resources to help with a different, but potentially rewarding parenting journey.
Work within the Environment itself for Generalisation
Generalisation refers to the child’s ability to use skills taught in a setting to apply these skills to a different setting. Often in many settings, generalisation is one of the most difficult to achieve. Whatever skills that are learned in an artificial clinical setting, or specifically at home, cannot seem to be spontaneously reflected in across different settings for the ASD child. For generalisation to occur, it is imperative that the interventionists plan this from the get-go. The triadic inter-mingling of what we do, and standardize, across different settings of home, therapy center, and school plays such an important part in helping the ASD child connect and form links of his subjective self and his environment. When it is time to increase in complexity our goals for the child, it becomes easier to align with one another, and the child reaps the benefits of gaining in confidence understanding others and being understood.
How do we deal with resistance?
Instead of seeing this as a behavioural issue, Dr. Steven Gutstein has advocated that it's more relevant to see this in the light of the child’s inability to borrow your mind to see through the tasks – for its interactive payoffs. Once the child is able to borrow the adult’s mind and see things through your lenses, the feelings of fear and uncertainty diminish and he is more likely to “go with the flow” or venture out into more uncertain territories.
School Suitability and Readiness
When it comes to rebuilding the brain, ensuring priority is given to establishing connectivity in the small little actions, and moments, this would mean that we need to give ourselves permission to allow time for things to happen, within the child-parent growth capacity. Some things cannot be rushed and increasing neural connections really is one of those. This follows that adopting the mindset that a structure that has been set externally (including prescribed education systems etc.) would be not so likely to be one that would have been designed with your child in mind. For many parents, not used to the idea of this, it can be understandably an isolating experience. However, recognizing this and working with a trained therapist to chart out the course of action in the next few months and years, would be, in be in our opinion, best practice, and may give the child a fighting chance of thriving.
Finally – Building Episodic Memory
There is so much research of how episodic memory is impaired in children on the spectrum. However, findings unfortunately haven’t trickled into real practice.
Check out – how our integration of practice from Centre, to Home to School works to help build on Episodic Memories.
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