Pediatric Neurodevelopmental Disorders
Neurodevelopmental disorders encompass a wide range of motor dysfunction that affects a person’s ability to moveand maintain balance and posture. While Cerebral Palsy is the most common motor disability in childhood (affecting 1 in 323 children), there are many other prevalent motor impairments due to autism, down syndrome, and other physical problems connected to an array of neurological conditions. The Individuals with Disabilities Education Act (IDEA) requires states to provide early identification and provision of services to infants and toddlers. The role of childhood health professionals has become particularly important because of the greater emphasis placed on early identification of children with delays. It is also essential to empower the families with the proper tools to improve overall progression of the child.
This workshop will provide participants with quick and practical techniques to identifyneuromotor impairments in infants and young children. The hands-on strategies will allow you to be a proactive clinician, allowing the implementation of a plan of care that can improve functional outcomes. Return to your practice with tools to immediately implement the best interventions, the latest research, and safely challenge this very fragilepopulation.
- Identify three red flags of neuro developmental impairment in infants and children.
- Implement treatment strategies and interventions to maximize progress,promote collaboration, and achieve results.
- Demonstrate analytical thinking and reflective judgment through discussions and hands-on labs for collaborativeinterventions.
- Develop comprehensive problem solving strategies as well as team participation skills needed for parent-therapist collaboration.
- Utilize outside of the box intervention strategies that carry over from one session to the other.
- Apply the intervention latest strategies, including therapeutic activities for tone management, orthotic selection, and kinesiology taping.
Our Perspective on Autism at a Glance
Autism and Autism Spectrum Disorder (ASD) are disorders of brain development characterized by difficulties in social interaction, communication and repetitive behaviors.
Current research suggests that there are multiple causes for autism. It is highly possible that there are multiple distinct types of autism, requiring different approaches to treatment.
Because there are significant differences among children with ASD, treatment needs also vary widely. We advocate assessing each child thoroughly to determine his or her individual strengths and difficulties and then planning treatment to fit the child’s unique needs.
Many children with ASD have additional neurological issues, such as motor planning or executive function difficulties, which often go unaddressed. The intelligence of these children is usually underestimated and they do not progress well with social and communication skills until their other neurological issues are addressed. The Growing Minds team has extensive experience in assessment and targeted program methods for these issues.
Practice changes the nervous system and allows ongoing development. All children, even those whose difficulties are most severe, can continue to improve as long as they are helped to practice.
We assess children for strengths and weaknesses both within and outside the common parameters of autism. Then we set progressive targets or goals that will help the child develop greater competence in the necessary areas. We create a loving, accepting and encouraging teaching environment, using methods that have been shown to be effective (evidence-based), in programs tailored to the child’s specific needs.
Every child with autism can grow, develop and enjoy a greater quality of life.
What is Autism Spectrum Disorder?
Autism spectrum disorder (ASD) and autism are general terms for a group of complex disorders of brain development. They include Autistic Disorder, Rett Syndrome, Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) and Asperger Syndrome.
These conditions are characterized by varying degrees of difficulty in social interaction, verbal and non-verbal communication and repetitive behaviors. Individuals with ASD may also have difficulties in intellectual performance, motor coordination and attention, as well as with health issues such as sleep and gastrointestinal disturbances. Some people with autism excel in visual skills, music, math and art.
According to the U.S. Centers for Disease Control and Prevention, around 1 in 88 American children are on the autism spectrum – a 700 percent increase in prevalence over the past two decades. Careful research shows that this increase is only partly explained by improved diagnosis and awareness. Studies also show that autism is much more common among boys than girls. An estimated 1 out of 54 boys is diagnosed with ASD in the United States.
What Causes Autism?
Until recently, science offered no explanations for the causes of ASD. Research is finally yielding more information. Over the last few years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these alone are sufficient to cause autism. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental stressors influencing early brain development.
To date, researchers have operated from the assumption that autism is one distinct condition. But each time a cause for autism is discovered, it soon becomes clear that this cause is only true for a percentage of diagnosed individuals. This has led many practitioners to suspect that that there may be many distinct forms of autism that do not share common causes. This theory is consistent with the experience of the Growing Minds team in working with hundreds of children and teens with ASD.
This Perspective on Autism
If there is no single type of autism, the diagnosis of ASD does not tell us much about a child. Because there are significant differences among children with ASD, children’s treatment needs may also vary widely. Rather than assume that a child has a particular difficulty that is commonly associated with autism, the Growing Minds Program begins with the assumption that each child must be assessed to determine his or her specific difficulties. For instance, while many children with ASD are predominantly visual learners, some are not.
Contrary to popular belief, some children with ASD are affectionate and outgoing. Some children on the spectrum like to be touched. Others have good eye contact. Some pretend, some are capable of deception and some show good signs of “theory of mind” (the ability to understand that others have beliefs, desires and intentions different from one’s own).
Because individual differences are so prevalent among people with ASD, we believe that effective treatment requires individual assessment, leading to programs that are custom-designed for the specific strengths and weaknesses of each child.
There are additional neurological issues that are not clinically associated with autism, while remaining highly impactful for those children who are affected by them. These issues are usually ignored in diagnosis and treatment planning. Some researchers suggest that at least one-third of children on the autism spectrum have difficulties with executive function (a set of skills that enable goal-directed behavior, which can be affected by neurological impairments). But because these difficulties only affect one-third of those with ASD, they are not considered defining characteristics of autism and are seldom discussed or addressed in treatment.
Many children on the autism spectrum (but not all) have dyspraxia (movement difficulties which can affect gross motor, fine motor, speech motor or all motor functions). Again, because this type of difficulty does not affect all children on the spectrum, it is often ignored. Many programs for ASD children are designed only to deal with issues thought to be common among most children with autism, such as social and communication issues. However, there are many children on the spectrum who cannot progress well with social and communication issues without also addressing their difficulties with executive function and/or motor planning. Individuals with these difficulties make the best progress when teaching methods are designed to accommodate their specific needs. The Growing Minds team has extensive experience in assessment and targeted program design for children with these issues.
A Strength-Based Approach
Most programs do not prioritize finding the specific strengths of the child and helping the child use his or her strengths to overcome difficulties. Most assessments and programs focus primarily on deficits. We are adept at helping children to find and more fully develop their strengths.
Every child with autism can improve. If strong, evidence- based methods are used, in an atmosphere that is infused with love, acceptance and encouragement, children can be helped to practice the very things that they find most difficult. There is more and more evidence showing that the nervous system can change depending on the demands placed on it. This is called “activity dependent plasticity.” This principle has been shown to hold true, not only for verbal and intellectual development, but for the brain structures that affect movement, spatial intelligence, etc. This means that all children, even those whose difficulties are most severe, can continue to grow, develop and improve as long as they are helped to practice.
Autism is not a defining quality of a person, nor is it an enemy. Each child has a unique personality, strengths, skills, gifts and deficits. We are not trying to make children be “neuro-typical.” We want to help each child develop enough motor skill so that he can move freely. We want to help each child develop an ability to communicate, should she choose to do so. We want to help each child develop enough social skill so that he can feel comfortable with others and develop relationships if he wishes to do so.
We want to help children develop the cognitive skills that will enable them to participate in the world of facts, information and ideas should they choose to do so – as receivers, contributors or both, according to their wishes. We want to help children develop the skills that they need to live independently, should they wish to do so. We want to help children develop the tools that they can use to enable themselves to be happy and to feel emotions that they find enjoyable and fulfilling. More competence means more choices and more options. More options mean greater freedom. We love and respect diversity, even as we teach competence and enable access to greater opportunities in life.
This program assesses children for strengths and weaknesses both within and outside of the common parameters of autism. From this assessment, we set progressive targets or goals that will help the child develop greater competence in the necessary skill areas. These methods have been shown to be effective (evidence-based) to help each child improve in programs tailored to his or her specific needs. We believe that each child can be helped to improve with effective teaching and sufficient practice.
- Children under age 5 who have recently been diagnosed with Autism, Asperger Syndrome, Pervasive Developmental Delay, Not Otherwise Specified (PDD-NOS) or Rett Syndrome.
- Children from 18 months to 3 years of age who show signs of autism or PDD-NOS, even if there has not been a formal diagnosis.
- Children starting from nine months of age who have neurological difficulties.
- Parents who are interested in a home-based program for their toddler or young child. Growing Minds is a good fit for parents who want to be central in their child’s early intervention and who understand that, no matter what other services the child may receive, the outcome will be better if the parents are trained and know what to do.
- Parents who are searching for an early intervention program for their child that combines loving playfulness with effective methods. We are a good fit for parents who find some of the play therapy programs to be too unstructured, while some of the behavior programs seem too rigid.
- Parents who want both training and follow-up support for their home-based intervention. Our program works well for parents who want seasoned professionals who will oversee their child’s progress, helping to modify the program as necessary, while also respecting the parents’ central and decisive role in the child’s treatment.
Early Intervention Programs
Early intervention for young children with autism creates the most favorable outcomes. While in the past, doctors often took a “wait and see” attitude, today most experts suggest taking action as early as possible to help children with signs of autism.
Our team has an unusually large amount of experience in training parents to provide home-based intervention for children who are newly diagnosed with Autism Spectrum Disorders, as well as for those have been identified as potentially at risk for ASD, even before they receive a confirmed diagnosis. Growing Minds early intervention programs serve children between 18 months and 5 years. We are also experienced working with children with severe neurological problems, starting at nine months.
Our strong background in both play-based approaches and proven behavior methods makes us uniquely qualified to develop and oversee programs for young children with autism.
Growing Minds early intervention programs vary in structure, hours, treatment goals and curriculum, based on the needs and age of the child. However every program includes:
- Parent involvement
- Intensive, playful social interaction
- Making the best possible use of the natural family setting, daily activities and parent-child interactions to enhance the child’s development.
- Determining and using the child’s interests to increase motivation
- Developing play activities to aid learning goals
- Setting individualized developmental goals
- Specific methods to progress with goals such as language, play skills, toilet training, self-care and social interaction as well as supporting cognitive development.
- Environmental recommendations
- Determining an optimum number of program hours per day for the child
Because it is often difficult for parents to find qualified therapists in their communities, we focus on training and supporting parents to implement their child’s program and to teach others (relatives, friends, volunteers) to help with therapy sessions if needed. Where parents are making use of paraprofessional staff, such as behavioral or play-based program aides, we can provide supervision, training, oversight and curriculum development to make programs as effective as possible.
Programs for Children with Pervasive Developmental Disorder
Pervasive Developmental Disorder – not otherwise specified (PDD-NOS) is one of the Autism Spectrum Disorders. The term is used to describe individuals who do not fully meet the criteria for autism or Asperger syndrome.
Children are likely to be diagnosed with PDD-NOS if they fit into one of the following profiles:
- They are functioning highly in many areas of development and may resemble people with Asperger syndrome, but they have some language delays or mild cognitive impairment (the Asperger diagnosis requires no speech or cognitive delay).
- They resemble children with autism but the onset of autistic symptoms occurred at a later age than is usual for autism, or they did not meet the criteria for autism in some specific way.
- They have characteristics of autism, but they display fewer stereotyped and repetitive behaviors.
Special Treatment Needs of Children with PDD-NOS
Within the professional community, there is general consensus that children with PDD-NOS benefit from early intervention and special education services. However, one child with PDD-NOS may have completely different strengths and challenges than another child with the same diagnosis. A form of treatment that is highly effective for one child may be completely unnecessary and ineffective for another. As a result, the treatments and interventions that work best will be highly individualized, based on the information gathered from a thorough assessment of the child.
The assessment must examine a wide variety of factors including behavioral history, current symptoms, communication patterns, social competence and neuropsychological functioning.
There has recently been a strong and needed emphasis on early intervention in the local community for young children diagnosed PDD-NOS. But often children who are five or older do not continue to receive the kind of individualized programs that would benefit them tremendously. Parents can compensate for this by creating a part-time home program.
A Forward Thinking Approach to PDD-NOS
In our experience, children diagnosed with PDD-NOS often have neurological difficulties, which remain undetected. These children tend to work extremely hard to compensate for these issues. They often do not get appropriate services because their diagnosis is not well understood and they are not thought to require the kind of services necessary for a child with autism (an incorrect assumption.)
Careful assessment of the child’s skills and the areas of difficulty is critical for children with PDD-NOS. Effective target setting and support to meet those targets, including help for any unaddressed neurological issues, will dramatically impact the future of these children.
For older children (over age 5) with PDD-NOS, we often recommend that school be supplemented with help from an extremely effective, part-time home program. We design these home programs and train parents to implement them. The programs consist of some structured teaching sessions as well as making use of the child’s daily activities, interactions with family members and play time with peers to help the child meet developmental targets, improve social and communication skills and reduce unwanted behavior.
Based on individual assessment, our programs are designed to accomplish specific targets necessary for the child to improve social, communication, cognitive, academic and play skills that are not being addressed sufficiently at school, with the aim of closing any developmental gaps that exist. We are available to oversee the child’s progress and continue to modify the program to keep up with the child’s growth.
Children with Severe or Classic Autism
- Children, teens or adults who have been diagnosed with any of the following terms: severe autism, profound autism, autistic disorder, low-functioning autism, classic autism or “Kanner” autism.
- Children, teens or adults on the autism spectrum who are not functioning well, not talking and not responding to requests or instructions — or who are doing these things on a very infrequent basis.
- Children, teens or adults with obvious movement problems.
- Parents who have seen signs that their child is more intelligent than the conclusions of previous evaluations indicate and parents who know that their child has more potential than his or her evaluations or diagnosis suggest.
A Forward Thinking Perspective on Severe Autism
In our experience, the more severely autistic an individual is considered, the more frequently mistakes are made in assessing and treating him or her. In addition, the more severely autistic an individual seems to be, the more often erroneous assumptions are made about his or her state of mind. The intelligence of these individuals is frequently underestimated.
Many programs for ASD are designed to address only those issues thought to be common among most people with autism. Thus most autism programs are not well adapted for individuals with more severe difficulties in functioning. As a result, those with more severe autism seldom progress well in autism programs, not because they are unable to make progress, but because the programs are not well designed for their needs.
In most cases, when a person comes to us diagnosed with severe autism, we are able to determine that their difficulties are more compound and complex than the diagnosis of autism indicates. For example, the person is autistic, but also has significant motor planning and motor control difficulties (dyspraxia). Or the person is on the autism spectrum, but this is combined with rather severe executive function difficulties. (Executive function is a set of skills that enable people to engage in goal directed behavior. Sometimes, if there is a neurological impairment, executive function is affected.)
It can be a mistake to think that the autism is more severe. In fact, the problem is not the degree of severity of the person’s autism, but autism in combination with other difficulties.
Dyspraxia and executive function can have nothing to do with intelligence. A person can have a genius IQ, and have severe motor or executive problems. Most people described as severely autistic have also been diagnosed “retarded” because they score low on an IQ test. However, this is “functional IQ.” It is not a measure of cognitive ability, but a measure of how well the person can function on an IQ test. Until that person is functioning better, no one will be able to accurately assess his or her level of intelligence.
Our Programs for Individuals with Severe Autism
Helping a person with compound and complex neurological difficulties requires a special set of eyes and a special set of helping skills. First, we must observe and assess carefully, considering the possibility of dyspraxia and executive function, as well as other possible neurological difficulties.
After careful assessment, learning goals need to be broken down into more basic steps than most professionals are accustomed to doing. Next, we often need very specialized teaching methods to accomplish those goals. Even if many previous attempts to teach the child have failed, we do not regard the learner as the problem. The problem is that most teaching methods will not work for children with these issues.
Individuals with High Functioning Autism, Asperger Syndrome and Nonverbal Learning Disorder
- Children, teens or adults who have been diagnosed with High Functioning Autism (HFA), Asperger Syndrome or Nonverbal Learning Disorder (NLD).
- Children or teens who demonstrate a broad array of average or above-average skills, juxtaposed with specific difficulties or deficits in functioning. People may typically find it hard to understand how these variations of strengths and weaknesses can be present in the same person.
- Children or teens who have obvious and significant difficulties in understanding emotions in others and themselves, as well as difficulty understanding how other people think and feel.
The Diagnoses of Asperger’s, High Functioning Autism and Nonverbal Learning Disorder
There are some controversies surrounding these diagnoses, centering on whether Asperger Syndrome overlaps or differs from the more informal category of “high functioning autism” (HFA) and whether “nonverbal learning disorder”(NLD) is a separate condition from Asperger’s or HFA. These arguments can cause confusion and unnecessary diagnostic hair-splitting. We believe that the most important question is not “What is your child’s diagnosis?” but “What is happening with your child?”
Children who receive the diagnosis of Asperger Syndrome, HFA or NLD are often misunderstood. The differences between people who share these diagnoses can be far greater than the commonalities. And yet well-meaning teachers, relatives and friends tend to search the internet to learn about the syndrome or read about other people with these diagnoses, rather than attempting to fully understand what is true for the particular child.
This becomes problematic when the child learns explanations about him or herself that are based on the experiences or opinions of others. These explanations can influence the child’s thoughts, feelings and attitudes in ways that are limiting, unhelpful or simply not true. Part of our work with children with these diagnoses often involves sorting through the beliefs that they have acquired about themselves, helping them to get past the learned answers and to develop more insight about themselves as individuals.
Some people who share the diagnosis of Asperger Syndrome refer to themselves as “Aspie.” On one hand, it is highly important to both accept and value people with differences and to not regard a diagnosis as an enemy. At the same time, the title “Aspie” is beginning to raise unreasonable expectations of special abilities and to create possible stereotyping. Our programs prioritizes helping each person to understand him or herself as an individual, apart from all the controversies and discussions, and then to take their insights back into the broader conversation, if they wish to do so.
This Approach to Asperger’s, High Functioning Autism and Nonverbal Learning Disorder
Because people with HFA, Asperger’s or NLD can vary widely, a treatment that is highly effective for one individual may be completely unnecessary and ineffective for another. This makes it essential to begin by obtaining a thorough and accurate assessment of the individual’s particular strengths and difficulties. The Growing Minds team is highly experienced and particularly effective at the kind of assessment that can be most useful for people with these conditions. Some particular areas of concern which we consider include:
- Often these individuals have unique strengths and deficits existing side by side.
- Sometimes the child’s difficulties are hidden by well-developed coping mechanisms and no one recognizes how hard he or she is working to function.
- Hidden or well-compensated difficulties in functioning can cause episodes of extreme frustration to appear, seemingly out of the blue, with no apparent cause.
- Often sensory difficulties, motor difficulties, executive function problems and visual behavior difficulties have not been identified or addressed because the focus is on academic skills, language anomalies and obvious social difficulties.
- Well-meaning parents, teachers and professionals often make assumptions about the thoughts and feelings of children described as “high functioning.” These assumptions may have interfered with the accuracy of previous assessments.
As determined by the assessment, we identify the targets necessary for the child to improve social, communication, cognitive or academic skills, with the aim of closing any developmental gaps that exist. We design the methods to reach these goals and train parents to implement them. We often recommend that school attendance be supplemented with help from an extremely effective, part-time home program.
The programs may consist of some focused teaching sessions as well as making use of the child’s daily activities, interactions with family members and play time with peers, to help the child meet any developmental targets that need to be addressed as well as improving social and communication skills and reducing unwanted behavior. We are available to oversee the child’s progress and continue to modify the program to keep up with the child’s growth.
One particular area of specialty in our programs with “higher functioning” children is an emphasis on developing self-confidence, self-esteem and the ability to manage strong feelings. We have developed special ways to teach about emotions that help people with Asperger’s, HFA and NLD to be more emotionally resilient, while also helping them to become more aware and understanding of the emotions of others and themselves.
This tends to work best when the parents have already had previous training and experience in working with their child at home.
Parents who Are Just Starting To Work With Their Child
- If you’ve never worked formally with your child and you have had no prior training.
- If your child was recently diagnosed, and you want to work with him or her at home, either in place of an early intervention program in the community or to enrich a community early intervention program with more one-to-one therapy at home.
- If your child is not flourishing in school, and might benefit from a home-based program.
- If you’re satisfied with your child’s school, but want to create additional support for him or her during afternoons and weekends.
The Benefit of A Custom Tailored Program
- Concrete methods for engaging your child’s attention and developing rapport
- How to gain your child’s cooperation
- Direct observation and coaching on your teaching skills
- Effective responses to your child’s challenging behaviors
- Strengthening your own confidence, optimism and peace of mind
- Recruiting and training therapists or teachers (optional)
- Optimizing your child’s environment and creating an effective teaching area
- How to use your child’s interests to increase his or her motivation to learn
- Exercises and activities to use at home
- Observing our staff work with your child
- Integrating your home program with school, if appropriate
Creating an Optimum Home Environment for Children with Autism Spectrum Disorders
It is not practical to try to give a single set of instructions for every family in every home with every child with some degree of autism. Not only is each child a unique individual with distinct requirements, but there are also many differences among families, homes and cultures that would make this task impossible.
However, it can be helpful to clarify certain principles about the effects of the environment on children with autism, which parents can consider and modify for their own child, home and culture. That is the purpose of this article.
Is your home a happy home? Is there a high level of stress? Do the people who surround your child tend to be uncomfortable or tense? Or is the predominant attitudinal tone one of ease, security, warmth and good feeling?
In my experience, children in proximity to adults who describe themselves as stressed or uncomfortable tend to react with one or more of the following behaviors: an increase in either the frequency or intensity of self-stimulating rituals, more oppositional and challenging behavior, decreased responses to requests, decreased eye contact, decreased smiling and more neutral facial expressions. I have often observed children whose motor planning ability appeared to reduced (which is generally the case when a child is stressed) and observed differences in speech, such as more repetition, less articulation, more “psychotic” talk, etc. Many children also appear more agitated and stressed when they are in the same room with adults who describe themselves as uncomfortable.
Here are some suggestions to help create an optimum healthy environment for your child:
1) Start with yourself and your own level of emotional comfort. That is all you really have direct control over (yes, you do.) If only one person in the family system becomes more comfortable, the entire family system is affected.
2) Become more “selfish”. This seems like an odd thing to say. Prioritizing your own physical, mental and emotional well- being is one of the most important things that you can do for your family and for your child with autism.
3) If you have no time for yourself, find a way to get time. Let go of something. Ask for support. Try asking family members, friends or neighbors to relieve you by spending time with your child. Hire a helper if necessary. Make this a priority.
4) Consider getting help from a professional counselor for yourself, or with your spouse. This is especially important if the stresses and tensions are high, or if you find yourself severely depressed, frequently enraged (once a week versus once every few months), or hitting (or wanting to hit) your child. There are many styles of counseling. Find someone who will help you deal constructively with your feelings and change your feelings – not simply ventilate them.
5) You don’t have to be in extreme discomfort to benefit from some form of counseling. Consider getting support if you are generally comfortable, but feel that you could be enjoying yourself and your family more.
6) Notice how you feel after you talk to friends and acquaintances. If you find that you feel discouraged, less confident or tired after speaking to certain people, then consider decreasing your time with them. If you notice that you feel more positive, more confident or more energized, after speaking to someone, then treat that relationship as a valuable resource. Spend more time with that person. Prioritize relationships that help you feel empowered and inspired.
7) Minimize your child’s contact with extremely tense or uncomfortable people. The people that your child experiences will help to shape his/her beliefs and feelings about interacting with all people. Do your best to surround your child with comfortable, happy people. Consider eliminating stressful environments and people from your child’s life, at least temporarily while your child is developing skill and confidence with people. Consider coaching or training the people who come into your home, to help them be more comfortable with your child.
8) Do not get uncomfortable about other people’s discomfort. Your child may be more influenced by your attitude than that of other adults. If someone is uncomfortable, focus on accepting them and realizing that they are doing the best that they know to do. If you practice this and get good at it, you will feel better, and interestingly enough, the people in your environment will be more likely to feel relaxed in your presence. All of this will tend to give your child a more positive, relaxing environment.
Many children with autism have sensory differences, particularly hypersensitivities involving one or more senses. It is a good idea to be aware of the sensory environment and how it might affect your child.
Background sounds that most people tune out might be at the forefront of your child’s awareness. Background music, machine noises, traffic, wind and nearby conversations might all be drawing your child’s attention. At those times, your child might make less eye contact, and be less focused or less interactive. As much as possible, find ways to minimize the background noises – especially when you would like to engage your child. Turn off the television and ambient music, run the dishwasher after your child goes to sleep, consider placing sound-reducing materials in places where you would like to have focused time with your child.
There are some children who are so sensitive to certain sounds, that they will appear disturbed, tantrum, whine, cry or cover their ears, when these sounds occur. If this seems to be the case with your child, it is important to notice whether she/he is sensitive to particular sounds, volumes or pitches. You do not have to eliminate these sounds altogether from the environment, especially if it involves the sound of someone’s voice.
Visual over-stimulation is also a consideration. In many of the classrooms in the United States, the United Kingdom, and Australia the classroom walls are literally covered with words, letters, objects, colors, posters, etc. The belief is that the children will learn latently by looking at the walls, even if they do not look at the teacher. This thinking can be counterproductive for children with autism. Eye contact tends to decrease in such a visually busy environment. The environment competes with people for the child’s attention. In places where you would like your child to pay attention to people, minimize the number of items on the walls.
Lighting can also be important. Many children tire quickly, show diminished eye contact and have shorter attention spans in rooms with fluorescent lights. These children do better with incandescent lighting. There are now high-speed ballasts for fluorescent lights that minimize the pulsating effect, but it is not yet clear if they are effective. We are also not sure about the impact of compact fluorescent bulbs. Sometimes, it is best to try different lighting, see how you feel with it and how your child responds.
In addition, colors can have an effect. Observe which colors your child notices most and use these colors judiciously. For example, suppose your child pays more attention to bright primary colors. You might remove items with these colors from the walls and eliminate them from your child’s wardrobe, since your child may pay more attention to the walls or their own clothing than to people. But when you want your child to pay attention to you, try wearing a hat, shirt or face paint in the primary colors or introducing new activities using these favorite colors.
The House as a Minefield
How often do you find yourself saying, “No – don’t touch that!” “Don’t go in there,” or “Leave that alone!”?
If you are saying these things frequently, then the environment may be a kind of ‘minefield’ for your child. Children who are intrigued by strong reactions from their parents will repeat the unwanted behaviors to get the interesting reaction. Other children, who are more prone to withdraw, will tend to explore and play less and be less motivated to interact with you, if you frequently tell them “No”. Either outcome is undesirable.
Consider locking the items that you do not want touched in drawers or closets or placing them in storage for a few months while you work to gain your child’s cooperation. Again, consider your own comfort and be reasonable.
In parenting a child with autism, establishing communication and rapport is a primary goal. Locking valuable or unsafe items away can eliminate situations where you have to say no or discipline your child, freeing you to interact with your child in more comfortable and user-friendly ways.
Locks can be seen in two ways. Some people associate locks with jails. Others see them as protection. Consider viewing locks as a means of making your home a safe place for your child’s exploration. Notice whether your child experiences tension with his/her siblings over the siblings’ prized possessions. If this happens, consider giving your other children a special way to lock up their valuable items.
Also, you must control access to reinforcing items and experiences. If your child can access these things freely, they will have no need to communicate or to cooperate.
Consider creating a playroom in your house, or at least having an area where you can encourage your child to focus on you and whatever you present to them. The playroom could be a bedroom at night and a playroom during the day. If your house is large enough, it is ideal to dedicate one room to be used for your work with your child. The room is designed to enable you to be the focal point and to provide an environment in which you can most easily use your time with your child to help him/her develop communication and interaction. In a special playroom, there are no distractions drawing your child’s attention away from you (or yours away from your child). There should be nothing in this room that you have to say “No” to.
Here is a list of suggestions about the playroom:
1) For most children, a room about three meters by three meters is sufficient. Size is discretionary – if your child is small and the room is really large, it can defeat the purpose of trying to create a more focused environment. If your child is large, you will both want more space for movement.
2) Minimize visual distractions. Put the shelves up high so that toys and other items are out of your child’s each and not at eye level. Your child will then need you to reach them, thus providing more opportunities for communication. Do not use patterned wallpaper. Paint the walls a light, neutral, pleasing color.
3) Include a table that can be used as a desk, and a chair in the room. We recommend using a table that is standard table height, and a Stokke Tripp Trapp chair that can be adjusted for your child as they grow. There are a number of advantages to this kind of seating arrangement.
4) Consider putting a covering on the windows that admits good light, but eliminates the view outdoors and decreases your child’s interest in staring out the window. The rough Plexiglas that is used in shower stalls is ideal.
5) If possible, choose a room with an adjoining or nearby bathroom, so that trips to the bathroom don’t become long and distracting expeditions.
6) Use comfortable lighting.
7) A padded floor is safer for certain kinds of play. This will also be more comfortable for you, as you may be spending time on the floor or on your knees. Consider putting linoleum over padding. There may be spills – and it is nice to not have to worry about wet carpet.
8) Be sure to have the items that you will need in the room at the beginning of every session, such as food, drink, toys, books and activities that correspond to your current curriculum. If your child asks for something, you can then run to the shelf and get it, without having to leave the room and disrupt the session.
9) If you are running a program several hours a day primarily using the playroom, consider some means of observation – either a one way mirror or a CCTV or both. One way to do that is to take the existing door off and store it. Mount a new door and cut a window opening into it. Mount a one way mirror. (Be sure to use tempered glass or some form of safety glass.) A listening device can be installed – even a baby monitor. There are a wide variety of surveillance systems available on line. Some people can switch on the playroom action in any room that has a TV. Also, this allows for ease of video recording of sessions.
One final, but very important consideration is to make the environment that you create for your child a comfortable place for yourself too. None of these suggestions are rules. They are guidelines and basic principles that you can adapt for your child, yourself and your unique family and cultural circumstances. Have fun!
Children Whose Progress with Autism Has Slowed
Dyspraxia – Movement Difficulties in Children with Autism Spectrum Disorders
What is Motor Control and Why Does It Matter?
Throughout the day, each of us performs numerous sequences of movements with little effort or thought, such as showering, brushing our teeth, dressing, driving, typing, etc. The list of these actions is vast, considering that most behavior involves muscle movement, including looking, talking, swallowing and even breathing.
Some of the most complex motor movements take years of practice, such as the twists and turns of an Olympic figure skater, the performance of a concert violinist or the jumping and throwing of a professional basketball player. From the rote and seemingly simple movements of daily life to the dazzling accomplishments of skilled athletes, moving the body in any way, for any purpose, depends upon a complex motor network controlled by the nervous system and maintained through an intricate physiological balance.
This network is based in the brain and connected to the spinal cord through specific pathways. The brain and spinal cord work together. They coordinate the planning and execution of motor movements – from learning to tie shoelaces to becoming an Olympic gymnast.
Dyspraxia is a general term used to cover a range of difficulties affecting the initiation, organization and performance of movements. It appears to involve problems with the brain’s ability to process information, which results in messages not being fully transmitted to the body. Dyspraxia can be present from birth or as a result of brain damage suffered from a stroke or other trauma. It may include difficulty with planning sequences of coordinated movements as well as difficulty with executing motor plans, even when they are known.
In the United Kingdom, the term dyspraxia is often used to describe clumsiness in otherwise typically developing children. In this article, dyspraxia refers to the more significant problems of movement described in the preceding paragraph and not to clumsiness in typical children.
Dyspraxia and Autism Spectrum Disorders
While many children with autism spectrum disorders show well-developed motor coordination and dexterity, there are numerous others with significant difficulties in movement and motor planning. Among this group, there are differences in the form that dyspraxia takes. In our experience, the various forms of dyspraxia can exist together or separately.
Some children have marked difficulties with gross (large) motor movements and they may show obvious problems with balance, walking, running, getting up or down, starting or stopping, imitating actions, getting “stuck” in a repetitive movement, etc. Due to low muscle tone (hypotonia), they may have difficulty sitting without support.
Others are more affected at the level of fine motor skills. They may have trouble with pointing, grasping, or with holding on to or letting go of objects. Still other children with autism have such difficulty controlling the muscles surrounding the eyes, that they cannot direct their gaze to a desired person or object.
Finally, there are children who have what is referred to as “speech dyspraxia.” While most of us do not think of speaking as a movement, speech is among the finest controlled combination of muscle movements that the human body can perform. When a child cannot control these movements, the acquisition of speech is affected: oral motor imitation is difficult, words are very difficult to learn and the same sound might be repeated over and over.
Motor Ability and Motor Planning
Your child’s motor ability is not the same as her ability to motor plan. There are many physical actions that your child can do, thus he/she is demonstrating motor ability. But if he/she has trouble doing what she wants to do when he/she wants to do it, he/she has difficulty with motor planning.
Perhaps she cannot always move her body in the way that she wants. He/she may have trouble intentionally performing certain actions. It may take his/her time and a lot of effort to succeed at performing an action. He/she might have some motor movements that are patterned and she may have difficulty stopping or changing these patterns, leaving her “stuck” in repetitive movements. When he/she is not trying, she may be quickly successful at various motor actions, while being unable to do the same actions when he/she is requested to do so.
If a child sees something that he wants at the top of the stairs, he might climb up the stairs and grab the desired item. But, if he is asked to focus on going up the stair, he/she might have difficulty doing it. There are two different kinds of intention involved. In one case, the boy is acting impulsively. In the other case, he is being asked to focus on the movement. Sometimes with dyspraxia, the child can act according to impulse, but has difficulty being successful when focusing on more planned and sequenced movements.
Another characteristic of dyspraxia is that your child might have certain movements that are habitual and routine. The strength of the routine can be much more powerful than his ability to motor plan. All of us have had the experience of going into automatic pilot and driving to the place that we habitually go, rather than to the place that we intended to go. We say, “Silly me,” and turn the car around. Luckily this doesn’t happen so much that it impairs our day to day functioning. But this dynamic could be severe enough for your child that it might impair his/her functioning. He might have a number of movements that he does, not because he/she particularly wants to, but because his/her automatic pilot is stronger than his intention.
Some of the children who are most involved in repetitious movements as self-stimulating rituals are dyspraxic. If a child is in good rapport, appears to be trying and is having difficulty responding to a clear request, he/she may be dyspraxic.
Other Signs of Dyspraxia
- Actions take a long time to learn. Then the child often responds with that learned action even when it is not appropriate.
- Delays in responding to requests – he does it, but after time has gone by.
- Your child is extremely inconsistent, sometimes performing an action smoothly and sometimes having great difficulty responding.
- Often he can do matching exercises, or other activities that require the same repeated motor plan.
- He/She has difficulty imitating.
- Your child takes your hand to perform an action (as if your hand will work better than hers).
- Your child has difficulty learning series of movements.
- Often the child appears unusual in certain movements. He/She can appear stiff, clumsy, or delayed in these motor skills. This can occur even though many other motor skills appear to be normal.
- Often, when writing or typing, the same scribble or key combinations appear over and over again.
- Your child might leave the table repeatedly because he is stuck in a motor pattern for getting up and going. Or he might bring things to his/her mouth repeatedly because he/she has this motor pattern. Often these children will welcome your breaking of the pattern, rather than appearing angry if you obstruct them. Some dyspraxic children even welcome a belt that holds them in a chair or in a bed.
- Often there is a strong sense that the child understands much more than she is demonstrating. Sometimes this comes from seeing differences in the quality of attentiveness when she is spoken to in more sophisticated ways. At other times, the child sporadically responds to sophisticated requests that were thought to be beyond her comprehension.
- Often there is poor bilateral coordination. Often there is no clearly dominant hand.
- There may be poorer performance of tasks that involve alternating contraction and extension of opposing muscle sets. For example, if a child is asked to put an object in a bucket, he might pick it up, hold it over the bucket and not let go. Grasping and then letting go involve opposing muscle sets.
- Sometimes, when a child with dyspraxia does respond, the movement is quick and impulsive. Slow, controlled movements may be rarely seen.
- Surprisingly, with some dyspraxic children who can write, their writing is as good or slightly better when they are blindfolded.
Some Signs of Speech Dyspraxia
- Your child has difficulty making speech sounds.
- She has difficulty sequencing sounds.
- He has difficulty controlling breathing and phonation.
- Your child has had difficulty with feeding
Under certain circumstances, children with autism spectrum disorders are likely to “fool” even a well-trained observer into concluding that they do not have dyspraxia, particularly if the observation time is brief.
When evaluating dyspraxia, it can be helpful to consider actions that are practiced extensively every day in a class by themselves. Extremely well practiced movements will be an indicator of how skillful your child can be with practice but they should not be used to evaluate for dyspraxia.
Dyspraxia and Intelligence
Because of their difficulties responding to requests, children with autism and dyspraxia are often considered to be either cognitively impaired or willfully uncooperative. These are both erroneous assumptions.
Dyspraxia does not affect intelligence but it does create problems with learning. Often the intelligence of children with dyspraxia is under-estimated. This creates a problematic cycle. Because they cannot show their intellectual capability, they are considered to have low intelligence and are seldom taught at a level that is commensurate with their intellectual ability. Over time, they are given fewer opportunities to learn, less intellectually challenging material and fewer chances to practice new skills than their peers. As time passes, they are likely to fall further and further behind, seeming to confirm prior assumptions about low cognitive ability.
Even in autism treatment programs, the special motor planning issues of children with dyspraxia are seldom addressed. Treatment tends to focus on the social and communication issues shared by all people with autism. When educational methods are not well designed for their specific needs, children with dyspraxia do not make the desired progress with social and communication issues. This often results in being labeled as more severely or profoundly autistic than children who do not have movement issues. Similar to the situation of children who have autism with executive function difficulties, the problem is not a more severe form of autism, but autism combined with dyspraxia. Until the nature of their problem is understood correctly and addressed with appropriate strategies, these children typically fail to make much progress.
Minimizing Motor Issues
There are a number of ways to help minimize motor challenges. One is to be aware of ergonomics. For teaching or therapy sessions, many children with dyspraxia do better in a chair with a hard back. This extra support gives them one less motor demand. Stuffed chairs that fully support a child can interfere with the development of needed support muscles.
It is important that the chair be a good fit for the child. When he sits in the chair with his feet flat, his upper legs should be parallel to the floor with his knees at a 90 degree angle. When he/she sits straight with his/her arms at a 90 degree angle (upper arm hanging straight down), the table should be just below his/her elbows.
In teaching sessions, be aware of where you hold the materials that you present to her. Present materials at a height where your child’s arms are relaxed and can be moved easily on the table. Also present the materials close enough to her body so that her arms don’t have to be extended, but not so close that he/she is jammed up. If you present the items while asking her to point, it will be difficult for her if the items are presented at her arm’s length. He/she would have to extend and support his/her own arm, as well as getting to the correct target.
When you present materials, also consider your child’s midline. Her midline goes from her nose to her navel. The midline is actually not a line, but a geometric plane that bisects your child, separating the right and left half of her body. If you present two choices, and she tends to indicate with her right hand, you might want to put both choices more to the right so that her right arm doesn’t have dramatically cross her midline to get to one of the choices.
Experiment and be more acutely aware of posture and positioning. Notice when she appears to have greater or less success.
Helping your child overcome motor difficulties
Here are several things that you can do to help your child overcome his or her motor difficulties.
Children with dyspraxia must work very hard to develop abilities that the rest of us take for granted, such as controlling their movements, practicing motor tasks, building strength and improving coordination. Encourage your child to develop attitudes that will help him enjoy making an effort with his body. Teach him to persist and keep trying. Encourage him to never get frustrated. Let him know that you know that he is smart, even though sometimes it is hard for him to show it.
Create a home environment where you enjoy challenges and where improvement and effort are highly valued. If he has success, that is great and it is celebrated – but success in a task is not the only source of good feeling. Good feeling can also be derived from determination, persistence and great effort each day. Some tasks will not be cognitively challenging for him, but they will help him develop coordination and control. Let him know that those tasks are not about how smart he is, but about how controlled he can be in his movements.
More Cognitively Challenging
Children with motor control difficulties are mentally faster than their bodies. For them, most communication and play take place at a speed that they cannot physically keep up with and so they give up on it. The things that they can do well with their bodies are simpler and less sophisticated than what their minds are capable of doing. This can result in children lounging around and not doing much or engaging in some repetitious activities that don’t really engage their minds.
You can design tasks to be cognitively challenging. Multiple choice questions with an array of two or three possible answers is an example. Play a tape of a sound (a train). Give him a choice of two or three items and ask him to give you the one that makes the sound. Place three written names in front of him and ask him to point to his name. Also to point to the names Mama, Papa, etc. These tasks are more cognitively challenging.
Find a Response Form
In order to design more cognitively challenging tasks, it is important to help your child find a “response form” that he/she can manage well. This allows him to show what he understands and it can also become the basis to teach new material and skills.
For example, we worked with a boy who was extremely dyspraxic and did not show control of his own hands. If asked to take one item from an array of three items placed on a table, he would turn toward one of the items and look at it. But his hands did not move. If he moved his hands, the movement was uncontrolled and he often knocked the items off the table.
It became clear that his most accessible motor response was moving his head and eyes. We outfitted a headband that had a pointer with a rubber tip extending out in front. Using this equipment, he rapidly gained the ability to touch the pointer to the desired item. Now, he had a “response form”, a way of responding that involved muscle groups that were under his control. By pointing in this way, he was able to show us that he knew names of people, animals, objects, etc. Often, the best response form for a child with dyspraxia is a motor response that changes very little. Let’s say that your child can put an item in a bowl. He/she has trouble pointing and he doesn’t respond when he/she is asked to touch something. But he/she can easily put an item in a bowl. You might put three bowls on a table, with a different item in each. Place an item that matches one of the items in the bowls in his hand. Ask him/her to “match.” If you see that he is able to put the item in the correct bowl, you can begin to make relatively small variations in his established motor plan, such as putting the bowl with the correct item the middle, slightly to the left or slightly do the right. This single response form can become the basis for assessing and teaching a variety of skills.
Use an Effective Teaching Method
Discrete Trial Teaching (DTT) can be very useful for children with dyspraxia. If you put some life and warmth into it, this teaching method has the potential to help your child tremendously, as it allows him/her to learn and demonstrate a great number of intellectual skills with a manageable set of motor skills.
A single teaching “trial” consists of a clear request, a pause, a prompt if necessary and reinforcement for a successful response. For instance, ask him/her to point to an item in a book. If she doesn’t, after 4 seconds, form him/her hand into a point and help him/her point to the picture. Then praise him/her for the correct response. As you continue with the activity, fade the prompt as he/she learns the task and responds more independently.
This method helps with dyspraxia because the task and the timing are clear. If the child gets confused, she knows that the answer will be coming in the prompt. Because you fully prompt your child by taking her body through the action, she can physically experience what it is like to do the task. If you use this routine frequently, your child will learn the routine and become skilled at the motor plans involved. She won’t have to figure out the ever-changing rhythm and order of the tasks she is given and she will be able to put more energy into motor planning.
Warn your Child
Warn your child – tell him a minute or more in advance what you will be asking of him next. This could enable him to prepare and help with motor delays.
If your child is having some difficulty, prompt her by moving her through the task. This is a physical prompt. You might tell her that you are going to “show her.” Then, take her hand or whatever body part is being used for the task and help her through the task. If she resists your prompt, stop the prompt. Consider telling her that she wasn’t quite ready. Tell her that you will give her a few seconds and then you will try again. Wait a few seconds and then try again.
When using physical prompts to guide your child through the action, be sure to slowly reduce the amount of support you are providing as soon as possible. Continue to “fade” the support until you child is performing the action independently.
Slow and Control Impulsive Movements
Sometimes your child may do an action very quickly, as if she is throwing herself at the task. When asked to point to a picture, she might tap her finger on the photo several times in rapid succession. This is not a well-controlled movement. If she does rapid and repetitious movement, help her go more slowly and in control. Demonstrate exaggerated pointing once, in a slow, controlled manner. Then help her, by prompting her if necessary.
When your child starts to master a task, he may pick up speed. Now is the time to work toward fluency with that skill. Fluency involves accurate and controlled speed. Many children with motor control difficulties want to go fast. If he is smooth and relatively fast in his movement (not blurting and impulsive) and if he can control his movement and change it to fit the task, then he is fluent.
When you notice that your child is getting good at responding to certain requests, and is starting to go faster, alternate the requests and ask him to go a little faster. This can add interest, fun and challenge to simple activities.
For example, a girl liked to put things in a basket. We made a slotted color box to put blocks in, sorted by color. When she had learned to correctly identify the colors and put the blocks in the right slot, she wanted to pick up speed. She maintained her accuracy and was not repetitious in her movements, even when she went fast. She appeared to be practicing fluency. She may have been motivated to experience herself as competent. She may have been making the task more stimulating and cognitively challenging by speeding it up. She may have been showing off. My bet is that she was doing them all. Practicing fluency can make a task more cognitively challenging and more fun and give your child a greater source of pride in accomplishment.
Many people have noticed that a number of children with dyspraxia do better when they are in physical contact with another person. Along with making sure that your child’s body is well-supported if she is doing a fine motor task, you might notice whether she appears to do better when she is in physical contact with another person.
In teaching sessions, experiment with forms of physical contact while she is doing tasks. Try putting an arm around her, sitting shoulder to shoulder, putting your hand on her back or leg or positioning the chair and table in the corner of the room and sitting close to her. These may be especially helpful when she is doing more challenging tasks. If she does better with physical contact, treat this like a prompt and fade the contact as she becomes more competent.
Practice Brings Improvement
Children with dyspraxia require much more effort to create motor patterns. They require more time to practice using motor patterns when appropriate and not using patterns when not appropriate. Over time, and with practice, children can become more and more adept at controlling their bodies. When they do, they begin to show the cognitive ability that they always had, but could not demonstrate. When this happens, they command more respect, and gain the belief of others in their abilities. With more control comes better expressive communication.
If you have the determination and the opportunity to help a child with dyspraxia to gain motor control, you help her to benefit more and more from the world around her, even as you receive the benefit of her growing ability to give to you.
If You are Dissatisfied with Your Child’s Progress, We Have Extensive Experience in…
- Identifying the reasons why a child’s developmental progress may have slowed or stalled.
- Implementing methods for the child to begin moving forward again at a rate commensurate with his or her potential.
- Breathing new life into programs that have lost momentum.
- Re-inspiring and energizing parents and teachers who have lost motivation or become discouraged.
- Providing methods and strategies for parents who sense that their child is not getting the right kind of help or not continuing to benefit sufficiently from an existing program.
These programs are recommended for:
- Children who seem capable of making more progress than they are currently making.
- Children whose progress has slowed after successfully using an intensive interaction program, such as Son-Rise, or Floortime. If your child increased eye contact, social interaction, speech and affection in these programs, but then seemed to reach a plateau, we can help.
- Children who have progressed well in an ABA program (for example, he or she does well when working one-on-one in school) but are not translating those skills into other areas of life.
- Children whose development seems stuck, especially in a specific skill area such as speech acquisition, verbal behavior, toilet training, communication or social skills. Parents observe that the child reaches a certain point and then can’t get beyond an apparent impasse.
Why Does Progress with ASD Slow, even when a Program Has Initially Been Successful?
Many approaches to autism treatment are based upon one central premise about autism. Typically the people originating and providing those programs are well-meaning and strongly convinced that their view of autism is correct. We refer to these as “single approach programs.”
For instance, the TEACCH program is based on the idea that people with autism are visual learners and that there is a culture of autism that is predominantly visual. The Son-Rise program is based on the idea that a non-judgmental attitude will create a human environment that will support more communication and social interaction for people on the autism spectrum. Relationship Development Intervention (RDI) is based on the idea that guided social experiences will help a child develop the dynamic skills necessary to form social bonds. The biomedical approaches are also based on the idea that autism is primarily a condition of poor immune function, the presence of toxins or other biomedical factors.
Each of these programs may be created around certain theories or practices that are, in fact, beneficial for many children with autism. However, none of these programs is sufficient to help all children diagnosed with autism spectrum disorders.
Why Single-Approach Programs May Be Insufficient
A minority of children with ASD have specific, limited difficulties that affect a single aspect of language development or attention. These children may be able to get enough help from a single-approach program to correct or compensate for the single deficit and then be able to move forward.
However, the majority of children on the autism spectrum have much more complex difficulties. They need more help and varied kinds of help. They may get some of what they need from “single approach” programs, but they will not get all of their needs met. When they have reached the limits of what that program can do for them, their progress will slow or stop.
At this point, if the parents are convinced that the program should be able to meet all their child’s needs, they may blame themselves for not doing the program well enough. They may try harder to provide more and more of the same interventions, while seeing less and less progress. Others may grow frustrated and give up trying. Parents are at risk for depression and loss of motivation during these periods. Relatives, friends or professionals, concerned about the parents’ distress, are likely attribute the lack of progress to the child’s innate limitations or assume that the child has reached the upper limit of his or her potential.
While all these reactions are understandable, none of the conclusions formed are correct. The child’s plateau is seldom due to the fault of parent or the limitations of the child, but an indication that the child has reached the limits of what that particular approach can do for him or her.
It is not uncommon for a child to benefit for a time from a program or teacher that is highly effective in dealing with certain specific deficits. When the child acquires strength in that deficit area, the child’s next area of need may not be a specialty of the existing program. Progress slows, or stops. It can seem like there is a wall that prevents further development.
For example, a child with poor eye contact, who does not look at visual targets when requested, will have trouble learning the names of common objects. A program that helps that child to increase eye contact and to respond by looking at visual targets will develop more understanding of language. Some children in that circumstance may begin to speak or dramatically increase their vocabulary. However, if that child also has motor difficulties that are severe enough to interfere with talking, that child will also need some very specific motor help. What is enough for one child is not enough for another child. What works for one child, will not work for another child.
Finally, there are children with very complex difficulties who do not have the physical/neurological foundations needed to fully benefit from certain programs. For instance, children with visual impairments will not benefit much from the TEACCH program, which emphasizes visual learning. Children with executive function difficulty or dyspraxia will not fully benefit the Son-Rise or RDI programs, which do not include methods to address these compound neurological issues. In these instances, a particular program may be inappropriate, even though it has helped many other children.
There is no single autism program today that will meet all the needs of all children on the autism spectrum.
For children who have reached a plateau in a program, the way forward is to forget about any single program and to focus again on the child’s strengths and on the areas in which he or she needs more specific help. Assume that the problem is not with the child, but with the methods being used so far. The way forward is to find specific tools and methods that may help that child with the target areas that will provide the greatest benefit.
Begin by assessing a child who not progressing well. We use close observation in person, (or through video, if necessary) to make the best determinations possible about the child’s specific difficulties. Based on this careful assessment, we make adjustments to both goal setting and teaching methods. When the new methods are in place, we observe the results and reassess to determine if further changes are necessary.
We can walk parents and teachers through that process through our comprehensive programs and, in some cases, through distance programs (by phone and internet). We can be the new eyes that help you assess what is happening with your child and make suggestions from a wide range of tools. We will do everything we can with our extensive resources to re-energize your program, to get you and your child over the hurdle, past the plateau and moving forward at a pace more commensurate with your child’s actual capacity for developmental growth.