It is likely that many of you visiting this website know a friend or relative whose child has a developmental disorder. This is not surprising, as current estimates now place one out of every 166 children on the autistic spectrum. This alarming statistic has prompted the recent launch of the federal government’s ten-year campaign to understand and treat children with autistic spectrum disorders (ASD). But if we are to truly change the outlook for these children, we must begin by changing our assumptions.
Prevailing wisdom regarding
the potential of children with these disorders is deeply pessimistic.
The widely used behavioral approach to treatment teaches rote skills
with the main goal of changing behaviors, the assumption being that
these children’s difficulties in the areas of reading emotional cues,
empathy, and creative thinking represent permanent limitations that can
not be treated.
But they can. Children
originally diagnosed with ASD can learn to relate, love others very
deeply, and many can learn to communicate and think creatively and
logically. In contrast to the older model, the new approach recognizes
that each child has a unique path to the disorder, and therefore each
child’s path to improvement must also be unique. In addition to
overcoming symptoms, the goal of treatment in this new model is to help
the child master the healthy emotional milestones that were missed in
his early development and that we now know are critical to learning.
Building these foundations helps children overcome their symptoms more
effectively than simply trying to change the symptoms alone.
Take the case of “David.” At 2 1/2 years old, David could not use language meaningfully, and made little eye contact with others. He engaged in repetitive behavior, lining up cars over and over again. David’s treatment program, based on the older model of treating symptoms, had enabled him to memorize more words, but he was not becoming more spontaneous or interactive with others.
It was clear that David was
missing crucial pieces of early development. Our goal was to help him
learn to enjoy true intimacy with his family, respond to social and
emotional cues, and use language meaningfully. To do this, we had to
figure out that he was very oversensitive to sound – the normal human
voice was almost frightening to him – and he was confused by what he
heard and saw, making it hard for him to enjoy intimacy, communicate or
think. David also had a hard time figuring out how to carry out actions
that required more than one step, such as running after the ball to
bring it back. This made it hard for him to interact socially.
As we worked with the
family on a comprehensive program to deal with the missing pieces in
David’s development, gradually we were able to create experiences where
he could take pleasure in a warm, close relationship with his family,
and become engaged in the back-and-forth of natural communication with
gestures and words.
By kindergarten, David was
able to relate to others with real warmth; he had lots of friends and a
mischievous sense of humor. He was in a mainstream classroom, and even
had somewhat precocious reading and math skills. David, now fifteen, is
warm, creative, and popular with peers – by any measure a typical
teenager. While not all children with substantial developmental
challenges will make this kind of progress, the majority of children
using the modern approach to development are making significant strides
in the areas of social and emotional as well as intellectual growth.
The modern model has the
potential to revolutionize early identification and intervention. In a
large health survey conducted by the National Center for Health
Statistics, the addition of the emotional milestones described in this
new model resulted in the identification of 30% more children at risk
for developmental problems. And in a review of 200 cases using this new
model, a subgroup of children was observed to develop abilities formerly
thought unobtainable for children diagnosed with ASD: intimacy with
adults and peers, empathy, creative and logical thinking. Like David,
these children participate in regular education programs and have made
excellent academic progress.
Unfortunately, the new
concepts are not yet widely used. In our review, more than 90% of
clinics and medical centers spent less than ten minutes observing
children spontaneously interacting with their caregivers when conducting
developmental evaluations. This resulted in numerous misdiagnoses,
underestimation of the children’s abilities, and treatment
recommendations with insufficient emphasis on relationships and family
Families and clinicians need access to this
modern approach to identification and treatment that is improving
outcomes for children. With this new model, we can do a better job of
identifying children at risk even earlier, rather than waiting for
symptoms to appear. We can help children become warm, related and
engaged. And we can define each child’s potential not by assumed
limitations, but by his own growth.
Back to About Autism Page