If your child has ASD, autism or Aspergers you most likely wonder what is the most useful, powerful and successful treatment for him or her? How can you help your child meet their potential? Simply, what is the most effective Aspergers treatment and help for aspergers? Many parents of aspergers children worry that their child will never be able to develop strong friendships let alone a human-romantic relationships that could eventually lead to marriage and children and a full life. Relationships during childhood, who you have as friends and how well you get along and attach, as Dr., John Gottman has pointed out, are the #1 factor in determining outcome later in life. They correlate to employment success, to later relational success and even to life span. People who related better in the 4th grade earn more money, are happier and live longer. It's more important that academic grades, prizes in science or awards in sports.
So can your child with Asperger's do well in relationships? The truth is, it is possible, but it takes a lot of work, the right advice, access to the right information and treatment interventions. Which ones work best? Regretfully, the answer is "it depends." What we do know is there are treatments know to work, and those for which there is no scientific support.
Here are the top 4 methods of aspergers treatment:
1. Applied Behavioural Analysis
2. Floor Time
3. Speech Therapy
4. Social-Cognitive Therapy (training in theory of mind)
Notice "social skills" isn't in this list. We are always teaching social skills, but there is a difference between a lack of social skill knowledge and the social-cognitive deficits children and adults with Asperger's suffer from. (I recently posted two great videos that explain "theory of mind" and urge you to watch those. Understanding the difference between a social skills deficit and a deficit in theory of mind is critical for successful treatment for you or your child. And many schools and therapists don't understand the difference.
At different times your child my need one or all of these treatment interventions. They each have their place at the appropriate developmental time, and can be adapted to use at different developmental moments. Heres a little more detail on each:
1. Applied behavioural analysis (ABA)
ABA is a method of teaching that involves breaking tasks into small, discrete 'teachable' steps. At each step appropriate behaviours are reinforced. ABA selects developmentally appropriate behaviours as teaching targets. These can range from maintaining eye contact to complex responses such as social interaction. The child is given enough support to ensure success, which is then positively reinforced by consequences that are reinforcing for that child. Gradually the amount of support and reinforcement is reduced.
Early intervention programmes for children with autism and Asperger's have the potential to produce positive changes in development and consequently reduce the need for later interventions. Therefore in many ABA programmes parents are trained to become the primary therapists and their children receive one-to-one tuition in their own homes. There is evidence that intervening in a child's development in this way can help children with autism to be more successful in mainstream schools (Keenan et al., 2000). Often parents want to avoid this step, especially if their child is a little most socially developed, verbal etc. DON'T AVOID ABA! ABA training is necessary for you as a parent to understand the basics of behavioural interventions. Exposing your child to good, competently taught ABA prepares them with tools you can use later to teach new skills. It's a tool best learned young, and then used again and again.
ABA is not everything, however, and for some schools and intervention programs it seems to be. There are other, more complex skills that cannot be taught through ABA. But ABA is the foundation of your future work.
2. Floor Time
Here is one description of ABA I really like, "During floor time, your child will stretch his imagination and logical understanding of the world as he stages make-believe games and locks horns with you over rules. He'll use gestures and words to express his needs and to explore a broad range of emotions, from exhilaration to anger. He will also hone his physical skills as his muscles strengthen and grow." Yes, floor time means getting down on the floor and MODELLING appropriate make believe games, using your imagination, and exposing your child to the idea of "sharing the floor" with another person. It's the environment you use to generalize behavioural skills you have taught. Later Floor Time can be thought of as becoming Social Cognitive Therapy I mention below in 4. Floor time has not been shown to change "autistic" behaviours (self stimulation etc.) but it has been shown to improve the quality of the relationship between the child and parent. I expect research will show it does the same with the child and therapist, teacher, teacher aide and so on. Some positive play time involving the reciprocal interactions between the child and adult needs to be part of any program. And it needs to be fun, reinforcing and relaxing!
3. Speech Therapy
Speech Therapy may help their child with communication difficulties. The difficulties are not in how the child speaks or pronounces words, but rather in how the child perceives the meaning of other people's speech. A speech therapist focuses on issues of social reciprocity, understanding the second level of communication in speech. Often this is more about what is not said than what is said. In speech therapy I would expect a child to learn to understand how what he or she says effects others. And in addition, a speech therapist is able to measure our overall progress in terms of "pragmatic language and help with simple speech difficulties that make communication, already difficult, even more difficult. Every child with Asperger's should be seen by a speech pathologist.
4. Social Cognitive Therapy
The I-LAUGH Model of Social Cognition developed by Michelle Garcia Winner is a framework of social cognition designed to explain the multiple skills and concepts that we must process and react to in order to succeed at social interaction and personal problem solving. Each of these elements of social cognition affects not only our ability to make and keep friends, but also our ability to process complex information in the classroom and the workplace. The I-LAUGH Model is evidence-based in that each aspect of it has been researched and defined as a trait of persons with social relatedness issues. A brief summary of the I-LAUGH framework from her web page is below. You can find out more about here work at her website at www.socialthinking.com:
I = Initiation of Communication (Kranz & McClannahan, 1993)
Initiation of communication is the ability to use one’s language skills to establish social relations and to seek assistance or information from others. Many students with autism spectrum disorders have significant problems initiating communication in stressful situations or when information is not easily understood. Language retrieval is difficult in anything other than calm, secure situations. Even within the higher functioning population with autism spectrum disorders, the student’s ability to talk about a favourite topic of interest can exist in sharp contrast to how that student communicates when needing help or when attempting to gain social entry into peer groups. Yet, these two skills – asking for help and understanding how to join a group for functional or personal interaction - are paramount for any student’s future success.
L= Listening With Eyes and Brain (Mundy & Crowson, 1997; Kunce and Mesibov, 1998; Jones & Carr, 2004)
Many persons with autism spectrum disorders and other social cognitive deficits have difficulty with auditory comprehension. From a social perspective, listening requires more than just taking in auditory information. It also requires the person to integrate information seen with that which is heard, to understand the full meaning of the message being conveyed, or to make an educated guess about what is being said when one cannot clearly understand it. For example, classroom teachers expect students to “listen with their eyes” when they point to information that is part of the instruction. They also indicate to whom they are speaking in a class, not by calling the student’s name but instead by looking at the student or moving closer. Students repeatedly relate to their peers through nonverbal cues, ranging from rolled eyes to signal boredom, to raised eyebrows to indicate questioning, to gazing at a particular item to direct a peer’s attention. Clearly to “listen with one’s eyes” requires students to have mastered the concept of joint attention – a skill that seems to effortlessly develop by the time a child is 12 months to 15 months old in neurotypical children, but may be missing from the social repertoire of the student with autism spectrum disorders, ADHD and similar challenges. Instruction in this essential and fundamental function of social interaction begins with teaching students that eyes share social information. Not all students understand this concept, nor do they grasp that listening requires full attention to both verbal and nonverbal cues. It can then expand to teaching students to relate to each other’s thoughts through play and other activities of social relatedness, followed by extending the student’s realm to attending to and processing increasingly complex cues that help students “listen with their whole bodies.”
A = Abstract and Inferential Language/Communication (Minshew, Goldstein, Muenz & Payton, 1992)
Most of the language we use is not intended for literal interpretation. Our communication is peppered with idioms, metaphors, sarcasm and inferences. Societies around the world bestow awards to writers, and even comedians, who are most creative with language. Each generation of teens creates its own slang; kids who follow along are in; those who don’t, are often out. Advertising and other forms of mass media follow these cues. The abstract and inferential component of communication is huge and constantly in flux. It is a mistake to assume that our students with social thinking deficits understand our society’s non-literal use of language. In fact, most of them don’t! Literal interpretation of language is a hallmark characteristic of individuals with ASD. Yet, as educators and parents, we either miss this impairment entirely – thinking our smart kids must understand our nuanced communication - or we address it in the briefest of ways, with instruction dedicated only to explaining idioms, irony and metaphors as part of English class.
U = Understanding Perspective (Baron-Cohen & Jolliffe, 1997; Baron-Cohen, 2000)
To understand the differing perspectives of others requires that one’s Theory of Mind (perspective taking) work quickly and efficiently. Most neurotypical students acquire a solid foundation in ToM between the ages of 4 to 6 years old. Perspective taking is not one thing, it represents many things happening all at once meaning it is a synergistic and dynamic process.
G=Gestalt Processing/Getting the Big Picture (Shah & Frith, 1993; Fullerton, Stratton, Coyne & Gray, 1996)
Information is conveyed through concepts, not just facts. When involved in conversation, the participants intuitively determine the underlying concept being discussed. When reading a book of literature, the purpose is to follow the overall meaning (concept) rather than just collect a series of facts. Conceptual processing is a key component to understanding social and academic information. Difficulty developing organizational strategies cannot be isolated from conceptual processing. Students with conceptual processing challenges often have difficulties with written expression, organizational skills, time management and being overly tangential in their social relations. (All of these concepts require us to stay focused on a central theme or main idea and to keep our writing, discussions or planning focused to this central point. Many of our folks struggle with this, over-focusing on details and not focusing in the concept (an intuitive skills for neurotypicals).
H= Humor and Human Relatedness (Gutstein, 2001; Greenspan, & Wieder, 2003; Prizant, Wetherby, Rubin, Laurent & Rydell, 2006)
Most individuals with autism spectrum disorders, Asperger’s and similar challenges have good senses of humour, but they feel anxious since they miss many of the subtle cues that help them understand how to participate successfully with others. It is important for educators and parents to work compassionately and with humour to help minimize the anxiety these children are experiencing. At the same time, many of our clients use humour inappropriately; direct lessons about this topic are needed and relevant.
Human relatedness - the ability to bond emotionally with others - is at the heart of human social relationships and the fuller development of empathy and emotional regulation. Teaching students how to relate and respond to other people’s emotions as well as their own, while also helping them feel the enjoyment that arises through mutual sharing, is critical to the development of all other aspects of social development.
Michelle Winner's "Social Thinking" approach may sound overwhelming, but it is in reality simply, fun and reinforcing for children. She has numerous books, workbooks, videos and other resources for use at home and in the school. One of my favourite is a book called "Superflex," a book for kids/students that teachers about the way the mind of a person with Asperger's works, and steps you can take to overcome many of the problems this brings. She demonstrates this through an exciting and funny set of stories involving super-heros battling super villains like "RockBrain," an evil doer who keeps you from using your brain in a flexible manner. If you have a teen, or are an adult with Aspergers, you'll understand and like this story.
This is a lot to think about, and most parents need to find someone to guide them through this maze of techniques, programs and new language. Often I see parents jump at quick and easy answers that make promises based upon "testimonials" of others. These include the use of "brain tuning," "hearing training," ""sound tuning," biofeedback or neuro-therapy and many miracle diets and supplements. None of these have any scientific basis, and many plainly don't make sense. These four treatment methods should be the foundation of your plan. They are supported by research, used in most schools and intervention programs, and are accepted by the professional community. If you insist on "testimonials" I can even say, although I am reluctant, that these are the programs most highly recommended by parents.
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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other social-cognitive deficits and learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
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