I was asked to write a blog after I contributed to a discussion on Irish Autism Action’s facebook page on the subject of Social Communication in Autism. My opinion differs from many on this subject and may have created some curiosity.
I have worked in the field of Autism for 18 years, predominantly in the UK and I have used many of the treatment approaches used today in Ireland throughout this time. I still continue to use elements of these approaches in my work, however 3 years ago I re-trained in the USA in a program that understands and treats Autism from a developmental and cognitive perspective and this has very much changed how I now view Autism. I do not claim to have a quick fix or “bag of tricks” nor should any other professionals in this area but after all my years working with both adults and children with mild to severe autism, I am a strong believer in the need to look deeper, when planning treatment for children and adults on the spectrum.
When considering this blog , I realized I would be putting the cart before the horse, if I went straight to discussing Social Communication in Autism. First and foremost, I thought it would be useful to look at why we may have to change the way we do things. I’m a firm believer in first asking questions, before we consider creating answers. I therefore have chosen to focus this blog on the “why” rather than the “how”. I am happy to follow up with some helpful strategies if readers are interested?
Deficits or Challenges?
We have known for some time that children and adults diagnosed on the Autism Spectrum by definition are struggling in many areas: social understanding, flexible thinking, communication and the list can go on depending on the specific needs of the child. Lorna Wing’s “Triad of Impairments” has informed and guided diagnosticians and diagnostic tools for decades now.
When we view Autism through the lens of a “deficit model”, we see these “impairments” as immoveable objects that are almost part of the child’s personality. We see unusual behaviour and explain it by saying things like ”he does this because of his Autism”, or “people with Autism don’t like doing this”. This might be true when we view these problems based upon observing behaviour alone, but it does not begin to explain to us why such problems exist in the first place for the child. This, I believe, is where the challenge lies.
Why do we need to look beyond surface issues?
It is easy to see the problems a child is exhibiting on the surface — outbursts, avoidant, limited verbal communication, clumsy, oppositional, etc. What you have to avoid, however, is the urge to take these problems at face value and assume that what you are seeing is the thing that needs to be treated. Sometimes that can be the case but many times there are more foundational or developmental issues that are causing the surface-level symptoms we see daily.
A child with autism who is nonverbal, for example, has a problem that is visible — she is not speaking. It seems obvious to focus on getting the child to talk, and parents are often told to look for a speech therapist to teach their child to speak. The problem with this approach is that it often does not take into account why the child is not talking. It fails to investigate whether missing developmental foundations are creating the surface problem of lack of speech. In the case of all children, there are a number of social and communication foundations that require development before words can be used effectively. When it comes to children with Autism, we see many children who have failed to master these critical foundations. If that factor is ignored, the child with Autism may still be taught to say words but will not be able to effectively use those words to communicate. Does this sound familiar?
If we look at the development of typical children, we know that speech is the last modality of basic communication that they learn. Speech develops after the child has mastered numerous forms of non-verbal communication and more importantly has developed an appetite for communication on a social level. How useful will words be for a child with Autism, if they have not yet developed such an appetite or do not have any understanding of the non-verbal foundations of communication?
The following video illustrates how typically developing children learn to communicate very effectively using non-verbal communication, long before they develop speech.
As you can see, these little guys have a truly reciprocal conversation going on without using any words.
The same is true for a child who exhibits problematic or challenging behaviors. The first response may be to hire a behavior therapist to treat the behaviors because that is what everyone sees on the surface. There are many more foundational or root issues that require investigation before deciding that we should treat the behaviour alone. Does she have adequate developmental foundations for emotional regulation? Are the communication and cognitive abilities in place that allow for understanding of the environment and communicating appropriate responses to it? If we fail to examine these areas we may very well treat the thing we see on the surface without resolving the problem at all because we have not addressed the real underlying problems.
Similarly, we see many children with Autism who appear resistant to change. We have compensated for this difficulty by encouraging parents and educators to make environments very structured for them. On the surface, this may appear to reduce stress and open the child up to better learning opportunities, but in the long-term are we not perhaps decreasing the child’s chances of living independently as an adult? The real world does not offer such structure and predictability. If we choose to look closer, there will be developmental reasons behind why your child is afraid of uncertainty. She may lack the cognitive abilities to process vital information from her environment. We all avoid things we do not understand and children with Autism are no different in this manner.
Autism is commonly accepted to be a neuro-developmental disorder. In many Autism treatments , we have largely ignored developmental psychology. I firmly believe there is fantastic work being carried out in Ireland by both professionals and families and I feel the emergence of developmental perspectives in Autism in Ireland will only serve to create much richer outcomes for those children we are working with.