Now that kids are back to school, it's a certainty that some parents are hearing about "red flags" from their preschool and kindergarten teachers. Maybe their child isn't attending as he should, can't manage circle time, is lining toys up in rows, or can't seem to interact socially. Maybe their child's language skills are underdeveloped, or their child has a tough time with loud noises and bright lights.
Whatever the issues may be, parents out there are wondering "is my child autistic? and if so - what do I do about it?"
Of course, if you really have concerns about your child, an important first step is to set up a screening - or, in some cases, a full scale evaluation. Based on the outcomes, you will almost certainly find that some form of therapy (usually speech, occupational and/or physical therapy) will be recommended (even for relatively mild developmental delays), and often provided free of charge. If your child is diagnosed with an autism spectrum disorder, of course, you'll want to learn about more therapies and options - but it may be a long wait (sometimes as long as ten months) before you get your evaluation and diagnosis.
What do you do in the meantime?
Fortunately, there are options available that not only can't hurt, but might very well help your child - whether or not he or she winds up with an autism diagnosis. Even better, several are free (assuming you're willing to buy a book or video and spend quality time with your child!).
My top recommendations for parents concerned about their child who is not yet diagnosed with autism:
- Read Stanley Greenspan's "Engaging Autism," and get started with Floortime developmental play
- Read "Talkability" by Fern Sussman, which describes the very parent-friendly Hanen approach to speech and social therapy.
In addition, you might want to take a peek at these articles on my Autism at About.com Website:
I am surprised to see prominent mention of various therapies and interventions without any mention of ABA. You might want to direct parents to the American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders”
“ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations. ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community. The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40
Harold, as I think you know, this is not an article about “top therapies for autism,” but about a completely different topic.
In fact, it is quite possible for people who think their child MIGHT be autistic to find their child is NOT autistic. In that case, they would NOT be offered ABA – and while ABA is well-regarded, it is by no means universally offered.
Again, as you well know, this site contains dozens of articles and blogs about ABA. In fact, if you google “autism ABA,” you will find that my articles rank near the top of the listings. ABA is not, however, the only topic of interest to my readers.
Lisa
I’d do nothing, most everything I’ve done has been worthless and money making for everyone but me.
I’d look to newer research in heavy metal poisoning, and find a research area that is following this in relationship to amyloid beta proteins, heme, testing for porphyrins, and hope and pray that there’s a way to reverse it. I’d picket for improving our cdc and our nih before I’d floortime with my child. Working on it with various therapies may well backfire and hasten progression, in the way the news today noted that attempts to sharpen the minds of alzheimers patients makes the disease progress more quickly. THEY were wrong, and have been for decades with alzheimers, why should we expect differently with autism. IMO and I’m sure no one likes it, we are just as likely to cause harm than not by employing any therapy, including speech. I’d do it over by letting him speak at his own rate, and putting him under no stress until it’s correctible.
Barbaraj and Harold – while I understand that you, Barbara, are most concerned about mercury and you, Harold, are most concerned about ABA, this is not a post about mercury OR ABA.
This is a post directed toward parents whose child MIGHT or MIGHT NOT be autistic, and who are waiting to learn whether the “red flags” they’ve been hearing about are or are not symptoms of autism.
The two recommendations I provided are simple, free (if the books are borrowed from the library), and absolutely risk free.
Alzheimers is a progressive, degenerative neurological condition of old age. Autism is not progressive, it is not degenerative, and its greatest challenges revolve around developmental delays resulting in children’s inability to engage and communicate effectively.
Your suggestion seems to be leading parents AWAY from interacting with their child, based on the possibility that doing so could harm them.
YOU CAN’T HARM YOUR CHILD WITH AUTISM OR RELATED DEVELOPMENTAL DELAYS BY PLAYING WITH HIM OR BY HELPING HIM TO COMMUNICATE. HELPING YOUR CHILD TO GAIN PLAY AND COMMUNICATION SKILLS IS ABSOLUTELY VITAL.
Obviously, if your child DOES have autism, additional therapies such as ABA will be recommended. And if your child DOES have medical issues, they should be addressed.
But, again:
PLAY AND SPEECH THERAPY ARE RISK FREE. YOU CANNOT HARM YOUR CHILD BY COMMUNICATING OR PLAYING WITH HIM.
Lisa
I knew you wouldn’t like it! Nothing ,is risk free, we do not know if stimulating or slightly overstimulating may be harmful. I can not say that there is no relationship between alzheimer’s and autism to even suggest that what is proven harmful in the case of one is safe in the case of the other.
NO my post was NOT about mercury, my post was about “what I would do today if I believed my son had autism” and why I believe it. It was 1:30 in the am , and I had been reading for hours, and would like to correct the “find a research area”, I meant” watch the research in this area”.
Barbara, it sounds like what you’re saying is “if, today, I feared my child had autism I would not interact with him in any way except to meet his basic needs and keep him safe, because any interaction could harm him. Instead, I would avoid any existing therapies for my child, and instead of treating my child I would dedicate myself to picketing and working for research into mercury poisoning, and wait for a biological cure.”
You’re right: if this is your point, I don’t like it. In fact, it scares me. Essentially you’re saying that early intervention, speech therapy, therapeutic play, or even ordinary human interaction has the potential to injure children with autism. Based on this theory, the best solution would be to place children with autism in a bubble and leave them isolated until such time as a medical cure is developed.
Our children, however, are not suffering from a degenerative illness. They are challenged by developmental delays. While I have no objection to picketing or pushing for research, I absolutely DISAGREE with the idea that kids with autism should be isolated or kept away from well-established therapies or ordinary interactions with other people.
If there is one thing we KNOW our children need, it is the tools for communication. I’d go a step further and say the other thing we know our children need is the awareness that they are a valued and beloved part of a community.
No one can communicate in isolation. No one can feel love when they are quarantined.
Lisa
Lisa I agree that parents should be involved as early as possible to connect and play with their children with autism. I also do believe that without awareness of typical development and how communication develops, adults who interact with the child can inadvertently do more harm than good in terms of building the child’s trust, motivation and developing meaning in thinking and communication. This does not mean it’s a good idea to not interact with the child and let them do whatever they want, of course. I just think it’s important that parents are aware there are tools available to help them be more effective in their interactions with their child.
Unfortunately, while intentions are good, there are children with autism who inadvertently become prompt dependent or develop an aversion to interacting with people because well-meaning adults often target communication objectives that are way too high developmentally, teach skills without function for communication, and are often not communicating for truly experience-sharing purposes. Functional communication is important, but many times it’s the only way people are communicating with children with ASD. Furthermore, even when we work on things like ‘joint attention’, which is supposed to be experience-sharing, often with kids with autism it’s still a demand or expecting a specific response from them.
In general, play can be fun and should be encouraged – however I’ve met with many parents who feel incompetent and frustrated because they are not sure what they should be doing (and I am sure this depends on the individual responsiveness of the child). At some point it’s a good idea to meet with a good therapist or consultant so parents can get specific feedback about the appropriate developmental level for their child, pacing of communication, functions for communication (not just to get needs met), use of nonverbal as well as verbal communication, and being comfortable operating at a slower pace for the child to process, think, and take an active role. If these things are not present, often the child is in a position of passivity or control, and eventually may develop secondary motivation challenges related to a lop-sided interaction (not really co-regulating with others). It is also very common for adults to overcompensate with people on the autism spectrum, even to the point where interactions appear balanced on the surface but really are not. Without training and awareness in this area, this is very easy to do (and I myself used to do it before I was made aware of it – it’s human nature!)
I think in terms of autism remediation more treatment is not better if it results in stress, too high demands, and negatively affects the family’s quality of life. It’s not normal for a child to spend every waking moment responding to prompts, demands or questions, yet we do this to children with autism in the name of therapy and expect them to turn out ‘normal’. And we often think this is ‘play’ – not being aware of the developmental processes that must be in a place for a child to play, and the fact that developmentally a child with autism is usually missing communication functions that are practiced in the first year of life.
Greenspan’s book is a great resource for parents who may be concerned, as is Gutstein’s book “My Baby Can Dance”, which has some real-life stories of families working on developmental processes that are lagging in autism. I also recommend “The First Relationship” by Daniel Stern – which describes what happens between parents and their babies and how important this process is for future cognitive, emotional and social development.
If parents are concerned about their child’s development, a few basic communication strategies may be helpful. These were developed by the creators of the RDI program:
1. Balance communication to a 1:1 ratio – give the child time to think and respond before repeating yourself (if he is verbal)
2. Pay attention to nonverbal communication – does your child only tune into your words, or does he check in with your face and gestures as well? If you are not sure, test it out by responding nonverbally before you give a verbal response.
3. Use more statements and limit questions. Stop asking the child questions to things you already know the answer to (otherwise it’s not genuine communication).
4. If you ask your child to do something, give up to 45 seconds for a response. Avoid the tendency to do for, do to, or to move your child’s body for him. Give time and if he doesn’t respond after your wait time, then give more support if needed (such as offering a shoe if you had asked to put shoes on).
These strategies seem very simple, yet can be challenging to put into practice consistently – we want to speed up, over-talk, over-prompt, etc.
With practice it becomes easier and the child begins to take more ownership, respond more quickly, process faster.
No, Lisa, that is certainly not what I am suggesting, I’m suggesting he find his place within my family (remember this is “if I found my child to have autism”) there would be no efforts made to force him into doing anything that didn’t come naturally. Of course he’d play, swim, draw, learn, but on a natural course without interventions. I didn’t do it that way, I sought out interventions, however I would not do it today. I would eliminate the stress of budgeting our time , coming home with programs to follow, showing response to failures, and over responding to successes . I’m less convinced today than ever before that this is helpful, and while the anecdotal stories of great successes surround many of the approaches, I’m just not a believer. My saying this shouldn’t influence others, that’s “kind of” my point, we should all do what makes us comfortable. In my house we try to do board games, “sorry”, “risk”, “monopoly” at least once a week for the benefit “I believe” we all get, through laughing, cheating, yelling, talking, getting mad, getting happy again, some may call that therapy, if so it comes without the stressors. This is way off, a very loose analogy, there is a book I hand my kids when they are pre teen’ish, it’s called “The Gift of Fear”, certainly off topic, yet it describes how the “feelings” we get are often on target, that intuition/gut responses to our surroundings shouldn’t be ignored because they are most often accurate. I believe until the facts are in, and they aren’t, that we should go with our gut feelings of how to nurture our own children. With love as the one thing we own with our children, we may already have our “tools” and know what’s best.
April, I love your list of basic strategies, they represent a very normal way of interacting with all children, asd or not. Sometimes the shoes are carried to the car in the morning by my “nts” because the “get your shoes on didn’t work”, the “toss of the shoes didn’t work” but surely going to school without them as a consequence would, so they have a ten minute ride to finish the “project”. Kind of my point, why should I put pressure on myself or my child to prove that he can follow a direction, then express such happiness that his shoes are on. Oh then, what if they didn’t get on, if it became a “fight”, should I take away his after school tv show? should I say “I’m so disappointed in you”, heck no, I’ll put the shoes on him until he decides he can do it. Chalk a loss up to me? No. IMO little things like this can build into battles, I’ll throw up the white flag first. Somewhere along the line he will do what is right, just in the process of maturation, perhaps slower then I would like but I can’t control his clock. So yes, April, I like those strategies , we can nudge, but we shouldn’t insist the progress matches our expectations.
Every child learns by modeling, and children with autism need this more so and more dramatic. I’m not sure what parents sits there spending every waking moment demanding response to prompts, demands or questions to a child with autism. For those parents that do that, probably the child will be stressed. At the same time, if a parent doesn’t treat their child with autism as they would another child, then their expectations are lower for the child with autism. If I asked my child if he wanted a drink, yes, any child would be expected to answer. I also disagree with asking your child questions of things you already know. That defeats the purpose of sharing from the child. It’s only when you know the answer that you as a parent will know the child is giving you accurate feed back.
I think putting shoes on is a developemental issue, and positive reinforcements are used by many but at the same time, for typical things like being too loud, screaming and meltdowns? You bet I ground my child like I would any child. My son still cant tie his shoes well, grounding for that wouldn’t be appropriate but grounding for not trying would.
What they fail to mention is that unless your head is where the sun cannot shine, you have already noticed these “red flag” warnings in your own kid. If you have to rely upon outside intervention, there’s nothing wrong with the kid, but the parent. What should be done as you are waiting for the official diagnosis is an extreme amount of research on ASDs. Then after that, look up what is done to help ASDs, NOT to CURE them. And to make sure you give that child as much love as they can withstand. Be an advocate for your child. Your feelings of grief have to wait so you can do what’s best for the kid. KNOWLEDGE is indeed power, power to help your kid no matter the outcome.
Wow, I’m really shocked at some of the responses. Why WOULDN’T you do the best available for your child even if it’s a little stressful?!?! Why have kids if you aren’t able to put up with a little stress now and then and do what all you can for them? We chose ABA therapy for our oldest son (6) who was 3 at the time of inital diagnosis. It has done WONDERS for him and us as a family. We moved and had tutors come in and do ABA therapy in our home about 20 hours a week. He started an integrated preschool program and this year just started Kindergarten…MAINSTREAMED!!! We are so proud of him and I know whole heartedly that ABA is a huge part of his success. I’m not saying it’s a perfect fit for everyone, but ABA across the board can help all kids on the spectrum or not. I’m not about to put him in a bubble or just play a family game with him every now and then…that’s not teaching him how to deal with the real world socially. I’m my child’s only advocate and I use that strongly. I have 3 boys…2, 4, and 6, two of which have special needs…what’s a little stress?
We started speech therapy about a year before we got an official diagnosis, and for about half of that year, were being told by our SLP that they thought our son was just a late talker. Once we started ABA, he thrived. He loved the therapists, he loved the activities, he just blossomed, there is no other way to describe it. Today he’s mainstreamed in grade one, and still making great progress. I can’t imagine where he would be today without all of the wonderful speech, play and ABA therapists who have helped him along the way.
I agree with Lisa, this isn’t really about top therapy choices, but what to do about it and none of that happens very quickly. Another aspect of that also is many private insurances do cover intervention choices, but there does need to be a diagnosis first. The only thing I will say about ABA is that it is great for many children, at the same time it’s not for others and when it comes to any therapy, the results will greatly rely on the skills of the therapist and their connection to the child with autism. Any therapy can be great, but it can also be the worst if the therapist isn’t right for the child. My son never had ABA, I personaly didn’t agree with it. Although he has Para’s (for academics and keeping other kids from picking on him), he’s always been in inclusion. There is no one therapy that will result in a child being in inclusion, either.
What parents in-waiting should do is read. There’s many good books out there. Another thing is observing the child and watch how they use words or don’t use words, how the play with toys and how they react to the outside ‘world’. I still find it amazing how my son does all those things. Parents can base their speech to adjust for that child, and how they model for the child.