Autism – Its Time we Stopped Compensating for the Deficits and Started to Believe in Remediation

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. What approach do we take to supporting the needs of these children? Historically, by and large, we have taken a compensatory approach.

In other words, we find ways to work around these problems so that the child / adult fits in to the mould of what we expect of them in given situations, be it school, home, college or in a residential service. Our main motivation becomes applying strategies that help them more appropriately fit into a box. An example of this is in the education system, where we employ strategies to get the child to sit quietly in class, do school work and projects, learn academic skills and wait in line without becoming upset.

While we make attempts to help the child with their social understanding and communication skills, we do this on a surface level with little understanding of the developmental processes that contributed to their difficulties. As a result of this poor understanding of these developmental processes, we resort to compensatory approaches which have limited long term impact on quality of life.

It is not difficult to understand how we started to depend on compensatory approaches to supporting people with autism, but it is more difficult to explain why we still depend upon them in our treatment of autism. I find it hard to come to terms with the huge gulf between what the research world tells us about autism and what we do on a day-to-day basis to support and educate people with autism. The majority of treatment methods are still looking at the disorder through the same lens of what we knew decades ago and not on what we know now about the core features of autism, current neurological research or developmental psychology. The longer we permit this gulf between research and practice, the longer we will starve our children on the spectrum of opportunities to develop a quality of life. The longer we exclusively focus on the deficits, the longer we avoid addressing the underlying developmental and cognitive issues.

I feel there is a societal lack of ambition or optimism for people on the Autism Spectrum which, today, is unnecessary and most unhelpful. Historically, the disorder has not been viewed as having a very favourable prognosis. We do not have to look back that far to when parents were told to institutionalise their children because they were considered un-teachable. Teaching strategies that emerged in the 1970’s and ‘80’s were a major step in the right direction. Teaching methods such as Applied Behaviour Analysis from Lovaas and Structured Teaching from Schopler began to pave the way for a conceptualization of the disorder that resulted in some positive outcomes. We then had some strategies to teach those with Autism some academic and life skills that people had said were previously not possible.

The problem is however, that while research on the brain and autism has continued to provide us with new information, our treatment approaches have stagnated and for many here in Ireland, there is no treatment at all. The methods and thinking we were using 30 and 40 years ago are still the primary methods being used today. It is not that there is anything wrong or bad about such methodologies but now we simply have new information that will support us to do better. We now have the capacity to take what we know about autism and take it onto a new level, beyond compensation and actually work to correct or remediate the core features of the disorder.

I can think of no other form of treatment for disorders or illnesses where clinicians are still doing what they were doing over a quarter of a century ago. I can also think of no other disorder or illness, where research has all but been ignored in the clinical world. With 1 in 91 of our children developing autism, society can no longer get away with blatantly ignoring the needs and rights of it’s most vulnerable.