What are the 5 most important things that research tells us about how to start effective remediation in our contact with a person living w/Autism?

In follow up to my previous blog advocating remediation over compensation, I was asked an interesting question..."What are the 5 most important things that research tells us about how to start effective remediation in our normal everyday contact with a person living with AS?" I thought it might be of interest for me to share my response...

The process of remediation is complex and it looks and feels different for every child we work with so therefore I would urge anyone interested in how this could process could work for their child to contact us directly. You can also visit our website at www.reconnectautism.org, there's a good video up there that illustrates how remediation is possible.

I would like to take the opportunity here to give you a flavour of how modern research on autism is very much opening the door to the possibility of remediation. Please note that remediation is not about a cure. It is about reducing the impact of a deficit in terms of achieving quality of life. In order to do this, it is essential that we revise our understanding of what autism is in order to get a glimpse of the opportunities.

Unfortunately in Ireland today, there is a huge chasm between the research world and the clinical world in the understanding and treatment of autism. The treatment programmes are based on research that is 30/40 years old. Our understanding of autism is still explained by the Triad of Impairments. No one disputes that people on the Autism Spectrum have difficulties in social interaction, communication and imaginative thought, but the big question has to be, what has happened developmentally to cause these difficulties? Research on autism has moved on so much since Lorna Wing developed this explanation 30 years ago and yet it is still being bandied around like it is the latest research. We need to stop focusing on what people with autism can not do and start asking why they can not do it? What have they failed to learn the first time around and what can we do to give them a second opportunity to grasp it?

I feel the 2 most exciting areas of research in autism have come in the areas of Neuro-psychology and Developmental Psychology.

If we take a look at the latest neurological research on autism, we find that autism can be characterized by under-connectivity within the brain. In layman’s terms, different brain centres fail to connect with each other in the way that they should. This explanation of autism clearly identifies why people on the spectrum are very good at certain types of thinking (static skills, sequential learning, black and white thinking) but very poor at others (dynamic ability, dealing with change, flexible thinking). This lack of integration in the brain leads the individual to have a quite one dimensional view of the world. The more integration between brain centres, the more multi-dimensional our perception of the world is.

We have known for some time now in treatment of other disorders such as stroke victims, acquired brain injury and even dyslexia, that if we identify areas of weakness / damage, we can remediate some of these difficulties by working on the weakened areas of the brain. We can promote new neural growth by challenging deficits because the brain is an experience dependent organ that changes according to what we do with it. Unfortunately in Autism this - until recently - had never been seen as a possibility. We have in fact done the complete opposite in our treatment of autism. Instead of challenging areas of weakness, we have created learning systems and environments that play to their strengths and compensate for weakness e.g. structured learning. In doing so, we are undoubtedly making life easier for the individual in the short term, but we are also making the possibility of them being able to cope in an ever changing real world that much more unlikely.

So if remediation is possible in other neuro-developmental problems, how could we begin to address it in ASD? How can we increase neural connectivity and integration? How can we get various brain centres to collaborate with each other? I feel the answer to this lies in the research in autism in developmental psychology.

Autism is a journey and not a destination. If we think of the Triad of Impairments, we are already at the destination, but why not ask the question, what happened or failed to happen to get us here? A child is not born autistic, they develop autism and surely what occurred along the way is worth our consideration? There has been extensive study on the development of typical children and the development of children on the Autism Spectrum. It is found that children with Autism miss out a number of key developmental stages in their early childhood and without these developmental foundations their development then goes off on a deviant pathway. Autism develops as the child moves off on a pathway that is weakened by the failure to develop certain foundational skills.

For the purpose of illustrating this point, I will refer to just one of the known developmental stages that is missed by children on the spectrum. This developmental foundation is critical to the development of social understanding and empathy.

When a typical child reaches approx 15 months, they develop a skill known as emotional referencing. This happens when a child is unsure of something, they look to, or reference their parent to see what their perspective is. If the adult gives the nod, wink, smile etc, the child can proceed, knowing that it is safe to do so, where as if the adult shakes their head etc, the child will learn otherwise. Essentially, what the child is learning to do here is to borrow the perspective of someone else. They are learning that by studying the reactions of other people, they can learn valuable lessons. As the child then develops, this skill becomes much more sophisticated and if we think about emotional referencing in our everyday lives as adults, we do it in every interaction we have. As soon as we say something, we watch the other person to see how they have received what we have said. We continually monitor other people's reactions to all of our actions and communication. In fact, this key developmental stage, which starts at 15 months, is the first step a child takes in developing what we commonly know as empathy.

Unfortunately, children with autism fail to develop this foundational skill and as a result their development then goes in a different developmental direction to that of typical children. Without learning this valuable skill, how could the child possibly understand social behaviour or develop empathy? You can teach the child social skills by rote, but will they understand those social skills?

Unfortunately for the child with autism, this developmental foundation that I have highlighted here is just one of many identified developmental foundations that are missed by children with ASD in their early development. However, what if we were to suggest re-teaching this skill, but in a much slower and deliberate way? There is nothing to say that you can not go back and start to teach these areas of developmental weakness and give the child a second opportunity to learn what typical children learn effortlessly. This is where the remediation comes in. You are not compensating for the autism, you are addressing areas of recognised weakness that result in the core deficits associated with Autism.

I hope this goes some way to illustrating how remediation is now possible in autism...its a little longer than 5 points but I'm sure you'll agree, its a relatively complex process.