The value of a relationship approach to autism

The value of a relationship approach to autism

When supporting children with developmental challenges, we must first recognize that it requires teamwork and a strengths-based approach. It is necessary not to focus on what the child cannot do, but to look at what the child can achieve and build on that. Parents can seek the support of professionals, but they must be aware that they are the most important people in the child's life and that promoting their child's development is not just the work of professionals, but a joint effort of everyone involved with the child. For interventions to be truly effective and helpful, they must be consistent and constant. The interventions must be the same in all areas where the child is.

It is crucial for us to understand children's environmental responses, whether or not they have developmental problems. When a teacher, parent or other person has a hostile tone, bad behavior, loud voice, etc. All of these things can be overwhelming for the child and cause a behavioral response. All behavior is purposeful and should be viewed as such, even negative behavior. Behaviors are a way in which the child talks to us about a stressful situation or an obvious need or desire when he or she may not be able to communicate this to us verbally. Lights, sounds, and other sensory stimuli can also cause stress in a child. We need to create awareness of what in the environment can serve as a trigger for stress and try to change the environment to make it a more comfortable and safe place for the child. We also need to be careful how we view children. If we view a child with negative behavior as a “monster” or feel that because a child is sometimes impetuous we automatically have to resort to medication, then we have adopted a negativistic attitude that will certainly be transmitted to the child. Children are very aware of adults' perceptions of them, even those with communication difficulties. We should look at our children through the eyes of joy and approach behavioral difficulties not in terms of how we can suppress them, but rather how we can meet needs, resolve conflicts, and eliminate suffering.

The Floortime model is particularly useful when working with children with communication and social problems. For non-verbal children, we can start by introducing hand signals, move on to using pictures, and then gradually encourage the child to use words or phrases to express desires. What matters initially is not whether the verbalizations are correct, but rather whether a verbal attempt was made. In the floor time model, when a child engages in a behavior such as spinning objects, we would not be dismissive, but rather gently introduce a new toy or object and attempt to distract the child into a more productive activity. In echolalia situations we can say things like “this is TV talk” and provide means to redirect this to another form of entertainment. It is important to give the child understandable signals and meaningful statements and sentences if we want him to behave differently.

In order for children with developmental problems to better integrate into the social sphere, it is necessary that they are not isolated in situations in which they are labeled and pushed away from typical peers. Rather, they should be included as much as possible with typical peers. They may need additional support and accommodations, but how will they begin to learn important skills if they don't have frequent and ongoing exposure to the world around them? I have developed the use of what I call “real-life rehearsals” where we can build a specific social scenario for a child. It may be the case that you can shop at the grocery store. The therapist and parent guide and coach the child in advance on how to perform such an activity and then have them actually demonstrate it. Social stories and cartoon conversations are very useful in conveying information as these children tend to be visual learners. Social stories can be made simply from booklets that the child helps to create that outline a specific task or scenario with expected behaviors. Comic talk is helpful in building empathic skills as well as reflective thinking as we ask the child to develop captions for what different people may say and think in different situations.

Finally, I believe it is crucial, although it may seem controversial to some, to establish that children with developmental challenges can and will benefit from a psychosocial and relationship-based approach alone. Some have chosen to resort to medication and I place no blame or condemnation on those who have made this choice, but I do make a suggestion that there are alternatives and provide information about those alternatives and the dangers of using psychotropic medications. First, I will not argue that medications can “work” in the sense of behavioral suppression. However, strapping a child to a chair would also work in terms of suppressing behavior. This would be aversive and possibly illegal. I see little difference between such an approach and the use of psychotropic drugs. The difference is that one is a physical limitation and the other is a chemical limitation. When we say something “works,” we often don’t consider the mechanism by which it works. Dr. Peter R. Breggin, MD, compared the use of antipsychotic medications in children to a "chemical lobotomy" because it blunts the functions of the frontal lobes. These drugs carry a risk of tardive dyskinesia, a permanent, disfiguring neurological impairment. In addition, drugs such as Risperdal are prescribed off-label and are not indicated for people under 18, but are still prescribed.

It may take more hard work, effort and patience, but I am convinced, having worked with over 40 children with developmental challenges, that relationship-based approaches rather than chemical restraint are a real way to teach our children skills to focus on capitalizing on their strengths, building on their development and helping to address challenging behaviors and address the true source of conflict and suffering, rather than just dulling them.

Inspired by Dan Edmunds