The Value of a Relationship Based Approach to Autism

In aiding children with developmental challenges, we must first realize that this requires a team effort and a strengths based approach. It is necessary to not focus on what the child cannot do but look at what the child can accomplish and build upon this. Parents can enlist the support of professionals but must realize that it is they who are the most important persons in the child's life and that furthering the development of their child is not just the work of professionals but is a collaborative effort from everyone involved with the child. It is necessary that for any interventions to truly be effective and helpful, that they must be consistent and constant. The interventions must be the same throughout all domains that the child is present in.

It is crucial for us to understand the environmental responses that children have, whether they have developmental conce
s or even if they do not. If a teacher, parent, or other person has a hostile tone, a poor demeanor, a loud voice, etc. All of these things can be overwhelming to the child and can provoke a behavioral response. All behavior is purposeful and should be looked upon as so, even negative behaviors. Behaviors are a way of the child speaking to us about a distressing situation or an apparent need or desire when they may not be able to convey this to us verbally. Light, sound, and other sensory stimuli can also produce distress for a child. We need to create awareness of what in the environment may serve as triggers to distress and seek to modify the environment to make it a more comfortable and safe place for the child. We must also be cautious in how we view children. If we look at a child displaying negative behavior as a 'monster' or feel that because a child may be rambunctious at times that we must automatically resort to medicating them, then we have taken a negativistic attitude that will surely be passed on to the child. Children are keenly aware, even those with communication struggles, of adult's perceptions of them. We should look at our children through the eyes of delight and address behavioral difficulties not in terms of how we can subdue, but rather how we can meet needs and resolve conflict and remove distress.

The floor time model is of particular usefulness in working with children with communication and social struggles. For those children who are non-verbal, we can begin to introduce hand signals, moving to use of pictures, and then gradually encouraging the child to make use of words or phrases to indicate desires. It is not important initially whether the verbalizations are correct but rather that a verbal attempt was made. When a child displays such a behavior as spinning objects, in the floor time model, we would not be aversive, but rather gently introduce a new toy or object and seek to divert the child to a more productive activity. In situations of echolalia, we can say such things as 'that's TV talk', and provide means to divert this to a different means of conversing. It is important to provide the child with understandable signals and meaningful statements and phrases when we are desiring them to behave in a different way.

In order for children with developmental conce
s to be able to integrate more into the social sphere, it is necessary that they not be isolated into situations where they are labeled and shuffled 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 unless they have frequent and continuous exposure to the world around them. I have developed the use of what I term 'real life rehearsals', where we may set up a particular social scenario for a child. It may be such a thing as being able to make a purchase at the grocery store. The therapist and parents guide and coach the child ahead of time in how to go about such an activity and then have them actually demonstrate it. Social stories and comic strip conversations are very useful in conveying information as these children tend to be visual learners. Social stories can be simply made booklets that the child helps to create where a particular task or scenario is outlined with what behaviors are expected. The comic strip conversation is helpful in building empathic skills as well as reflective thinking as we ask the child to develop captions for what different individuals may state and think in various situations.

Lastly, I think it is crucial, though it may appear controversial to some, to state that children with developmental conce
s can and will be benefited from a psycho-social and relationship based approach alone. Some have decided to resort to medications, and I am placing no blame or condemnation on those who have made this decision, however making a suggestion that there are alte
atives and informing of these alte
atives as well as the hazards of psychotropic medication usage. First, I will not argue that medications can 'work' in the sense of subduing behavior. However, strapping a child to a chair would also work in regards to subduing behavior. This would be aversive and quite possible illegal. I see little difference between such an approach and that of using psychiatric medication. The difference is that one is a physical restraint, the other a chemical restraint. When we say that something 'works', often we are not looking at the mechanism by which it works. Dr. Peter R. Breggin, MD compared the use of anti psychotic medications in children to 'chemical lobotomy' as it blunts the functions of the frontal lobes. The risk of tardive dyskinesia, a permanent disfiguring neurological impairment exists with these drugs. In addition, such drugs as Risperdal are prescribed off label and are not indicated for anyone below the age of 18 but continue to be prescribed.

It may require more diligence, effort, and patience, but I remain convinced after working with over 40 children with developmental challenges, that relationship based approaches, rather than chemical restraint, prove to be a true means to teach our children skills, to focus on their strengths, to build on their development, and to help address challenging behaviors and to address the real source of conflict and distress rather than just blunting it.