Autism Approaches Should Respect Children’s Emotions

Nearly thirty years ago, as a newly minted clinical psychologist, I was fortunate to learn about social-emotional development from the writings of such pioneers as John Bowlby, who launched the field of study known as attachment theory. Bowlby was among the first to recognize the importance of early emotional attachments and their positive impact on development throughout the lifespan.

I also gained wisdom and perspective from the amiable and kind Dr. T. Berry Brazelton, whose cable TV show, What Every Baby Knows was a constant companion while I raised my own children in the ‘80s and ‘90s. As a child psychologist and a mother, I saw the path toward healthy parenting and clinical practice clearly: when it came to children’s mental health, early, loving, and attuned relationships mattered.

Then the incidence of autism increased. More and more families whose children fit the diagnostic criteria for autism came to my office and the schools and clinics with which I consulted. In the early 1980s autism seemed a rare phenomenon, but through the late ‘80s and ‘90s, the numbers of diagnoses skyrocketed. To meet the growing need, models of treatment emerged, many with a very different tone than those devised decades earlier.

The mainstream treatments for children and tots diagnosed with autism focused primarily on reinforcement schedules, with little attention to the child’s (or parents’) emotional life or internal world. These approaches considered emotions and relationships ancillary to the main goal of tracking readily observable behavioral tasks and goals.

While I saw utility in measuring observable progress, I became increasingly concerned about the practice of ignoring toddlers’ negative expressions of emotions (fussing, refusing, crying) to avoid reinforcing them. In my mental health training, these behaviors were important to understand, while in autism treatment they were often deemed as something to ignore in the service of extinguishing “non-preferred behaviors”. In other words, the mental health principles of emotional attunement that Dr. Bowlby and Dr. Brazelton espoused were not applied in autism treatment.

Essentially, a new standard had been established. Doctors prescribed toddlers and young children diagnosed with autism multiple weekly hours of structured therapies that downplayed their (or their parents’) signals of emotional distress. Protocols were constructed to teach children how to respond and behave like typically developing children, even if this meant that they became upset or frustrated in the process. This approach reinforced appropriate behaviors and responses, suppressed repetitive behaviors, and tried steering children away from “obsessive” interests.

When I studied and tried applying these techniques, they seemed artificial, especially the technique of ignoring a child’s emotional distress or bids for attention. Over time, I moved away from approaches that focused on making the child “indistinguishable” from typical peers and towards emerging alternatives that valued emotions and relationships within development. These approaches upheld the principles of attachment science and valued and leveraged children’s individual differences and preferences, rather than simply trying to change them.

When we prioritize pre-academic, rote memory tasks, and compliance but fail to consider a child’s (and caregivers’) emotions, we may be introducing additional stress factors into the child’s life. To be sure, tracking  progress and being consistent is important, but what is most essential is the foundation of all human development: the ability to feel safe and calm in loving relationships.

Now, it’s important for providers and parents to know that there are effective treatment options that are respectful of emotions and relationships and are supported by neuroscience and research.

In treating and supporting children with autism:

*All approaches should respect children’s emotions, and the trust they develop in relationships with their providers. We need to remember that trust, emotional security, and feelings of safety are critical to memory and cognition. Trusting relationships are essential for all children to learn and grow

*All approaches should consider what behaviors are targeted for change and why. For example, Dr. Stephen Porges, noted neuroscientist, cites gaze aversion as an adaptive strategy that helps many autistic children feel more comfortable in social situations. If we take this away from children, it can actually increase a child’s feelings of stress. We must always consider the impact interventions have on a child’s sense of safety in the world, and reflect on what their body is doing naturally before simply discouraging behaviors. Additionally, we can view preferred interests (often described as “restricted” interests) as a portal to relating and engaging with the child, rather than something to be extinguished

I describe this new standard for childhood professionals across disciplines in my book, Social and Emotional Development in Early Intervention. There are things all professionals and parents can do to protect the social and emotional development of our most vulnerable children.

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