A Missing Ingredient in Autism Therapies

Elliot was four years old when he was diagnosed with autism. A psychologist told his parents that he was “high functioning” and that he would likely benefit from early intervention. Elliot’s evaluation team recommended the treatment known as Applied Behavioral Analysis (ABA) as well as speech therapy. Since his parents’ insurance plan covered both, within a month of his diagnosis he was spending more than twenty hours a week with therapists.

Before that, Elliot had been a happy little boy who knew the names of more than twenty dinosaurs and loved to chatter about his favorites, Sinosaurus and Brachiosaurus. His parents had no major concerns about him besides his picky eating and difficulty playing with peers. But after treatment began, things changed. Elliot began to cry when his parents dropped him off at preschool, and he protested going to bed at night. Once upbeat and contented, now he seemed anxious and distant.

While many would write off Elliot’s behaviors as insignificant, they are indicative of a surprisingly neglected aspect in certain autism therapies: the emotional life of the child. It’s not that professionals don’t care about the child’s emotions; rather, behavioral therapies don’t systematically consider the impact of the treatment on the child’s emotions and relationships.

When children are diagnosed with autism, it’s common for professionals to recommend ABA therapy, which, among other things, is designed to either increase or decrease certain behaviors. Within this structure, therapists are trained to be neutral or ignore children’s emotional protests, often designating them as “non-compliant behaviors”. In my role as a mental health provider on autism treatment teams for two decades, I have come to believe that the emotional life of the child is the single most neglected aspect of behavioral autism therapies.

Why have I come to this conclusion? Contrary to popular belief, autistic children are active communicators. Because they don’t communicate in the same ways as neurotypical children, they are frequently misunderstood. When we interpret an emotional communication—such as a slap or shout—as intentionally disruptive or “non-compliant” we miss important opportunities to understand the child’s emotional life.

Since many autistic children struggle to explain their feelings in a typical fashion, they are conveyed through physical behavior. It is important that we understand the meaning of behavior before we create programs to get rid of them. Elliot, the little boy who loved dinosaurs, began to experience stress because his protests were not properly understood. If a child’s primary method of communicating emotional distress is through behaviors and we deal with behaviors only by trying to eliminate them, who is “minding the store” of the child’s emotions?

Emotional distress is supported through loving relationships. That’s why I believe that children receiving traditional behavioral therapies will benefit from the additional layer of a developmental, relationship-based approach to their treatment. The most popular of these is known as the DIR approach (for Developmental Individual-difference Relationship-based). This approach helps the child’s team recognize and respect children’s emotions, and develop ways to make treatment goals friendly to the child’s sense of trust in relationships. These therapists are located across the country and internationally through www.profectum.org and www.icdl.com.

Here are some things you can do to support your child’s emotional life on the autism journey:

  1. Understand that behaviors are a form of communication and connect to the child’s emotions.
  2. Consider how all interventions impact your child’s level of trust in relationships, critical to healthy emotional development.
  3. Ask all team members to tailor interventions to respect your child’s emotional life.

Developmental and relationship based approaches are designed to help each child thrive emotionally. They can be used across settings in conjunction with other therapies to help bridge this missing ingredient in autism treatment.


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