As I’ve traveled the country meeting early-intervention professionals and parents, I have come to realize a troubling paradox. We know from research that certain factors make autism intervention most helpful to very young children. But many specialists working with children don’t systematically use or recommend these approaches. The reasons are complex.
Researchers studying early intervention have identified four key features that make early-intervention treatments effective:
-Parents are highly involved, learning to be sensitive and responsive to their child’s emotional cues and behavior.
-Professionals individualize the treatment to address each child’s developmental profile.
-The treatment focuses on a broad range of issues rather than narrow targets.
-The treatment starts as early as possible after challenges are detected.
Too often, though, professionals recommend treatments that do not systematically value how important it is for mothers and fathers to be attuned to what their children are communicating through their behavior.
That’s because most agencies advocate only one autism treatment—just as most insurance plans cover only one autism intervention. That treatment is Applied Behavioral Analysis, known as ABA. Its focus is modifying behavior—that is, encouraging behaviors deemed desirable, and reducing those considered undesirable. If your child is currently receiving ABA and you are satisfied with your child’s progress and emotional health, that’s great! The rest of this article may not apply to you. If, on the other hand, you have questions, the rest of this article may explain why.
ABA is a therapy with a focus on measurable behaviors. One aspect of ABA involves training children by offering rewards such as verbal praise or edible treats for complying. With the emphasis on behavioral compliance, ABA doesn’t necessarily encourage parents to become sensitive to a child’s emotional cues or stress levels prior to working on behaviors.
That’s probably why some parents share with me their discomfort with certain aspects of ABA. Many find it difficult to watch their toddler become upset when a therapist withholds a reward (such as a toy or edible treat) until the child complies with a directive.
One mother recounted her experience watching a therapist interact with her young son “Eric”, who loved to play with miniature toy farm animals. In an effort to teach the boy to request the toys verbally, the therapist held each animal in front of him, refusing to hand it over until Eric said its name aloud.
Watching her son reduced to tears was confusing to Eric’s mom, who didn’t feel comfortable carrying out the procedure with him on her own.
Sometimes, strict ABA programs do not teach parents how to sensitively respond to their child’s stress cues—things like fussing and crying—in the service of behavioral compliance. While the approach might help a child master isolated behaviors or skills, it’s focus is not on the emotional co-regulation between parent and toddler. Emotional co-regulation (helping the child feel calm and safe when distress is experienced) is an important part of attachment and bonding with one’s child.
This conflict can place parents in a bind. Should they follow the professional’s advice in the hope of ameliorating the child’s autism? Or should they follow their own intuition and attune to their child’s emotional needs? It’s a dilemma, but newer blended approaches to treating autism in young children are available to address these concerns.
Parents should know that there are a growing number of research-based approaches in addition to ABA for treating autism in infants and toddlers. Two examples, Early Start Denver Model and DIR-Floortime, are both relationship-focused, play-based strategies. Another is the SCERTS Model, which stands for social communication, emotional regulation, and transactional support. Each of these approaches recognizes the importance of the child’s sense of emotional regulation and feeling safe. These are essential to development and the psychological health of both parent and child.
If your child has been recently diagnosed with autism or if you are unsatisfied with your child’s current program, keep these helpful tips in mind:
There are options in autism treatment. Since professionals and educators may not apprise you of the many choices available, it’s essential to do your own research and pursue the approach that feels most suitable for your child and family. The free parent programs at the non-profit Profectum Foundation can help you understand what options are available and what are most appropriate for your child.
Trust your instincts. If a treatment method doesn’t feel right or makes your child uncomfortable, ask questions. Treatments for any developmental condition in infancy and toddlerhood should involve parents, and be both enjoyable and developmentally friendly.
Make joyful interactions a part of each day. Joy fuels learning, communication, and feeling safe. All three are necessary for your growing toddler, and should be no less part of the life of a child receiving early intervention than of any other child’s.
I invite you to comment or express diverging opinions about this important topic, and join me on my Facebook page, where I post helpful resources for parents and professionals.
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