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Saturday, March 26, 2011

Treatment of Autistic Spectrum Disorders

Some children who don't seem to bond normally to their parents and appear disconnected may be helped by being seen by a doctor and assessed for this disorder.

Some notes from a lecture I attended by Dr. Barbara Kalmanson, Clinical Psychologist on "A Developmental, Relationship-Based Approach to the Treatment Of Autistic Spectrum Disorders":

Often referred to by those in the field as DIR, Kalmanson has been one of the pioneers in working with ASD and looking at this disorder by viewing development through relationship.  The etiology of this problem is still unknown and there has been an evolving view in the field.  Treatment methods have been changing too.  Even now there is the school of thought called applied behavior analysis which is primarily a way of intervening with these children through behavior shaping alone.  In other words, they are taught, by rote, what appropriate interpersonal interactions are.
The method Dr. Kalmanson spoke about tries to coach the parent and uses the parent-child relationship as the route of intervention.
Current thought about how this syndrome comes about is that it is a combination of genetics, environment, some sort of trigger and the parenting relationship.  In normal development we have recent breakthrough research that tells us how much babies are capable of at a very young age.  For example, Elizabeth Spelks discovered that at 3 months old, babies already know that there is predictability in the world.  It has also been demonstrated that newborns are able to mirror some human behaviors.
In addition, babies are now understood to follow a gaze to try to understand what an adult is thinking or maybe going to do next. They know that gaze indicates the intentions of others.  Children who do a lot of this have been found to have more advanced language development by age 2.  One of the hallmarks of the autistic disorder is the absence of eye contact.  (Another is echolalia)
Some of the developmental capacities that Dr. Kalmanson listed as examples of what is looked for or worked toward in interventions are:
to be calm and regulated
ability of reciprocity
regulating sensory information
adapting to unexpected events
The parents' relationship with the child is seen as the most powerful for change to mediate experience.  The idea is not to teach behavior but to watch for the child's capacities and draw them out so they are not performing by rote but, spontaneously interacting.  She tries to help create co-regulation so that there's a shared experience with the parent and child not just an alone experience.  One of the methods is called Floortime which is play therapy that is trying to mobilize affect which gives meaning to learning.  There's an effort to move from the non-verbal to the verbal and to encourage self-initiation in the child. It is believed that if the child is motivated it will help the child to move up the developmental ladder.  There's an emphasis on keeping a continuous flow going, helping the child, again, to move from sensory-motor activity to symbolic.  This is done by following the child's interests and capitalizing on them.

This is a brief overview of current developments in the thinking about and treatment of Autism spectrum Disorder.  If you are interested in this topic, you may find it useful to read further-perhaps taking a look at the books on the link.

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