Treatment for Children with Autism Spectrum and Related Disorders

FatherSonPlayingYardThis has become an area of specialization for me over the past 20 years. Much of my professional development has focused on this population. In the 1990’s, I became aware of the DIR® (Developmental, Individual Differences, Relationship Based)/Floortime Model developed by Stanley Greenspan, MD and Serena Wieder, PhD. Its core principals are very much in keeping with my own belief system, the latest brain research, and what I have learned over my many years of clinical practice.

Two key assumptions are: 1) Rich, warm, reciprocal interactions are needed for the brain to develop properly. 2) Children on the spectrum have neurobiological differences that interfere with their ability to benefit from interaction opportunities, even in a stimulating environment. For example, a child who was born neurologically intact but who spends the first few years of his/her life in an orphanage where there is little human interaction, will most certainly look autistic and developmentally delayed by age 3 or 4. Children on the spectrum who are raised in perfectly fine homes, are hampered from benefitting from the rich reciprocal interactions due to the way their brains are wired.

In Floortime, we learn to play and interact with a child in a way that promotes their core developmental capacities. When we understand the child’s unique way of processing information and motor planning, we can tailor our interactions to achieve the important goal of increasing reciprocal interactions. Our goal, as stated so eloquently by the late Dr. Greenspan, is to “Join in the child’s world, so that we may pull him/her into a joint, mutually fulfilling world.” It is important for parents to practice Floortime with their child daily, not just when we meet. 

I tell parents all the time that they in no way contributed to their child’s diagnosis, but they can play a big role in their improvement. Research has shown that the greater the parental insight into what makes their child tick, the better the developmental outcome. This is true for all children, including those with special needs.

I often serve the following roles when working with a child with special needs: 

  • Floortime Coach: For younger children, I am generally on the floor with the parent/caregiver and child modeling and coaching play and interaction styles that lead to developmental growth. As children age, floortime evolves to meet the needs of the older child and can often take the form of conversation.
  • As I get to know the child’s core challenges, I provide guidance and support to the parents in ensuring that their intervention program is tailored to the child's most important areas. Parents come to learn not only what ancillary services their child needs, but also what good therapy (e.g., speech, OT) should look like for their child. They can then become strong and effective advocates.
  • I provide the parents with guidance and support in making key decisions as their child ages. For e.g. what type of school is right for him/her, when are changes in the intervention program needed, planning for transitions to kindergarten, middle/high school and adulthood.
  • I consult with other Team members to ensure that there is coordination. This may include school observation and Team meeting attendance either via conference call or in-person.
  • I offer facilitated play dates and small play groups in my office when the child is ready.
  • I also monitor the emotional functioning of the family as a whole. The stress and emotional reactions to having a child with special needs can be quite challenging for parents and siblings. It is important that there be outlets for these emotions for the family to function optimally. The child with special needs’ developmental progress is significantly affected by the family’s ability to communicate and be “real” about their feelings.