Tag Archives: sensory integration

The gambit of therapies

These days it is fairly common for children to receive vast amounts of therapy. The inability to compete academically, socially or physically can sometimes be resolved with therapy. It is therapy that can often close the gap between a child’s abilities and inabilities. In younger children, problems are often treated too hastily. If left alone many problems may resolve themselves, but there are also cases where a more serious problem may develop. Because there is sometimes a small window of opportunity to correct certain problems, many parents are just not prepared to take a risk and immediately resort to therapy for their kids. This is a typical situation for neuro-typical children, so imagine then the therapy needs of a special needs child. When there is so much more at risk and so much more to address, missing the window of opportunity is loaded with even more consequences.

My autistic spectrum son does all the mainstream and common therapies. Fortunately the bulk of them are during school hours – speech twice a week, occupational therapy twice a week and physiotherapy once a week. In the afternoons, he also does remedial therapy, play therapy and behavioural therapy. We have done ABA (applied behavioural analysis) therapy in the past. Over and above his special needs schooling, this equates to an additional 8 therapy sessions a week.

This makes me wonder if my son receives too much therapy – is he “over-therapised”. Research supports that children with Autistic Spectrum Disorder (ASD) who have 20-40 hours of therapy or interventions per week, have a higher probability of improving their condition and symptoms. Some even go on to speculate that early and intense intervention can “cure” autism. I personally do not know what I believe when it comes to autism being curable. I believe children can learn many coping strategies and behavioural techniques, such that with maturity, they may no longer present as ASD. Perhaps a more appropriate term used is that autism is “recoverable”. This may appear to be semantics but I quote below casework and research conducted by Dr. Rimland to highlight the difference. Dr. Rimland is an American research psychologist, writer, lecturer, and advocate for autistic children, ADHD, learning disabilities, and mental retardation. Dr. Rimland was the founder and director of the Autism Research Institute (ARI) and founder of the Autism Society of America (ASA). Rimland was long an internationally recognised authority on autism spectrum disorders and was the father of a high-functioning autistic son.

“Dr. Rimland did not want to use the word “cured” to describe these children. Instead, he preferred the more appropriate term “recovered.” He liked the analogy offered by Stan Kurtz, director of the Children’s Corner Schools in Van Nuys, California, and a supporter of ARI and evidence-based medical approach, to illustrate what recovery means: ‘Assume that a person is hit by a car. His legs are broken, and he suffers brain damage. At this point, he is considered disabled. Now let’s say after intense rehabilitation, he is able to walk again with a slight limp and has some remaining neurological issues but can live a normal life-or maybe he heals so well that you couldn’t tell he was in an accident at all. That’s recovery.’”

“The only difference between that and autism is that our children were somehow more susceptible to being hit by the car-and some of the shrapnel from the car quite often remains in their body. We need to help these kids get rid of that shrapnel-and keep them away from the street-in order to give them the best opportunity for recovery. Similarly, many children once diagnosed as autistic now exhibit only nuances of their former behaviours; for instance, some still have mild ‘stims,’ or an exaggerated focus on favourite topics. Despite lingering issues, recovered children will, in many cases, be able to live independently and happily, have productive careers, and enjoy rewarding relationships with others. They may not be ‘cured,’ but they are certainly recovered from the devastating symptoms that once blocked their path to a normal future.”

I personally struggle to believe that a condition that stems neurologically can be cured or reversed? When looking at years and years of research, two of the latest research studies I want to pick up on, highlight how complicated Autism can be and how it is a genetic condition that stems with neurological complications. (i.) The latest research from the Beth Israel Medical Centre, in conjunction with the Harvard Medical School, very simplistically have linked some cases of autism to a microscopic deletion or duplication in DNA. (ii.) Recent research (July 2011) scientists at the Weizmann institute have seen in sleeping autistic spectrum toddlers fMRI scans showing lowered levels of synchronisation between the left and right brain areas known to be involved in language and communication.
These two examples are only but a few that make it difficult for me to understand how autism could be curable unless the condition in the brain could be reversed. However I have read much literature that does advocate for the possibility of autism being cured. The Autism Revolution has many examples of children who have been cured. On the basis that autism is a recoverable or curable condition, therapies and interventions seem to be paramount in improving a child’s prognosis.

My son receives about 30 hours of intervention a week, including his schooling. This is still within reasonable realms. I also believe firmly in giving a my son the ability to be a child and to explore play, relax, be physically active, be bored and do all the things a child should do. He needs to have ample time every day to be a child.

There really are so many therapies for ASD children. There are the mainstream therapies (or conventional therapies) and then there are the alternative therapies and of course the more controversial therapies.

We have tried and are still continuing with some of these; speech, occupational therapy, sensory integration as part occupational therapy, play therapy, floor time approach, behavioural therapy, remedial therapy, essential fatty acids (yes this is a recognised therapy).

Some of these approaches such a floor time, ABA and sensory integration have become methodologies that we really try and implement daily at home. For example through brushing programs, weighted duvets, floor time play sessions, ABA is used daily in how we talk to him and rationalize with him. And of course good nutrition, vitamins and essential fatty acids are part of day-to-day living. We have also read success stories of other therapies and although we may not have actually done the therapy we have adopted a version at home to great success; for example visual schedules have worked really well for us when implementing new routines or going away on holiday. Social stories have also worked really well for new experiences and lowering anxieties.

All of the therapies above have made a difference in our son’s life. We have continued with the ones that we feel are essential or find sustainable. We have discontinued the ones we feel have served their purpose and we are constantly in exploration of others. We know in time we may have to revisit previously used therapies and will use some of the others mentioned below.
Visual schedules, PECS system, neurotherapy, Social story therapy, Casein free diet, Gluten free diet, Vitamin C therapy, Vitamin B6 and magnesium therapy, Auditory interventions, vision training, relationship development intervention, auditory processing are all therapies one can do. For us some are not suitable and others we would like to try in future.

It is a difficult decision to choose which therapies to do now, which to ignore and which to do later. There is only so much time in everyone’s lives. For us it is about what is available in South Africa, what is convenient and appropriate at our son’s stage of life as well as ours. What has benefit for him now and makes sense emotionally, physically and financially for all us. Whether or not therapies will work, we never know. To paraphrase Temple Grandin’s comments from her book, Thinking in Pictures – some therapies will work for some children and other therapies not. With this complex disorder you will only know once you try.

Autism is a complex brain disorder .We adore our son and want to give him the best possible life. This is only one of the reasons why we have intervened and why he receives 30 hours of intervention a week, excluding all the other things that are part of his daily life and routine. We hope that all of our endeavours and interventions will lead to him having, according to Dr Rimland’s research, a “normal future”.

I do want to caution parents about a few things with regards to therapy. Make sure you are using a reputable therapist that comes with references. There are “therapists” who have no qualifications or experience in special needs. When dealing with neurological based problems, trained professionals, or someone who has proven experience in the field, will be better equipped at making a difference. When it comes to alternative therapies (many of which I have not explored myself), make sure you are learned in them and they are not irresponsible therapies. There are treatments that are dangerous to children and there are sadly individuals who are looking to make a quick buck. You are entitled to a second (or third) opinion if you are not sure. A very simple example where something can go wrong is Vitamin B therapy – you need to be with a skilled physician who is obtaining optimal levels in your child’s body. I am not saying do not do Vitamin B6 therapy – it is something I hope to do one day – just make sure your child needs it and that the therapy is properly administered and monitored.

If you feel a therapy or even therapist is no longer making a difference in your child’s life or working for you, take a break. You may then see a change in behaviour that proved it was still valuable. Or you may realise your child has out grown that therapy or it is not longer helping. We become very comfortable in what we know as we do not like the change too much in our special needs kids lives (rightly so), but sometimes we reach a status quo that is a waste of time and energy and it is best to move on.

Lastly whether or not you believe autism is curable or recoverable, be aware of people who make false promises in this regard. If you believe the condition is either curable or recoverable, then stay realistic. To go back to Dr Kurtz’s example – there will be some people who will recover and learn to walk again and some who will not. The factors in this are many and variable. I think the same applies to Autism – some low functioning kids will learn to speak, and some high functioning kids will recover but of course there are the cases where this will not happen. Do not become all consumed and ruin your finances, marriage and family in pursuit of an unrealistic goal. Parents need to achieve the balance between faith in their child’s abilities and chances of recovery and being realistic. Parents are the child’s championing force but need to remain cautiously optimistic, and trust their guts. I do not know how and when to tell a parent it will not happen or it will happen. Of course they need to try, and of course at times they will disagree with their spouse/partner, and of course their child may be a miracle child. We know there are so many. But somehow they need to maintain perspective – we all discover in our own way, what this perceptive is and how we find it. Find your grounding force and keep it alive. For me it is the support structure I have set in place. I always have people who know my son that I can ask what is the likelihood this or that will happen and whether I am pushing too hard. Sometimes I even underestimate him and in this case they put me back on track. When there are times that something may not be achievable by him, I try as best as I can to mourn the loss and move on.

P.S. Please refer to Informative reads page for interesting articles and information relating to this post

The vast spectrum

My husband and I have battled to get an accurate diagnosis of our now nearly 6-year-old son. His initial diagnosis was PDD-NOS, we have had a fully Autistic diagnosis and we have had an Aspergers diagnosis. All we can confirm is that he has autistic tendencies and he is high functioning. He has co-morbid conditions as well; such as ADD, low tone, anxieties, dyspraxia, sensory integration problems and learning difficulties. The list is long but most special needs children have a primary diagnosis, with many co-morbid conditions associated to this diagnosis.

We have many times been bogged down in the pursuit of an accurate diagnosis for our son. The co-morbid conditions are easy to see, but the underlying primary diagnosis has had us and many professionals stymied. I think we get stuck as we assume if we can understand his condition intellectually, we can find better treatments and we will be able to understand our son and his difficulties better. With his difficulties come so many behaviours and symptoms that are constantly evolving. Some of these disappear with time and little intervention. Others evolve into normal behaviours and some become issues that need to be addressed. Consuming vast amounts of energy, time and patience. For me a very disempowering aspect of having an ASD child is that you live a life of great uncertainty, never really having much of an understanding about your child’s current prognosis or future potential.

I do not profess to have expert knowledge on the classification of the autistic spectrum. Like parenting it seems to be a constant moving line. We have gone from Autism and Aspergers to the Autistic Spectrum. From Autistic spectrum disorder (ASD), which included Pervasive Developmental Delay specified (PDD) or non specified (PDD- NOS) as well as Aspergers and even Attention Deficit Hyperactivity Disorder (ADHD / ADD) and Obsessive Compulsive disorder (OCD) have been on this spectrum. The latest pending classification is simply Autistic Spectrum disorder (ASD) with all of the above disorders removed.

In a recent discussion with an acquaintance from Autism SA, my comment was that parents would need more accurate classification. Surely the very broad ASD classification will need to be split up focusing on high functioning vs. low functioning children and where my child is on the continuum. Let’s see what evolves.

In truth it does not matter. Behaviour can affect the learning abilities of an ASD child as much as intellect can. Low functioning or high functioning children will be treated similarly behaviourally. This is where remedial and special needs schooling becomes paramount.

Why do these children have behaviours that are hard to control or may be seen to be behaving badly? Due to a multitude of issues, where the wiring in their brains have been compromised, frustration tolerance and communication issues can cause them to lash out. Sensory integration and ADHD affects behaviour, impaired social abilities lead them to not know what is appropriate or inappropriate. All kids need to be taught how to behave. For special needs kids, the lessons just take a lot longer and social cues from others have no impact in fast-tracking these lessons.

Besides behaviours the symptoms of children with ASD vary so widely. This is extremely frustrating as there are no best practice scenarios with ASD as there may be with other special needs issues. It is a condition that manifests neurologically and therefore affects all children so differently. For me this realisation has been the hardest. How in today’s technologically and medically advanced society can we not understand the workings of these brains better?

Research and understanding the ASD brain is developing all the time. With functional MRI’s we can see where our children’s wiring has been compromised and better understand where they may experience problems. But neuro-typical people are also diverse in their skills, abilities, personalities, behaviours and habits, can we realistically expect to understand how then the challenged wiring in an ASD child really moulds and shapes them?

All I know is that it is vast and daunting. As many children grow and change so does their diagnosis. As they enter adult life some have next to no symptoms, some have social problems, some behave a bit strangely, some need life long care, and some need partial assistance. Some will marry and some not, some will have children and families of their own and some not, some will have professional careers and some will work in a trade. To me this sounds very much like parenting any child. We cannot know their futures.

So I try to remind myself daily I cannot plan too far ahead, no ones futures are certain, To do my best, treat the issues as I am faced with them and see where life takes me and my children.

Yes some days I do fail miserably especially when we are facing an Autism crisis, as I like to call them. But I am only human!

By Amber Tucker

1. Autism – A neurological condition, present from early childhood, characterised by great difficulty in communicating and forming relationships with other people and in using language and abstract concepts
2. ASD – is a spectrum of psychological conditions characterised by widespread abnormalities of social interactions and communication as well as restricted interests and repetitive behaviour.
3. PDD-NOS – is one of the autism spectrum disorders and is used to describe individuals who do not fully meet the criteria for autistic disorder or Asperger syndrome.
4. PDD – refers to a group of five disorders characterised by delays in the development of multiple basic functions including socialisation and communication.
5. Co morbid conditions – Having more than one concurrent diagnosis.  Another term for this would be “dual diagnosis”.  Many people with autism have one or more additional diagnoses, such as ADHD.
6. Dyspraxia – Developmental dyspraxia is a motor learning difficulty that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body.
7. Aspergers – Asperger syndrome or Asperger’s syndrome is an autism spectrum disorder that is characterised by significant difficulties in social interaction, along with restricted and repetitive patterns of behaviour and interests.