“The Best Advice”

I’d like to share with you some of the best advice that we have been given on our journey with ASD.

Background

We were advised to consider the “core deficits” of ASD and the “co-occurring conditions”. (see below)  With every intervention we considered, it was worth asking if it was addressing the core deficits or the co-occurring conditions.  This would help to make realistic expectations.  Dealing with co-occurring conditions is important when these conditions get in the way of addressing the core deficits, but overcoming these conditions will not improved the core deficits.  It’s helpful to be clear about this.  Unfortunately, many therapies focus on co-occurring conditions and not so many on the core deficits.

Core Deficits

The core deficits are to do with relationships.  Here are some relationship skills which people with ASD tend NOT to have:

Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others

Social Coordination:  The ability to observe and continually regulate one’s behaviour in order to participate in spontaneous relationships involving collaboration and exchange of emotions.

Declarative Language:  Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.

Flexible Thinking:  The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances.

Relational Information Processing:  The ability to obtain meaning based upon the larger context.  Solving problems that have no “right-and-wrong” solutions.

Foresight and Hindsight:  The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner.

Co-occurring Conditions

These conditions are present in many people on the spectrum, but probably no two people would have exactly the same set of conditions:

ADD, Anxiety and phobias, Allergies or food intolerances, Speech/Language disorders, Depression, Attachment disorder, Eating disorder, Hearing problems, Learning disability (eg dyslexia, dysgraphia), Memory deficits, Mood swings, OCD, ODD, Visual-motor problems, Seizures, Sleep disorder, Vision, Toileting problems, etc.

The Best Advice

We were advised to find as many opportunities in the day to “share an emotion” with our child.  And, to do so first with non-verbal communication (ie body language), second with “voice effects” (ie changing pitch, tone, timing of your voice, eg intake of breath, big pause, etc), and third with “declarative words”.  For example, if we noticed that our child was looking at a big truck, the first thing was to share non-verbally – smile, look surprised, point.  Next we might say “oooohhh!” and pause to see if our child looks to us and then we smile, point, etc.  Then we might say “BIG!!!!!”  or “LOUD!!!” (but not “truck”) and continue to look at our child, then at the truck, then back to our child.  The idea was to create a brief second of genuine “connection” with our child.  That is – to share the emotion of the moment together – making it more about “us” and less about the truck.

If our child was not focussing on us, we needed to “spotlight” the moment (over time we systematically reduced the spotlight).  Spotlighting may include moving very close to our child in his line of vision, so that his attention shifts to us before shifting back to the truck.  It may involve making an unusual noise (eg exaggerated intake of breath, or a whistle, or “WOW”) and it nearly always involved big exaggerated facial expressions from us.  All of this was to be done very slowly to allow our child to process what was going on.

It sounds simple (it comes naturally to any adult playing with a 6 month old child) but it is really hard with a bigger toddler who is not giving you any feedback.  However, over time we got better and better at it and learned to go slower and slower.  Our child soon learned that there was no particular performance required in this type of interaction (as per most parents, we had gone through a lengthy phase of trying to “get” our child to “do” things).   He learned that our faces were interesting to look at, our reactions were not always the same as his (and that this is OK, and adds a pleasant novelty), and that he could play a role if he wished (initiating getting our attention to share something by pointing or vocalising).

It was wonderful advice and laid the groundwork for everything we have done since (which is quite a lot but I won’t go into it here).  It set us on the road we have travelled to now, when we have a socially competent young boy with whom we have a dynamic relationship, and who can adjust to the complexity of life at school and in the playground.