Friday, May 10, 2013
RELATIONAL APPROACHES TO AUTISM (NORTHEAST PA/POCONO REGIONAL AUTISM ACCEPTANCE PROJECT)
tO ARRANGE A CONSULT WITH DR. EDMUNDS, CONTACT firstname.lastname@example.org I met with a 5 year old autistic boy who was non-verbal. He came into the office and began banging his hands on the computer keyboard. The secretary’s immediate response as it typical was to suppress that behavior and make it go away. Instead, I told her to let him go. We had a ball pit in the center of the room, and I told the boy that if he wanted to keep hitting the keyboard that I might have to pick him up and toss him in the ball pit. He continued, and I picked him up and tossed him in. He got out of the ball pit and walked back over to the keyboard. This time, he did not hit the keyboard but outstretched his hands toward it and then fell back into my arms for me to toss him in the ball pit. He giggled and laughed and then spoke the words, “do it again.” I was amazed. Relationship was at the key of this interaction and an emotional connection was forged. I entered into his world, and he reciprocated and entered mine. I met with a 3 year old boy who was also non-verbal. He had been placed into foster care almost from day one of his life and both his parents were violent and abusive and there was chaotic family dynamics. The foster family were not equipped to deal with the challenges. The boy would often have intense meltdowns lasting an hour at a time where he would scream and cry uncontrollably. The first thing was to explore why this was occurring, what was triggering it? Why was this child becoming so frustrated and overwhelmed? I came to learn that the foster mother was working a lot, and there would be periods of separation . This is was at the root cause, and it was later acknowledged by the family. Typically though the establishment would see these meltdowns as ‘dangerous’ and problematic and want to shut it down with an antipsychotic drug rather than seeking to understand why it is occurring. I would spend time with the child, letting him take the lead, and just merely being a presence, and hoping he would allow me to enter his space. I encouraged the foster parents to do the same, however this did not occur. These foster parents made the decision that with their current dynamics that it may be better for the child to be in a home where more time could be devoted. A new foster family was arranged, where no other children were present, and the foster mother stayed at home. The child thrived in this setting, and his language developed at a rapid pace, and the meltdowns became minimal. The foster parents began utilizing relational approaches and spent much time seeking to understand and make emotional connections with the child. Gradually, they began seeking to have him interact with peers, and this became much easier for him to do. Their entire approach was based on acceptance. I received this letter from the father of one of my former clients who at the time was 7 years old. “Dr. Edmunds has developed a strong rapport with (my child). He even waits at the corner of our street in anticipation of his visits. More importantly, over the course of the summer we saw a definite improvement in (his) socialization and behavior at home...I have been extremely impressed with Dr. Edmunds' extensive knowledge...I also appreciate the comfort we receive in learning of positive results he has achieved with other children. Although I have read extensively myself and spoken with his developmental pediatrician, Dr. Edmunds has been able to translate his theoretical understanding into practical steps that have helped (my child) and us.” In my work with this young man, I sought to build a connection and a relationship and as the father notes, this came in a way where he would await my visits whereas he was previously known to be one who was somewhat disengaged and oblivious to others. I used his interests and his strengths to build this connection and in the process of him opening his world to be, I began to introduce him to that of the mainstream, so he would have an awareness. He had a number of sensory concerns and transitions were always challenging for him, but we worked through pro-active ways to address this. When transitions came forward, he was more prepared ahead of time to deal with them and therefore the need for meltdowns reduced significantly. I also always sought the engagement of the parents. This is the key component, I was present for a brief time, so it is the parents who ultimately must carry things onward and continue to help their child in making emotional connections and being able to navigate through the world. I worked with an autistic child who was blind and had paralysis in his legs. When frustrated and overwhelmed, he would require a helmet at times because he would bang his head. Many would dismiss any attempts to engage with him believing him to be ‘too disabled’ or ‘too troubling’. But even here, there was work done in assessing his environment, seeking to alleviate those things that caused distress and overwhelm. And emotional connections were able to be made with him in spite of his challenges and differences. I let him take the lead, and he would at times grasp my hand and lead me through his house. In spite of his blindness, he knew his surroundings by touch. He enjoyed listening to music and he had one game he would play where he would cover himself with blankets and giggle. These were important emotional connections not to be ignored.