Autism: What we Believe

In every child diagnosed on this spectrum is found an individual personality, bound by a strong motivation to protect the self, yet yearning to join the world and have the relationships which make life worthwhile for all of us. If we, the professionals, took the trouble to really find this person beneath the sensori-motor, and emotional-relational developmental delay, we discover their beauty, and their understanding of the world. Once we have the trust of this child and meet each other at a joining point, we move forward together with mutual respect and validation of each other.



When we design an intervention program for a child on the spectrum, we always assume intelligence, no matter how much relational difficulty there may be. There is a developing person in there who may be afraid of the stimuli of this world, but is also yearning for human contact. This human contact is very necessary and core to developing the deficit of, what scientists call, “theory of mind”. So many children and families arrive at our door looking for the answer with regards to social skills, relationship recognition and a need for the child to be able to play with peers. Simply putting them in a group or with another child is not the answer, but looking at what is contributing to the developmental delay certainly is.

We are not a medical diagnostic center and we are not about deciding which diagnosis is going the right fit, but we are about the “how” and “what” to do to intervene in the life of each individual child.

We also need families to understand that it is not about age, the brain remains neuro‐plastic until we leave this world permanently. The prime time for maturation of the central nervous system does occur between 5 to 7 years of age, but this does not mean there is a sudden cap or ceiling at that age. Once a child is older, his habits and most frequently used central nervous system pathways are more strongly formed, and even though this might mean taking a longer time to work through these habits, it certainly does not mean that we cannot effect change. We see ample change in also older children.

When we deal with a pervasive developmental disorder, we are dealing with a neurobiological factor and this factor involves the central nervous system. In order to effect change, you have to deal with the development of all the entry points of stimulation of the body as this is the first order of business as the baby is born. This does not mean families should not seek biomedical interventions if they are so inclined, but it refers to where our intervention program starts. Something else might have caused the “injury” (still much debate about that), but we are more concerned with the downward spiral of the developmental delay that it causes. It is a simple fact that we have to consider the origin of a problem, if we are going to be able to affect the product.

We believe in the inner self of each child and any child’s internal drive to want to connect to another person. We do not believe that it is about the behavior or the outcome or product, that which we can “see”. It is about what is causing that behavior to occur, what is making this behavior necessary for the child to use it, and how do we deal with this in our intervention plan. We do not believe in extinguishing behaviors for the sake of public need or an adult need for the child to “fit in”, though of course we consider it. We believe in the child’s ability to react to what pressures the environment is placing on him or her and that the child would want to participate in anything they feel successful at. On that same level, they will want to avoid what they do not feel successful at or feel uncomfortable with. All of us love our comfort zones and being a child does not make this affinity any different.

One of the key features of our program is to work on that internal drive to become motivated to want to participate in the world around them, to find pleasure in relationships and the complexity that this brings to the table. This is not an easy quantifiable or researchable area, but it is the very complexity and individuality that we as typical adults enjoy in our relationships with people. This is, in essence, true theory of mind.

We believe in play, not regimen. It is through play that all typical children learn in the early developmental years and it is through the fun of play that we can draw children into the world. The belief that play has no meaning but is considered a passing of idle time is a myth. Children gain so much richness from play in terms of social and cognitive abilities, including sequencing and problem solving, not to forget mentioning what is socially acceptable to a play partner or not. Most children come to us with strong delays in play skills, yet we expect them to understand what it means to be in a group, to attend to circle time, and to understand concepts that we take for granted in typical children. Children with delays in play skills have difficulty understanding how their selves fit into any social sphere, how cause and effect really works and what change really means.

Other concepts they have difficulty with are concepts of before and after, time, sequences, and also the concept of order. These concepts are not found in curriculums today, but it is expected of the learning child. Typically developing children learn this through play and it highly affects their readiness with regards to academic achievement. Children with this diagnosis are usually cognitively intact, but because of the lack in development in these developmental areas they are unable to show and comprehend the richness of learning and the abstract meaning of concepts, which causes them to compensate with their extensive memories and literal capacities to learn. It is not about teaching the understanding of non‐verbal skills, it is about applying methods and techniques to facilitate these very necessary areas of development in order for the child to more fully grasp complexity, rather than only focusing on what he or she sees.

A final thought is that it is about process and not product. If a child understands the “how” in getting there and has the ability to figure things out, the product will always be there. The building of self esteem does not lie in following other people’s expectations or agenda’s, but having the ability to cause an effect on something or someone yourself and know that you have done it. The achievement has to be yours! So many educational programs we visit are very well meaning and well thought through, but lack the understanding of the complication the child’s emotional world brings to the table. Sometimes it is not about inability (often wrongly assessed as uncooperative, unwilling or even stubborn), but about fear and anxiety and using whatever means the child has to get out of the situation. It is so important to us that our families understand this, though we understand that these areas are incredibly gray and our need is so high for the child to be “better” and enjoy life more.


The Central Nervous System

When we consider pervasive developmental disorder, we are dealing with a neurobiological factor and this factor involves the central nervous system. In order to effect change, you have to deal with the development of all the entry points of stimulation of the body as this is the first order of business as the baby is born. This does not mean families should not seek biomedical interventions if they are so inclined, but simply refers to where our intervention program starts. Something else might have caused the “injury” (still much debate about that), but we are more concerned with the downward spiral of the developmental delay that it causes. We have to consider the origin of a situation (as much as possible), if we are going to be able to affect the outcome.

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*EnCongnitive.com


Internal Drive vs. Behaviour

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A Developmental Progressive Program

Over the years we have developed a phase system that seems to work well with our children who exhibit pervasive developmental delays. Our program is defined as a developmental progressive program that truly enhances most of the developmental aspects based on typical development. The program does not constitute a “cure”, as many adults with spectrum disorder diagnosis would prefer not to be referred to as “cured or being cured”, but we have certainly seen much success in transitioning children into public school systems with minimal to no assistance. It is also not an overnight cure and is certainly no “quick fix”, but it focuses on the steady development of core issues affecting the very areas of need that we see in their learning and behaviour.

 

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Though the methodology used in the different programs may appear to be similar for some children, the art of facilitation and programming is different for each child. We have not originated the different programs, though we certainly hold certifications in all the different aspects and attend national and international conferences to remain updated in newest developments. We have researched these programs and have first hand experience that these programs work as described in the multiple testimonials on our website. It is not about only having one program to offer, but deciding at each juncture, which program would be more beneficial for the child at this point in time of his or her development. What we will describe now is the general direction of an intervention program that might take 18 months to 3 years, though not ongoing and with periods of consolidation and “breaks”. It is also important to consider that no family is “locked” into the entire program. Each phase is considered with multiple consultations and video reviews for the families in order to consider the best possible direction for each family. The intervention program is flexible and fostered by team decision.


Phase 1: Foundation

The developmental processes that started during the development in the womb continue to work on maturing the central nervous system when the baby is born. This is the first place of origin, not in terms of causal entities, but in terms of known intervention program planning. We use Sensory Processing as our primary “developer” in the first phase of 6 months, and we also add Reflex Integration to this phase of intervention. In order for the brain to learn and grow, it has to depend on the processing of incoming information as a first process. If the processing in our different senses is delayed, it makes sense that the way we organize and respond to the incoming information will be delayed as well. During the initial evaluation all the different sensory systems are considered and the primary players causing most difficulty is identified. Our occupational therapists and physical therapist is trained in sensory processing work and there might be different possible options for your child to consider.

Under Age 2

At this time, we might suggest attending occupational therapy and/or physical therapy on a weekly basis with the combination of home programs at home that might include Therapeutic Listening over a stereo system at home. Depending on the evaluation we may suggest intensives of 10 consecutive days in order to boost the nervous system to a newer platform of function. To initiate social and emotional wellbeing and play, we would recommend DIR / Floortime services as well. This could be in the form of a weekly visits, when a therapist will coach the family in how to use this method at home more effectively to effect generalization of skills as early as possible. This could also occur through our P.L.A.Y. Project, which consists of monthly home visits.

Over age 2

We would recommend weekly visits with occupational therapy and / or physical therapy, again with the combination of home programs that may include sound therapy, such as Therapeutic Listening. Or we might make a recommendation for a stronger clinic based intensive program, which will include occupational therapy and / or physical therapy with Tomatis Sound Training. This program has been highly effective in creating lasting results in children of many different ages and there are multiple testimonials on our website testifying to this.


Phase 2: Organization

For some children this phase (6 to 12 months) is a continuation of the weekly Occupational therapy and Physical therapy services with home programs (Timocca and others), as well the DIR / Floortime work. Since the child’s is more receptive to language possibilities at this time, the time is ripe for children to really benefit from more intense Speech Language therapy. Some children might benefit from one or more 10‐day booster loops of therapy intensives with Tomatis Sound Therapy. Others might be ready to complete a program called Interactive Metronome. This program is ideally suited in the developmental trajectory when the child is struggling with sequencing, albeit in motor skills or speech language skills, or organizational skills, social reciprocity and timing, as well as needing improved motor coordination skills.

Sometimes we might see from our assessment that the child can benefit from more Sensory Processing work with Tomatis Sound Therapy, but in combination with the Interactive Metronome Program. We will then combine the two programs in a 10 or 12 day intensive to complete occupational therapy work with Tomatis Training during the first hour and Interactive Metronome in the second hour. This frequently occurs when the child is not quite ready for the exact rigor of the interactive Metronome program, and needs some intensive therapy work in the first hour to gain more intensity and readiness. We also utilize Balametrics and other laterality based activities during all three levels of programming, though mostly in this second phase. This program might be a combination of more than one intensive of 10 days times 2 hours daily with weekly visits in‐between and will be individualized for each child’s needs. Attention is paid to the complex visual, auditory, and motor aspects of learning to read and write.

All the while though, parents will report functional changes. This phase is generally concerned with working on the motor planning and organizational structures of the brain and will also affect the child’s ability to pay more effective attention and also promote increased active working memory.


Phase 3: Achievment

This phase could still involve weekly therapies with home programs, though the home programs are more directed to refining higher order skills and executive functioning skills, such as social and fine motor skills. It makes developmental sense when you consider that we have first spent time working on incoming processing, then how the brain organizes it, then how the child produces a product, albeit socially or academically.

So frequently we observe treatment plans where the focus of fine motor and social skills is super imposed on a foundation that is not ready to accept it. When you test fine motor dexterity the child may have all the fine motor muscles intact, but it is really how the brain is organizing itself in applying the goal to the action. Some IEP’s (Individualized Educational Plans) have handwriting as a goal for years, yet if the child is unable to plan his or her thought into a productive action, all we will have gained is rote memorization skills, which inhibits the child’s ability to perform flexibly in a timely manner with the same timing and rhythmicity than his or her peers.

During this phase we could also be recommending more therapy intensive work through the combination of Occupational, Physical, Speech Language and DIR / Floortime therapies. These could also occur in combination with Tomatis Sound Therapy, Interactive Metronome and Captain’s Log, a cognitive training program with a big boost in attention ability. Intensives could be planned for two, three to four hours daily for a period of two to 4 weeks and usually with 2 to 3 months break in between. For reading achievement we might include Cellfield Reading Breakthrough Program in this phase of intervention. Cogmed is also considered in cases where working memory is a difficulty for children.

We might also recommend an intensive loop of occupational therapy to specifically target learning to read and write the alphabet. The first level is working through the alphabet upper and lower case. The second level works on word attack, and the third level on reading and writing comprehension.

Even though some children, with a pervasive developmental diagnosis, have been observed to read from as early as the age of 2, most of these cases were found to be cases of hyperlexia, a reading diagnosis made when the child is able to identify the different stable shapes of the letters, but not derive meaning from reading. Research has also shown that it is not the language center in the brain that is lighting up during this type of reading, but the areas of the brain that are more concerned with form and shape. In order to create meaning from reading and put your own thoughts on paper, we still have to go through intervention programming for this area.

At this stage, the child may be ready for more intense emotional processing work and could enter a program called Sandplay. This work is incredibly important for understanding the symbolic emotional world of children more fully as they also build their own ego center and self-identity.

At this time we hope to not have overwhelmed you, but rather have provided you with insight into what it takes to plan a comprehensive intervention plan for a child on the spectrum. We also do not contend that other medical, biomedical; counseling or other services are not relevant, as we certainly do refer as needed. This is merely a synopsis of what we are currently offering as we continue to develop our understanding of this very complex neuro-biological disorder.


For Families and Siblings

Mothers: We offer a Tomatis Pregnancy Program for mothers in their third trimester of pregnancy. Since research is showing us that many siblings of older brother and sisters could have possible developmental delays as well, we wanted to offer something for atrisk mothers as well. Since we have seen so frequently how children calm down and express so much less anxiety while in our intensive programs with sound therapy, we want to offer this same calming opportunity to the pregnant parent. It is only a 10 day commitment, but quite powerful in calming both parent and unborn baby. The newborn baby can hear and smell everything the mother is exposed to in the third trimester of pregnancy.


Siblings: Many parents have requested over and over again for programs to assist the siblings of their children with special needs. Groups do work to some extent, especially when the children are able to verbalize their feelings and able to express them. We have found another avenue over the years to be quite effective and this is through the medium of Sandplay Therapy. This therapy focuses on the child’s external expression of their inner self in a totally accepting and validating way. Siblings frequently understand at a cognitive level, though have difficulty understanding on an emotional level as they too, are still developing and need to understand their own selves with their own identity.


The Building Blocks of Motor Planning Featuring Maude Le Roux

Motor planning and sequencing is but one aspect of individual differences, or the "I" in the DIR® Model. Daria Brown talks with Maude about the other sensory aspects of this component of the "I" and their impact on learning. Maude's pet peeve is when we try to teach children before they have the necessary building blocks. If they are not developmentally ready, they will either go into fight/flight mode or they'll find a bypass to please you that won't be developmentally helpful to them. In this blog, Maude will take you on a tour of the building blocks for motor planning!


Click HERE to read the blog and listen to Daria and Maude!


Testimonials

Parent Comments


As a parent and a physician looking to maximize my twins (with Autism and PDD) potential, A Total Approach has provided the foundation of interventions on which we are able to build our children's future. Maude Le Roux understands the complexity of the challenges faced by our children on the autism spectrum. By providing an "integrated" approach while understanding the uniqueness of each child/family's needs, Maude and her staff of caring and energetic professionals are helping us maximize our children's progress. With a diverse array of services including DIR®/Floortime™ (Greenspan DIR Model), Sensory Integration, Physical Therapy, Tomatis (Auditory training) and nutritional support guidance, A Total Approach is not just a name but a comprehensive philosophy all in one location.


As parents we were initially disheartened and frustrated with the medical and educational system that gave us a "diagnosis" and a "social worker" but little direction, Maude has been a godsend, giving our family support, strategies, solutions and most importantly, "Hope" for a brighter future for my children. Our twins have made great progress in the past 16 months and A Total Approach / Maude Le Roux has helped us turn our panic into passion...and our "hopes" into expectations.


Dr. Pat and Marie Elliott


A Total Approach Comments


The twins have learnt much and so have we. The important message to everyone "out there" is that the combination of therapies make the difference. Even more importantly, a note to all parents of especially twins, to ensure that each child receives his / her own individualized program. It is an overwhelming occurrence in any family's life and the tendency to compare is strong. One child may have stronger needs than the other, yet both should receive equal attention as to how to individualize their program. Our sincere thank you to our parents for teaching us so much!

John Continues to Negotiate the Complicated Emotional Road


Hi Everyone!


Last night (Monday) I took John for a guitar lesson at the music place where I work. I also set one up for Saturday with a different teacher, and then he will decide which teacher he thinks will be better for him. I was able to go in with him last night because I wasn't working, but on Saturday, he'll go in with the other teacher on his own because I'll actually be on the clock. He met both teachers last night and whoever he chooses will be a great fit for him. They're both great guys and I think he'll do well either way.

Driving home last night, it happened.

John said, "Mom, I thought I was going to be really nervous. I thought I would be so nervous that I wouldn't be able to do anything. But Mr. Ben was very calm and welcoming, and I felt really good while working with him. I was able to hold the guitar and play it because he helped me just be calm."

He FELT nervous! He felt NERVOUS! And he SAID so! He talked about his emotions!

He wasn't worried about being too perfectionistic, he wasn't even hesitant in talking about it. It was as though we'd *always* talked about these things.

I'm SO impressed!

Meanwhile, in addition to piano, John now plays the electric guitar. Oh yeah - we stopped and bought a starter guitar kit on our way home because if you're going to take guitar lessons, you're going to need a guitar.

I told my co-worker that he's earned a permanent position in our family's hearts because of this. I told him that while he probably thinks he was just teaching guitar, he was really giving us keys to open a door to a whole new experience for John, and all the goodness that comes with that!

That's good news for a Thanksgiving, right? We have lots to be thankful for!

Thank you to all of you for investing your time and energy into our boy - our tween, as he refers to himself. We couldn't do it without you, and it turns out that John is a REALLY cool kid! I never doubted that, but it's so fun to see who he's becoming! Thank you for the large part you play in that! We are so blessed to have you all in our lives!

Much love and wishes for a very happy Thanksgiving!


B. mom of team of ASD