Expert: Dr. Sharon A. Mitchell - 10/22/2008

Question
My two year old daughter had been developmentally delayed on the gross motor and speech/communication sections of "Ages & Stages" since her 6 month check-up. We began an early intervention program at 9 months. We focused first on gross motor, since at that time that was the area in which she was lacking the most. Throughout the next year after starting the program she hit every milestone in order just delayed...she finally began walking at 22 months. At 18 months we had an MRI& hearing test (both showed no problems). We began speech therapy at this time for my daughter was not speaking at the rate she should have been. We increased speech to once a week starting this past August. She will babble constantly, will make some consonant sounds (not on demand), and can understand receptively everything you are saying to her. We had her back to the neurologist at the beginning of this month to rule out Autism. She was not willing to "perform" during this appointment; however, the doctor asked me questions, and said that she was not autistic. So you are probably wondering why I am asking a question to this board. I had a meeting with her early intervention team (speech, PT, OT) and they mentioned ABA therapy to help my daughter with more "on demand" response and to help her with her expressive language. All I can find to read on ABA is for austistic children, so why would they have suggested ABA if my child is not autistic. And will this help her? Do you feel I should get another evaluation on Autism based on what I have told you about my daughter? She passes the MCHAT. Her red-flags for signs of autism are non-verbal and when she get really excited she will shake her arms and hands...but this isn't everyday. I am just worried that I am not doing the right thing. I don't want ABA if it is only geared to autistic children... I have been to every specialist and I am confused about where to turn to next. Thanks!

Answer
Many of the therapies commonly used with kids with autism are effective not only just for kids on the autism spectrum. ABA is just one example of a method that has helped many children.

ABA or applied behavior analysis is a systematic way to work with children. At the heart of it are two key factors:
- conducting a good functional behavior assessment to see where the child is now, which key behaviors to target first, and noting progress along the way
- discrete trial methods of having the child gradually respond in the way you would like

I think your team suggested ABA as one way to work towards eliciting responses from your daughter. This does not mean that they feel she has autism but that she might benefit from this approach.

No, I don't think you need to have a further evaluation regarding the possibility of autism. It sounds like several people have ruled this out.

Many kids who have developmental delays have weak language skills and will flap when excited. This does not mean that they have autism though.

For your daughter, I don't think the exact label matters. What you want is for her to progress to the highest level she's able. You've done so many things right and it sounds like you've been proactive in seeking out as much help for her as possible. She's a lucky little girl to have this kind of support.

If you don't like the idea of structured ABA sessions, there are other, more play-based approaches you could consider. Although these are often used with kids with autism spectrum disorders, they work for other children as well.

I like therapies that both fit into the lifestyle of a family and are play-based. One such one you could consider is PRT (Pivotal Response Therapy). What's nice about it is that it's a way for you to play with your child. You don't need to slot in an hour a day at a consistent time but can just play with him whenever you get a few moments. It's something you can get started with after doing just a bit of reading.

Another nice thing about PRT is the low cost to get started. Most of the training manuals are about $7 each http://kady.education.ucsb.edu/autism/behaviormanuals.html

Here's some information on PRT http://www.brookespublishing.com/autism/prt/interview.htm  PRT was featured on one of the Super Nanny episodes http://specialchildren.about.com/b/2005/11/04/more-on-tonights-supernanny.htm The main PRT manual is available here: http://tiny.cc/AeTcB

Here's are three short video clips of a young boy prior to PRT then during subsequent PRT sessions: http://www.brookespublishing.com/autism/prt/video.htm

If you don't want to or nor have to time to do some reading on PRT or similar play-based approaches, you could focus just on enhancing your son's language while you play. Sites like this one give good but practical tips any mom can incorporate into the child's day: http://www.tr.wou.edu/perc/documents/INDIRECTLANGUAGESTIMULATION.pdf

Another approach that you can do at home with your little girl is Dr. Stanley Greenspan's DIR/Floortime. It's also a form of play, like PRT and designed not to elicit on-demand responses but spontaneous expressive language along with developing relationships. You can learn more about it here and see how to buy a book on the technique: http://www.icdl.com/dirFloortime/overview/index.shtml

Just like there's no one right method to take with a child with autism, there are also not methods specific only to kids with autism. I'd go with what feels comfortable to you, fits into your family's way of life and seems to produce results for your child.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca