Expert: Dr. Sharon A. Mitchell - 2/1/2009

Question
Hi,
My daughter who is former micro preemie (27wks)due to a torn emergent cerclage is severely delayed in speech and has sensory processing issues with noise , texture of food ,tactile, vestibular..auditory
Now the EI has recommended ABA for her she is now 25 mos old.Already she has got OT and ST.Now my question is this, for kid who main issues is SPD would ABA help her.SHe failed in M-Chat in not pointing always and not bringing over new things to me to ask me what it is.I feel her main issue is SPD..she has defensiveness in almost all senses.
Please can you throw some light on this ABA wrt to my girl.joint compression and brushing help her a ton..but there are times when she makes noises inappropriately..talks too loudly random words etctec
Thank you so much for answering my question  

Answer
Asha, it sounds like you're doing so many good things for a little girl who has Sensory Processing Disorder. Now, you're wondering about ABA.

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 more of the responses you'd like from your daughter. This does not mean that they feel she has autism but that she might benefit from this approach.

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.

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 daughter'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

Sometimes parents feel so pressured to do all the right things to help their child that they end up running constantly from appointment to appointment. This can create havoc with home and family life. And think about the child. Just as we need down time, so do kids. What you're doing right now is helping your child. OT sounds like the therapy she needs most right now. If ABA concepts can be incorporated into your OT and ST sessions that might be Think about how typical two years spend their days and allow some of that for your little girl. Don't forget that loving parents can do a lot at home to help their child progress.

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