Tuesday, June 23, 2009

Common Denominators In Autism Recovery

Thoughtful House graph of autism epidemicImage via Wikipedia

Every time I teach workshops, conferences, or individuals parent trainings, I always make a point to bring to the forefront what I feel is one of the most overlooked issues in autism treatment. What are the common denominators in autism recovery? With the epidemic of autism soaring out of control, as shown on the chart to the right, we have to start focusing more on what's working and why, to insure positive outcomes for children being affected.

I recently taught a workshop where several families, service providers, and advocates were present. We covered all the topics such as biomedical intervention, dietary intervention, functional communication, behavior modification, and IDEA law & navigating IEP meetings. Most of those in attendance were on the same page, yet there were some who no matter what was said, had a reason they would not be able to do what was being suggested. No matter what objections that were thrown out, I could always come up with a feasible solution to eliminate the problem, until that is, the next one was thrown out, to start all over again. In the end, and for many differing reasons, they had convinced themselves they did not have what it takes to help their kids and could only be dependent on what could be provided.

After years of working with families struggling with autism, there are a few things that have become very identifiable trends. I've decided to start hitting these head on, as someone needs to be truthful with families, even when it's not the popular thing to do or say! Let me very clearly say, before we go any further, this is NOT meant to berate parents, incite guilt, or try to make anyone feel inadequate in any way. Most families dealing with ASD are struggling enough without us adding to that! This is also NOT a blanket statement that applies to everyone, as I can see the hair on the back of some necks starting to stand up, even as I type! What this post is intended to do is create awareness and education about a trend we see happening that is very frustrating and sad, in hopes that we can effectively address it for families in need. This post is also intended to encourage parents or caregivers to seek out the needed training to help their children and that most of you DO have what it takes to help your child make significant progress! There is NO COST training, education, and help available to take you as deep as you want to go into the education and treatment of your loved one with autism, as well as the support to help you traverse the difficult parts of the journey.

So what are the common denominators in the recovery of autism? Well, there are a few we will cover throughout the next few blogs, but by far, the most important of them all is parents who become the experts and have a can-do attitude. These are the parents who take the stance that they will do whatever it takes to insure their child has access to what is needed. They are willing to study until their eyes can no longer read, turn over every rock in the path, beg on the street corners for funding, and take on the big fish when it comes for fighting and advocating for their child. They often know much more than the physicians and professionals, and become the driving force behind the interventions for their children and the correct implementation of such.

This is especially important in rural areas, where service provision is extremely limited. Families often find themselves holding the bag when it comes to intervention, or lack thereof, yet need to be encouraged that no matter how dim the journey appears, there is help available to educate and train them to do many of these services themselves, insuring access to what is needed.

Go to an autism conference such as Autism One or DAN? and you will find hundreds, if not thousands of these families, which is why they are usually there, to dig up more useful information to help their child. Outside the autism circles though, that dynamic changes, and sadly, a small percentage of the families on the street are meeting this critical criteria.

I had a reporter ask me some time ago what our recovery rate was. I told him I was not really able to tell him the way he wanted to know. He was looking at statistics only. How many families have you served total and how many recovered kids do you have? Only it's not that simple. If we say we served 100 individuals (just grabbing easy round numbers here) with autism, 10 have made significant progress, and 4 have recovered, that would not look so good. Yet it has to be realized that those numbers are not quite as cut and dry as that. Out of those 100 individuals, typically only 10 or 11 of them actually did even a part of what was suggested. So needless to say, 4 out of 100 would not really be a fair statistic.

What we have found is that an enormous percentage of families fail in recovering their children because they get overwhelmed and don't follow through. Now before I get any angry letters from those of you who have busted your butts and your child has still not progressed the way you would like, let me say there are definitely exceptions to this rule, so this is not a blanket statement. However, from what I have seen first hand, the majority of the children I have worked with could be doing significantly better if the parents were driving the bus, rather than traveling as passengers. In all fairness, many times the parents are spectrum themselves, and already overwhelmed and in shut down mode. That's not their fault, yet it often impacts the ability to provide appropriate and consistent interventions as needed and stay the course. Far too often we see families give up just short of what would be a breakthrough, if they had just continued. Then the interventions themselves, such as biomedical, dietary, or behavioral interventions, get the bad wrap for not working, when in essence they were not utilized as directed and often stopped! In contrast, those who did follow through see remarkable results in most cases.

So where does this leave us? In a rather uncomfortable position, I'm afraid. In the workshop I referred to above, I decided to take the pro-active approach to hitting the problem head on. After numerous attempts at overcoming objections, I finally closed the conversation by saying the following:

"Here's the bottom line. Kids are recovering from autism every single day. We know every child is different and every child needs a specific protocol designed to meet the particular and individuals needs. But we also know that for every time we hear reasons why something can't be done, we also meet some parent with the same situations doing it very successfully. Yes, it's very difficult. No, it's not a walk in the park. Often 3-6 years of intensive intervention, or more, can be required to get these children where they need to go and that's devastating emotionally, physically, and financially. Yet, it's also very temporary and if it yields incredible improvement or recovery in the end, is that not worth it? We can do anything we choose to if we set our minds to it, make the decision to just do it, and we realize it's not forever, no matter how uncomfortable it is. What I still have difficulty understanding though, is that many will not commit to even 6 months of hard work to improve a child, yet by default, they are committing to a lifetime of work and dependency if these children are not treated appropriately. I am not trying to place blame or cause guilt, yet it has to be pointed out that this is a choice, and by not making it, in essence, you have chosen."

Yeah, I know. Kind of a hard line, but here's how I am looking at it. Someone has to tell the truth! Doing nothing yields nothing. PERIOD! These kids don't get better by osmosis, it takes a tremendous amount of time and hard work and there are no shortcuts, at least not yet! Though many get very angry with me when I tell them what they don't want to hear, eventually, many of them will come to terms with what has to be done and move forward. Sometimes in days, sometimes in weeks, and sometimes it's years. The hard part for me is knowing time is of the essence and these remarkable children don't have time, which is why I have become more direct and to the point. Hopefully, in hindsight, most will realize I'm trying to do them, and their children, a favor that could have significant impact! If it saves just one child, it's worth the risk of making someone mad!

There is also the issue of finances, that were brought to my attention today by a reader. I honestly don't think most realize that they have access to the tools, education, and training needed to provide many of the sought after services themselves, and often more effectively! This also alleviates the long-standing problem of bankrupted parents, mortgaging everything they have to provide for their child.

Many seek services through school systems and/or private insurance, yet when they have difficulty accessing the services in the amounts needed, they feel discouraged, defeated, and often give up, not knowing what else to do. Our intention is to encourage those of you finding yourselves in these circumstances that there is HOPE! Though it's not uncommon to think we don't have the skills or expertise to make a difference working with our children, the truth is that many parents have dramatically improved and/or even recovered their children by taking charge of the treatment and interventions, and gaining the education necessary to do much of this work themselves. The process is often quite wobbly in the beginning, yet with time and progress, with positive visible outcomes and increased amounts of education, parents rise to feeling empowered, understanding what has to be done, and figuring out how to do it!

We live in a time that unfortunately is putting the bulk of the responsibility (both time and resources) on the backs of the families, who are already strained beyond belief. If we can identify the characterists that are common among those who have recovered children with autism, then perhaps we have somewhat of a map, to encourage parents to gain these skills, that they might do the same!

So, in closing, what are the main characteristics of the parents who succeed in this challenge?

1) Positive attitude and determination that they will do WHATEVER it takes to help their child and they will NEVER give up!

2) Becoming the expert and a research maniac! Reading everything you can get your hands on and becoming more of an expert that those who are treating your child! Let's face it, no one knows your child as well as you and if you don't know what good speech therapy looks like for a child with autism, how do you know if it's being done correctly?

3) Driving the treatment bus! Be in control of your child's treatment program, in all areas. Know enough about all your child's programs to be able to train the professionals and tweak programs that are not quite right. If you are depending on the school system, the physicians, or the professional service providers to recover your child, you are in BIG TROUBLE! Even the most skilled providers are being led by YOU! It's also critical to point out that continuity across all settings is paramount. Though I advocate for an excellent school program and interventions, at the end of the day, I treat it like glorified daycare and make sure that I am doing everything that needs to be done at home, just in case!

4) Involve yourself with other like-minded parents, who are also the experts and driving their child's treatment bus! I can say without any doubt that I have learned more from parents along this journey than from the professionals, and more often than not, I ended up training the professionals to work appropriately with my children!

We will look at some of the other common denominators to recovery in autism in our next blog post. This is an evolving blog, and will cover the most pressing issues we see within our practice of treating children at the Autism Solution Center, Inc. If you have suggestions for a topic or questions you would like to have answered, please email them to encourmin@yahoo.com.




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5 comments:

  1. Okay...yes and no. First of all I have a Master's Degree in Counseling and worked as a child and family therapist before having an ASD child. I 100% agree that parents need to be the driving force in their children's treatment. My son has SPD (sensory processing disorder) as well. I was aware early on that my son had SPD, and I was aware that my daughter was not developing as needed.

    I asked my pediatrician for an OT referral for my son, and called EI for speech help for my daughter. We had to back out of OT for my son because we couldn't afford the $140 a week bill. We have private paid for school and an individual aide for my daughter, and have private paid for speech. I also have an attorney who helped us with the school district. Financial strain is one thing, bankruptcy and foreclosure are other matters. I know families that lost their homes pushing themselves to bankruptcy to help their children. Many families have other children so it's not just about the ASD child.

    I had to pull my daughter out of EI because we got speech for 15 minutes a week and crappy services for her. Then I spent a year on waiting lists. No decent speech therapy until she was 5.

    So...while I agree that time is of the essence you can't put all of this on parents. Some families can absorb the strain better because they have family support. Some can have more financial resources than others. I mean sheesh, it's freakin $20 for one bottle of cod liver oil.

    Yes I agree that parents that advocate/learn about treatments for their children get the best results, but they can't do it alone. Just as you are choosing to be brutally honest with families about what they need to do, the education system needs to be brutally honest with families about what they can't do. Too many parents rely on the school districts for services (as I did initially) and then spend years on waiting lists. Had I been told right away "hey, we only have funds to give your child 15 minutes of speech a week, we suggest you get her more elsewhere" I would have gotten on the waiting list when she was 2, rather than seeing the lack of progress and getting on it when she was 4.

    Parents need to step up to the plate and be parents, no disagreement there. Schools need to stop the "ready, willing, and able" bs and let parents know they can't adequately meet the needs of their child. Tell parents to seek more help in addition to what they are getting from schools.

    Parents need DIRECTION initially and the early intervention programs are where they get sent. It's not typically until they have a bad experience or see lack of progress then parents start to research other avenues. In the meantime, important developmental time ticks away.

    I'm not sure telling parents to head into bankruptcy or foreclosure is the right solution. While it may only be 3-6 years of intense treatment, a parent has to survive those 3-6 years and often are responsible for other children.

    It's one thing to give a parent a swift kick in the behind that isn't doing what they need to do for a child. It's another thing to tell a parent that is teetering on the verge of bankruptcy and foreclosure that they aren't doing enough for their child. There will always be a reason to not do something because of reality...until then parents have to make hard choices about what they can and can't do. In the meantime, essential developmental time passes...and that is the saddest part of all.

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  2. Hello Melina!

    I could not agree with you more, and as I said in the post, there are exceptions to every rule. For the most part, that is not what I am referring to though.

    There is no question the schools are not being honest with parents and families are expecting much more than is realistic to receive. That is why we advise assume it is glorified day care and drive the treatment bus yourself.

    The situation you encountered while in EI is a perfect example of exactly what I am talking about. We too were offered inadequate services through EI, and it was through educating myself and advocating sternly for my child that I was able to obtain the appropriate services for him. Developmental preschool, 5 hours a week of speech, 2-3 hours a week of occupational therapy, 1 hour a week of Music Therapy, and 35 hours a week in a home ABA program. Because I was educated on what was needed for my child, I was able to effectively advocate for those services and secure them at NO COST. I also add that even though many times the service providers may not have been adequately skilled to work with my child, my knowledge lent itself here as well, as I trained many of the professionals how to work appropriately with my child. So, in the end, I received the services needed at no cost, handled much of the training and programming myself, and insured my son got what he needed.

    I do completely understand that there are many who may not be able to step up to the plate in the way they need to, I am simply stating that these are the things we see consistently with families who have recovered their children from autism.

    BTW, it's incredibly important to point out here that I would NEVER suggest anyone go into bankruptcy to do this. There are ways these children can receive the services they need, at NO COST no less, if the parents are willing to learn what needs to be done. What I am suggesting is not creating devastating financial strain, what I am referring to completely eliminates that. That's what's currently wrong with the system and requires a complete paradigm shift. Even if we received a multi-billion dollar grant tomorrow (I wish!), there are not enough skilled people in the field to appropriately handle the influx of desperate families who need assistance. Which again points back to the importance of these families NOT depending on service providers, but learning to do much of this themselves.

    Again, there is no question there are exceptions to what is posted here, and that will always be the case. However, that is not the situation I see the majority of the time. Many of the families are more than capable, yet for a multitude of reasons are not stepping forward, and it's not because of finances, as training is available for FREE!

    So while I agree with your assessment in some ways, I think there may be some misunderstanding of what I am asking families to do, so let me clarify:

    1) Become the expert. Do your homework and learn how and what interventions are critical for your child's progress and become sufficiently skilled in them, so you are NOT dependent on the system.

    2) Train the professionals or secure volunteers. If you are skilled in what needs to be provided for your child, then you can train the current services providers working with them, or bring in volunteers to train. This costs nothing. I also have been suggesting for years that parents learn these skills and swap services. That way they are not working with their own child, yet are still receiving FREE services by someone adequately skilled.

    And yes, there will always be a reason to not do something because of reality, however, when a mind is made up to accomplish a task, even the toughest of obstacles can be overcome. It takes becoming resourceful and finding other ways to accomplish your goals when finances, time, and life interfere with what lies ahead. Mountains are never easy to move, yet there are those that move them every single day.

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  3. I think it's fabulous that you could get all those services at no cost, but a family can't get services that don't exist...there is NO ABA therapist in my area. NONE...zip, nada. So great a family has a cash wash to raise money for treatment. Great...no one to do it.

    The one music therapist in my area only does geriatrics. There are not enough speech therapists to do 5 hours a week of speech. Seriously, I had to drive 1/2 hour to get one hour a week because that was their only slot. How does a parent that only has one car or no car do that? Who is going to drive them for free? My area has 12.4% unemployment AND some areas are as high as 20%.

    So, yes parents need to advocate for themselves, but I think it sets parents up to fail and feel guilty when they can't access services for their children that don't exist in their area. I would hate for some parent struggling to figure out what to do, who is still mourning their child's diagnosis to come across this post and feel more inadequate.

    I'm all for kicking parents in the behind to do what they can, but it is devastating to local parents who want ABA who can't get it. I also think that many of these parents are visual learners themselves. They need to be SHOWN what to do and then can do it. Many of these are not parents that can read a book and apply the knowledge. Let's not tell them they are inadequate for not learning the way you or I might.

    I think one of the worst things we can do is make parents feel MORE inadequate. They already feel that way. For many parents raising an ASD kid feels powerless. The trick in helping these parents help these children, is to help them regain a sense of power and control.

    I acknowledge the reality that many parents just don't have the mental strength to do this on their own as the current system requires them to do. I'm not going to berate them for being "less than adequate." A parent can't mentally give their child what they don't have.

    So I guess my question to you is why do you think this approach will work with parents that aren't adequately advocating for their children?

    I think if you want to help those parents that are stuck trying to figure out how to help their children, then you need to focus on the mental barriers that those parents have. They already know WHAT they need to do...really they do. You need to help them overcome their mental barriers to change. Parents want to be rescued because they are completely and totally overwhelmed. Help parents be less overwhelmed and you will help them start to gain control.

    Be literal. Seriously, step 1. Read this book. Step 2. watch this video. Help parents hehave their way into success by removing all of the noise that is the autism community.

    If you write generic posts about different options, then you will only help the can-do parents. They can take and process and filter well. The parents you want to target...can't. So help them filter, if you really want to be helpful.

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  4. Thank you again for your response! I want you to know I greatly appreciate your dialog on this topic.

    I think somewhere along the line I must not have articulated this as well as I had thought, so I'm going to try again and go back to re-edit this for more clarity, as I think it's HIGHLY IMPORTANT that parents realize we are not berating them, attempting to cause additional guilt, or make them feel inadequate. The whole point of this post was to help parents to see that they CAN DO IT, there are tools, training and support to help them do it, and they do not have to be dependent on the system and 2nd mortgages for their kids to get well. However, if a parent given access to what they need at no cost has already made up their mind that "they can't do it," then the liklihood is that they won't!

    I'm right there with you when you say that many parents can't just read a book and translate that into therapy. I was one of those! I need to be taught, not just reading the book. But reading the book is still a big part of the lesson. Then it is taught how to put those concepts into practical action plans.

    Part of what we do here is provide FREE training courses and workshops for families in need, in exactly these positions, so we can walk them through the process and teach them what they need to know to become the experts and help their children. We do give them step by step instructions, suggested reading lists and the order they should be tackled in, and the tools and training necessary to tackle many of these issues we are discussing. I realize that's not typical to have access to these services FREE, but again, that's my whole point. It's available to those who would like to access it. We are even beginning to record our trainings on DVD, so families internationally will have access to the training needed to help their children. We have a podcast program also, that has been very beneficial to many families.

    One of the things that I pointed out is that there are not enough skilled professionals in the field to cover the needs. That is precisely why parents need to be educated on the interventions themselves, so they are able to provide FREE services to their children, whether they are doing it themselves, or training someone else to do it for them on a volunteer basis.

    We have a large number of families who live in very rural areas who don't have access to the professionals they need to provide many of these critical services. Parents don't need to be berated, you are correct, they need to be educated and encouraged to pursue these skills themselves, help their children, and know they can be successful doing it. AND THEY CAN!

    I mentioned early in the blog these were not blanket statements meant for everyone, but that many have access to the needed help and choose not to pursue it. This is what I am referring to throughout the blog, and I must not have made that as clear as it needed to be.

    Our long-term goal is to make sure every family has access to the training, education, and assistance they need at NO COST, to insure every child with ASD's has an opportunity to reach their fullest potential, whatever that is. Far too many fall through the cracks and we have to start changing how we think about service provision, as what's currently available to most is not working!

    I hope that makes more sense and you now understand that we are not coming from the standpoint of being accusatory! Quite the opposite! We want parents to know this can be successfully done, and there are FREE resources out there to teach THEM to do the work themselves, where there is no one else to do it. Often the anxiety in thinking about it is much worse than actually doing it! Walking parents through these processes and helping them to see they can be successful is what we are all about, but parents also need to be challenged to step up and just do it. (continued)

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  5. (continuation)



    One of the difficulties in writing is that others only see the text and not the emotion behind it, and that same text can be interpreted in different ways by different people. I can see that I am going to have to be much more careful & better articulate our position on issues we blog about, to alleviate misunderstanding in the future. But you know, this is a living document, that hopefully will improve as we continue and learn more of the rules of the blog trade! We live and learn from experiences and like everyone else, I have to tweak a lot of what I do as well!

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