Friday, January 28, 2011

My Journey into Autism Treatment as an SLP from the Stone Ages

Someone recently asked me if I had a special interest in Autism since we are promoting programs suited to this particular population.  I paused a moment and answered honestly, "Well, I do now because children with Autism were walking through our doors and we had to figure out what to do with them."  I am not sure if I should smile or grimace as I think back to my first experiences with children on the spectrum.  I knew next to nothing, but I did the best I knew to do, which was not nearly enough. 

I went through my college programs between 1980-86.  Autism treatments were in their infancy back then.  University programs in Speech Pathology were not yet being accredited.  We had no classes on Autism; I am not sure the term even came up more than once or twice.  The closest information I studied was in Special Education classes.  (My program offered education degrees so I chose Special Education endorsements).  In these classes the terms were Childhood Schizophrenia and Minimal Brain Damage for diagnoses now called, for the most part, Autism, Learning Disabilities, and ADHD.  Instead of Ritalin for ADHD, serving coffee was recommended.  As a youth, I was intrigued by children with disabilities.  I recall reading the book Lovey by Mary McCracken about the work of a teacher of children with disabilities.  The title character was a little girl with Autism. My first personal encounter with Autism was my first year or two of working in the public schools.  A beautiful boy with dark read hair came into my speech therapy room for  an assessment.  He had limited verbal skills but he went through my box of crayons and picked up one of the few in my box that was an off-brand and he said, "Kmart"; sure enough the crayon had Kmart marked on it.  His mom explained that read labels all over the house such as "whirlpool, maytag, etc."  I was fascinated by this high functioning hyperlexic child.  Amazingly, with over 100 students on my caseload, he is the only one I can remember who actually was diagnosed with Autism.  I am sure there were many, but I think they were tucked away in the self-contained classrooms.  And with a 100 students on my caseload, I did not go looking for students who were not being referred. 

I moved from the schools into working with adults.  When I returned to pediatric work and bought a private practice, I quickly found myself facing Autism again.  Luckily I had a new young therapist with me who had more training in the area of Autism and even had learned ABA (Applied Behavioral Analysis) in her program; so I was happy for her to pick up these clients, after all, she understood them better than I did.  I watched out of the corner of my eye all the while and tried to increase my skills.  I have to admit that I was a bit afraid of these children who did not respond to the same toys and games that other children loved, who could be calm one moment and the next moment be screaming for some unknown reason, or who just sat unresponsive.  Then my dear therapist moved away and I was faced with clients with Autism who needed treatment, from me. Luckily I had attended PECS training (Picture Exchange Communication System) and found this invaluable in working with these children.  The principles of picture communication fit perfectly with the visual strengths of individuals with ASD (Autism Spectrum Disorders).  Next I started digging into information wherever I found it.   I am no expert, but each child, as different as each has been, has added to my understanding of this disorder.  I feel fairly capable with them, most of the time.  But I must admit, I still am stricken by fear when I face that child who melts down unexpectedly.  Fear that I will not be able to regain control of the situation.  Fear that I will not be able to help this particular child.  However, I am learning that there is nothing ultimately to be feared.  Sometimes things will not go well in a session.  I just need to stop and observe the situation and provide whatever comfort I can.  Sensory strategies and pictures are very helpful most of the time.  (We know so much more now about these children and we have so many more tools than ever before: thankfully).

This past year and a half I have been working on assimilating a new area of learning: Social Skills development.  Most of our ASD clients are high functioning or Aspergers.  I found that language therapy was not hitting at the heart of the difficulties these children encounter socially.  We worked on vocabulary, concept formations, expressive language skills, inferencing skills, comprehension, and processing, but something was still missing.  These kids still were not connecting socially to me and were outcasts among their peers.  Then I attended a workshop at my local service center by Michelle Garcia Winner, called Social Thinking. 

Many years ago at a state convention I had attended a workshop on Theory of Mind (TOM) as a new emerging concept. I had bought and read one of Michelle's books 2-3 years earlier but just did not quite grasp the concepts.  I had some exposure to these ideas of perspective taking.  Reading about RDI (Relationship Development) and  Greenspan's work furthered my understanding.  But listening to Michelle in that workshop, it was as if a light bulb suddenly began to glow above my head, growing brighter and brighter.  I had my "Aha" moment.  These things she was saying, these things made sense, they were the missing pieces I had been lacking. They are by no means cures, but they are methods and strategies that help the individual with social pragmatic disabilities improve their understanding of the social world and learn how to navigate through it.  Just as it is a slow process of assimilation for them to understand these ideas, digesting Michelle's insights has been and is an ongoing process for me as well.  To learn more about Social Thinking, visit


Kim Reeves Gray said...

This is why you and I are such a good fit. I'm so thankful God put you in my life to teach me and help me grow. I can't wait to get back to SLAL and dive in to helping this population with you. It has been placed so heavy on my heart and I just can't tell you enough how excited I am. Teach me everything you know! :)

Suzanne Herman, M.Ed., CCC-SLP said...

Thank you Kim. You will fit right in with us! You can also help me with this techie stuff like blogs and such.