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October 31, 2014 / 7 Heshvan, 5775
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Life Lessons From Raising An Autistic Child (Part III) – Therapy


Arnold-053113-Girl

The father’s story:

What’s your parenting philosophy? How do you feel about discipline? What educational approach do you find most compatible with the sum of yours and your child’s personalities?

As parents, we’re called upon to make countless decisions regarding the chinuch of our children. Some will happen via research and thought-out discussion, but most tend to be made by the seat of our pants. Now, though all of us would admit that it’s wiser to think out our approach before we’re in the heat of the moment, usually we get away with it. However, when raising a severely autistic child, the stakes are different. The only hope for getting through to him is by keeping your instructional and disciplinary methods consistent and predictable. Therefore, the choice of educational approach takes on added significance.

There are two popular schools of thought regarding therapy for autistic children. We only wish we’d known as much about them at the beginning of our journey with Menachem as we do now…

The DIR Therapy Session:

Menachem is sitting and staring at the wall. Though it does not look like a particularly exciting activity, he is, for the moment, blessedly silent. I contemplate attempting a quick phone call. No. It’s our daily twenty minutes of DIR therapy time, and that means that I’m supposed to enter his world. The focus of DIR, an acronym for the major therapy components of Developmental, Individual-difference and Relationship-based, is to join him where he’s at, in the throes of his activity, in the hope that we will, through that, form a connection.

Arnold-053113-HandsSo I sit in front of him, directly in his line of vision, so that he’s looking at me instead of the wall. He blinks his eyes. I blink mine. He scratches his nose. I scratch mine. Hello Menachem, I say to him, wordlessly. I’m here, I’m your father, and I care about sharing your world.

Menachem gets up and climbs onto the bed. He begins to jump. I take a breath, climb on and jump along. He jumps off, and runs out of the room. I follow him. He tears through the house, his usual whirlwind. So now I’m chasing him around the house, which is not much different from what I do at any other time, but, hey! I’m doing DIR!

No cynicism, I admonish myself. Now Menachem heads for the stairs. He starts to run up and down. No big surprise; this is one of his favorite activities. Here goes. I’m running up and down the stairs myself. We pass each other on the way. Up and down. Up and down. This is called therapy? I try to silence that inner cynic but it’s hard, oh so hard, when my son cannot dress himself, cannot go to the bathroom, cannot put two syllables together…and I’m getting goals from therapists that are about making eye contact and imbuing communication attempts with significance. All nice and high-sounding…but completely immeasurable. How in the world do I know if I’m giving my son the desire to communicate or merely chasing him around the house?

But the evaluating doctor was so confidant and definitive when he told us to enroll Menachem in a DIR-based preschool – and even offered to pull strings to make sure he got a spot. Overwhelmed and grateful, we didn’t think to question his advice, or to investigate whether there are other approaches out there, better for our son. They started with him on the first stage, which is regulation. After all, nothing can be accomplished if the child isn’t calm and receptive, so the first step in DIR therapy is to help Menachem calm himself down when he is in a hyperactive state.

My wife and I eagerly await the secret of how to do this. But there is no secret. Menachem tantrums, and we are instructed to sit down next to him, massage him, speak softly, do whatever it takes to soothe him, to make him feel that his feelings are understood. After all, if he’s crying, there must be a reason. Enter into his world.

Problem is, we have no clue why he’s crying, and if Menachem knows, he’s not telling. My son is particularly hyper, and over time we try everything we can think of to calm him down, including changing his diet, putting him on medications, but nothing works.

After several years of not getting past stage one in DIR, of spending every therapy session unsuccessfully trying to regulate his hyperactivity, we finally decide it’s time for a switch.

The ABA (Applied Behavioral Analysis) Therapy Session

“Say ‘more’.”

Menachem looks at me briefly, then tries to grab the cookie on the table. I reach it first, and shake my head at him firmly. “No.”Arnold-053113-Train

I try again. “Say ‘more.’” I over-enunciate, so that he can observe the mouth movements.

Menachem wriggles and squirms, and makes another attempt for the cookie.

“Say ‘more.’”

“Mmmma.”

My eyes widen, and, exultant, I hand Menachem the cookie, which he gobbles up.

He reaches for another.

“Say ‘more.’”

We go through this routine for the prescribed amount of time, which isn’t a whole lot, when taking into account how long Menachem can reasonably be expected to sit. Later in the day, I’m still on a high from our victory, when Menachen begins pushing his little sister. She wails, and my insides tense up. But I know the ABA rules of behavior modification, and I’ve learned to plan before reacting.

“Menachem, no pushing,” I say, separating him from my daughter.

She edges away. Menachem eyes her, ready to pounce. Now is not the time for any rewards. I continue holding him, protecting my daughter from an attack. Slowly, I feel him slacken, feel his body relax, and I can tell the urge to hit has left him. Now I can present him with his reinforcement.

“Good job, Menachem! You aren’t pushing.” I hand him a candy.

No more spending countless hours making Menachem feel we understand his tantrums. In ABA therapy, they don’t stand for such nonsense. Child’s screaming on the floor? Then make him sit up. Not by force, but by behavioral reinforcement. In ABA, it doesn’t really matter what the child’s feeling; this is a scientific program aimed at teaching specific skills. And by acquiring those skills, be it learning colors or learning to dress himself, the child is gaining knowledge that helps him become a more integrated, connected member of society.

For me, this is a breath of fresh air. Finally, a therapy that makes sense! A system that is logical and measurable, that is designed to teach functional behaviors; I wish we’d heard of this option sooner. Perhaps, had Menachem not wasted his critical early years working on eye contact, he would be toilet trained by now.

To me, it seems like Menachem is taking to this approach. I can sense the tension drain from him, as his therapist shows him his daily pictorial schedule. First we say hello and take off our coats, then we sit and do work, then snack time…as each task is completed, each picture is removed from the board. There are no surprises; Menachem knows exactly what to expect. For children with autism, this is hugely comforting.

But there are expectations that go along with this therapy. Unlike DIR, where the focus is on understanding the child, and giving meaning to his world, in ABA the focus is on the child understanding what is expected of him, and complying. And my child, it turns out as time progresses, is not very compliant. After three years, he is thrown out of his school. The therapists say he’s too uncooperative to work with.

No one ever said raising a child such as Menachem was easy.

Will Menachem ultimately grow more using the holistic, child-centered DIR approach? I do know that, in our efforts to learn and use this therapy technique, we have gained something priceless: some wonderful moments of connection that we otherwise would not have known how to elicit. When I join Menachem in his races up and down the stairs, and he suddenly looks at me and smiles, or when he takes me by the hand and starts to jump, telling me in the way he knows how that he wants my company in this activity, I know that DIR has given me the gift of a loveable child.

Is the behavioral ABA the better approach for him? Though he had trouble cooperating with this approach in school, I do know that whatever skills he has managed to acquire over the past eight years have been thanks to the methodical system of teaching and reinforcing that we learned from ABA.

And then there’s the all-important question: which approach is best for me? Which technique jives best with my household, my family dynamic, my personality? There’s something about the ABA approach that speaks more to me, and I’ve learned, through testing my limits, that I’m able to effectively carry it out, to see an incident through to the end, to refuse to negatively reinforce a tantrum though it is so very tempting when we are in the supermarket and one simple promise of a cookie has the potential to make him pop up and cut short my embarrassment. Still, I refuse, and wait until he has reached the calming down point, only then reinforcing that positive behavior with a treat. When I’m with Menachem, there’s no such thing as needing to get to another appointment in fifteen minutes. I am with him fully, and everything else in my life stops.

Yet my wife has a more natural affinity to DIR, to entering his world and making him understand how beautiful it is to connect to others. And this is good, because Menachem needs both approaches, and even if his schooling up ‘til now has not been a resounding success, we have learned the lesson that every parent, to be a good parent, must come to realize: that, at the end of the day, the responsibility for educating our child falls squarely on our own shoulders.

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The father’s story: What’s your parenting philosophy? How do you feel about discipline? What educational approach do you find most compatible with the sum of yours and your child’s personalities?

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Printed from: http://www.jewishpress.com/sections/family/challenging-parenting/part-iii-therapy/2013/05/31/

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