Bridges Behavioral Language Systems

Guide for Parents of Newly Diagnosed Children

No one plans to grow up to be a parent of a child with autism.

At Bridges we recognize that the entire family is almost certainly profoundly affected by the problems of the child. Many times parents are afraid to tell their relatives or friends about their fears. Some families become very isolated, because it is so difficult to go out in the community with their child. Some families are embarrassed by their child’s behaviors. Often the siblings of the diagnosed child are affected very deeply as well.

Once the diagnosis has been made families may react in different ways. Often this is the most devastating event that has ever occurred in the lives of these young families. Some parents react to this news with a need to deny that it could be true. Some parents say they are relieved to have found the reason for their child’s strange behavior and learning problems. Many parents feel a urgent need to do something right away. This is a very appropriate response, as peer-reviewed research shows us that intervention is more likely to be successful if it is started at an early age.

What Parents Can Do

It is important to remember that there is something you can do. If you are in California, contact your local regional center and start the process to become eligible for services. If your child is over three years old you may also want to contact your local school district for the options they may provide. We strongly recommend you contact your local FEAT representative or other parent groups for help with emotional support, sorting through the tangle of regulations and rights, advocacy if needed, and to obtain information about services. Your local school district and/or regional center will also have information regarding options for treatment and other services. There are links to the FEAT and Alta California Regional Center websites in the web links section of this site. You will need to research the various options available for your child before deciding which one is the most appropriate.

There are options available to your child and your family to help all of you deal with this devastating diagnosis. People new to autism are often overwhelmed not only by the demands of parenting the child but by what can be a bewildering array of options. If you have found this site then you have already started researching your options. Options for treatment can generally be divided into two categories, those that are bio-medical in nature and those that are not.

Some of the more common non-biomedical approaches to children with autism are:

  • Intensive early intervention applied behavior analysis (Some times called ABA or EIBT for intensive early behavioral treatment). This is what we do.
  • Speech therapy
  • Occupational therapy typically (including sensory integration)
  • Special education classrooms, usually either with a specific autism curriculum such as TEACCH, or an eclectic curriculum.
  • Socials or functional skills training
  • Music therapy

Some popular biomedical treatments are:

  • Special diets
  • Special vitamins
  • Treatment to remove toxins such as mercury or other heavy metals from the body
  • Special drugs

It is especially crucial when researching biomedical options that side effects are explained to you in great detail.  Many children who use biomedical approaches also use non-biomedical treatments such as ABA at the same time.

Bridges does not claim to have the expertise to advocate for or against biomedical interventions. We recommend that parents contact their doctors for advice regarding these treatments.

What to Look For When Considering Treatment Options

It is important when researching your options that you are able to evaluate the claims you may see for various therapies or programs. It is crucial that you make your decisions as an informed parent. It is appropriate to request and read the research supporting all the options you are considering for your child.

Many therapies claim to have been proved to be effective in research. It is important to evaluate the research that supports these claims, as some research is considered more reliable than others. All research should be peer-reviewed to be considered a reliable source.  Peer-reviewed means that the research paper was submitted to other experts in the field to make sure that the experiment was performed correctly and that the claims made by the author were supported by the data of the experiment. The peers do not typically know the name of the submitting author. There is typically no payment for authors of peer-reviewed research in this field. However, they may be recognized for their research by their university, with offers of tenure or other similar career advances.  When looking at research that was not peer-reviewed there is less certainty that the experiment showed what the author claims, or that any changes seen could not be attributed to other factors.

Research needs to show a change in an actual person with autism. Research that uses only the opinions of people involved with the child as data is not considered a reliable source of information. Autism is a medical condition. The research for treatment must be held to the standard of the medical community. A new medicine would not be considered adequately researched if the paper simply asked the opinions of people around the patient, rather than measure the changes in the patient directly.

Research needs to be done without bias. That means that if the person doing the research has a financial or other reason to want the data to show a specific result it is not as reliable as research done without that factor.

Having an ABA Program in Your Home

We recommend that all parents view at least one (and often several) of our clients in their homes before they start a program for their own child. This allows parents to see what actual therapy looks like and provides a chance to meet other parents and talk to them about what living with an ABA program entails. We have a short video of what therapy looks like: You'll find it as a link at left to "Towards the Light."

Intensity

One of the crucial components of effective ABA therapy is the intensity of the program. Intensity means the amount of time that therapy is provided on a one on one basis to the child. Typical children learn from the natural environment nearly every waking moment of their lives. Children with autistic spectrum disorders seem to have a great deal of difficulty learning from the natural environment. The intensity of the program allows these children to learn for a higher percentage of their waking hours. It usually reduces the amount of time they may be engaging in inappropriate behaviors, as these often occur when the child is not engaged in an activity. The end goal of all intensive programs is to give the child the skills to learn from the natural environment as other children do. At that point the child no longer need the high level of intensity.

Peer-reviewed research has shown us that programs that do not provide enough hours of therapy produce significantly poorer results. Current research demonstrates that less than 20-25 hours per week of one on one therapy for the children is considered subclinical. That means that intensive programs will need to be provided for at least 25 (and 40 is the standard most often cited) hours per week. During intensive programs a therapist will be working with the child approximately 5-8 hours per day on weekdays. Usually this is divided into morning and afternoon periods of 2 to 4 hours with a break between them. Children are also provided many short breaks during the therapy time to prevent fatigue and to provide opportunities for generalization of skills. The level of intensity for each child Bridges serves is prescribed after the initial assessment. This level sometimes changes as children progress. Therapy takes place year round. Vacation breaks of longer than two weeks present a risk of regression and are not recommended.

The following scenario is presented to all of our staff as part of their training:

While every family’s story is unique, it may help to think of some of the experiences commonly reported by parents of children with autism.

The crib is waiting and the nursery is freshly painted in bright colors as the long awaited baby finally comes home. At first, everything goes just as expected and the new baby smiles and coos and perhaps snuggles up and fulfills all the dreams of what a family should be.

At first.

But later – six months, a year, perhaps two, there may be doubts that refuse to go away. Perhaps the perfect baby is just “sort of not talking” -  not really interacting the way babies are expected to. The baby may be developing some strange behaviors -  rocking his body back and forth, or flapping his hands when he’s excited. The first several times he does that it’s cute. After a while it’s not cute any more. Maybe the behaviors become more severe -  banging his head over and over without seeming to feel any pain. Perhaps a minor household accident will occur and the parents see their child cheerfully bleeding from a cut or scrape that would have any other child screaming.

Or maybe the baby did talk. Everyone heard him say mommy and daddy, right on time. Until the day a parent realized he hadn’t said anything for a while. And in the weeks that followed they may have tried ever more frantically to get the baby to talk and instead watched him fall into silence.

Many parents report that they wavered back and forth between telling themselves it was not something to be concerned about  and harboring very serious worries. It is common for parents to report that many relatives told them these concerns were nothing to worry about, that the baby would “grow out of it”. Difficulties often arise when one spouse is more worried than the other. After making the decision to have the baby evaluated (and typically waiting several months for that evaluation appointment), these parents have taken the baby in and received a diagnosis: autism.

ABA is a therapy that involves families. It takes place in the homes of the children we serve, and because of this forces a relationship among the therapists and families that is much more intrusive than the relationship found in a school or clinic setting. Many parents are very young, often still in their twenties. Many times at least one parent is not able to work outside the home because of the demands of an in-home program. Parents may face financial difficulties as well as the isolation that comes with parenting a child who cannot go to the grocery store, the post office, even the park, because the child’s behaviors will not allow it. They may face heart-breaking choices about what sacrifices must be made of the family’s time and financial resources by the other children in the family in order to help the child (or, far too often, children) with autism.  Families that are already dealing with the realities  of a child with disabilities now find themselves in the position of having a seemingly endless stream of therapists and their supervisors in their home. Some parents may feel “judged” by the therapists and supervisors that work in their home. When presenting behaviorally sound strategies to families we must all must keep in mind the respect due to each family member. The reason behind each recommendation and how different reactions affect the child’s behaviors must be given to the parents. They are the ones who will live with and deal with the consequences in the long run, and we are ethically required to educate them as much as possible in the methods that are effective for their child. Any recommendations must be given with the realization that no one can be one hundred percent consistent all of the time. Strategies that rely more heavily on reinforcement than punishment are most effective and easier for families to implement.  Some families may feel obliged to treat the therapists and supervisors  as guests, feeling a need to tidy up or be presentable. This is not a reasonable burden 25- 40 hours a week for most families with young children, to say nothing of families with a child with autism. It is a privilege to work with these families, and we must always remember the enormous responsibility that these families have entrusted to us – the chance for their child to be as independent as that child can possibly be.

We recognize the responsibility and privilege of working with these children and their families.  If you would like more information about Bridges programs for your child please contact us. You can also place your child on our waiting list by completing the waiting list request and sending it to us. Click on the link at left or here to see the waiting list request.

References

Howard, J. , Sparkman, C. , Cohen, H., Green, G., and Stanislaw, H., (2005) A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in developmental Disabilities, 26, 359-383

Lovaas, O. I., (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3 - 9.

Lovaas, O. I. (1993). Teaching developmentally disabled children: The me book. Austin, TX: Pro-Ed.

Maurice, C. (1993). Let me hear your voice. New York: Knopf.

Maurice, C., Green, G. & Luce, S. (1996). Behavioral intervention for young children with autism. Austin, TX: Pro-Ed.

McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 4, 359 - 372.

Page Updated 6 August 2007

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