I believe that a recent Canadian study on DIR/Floortime therapy, which I wrote about in the September issue of Today’s Parent may be the most important autism study in recent years. In order to understand this blog, I’d suggest you read the article first (but feel free to work backwards!)
Here’s why I think this study may change the way we understand autism and how to treat it.
1. The study shows it is possible to change the social brains of young children with autism. This was the first study ever that measured children’s brain activity before and after treatment. The brain data showed that successful treatment resulted in a dramatic reduction in the amount of brain activity and the number of brain connections children were using to process social information. As I wrote in my Today’s Parent article, children with autism have “too many” connection in some parts of their brains. Thus their brains are “too busy” when processing information, particularly sensory, social and emotional information.
If therapy can reduce excess brain connections, it follows that it should be possible to reduce the sensory, social and emotional stress that appears to cause many of the behaviours we associate with autism – repetitive behaviours, avoiding eye contact, unusual social responses. If these behaviours can be reduced then other behaviours like making eye contact or enjoying and initiating social interaction can be learned. Learning those more typical behaviours should enable the child to be involved in more typical types of interaction. How could that not alter a child’s brain development in a positive way over the long term? Remember, brain development continues throughout childhood, even into early adulthood.
2. These results suggest that, if we can diagnose and treat children with autism when they are very young, which is already starting to happen, it will often be possible to moderate the level and severity of the symptoms and behaviours they develop.
I’m not suggesting that children with autism are born with typical brains that become damaged as they develop. In fact, there is little doubt that autism is a neurogenetic disorder, ie. children with autism are born with brains and nervous systems that work differently, leading to changes in their emotional, social and cognitive development.
However, this study shows that the brain development of children with autism is also affected by the experiences children have – or more importantly, don’t have – because of these brain differences.
If a baby has trouble processing the information from his senses, that will cause stress and it will affect the way he responds to his environment, including his parents and other people. That, in turn, will make it very difficult – if not impossible – for the baby to have the kinds of social experiences that are necessary for typical brain development and social development. These atypical experiences cause further changes in the way the brain and its pathways develop as the child grows.
This study shows that by changing a child’s social experiences early in life, it’s possible to alter the way his or her brain develops. That suggests enormous potential for positively affecting the neurological and social development of very young children who are born with brain and neurological differences.
3. This study challenges the idea that Applied Behavioural Analysis/ Intensive Behavioural Intervention (ABA/IBI), is the best treatment for young children with autism. Clearly, the jury is still out and there will be lots of debate for years to come. ABA/IBI, a kind of behaviour modification training that uses lots of repletion and rewards, has been shown to be an effective way of teaching behaviour skills to many children with autism.
Right now, in Canada, most money governments spend on autism treatment goes to ABA/IBI. The may start to change because of the impressive results of this study.
Having said that, children with autism are so diverse – both in terms of their problems and their capabilities – that there is no way that any one therapy will be the answer for all of them. In fact, most children with autism will probably benefit from more than one kind of therapy. Dr. Stuart Shanker, director of the Milton and Ethel Harris Research Initiative, where this research took place, believes that providing children with DIR/Floortime therapy would make ABA/IBI therapy more effective.
4. DIR/Floortime therapy may be helpful for other kinds of childhood problems like Attention Deficit Hyperactivity Disorder (ADHD), anxiety disorders and various behaviour problems. Dr. Shanker believes that autism and many other childhood behaviour and mental disorders are related to problems with self-regulation. Self-regulation is a complex idea, but basically it refers to children’s ability manage their energy level, mood and physiological state of arousal (how excited, calm, upset, alert or attentive they are) to the demands of the situation they are in. Self-regulation is also about the ability to deal with the minor and major stresses people face each day and – this is very important – recover from the effort of doing so. (Obviously, when children are very little, they can’t “regulate” themselves, and need the love, support and care of adults to do so.)
A big cause of many childhood behaviour disorders, Dr. Shanker believes, has to do with how hard some children have to work (in a physiological sense) to deal with the “normal” stresses of life. When children have problems with self-regulation they have to work much harder than others to deal with these stressors. When they are unable to deal with stressors, or when they are physiologically, mentally and emotionally exhausted from the effort of doing so, as is often the cause with children with autism, it can have negative impacts on their behaviour. Think of an exhausted, overwhelmed two-year-old having a tantrum. That is basically a response to stress that the child can’t deal with. Dr. Shanker believes than many children’s behaviour and attention problems are also at least partly related to neurologically based problems that cause them to experience (and be unable to cope with) stress.
A therapy, like DIR/Floortime, which helps identify and mitigate a child’s unique stressors, and then teaches adults ways to understand, support and interact effectively with the child, should help reduce the stress that causes or contributes to various childhood learning and behaviour problems.
A word of caution.
We can’t say DIR/Floortime is a “cure” for autism. In this study, most children who were successfully treated still had significant impairments, although some of their parents report dramatic improvements. And, unfortunately, treatment was not successful for a small number of children in the study.
But still, I’m convinced that the therapists and researchers at the Milton and Ethel Harris Research Initiative have demonstrated that DIR/Floortime deserves more attention and more government funding. The findings are a very, very exciting development in our understanding of autism, how to treat it, and ultimately, perhaps even how to prevent some of it’s behaviours and impairments from developing.