ABA: Applied Behavioral Analysis. Also known as Lovass after its founder, Ivan Lovass, or DTT (Discrete Trial Therapy). It’s the most widely used approach for spectrum kids because it has the most comprehensive studies that show it works. The basic approach as I understand it is to break things down into simple steps. Teach a child to say "cat" when she sees a picture of a cat. Reward her with treats or hugs. Etc. It’s essentially rote learning, though they do bring the kids out into the field, so to speak, to generalize what they’ve learned. Dan and I got a lot of flack from other parents for avoiding ABA for Damian, but it didn’t feel right. Floor Time was a better fit. I do think some kids benefit from ABA, preferably in combination with Floor Time, but Damian needed (and needs) what Floor Time has to offer.

Autism: It affects communication and interaction. Speech and friendship, basically. Here’s a set of definitions, including the official DSM IV criteria. Autism spectrum disorders include:

    Asperger’s (AS), usually defined as autism without the language delay. Informally known as Little Professor Syndrome because kids with AS tend to lecture on their favorite subject.

    Classic Autism, also known as Kanner’s Autism. Kids who are more severely impacted by the condition.

    High Functioning Autism (HFA), also called Mild Autism but the two are actually somewhat different. Someone can be high functioning (ie: able to function in the world on their own) but have some severe deficits. But someone who’s mildly affected is also high functioning, so it’s an understandable confusion.

    PDD-NOS, short for Pervasive Developmental Disorder Not Otherwise Specified. Autism and Aspergers are PDDs. So if you have a kid who doesn't quite fit the profile but mostly does, you label him/her as PDD-NOS. Our developmental pediatrician told us the basic difference is that autistic kids stim; kids with PDD don't. Some parents seem to prefer the PDD diagnosis, thinking it somehow means their child is less severely affected. Personally, I think it's mostly semantics.

    Hyperlexia may or may not be on the spectrum. It's when a child learns to read precociously early but his or her speech comes in late. Other markers involve social issues that make it sound a lot like a spectrum disorder to me. Same with Semantic Pragmatic Disorder, which is not an autistic disorder in and of itself except that maybe it is. You might want to read this fascinating article exploring the fuzzy boundaries of the autism continuum.

    Then there's the term Stanley Greenspan coined, which if it catches on, would get rid of all the others: Multi System Developmental Disorder (MSDD). It doesn't label or categorize according to degree or type, just says yes, this kid has some issues here. I like this way of thinking.

Closing circles: the heart of Floor Time. Basically, back and forth communication/engagement. If I offer you a toy, I'm opening a circle of communication. If you accept the toy, you're closing that circle. If you throw the toy at me, you're also closing the circle. The point is, you're responding to my overture. And my overture doesn't have to be so easy: If you're pushing a toy truck on the floor and I take a toy motorcycle and crash it into your truck, I'm also opening a circle. Any reaction from you to what I've done? That's you closing the circle.

DIR (Developmental Individual Relationship-based) therapy a/k/a Floor Time, also referred to as Greenspan after its founder. What we're doing. I wrote a thumbnail sketch here.

When someone repeats exactly what you say back to you. For example: "Damian, do you want lasagna or pizza for dinner?" and he says "Damian, do you want lasagna or pizza for dinner?" It's a normal stage in a child's language acquisition, but it's usually short-lived. A kid on the spectrum can get stuck for months or years repeating some or all of what the people around them say. Damian did this a lot for about a month and then it gradually faded away.

Occupational Therapy (OT):
(OT also stands for Occupational Therapist.) I don’t know the official definition, but in my view, it’s all about helping kids live in their bodies more fully. Everything from fine motor (pre-handwriting skills, picking up utensils, threading beads, etc) to strengthening leg and arm muscles to learning to keep your body in balance on a swing to crossing the midline (when your right hand reaches for something on your left side, you cross the midline) to helping a child handle sensory input (shaving cream, tooth brushing, strange noises, being bumped, etc).

Mechanical play. Play that doesn’t have a goal or a purpose or any imaginative intent. No make-believe. Just doing the same thing over and over. Rolling a car back and forth. Lining toys up next to each other in a row. Putting a ball in a chute repeatedly. Shoot-em-up video games (just kidding -- sort of). Mindless play.

Scripting: Quoting from books or videos. Sometimes using the words to communicate and sometimes just randomly quoting. For a long time, scripting was Damian's main form of speech.

Sensory Integration Dysfunction: In a nutshell, SI Dysfunction is when you’re not properly decoding the input from your senses. You may be undersensitive to sound, you may be over-responsive to touch (tactile defensive), etc. There are also two more senses: the vestibular (balance) and proprioceptive (body positioning/body awareness/grounding). When these are off kilter, you can be clumsy or afraid, uncoordinated or always in motion. OT helps enormously as long as you find an appropriately trained therapist. You can do a lot at home, too. We have a bucket of dried beans for Damian to sit in, a trampoline, and squishy frog and bug toys. We’ll get a therapy ball soon too. A child can have SI issues without being autistic, but I think most kids on the spectrum have at least a little SI Dysfunction.

Speech therapy (ST):
(ST also stands for speech therapist (also known as an SLP, Speech and Language Pathologist)). What they work on is mostly obvious, but it turns out it also includes blowing whistles and drinking from cups -- anything involving oral motor activities (using your mouth) counts and can help you speak louder, more clearly and with more control.

Stim: short for self-stimulation, which can be anything from rocking in place to spinning to banging your head against the floor (or something softer) to opening and closing your hand again and again, fixedly watching your fingers like someone on acid. Usually it’s something repetitive that gives you some kind of sensory input, sometimes too much input (spinning makes a normally wired person dizzy but for some people, it’s the only time they feel in balance; same thing for someone who’s undersensitive and bangs his head against something hard -- he wants to feel the sensation). When I see a kid stimming a lot, it makes me think of someone jittery and itchy, uncomfortable in his own skin. In my experience, OT (occupational therapy) helps. A lot.


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copyright 2002 Tamar