The Four Therapies that Made the Biggest Difference with my Autistic Daughter
I’ve mentioned all of these tools in previous articles, but wanted to give you this one-stop overview for easy reference.
A Word on ABA
We did not do ABA therapy and do not have any immediate plans to start it. At first, this was primarily a financial decision: our insurance did not cover a single hour of the 40 per week that was recommended, and I would have to drive over two hours round trip to the closest practitioner. Additionally, many actually autistic adults are vehemently opposed to ABA, saying it is more akin to dog training than therapy and can cause emotional damage to the individual receiving it.
My stance on ABA has softened over time. I have heard many stories from autistic people and their families of just how much ABA has helped them. Oftentimes it is a matter of life and death: ABA can teach a toddler who is prone to eloping (running away) to stay with mom in a busy parking lot. ABA can teach a child who cannot swim the importance of not jumping into the pool on an impulse. Additionally, ABA has come a long way from where it was a few decades ago: it is now more play based and emotionally responsive.
I do not condemn anyone who uses ABA, nor anyone who decides it is not right for their family. My major issue with ABA is the hours involved: forty hours a week is a full time job, and to expect a four-, five-, or even ten-year-old to do that (on top of school, potential other therapies like OT, and any other extracurriculars) just seems like way to much for me. We decided to look for alternatives, which I’ve listed below. If you do decide to use ABA, these tools can definitely be used in conjunction with it.
Relationship Development Intervention
Relationship Development Intervention was invented by Dr. Steven R. Gutstein and Dr. Rachelle K. Sheely, and it focuses on building reciprocal relationships between autistic individuals and others. Instead of “masking” behaviors or giving rote scripts, RDI essentially teaches an autistic individual the elements of relationships with which so many of them struggle.
There are different stages, starting with teaching a child how to seek a relationship partner for information. This does NOT mean forced eye contact, but rather organically teaching a child how to “read” nonverbal information from a partner that will help them more fully understand a situation. Much of RDI revolves around play, and I have many fond memories of our RDI-intensive days. One of our favorite games was “Look Where Mommy’s Looking,” in which I would hide M&Ms around the kitchen. My daughter, Emmy,** would have to reference my face to learn where the M&M was. I had to start about six inches away from the candy, but after a few weeks she could find the M&M based on my gaze from across the room. Other skills Emmy learned through RDI were how to clarify her requests (see my article “The First Time My Daughter Played With Me”), flexible thinking, and increased imaginative play, and a developed understanding of body language and facial expressions.
What I like about RDI is its basis in family and relationships. Many autistic individuals are incredibly bright, but lagging social skills can lead to struggles. Additionally, it is very customizable and parent-led. If your child doesn’t like one of the games, modify it! Try a different one! There were so many paths to choose, kind of like a pick-your-own-adventure book.
There is an online community for RDI. I used this website to find a consultant with whom I did an initial evaluation, and then used the handbook* to plot our family’s custom course. Depending upon your comfort level, you can use any and all of the above to incorporate RDI into you and your child’s own autism journey.
Declarative Language
One of the things our RDI consultant highly recommended was Linda K. Murphy’s “The Declarative Language Handbook.”* And I want to pass that recommendation on to you, along with her companion book, “The Coregulation Handbook.”* Both books are very short and approachable, and I can truly say they were life-changing in our household.
For an in-depth look at how we started using declarative language, you can read my article on our first day with it here. But in a nutshell, declarative language takes the “demand” out of our communication. Many individuals with autism have an overdeveloped fight-or-flight drive, and even a simple command such as “put on your shoes,” can feel like a major loss of autonomy. If this sounds like an impossible problem to overcome, don’t despair. With a little practice, it becomes second nature. Now, instead of saying “put on your shoes” I say “your shoes are by the door.” “Your plate is still at the table” has replaced “clear your place,” and “the dog hasn’t had dinner yet” has replaced “did you feed the dog yet?” You get the idea. Emmy is much more relaxed, helpful, and capable since we switched to declarative language.
Meaningful Speech
I stumbled across Meaningful Speech on Instagram and learned the term “Gestalt Language Processing.” I read all the free stuff I could, then subscribed to the site. It opened up a whole new understanding of how Emmy was communicating. Like many autistic individuals, Emmy used echolalia (the repeating of phrases over and over again, either right after she had heard them or days and weeks later) a lot. My mama intuition told me this was communicative and I never made her stop, acknowledging what I recognized and trying to puzzle out what I didn’t. Remember, a few articles ago, where I mentioned normalizing autistic behavior by asking the question “is this hurting anyone?” and if the answer is no, just letting it continue? This is one time it truly helped!
Gestalt Language Processors learn language in whole to parts instead of parts to whole. They often sound more advanced than they are, using grammatically advanced structures in the whole scripts that they memorize. What this meant, for us, is that Emmy could recite movie scripts but couldn’t tell you what flavor ice cream she wanted. Well, she could, but not in the usual way. Instead of saying “I want chocolate” she’d say “What is that amazing smell? Mmmmm…chocolate!” (Like Ana and Elsa in Frozen). As Gestalt Language Processors learn, they begin to break down their chunks into mix and match pieces. So eventually Emmy went from the whole line to “Mmmm…chocolate!” To just “chocolate,” but it took a while.
Many of her gestalts were not as direct, either. For example, when she was very little, many of her first gestalts were from the “If You Give a Mouse a Cookie” series of books. So when she started talking about getting all sticky and needing a bath, I knew she was requesting pancakes, like in the Pancake Pig book. As I said, I had an intuition that this was all communicative and was able to respond to it. But learning more about it from Meaningful Speech really opened up communication for both Emmy and I.
Primitive Reflex Integration
Emmy has been receiving some sort of occupational therapy or other since she was two, but it wasn’t until she was seven that I heard about Primitive Reflex Integration, and really any and all brain-body movement therapy. Primitive reflexes are the movements young infants make automatically to help them survive. This handy chart, which I found from Brain Balance, gives a nice overview of what the reflexes are and what purpose they serve, and how retaining them can possibly influence an individual later in development. I knew of the Moro reflex, the rooting reflex, and the startle reflex, but there’s a whole bunch more. In some individuals these do not fully disappear, or integrate, as they get older, and can get in the way of more coordinated movement.
There are a series of exercises developed by scientists to help those individuals work towards full integration. They are pretty simple, and we made them fun using stickers, baby dolls, and funny noises. We did these exercises daily for six weeks, and at the end of that time Emmy was more coordinated, had a fuller range of motion, and as a result seemed more confident in trying new things, obtaining new physical skills, and also seemed to have gained new cognitive skills, as well.
The increased cognitive ability really caught my attention, and I’ve since been reading more about how one can use the body to work on the brain, and there is some promising research out there. That is the topic for another article, but if you want to dive in, I’d suggest reading this book, as well as starting your own primitive reflex exercises.
Some last thoughts
This is not an exhaustive list of everything that has helped us: our OT and Speech Therapist have been pivotal in facilitating a lot of Emmy’s growth. I also cannot thank her regular teachers enough for their patience and dedication. Finally, a lot of things just depend upon the special interests of your own child. For example, Emmy learned to read through the Biscuit books, refusing to read any other book in the Learn to Read series. But your child could be different: only liking the Lego or Disney Princess books instead, and refusing the Biscuit books. Use this as a jumping off point, and keep your kid’s personality and interests in mind. With that combination, I’m sure you’ll start seeing improvements, as well! If any of these therapies (or others!) have helped your child, I’d love to hear about how in the comments.
*Affiliate links. Thanks for helping a mama out! **Names have been changed.
Annie Newman is a substitute teacher, mom, and aspiring children’s book author raising two children: one neurotypical and one autistic. You can also follow her day-to-day learning on Instagram and on Tiktok.