978-1572305441

138 A MIND APART
more sensitive to the subtlest forms of nonverbal communication. Certain
sounds meant that Trevor was unhappy; rocking was an indication
of mounting anxiety about some anticipated change in routine. All of a
sudden, Alice understood that Trevor was communicating all the time!
It was just that he was using a different communication system. Alice’s
role was to break the code, and once she understood this, she became
more patient, less likely to become angry and misinterpret Trevor’s actions
as willful and stubborn rather than as directed at keeping his
world in order.
Alice and Trevor were now ready to begin treatment. She was getting
a little frustrated with me because I kept postponing this discussion
about treatment until she could integrate all the information about ASD
and see how it applied to Trevor. But it is so important to stop the frantic
search for a cure and understand the context of what having an ASD
means to the child.
“When are we going to begin treatment, and what treatment are we
going to use?” she kept asking me. I didn’t mean to appear secretive, but
there was a lot of information to impart about treatment, and that takes
time. Spending a few months on assessment, understanding treatment
needs, having a good appreciation of cognitive strengths and weaknesses
is essential. Understanding the capacity for learning very simple
skills takes time and is essential in ensuring that the treatment is delivered
in as efficient and effective a manner as possible. Taking that time
does not delay the initiation of treatment; in fact it is an essential part of
treatment. Starting treatment too early can be delaying treatment as well
if it leads to false starts.
There has been an important shift in the philosophy of treating
children with autism and AS over the last decade. Part of the reason for
that shift has been a greater awareness of what is realistic to expect in
terms of treatment response and a greater appreciation of the unique
features of ASD as a disorder that affects all aspects of development. In
the past, the emphasis was on reducing autistic behaviors such as
echolalia (repeating phrases), behavior problems, and motor mannerisms
(such as rocking, spinning toys, finger flicking) using a number of
techniques, including punishment. Some of the therapists who used
such techniques also made extravagant claims of “cure” in the absence
of well-documented changes in day-to-day functioning. The goal is now
not so much to reduce or eliminate “autistic behavior” but rather to
facilitate social and communicative competence and so reduce the degree
of impairment in day-to-day functioning. In this way, the so-called