Finding the Key
By Elizabeth G. Donnellan, MEd, ABD, Faculty Member, College of Social and Behavioral Sciences
Years ago, I worked in my own practice seeing children and teens diagnosed with AD/HD, dyslexia, Asperger’s syndrome, anxiety, behavioral disorders, and autism. We had hired a behavior therapist to work with our autistic clients, so I did not actually work with them at first. However, one afternoon, the therapist brought me a young boy. She simply said, "I cannot connect." I understood and quietly showed him the toy section of my office. He sat down and stared at me.
I called his name a few times without response. I requested his file and invited the therapist to leave him with me. After reading the file, I simply sat on the floor near Matthew (name has been changed). He looked at me but said nothing. I knew from the file that he was diagnosed as having autism; however, his mother spoke only Spanish and said that she had not understood much of what the doctors told her at the time of diagnosis. I assumed that he had the typical symptoms of problems with social interactions, delayed speech development, and intense interests/behaviors. Hoping to find a connection to his world, I dumped out some toys on the floor of the office and left him alone for a few moments. When I returned, he was going through the toys. Finally, he looked up at me and yelled “Spiderman!” In a proud voice he began to sing the theme song to Spiderman. I joined in much to his delight. I was overjoyed; he had shared his "key" with me.
For the next two years, Matthew came to our center to work with the behavior therapist and me to develop his social and language skills. Every Friday afternoon, we festooned the office with Spiderman pictures, streamers, and action figures awaiting Matthew's arrival. He loved to come in his Spiderman costume and we all pretended that he was actually Spiderman when he came in. During his treatment time, we stocked the office with Spiderman pencils, pens, crayons, books, and anything else that we could find. We worked with his school to allow him to bring some of those items with him to school. Why did we encourage this intense obsession with Spiderman? We understood that it was not an obsession so much as the key to his world.
While Matthew was not our only client diagnosed with autism, he taught us about the isolation and frustration that comes with the inability to speak or connect with others. We learned his moods, hand gestures, utterances, and outbursts were related to his trying to communicate with us. Together, we all used the Spiderman key to pave a path into Matthew's world. So, how does one connect with children who seem so disconnected?
One of the best ways to make a connection with children diagnosed with autism is to find the one stimulus that elicits a response. In Matthew's case, it was his intense interest in Spiderman. Then, once the interest is identified, use it to communicate with the child. This strategy is the same as the one used to connect with people who are depressed or even suicidal: form connections. Once the connection is made, the therapist has to use it. Together, the therapist and child develop a special language and understanding. It is through this understanding that the child begins to feel safe. The child will develop an interest in language because of his interest in connecting with the therapist. With increased interest in social interactions, the therapist has an opportunity to use play therapy and behavior plans to train social skills.
Interactions help the child to take an interest in communication, which often prompts a path to language development. Depending on other existing factors or co-occurring disorders, the child will increase his or her vocabulary. A key point to remember is that a diagnosis does not define the child. Everyone diagnosed with autism will experience the symptoms differently. For this reason, therapists have to continue to tweak treatment to match the individual needs of the child. Some children interested in social interactions will still struggle to speak in phrases. Some children will develop limited speech but will not be able to understand written language. Focus on the individual child and try not to use the same treatment with each child.
As with any treatment setting, take the time to find the "key" to your client's trust. It is easier to do with children who have developed normally, but can take time and patience with those who experience asymmetrical development. Do not assume that one autistic child will react to the same treatment advances as another. Properly identifying each and forming individual treatments for them is a more successful approach than assuming some standard treatment.
If you are interested in working with this special population, the best education that you can receive comes from the clients themselves. Contact Autism Speaks to see if there are local chapters (Kaplan University has an online chapter). Then, look for volunteer opportunities to help with Special Olympics or workwith a child in a school setting. There are even volunteer programs available in some communities to work with autistic adults in job training. What is the key to connecting with an autistic client? Have your clients teach you about how they experience life through their symptoms. To this day, I silently thank Matthew for teaching me about his world!