Early Intervention Goals
However, before we go further into what these therapies are and how to choose them, it may help to stop and ask what our goals are while we put the child through these early interventions. Yes, the child is on the spectrum, yes, she has certain challenges but then, what should early intervention help the child with? Once we are clear about the goals of for the child, we can go ahead and talk about choosing interventions accordingly.
To start with, early childhood development goals for children on the spectrum are not different from the same goals for children in general. In both cases, one is looking for development along physical, social, cognitive, and emotional dimensions. However, children on the spectrum are likely to have a variety of specific challenges in these areas, and therefore, the goals are likely to be more specific. They may also find it difficult to learn these behaviors from the environment by observing and copying adults and other children, and so, may need suitably designed interventions and therapies.
Communication Goals
Children on the spectrum tend to face challenges related to speech, language, and communication. Some children may not be able to speak at all, due to poor motor coordination and other physical and neurological difficulties. Some children may be able to produce all sounds but limit their verbal interaction to a few words and not sentences. In some cases, children may be able to produce language fluently, as in be able to speak full sentences, recite poems etc. but may not be able to use language to communicate by asking questions, making observations etc. Many children may not understand verbal inputs and instructions. Some may be able to understand but may not be able to respond. Even in cases where children are unable to speak, they may show a willingness to communicate if the speech barrier is removed. In most cases, parents manage by trying to guess what the child means or wants. As the child grows up, this does not work and the inability to communicate leads to anxiety and other difficulties. So, an important goal is to help children develop a channel for two-way communication either using speech or using other alternative forms of communication.
Social Goals
Children on the spectrum also have a variety of social difficulties, starting with not responding when parents call their name, not being able to interact with parents. Children may not want to interact with peers or may not know how to take part in interactive games. They may behave inappropriately as they do not understand the rules of social behavior. For example, when in a play area, they may just follow other children around, copy their actions or snatch toys from others. So, teaching appropriate social behaviors and helping children cope with the demands of everyday social interactions at home, play areas and public places is another goal.
Physical Goals
Children on the spectrum may have physical challenges, with movement and balance. For example, many children walk on their toes, or find it difficult to hold erect posture while walking. Some are not able to balance naturally and so might find it difficult to walk up and down stairs, step over small obstacles like doorsteps etc. A few children may experience significant difficulties in coordinating their movements, to the extent of not being able to move around or use their hands without assistance. Many children also present with low muscle tone and overall poor motor coordination. One of the goals of early intervention is to help children develop better motor coordination and be able to navigate their world comfortably.
Sensory Goals
Children also present a variety of sensory challenges. Due to their neurological uniqueness, some children may have a different sensory experience than others. For example, some children are overly sensitive to the sound of a pressure cooker whistling. They may close their ears, run away, or show other unusual forms of distress around the noise. Some children find it difficult to handle different textures either to touch or to mouth. They may refuse to eat certain kinds of foods and may prefer to stick to one or two items of food. This preference might pose significant challenges when children end up eating only chicken nuggets or fruits and milk for years together. The interventions we choose need to address the sensory challenges of the child.
Behavioral and Emotional Goals
They may also experience a variety of behavioral and emotional challenges. Many children do not like to be disturbed when they are engaged in an activity and may find it difficult to transition from one activity or physical space to another. For example, a child might go to the play area and might resist coming back home. Or she might be playing with toys and may resist moving to the dining area for lunch. Children may also appear to not understand emotions – they find it challenging to read the emotion from facial expression and body language. Young children may not have enough linguistic and cognitive ability to understand emotions in the abstract. Guiding and helping children manage these variety of challenges needs to be among the goals of early intervention.
Key Focus
It is important to understand that the way a child experiences autism and the way it shows up through her behavior in the environment, comes from a combination of multiple factors. A child may not like the texture of food presented to her, may have a severe sensory response to it and may start feeling distressed. Now, she does not have language or other tools to communicate the same, does not understand the social behavior expected of her, and may start experiencing a serious emotional response. When a helpful adult tries to touch her, feed her, or talk to her, the added physical and verbal inputs further aggravate her distress. If she does not get help at this stage, she may resort to what is seen as ‘inappropriate behavior’ to communicate her distress. For the others around her, it looks like the child was offered tasty food, was encouraged to try out and taste it, but instead of doing what is expected, she has started closing her ears, shouting, kicking, and throwing the food around. However, the way she experiences the entire interaction is hugely different.
As we have seen above, these difficulties sometimes work together to produce profoundly difficult outcomes, and it is important to take all these areas into account while planning the goals for early intervention. The focus is to understand the variety of ways the child is distressed by the environment, trace the distress back to various difficulties the child has, and try address these difficulties, while building her skills and competencies.