Therapy can remediate the core deficits of Autism, aiming higher than simply compensating for the challenges a child faces in their life.
When I start working with a new family, part of the process of getting to know the child with Autism and their family involves talking about therapies they are doing or have done in the past. Stopping and thinking about the work a family is doing is a crucial part of the therapeutic process, especially teasing apart the difference between things that are really helping with the core deficits of Autism, and things that are simply working around the child’s problems.
Let me contrast this so it’s clear what I mean.
Compensation means something that is done to work around a problem and offset the shortcoming or deficiency; a work around.
Remediation means working on or correcting a deficit or fault to the point where it is no longer a problem or no longer presents as an obstacle.
It’s important to contrast these two ideas as it pertains to treatment of Autism. This is because a lot of therapeutic interventions that families access fall well and truly in to the first category. It’s an unfortunate throwback to the world of Autism from 30 to 40 years ago, where Autism was poorly understood, and the prevailing wisdom was that the core deficits of Autism were not able to be remediated. It stands to reason then that therapies of that time focused on compensating. The assumption was that the person with Autism was incapable of growth and further development. The problem with this idea is that we have so much more knowledge and understanding of Autism today. We know that neurological growth is possible and ongoing throughout our lives, yet at the clinical level, there is still a lot of reliance on compensation only. To stop and think about this can be really uncomfortable for some parents and therapists alike. It’s hard to realise that the work we’ve been doing comes from an assumption that the child with Autism is not capable of more, and that we are inadvertently capping their potential. For example, a Speech Pathologist might work on having a child practice a script to say “Hello” over and over and over – a compensatory approach. Whereas we can work on developing a child’s connection with other people, their motivation and interest in communicating with them to learn about another’s inner experience, and to share one’s own ideas and insight. Isn’t this remediation approach better?