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On The Issue Of... "Therapist" Qualifications... When it comes to the issue of "therapist" qualifications, there is a mistake that parents seem to make over and over again... and it can be one that, in my opinion, can be devastating to your child... This mistake on the part of parents/families is the assumption that because a person has the "title" of "therapist" (i.e., Behavior "therapist", etc.), that these persons are actually qualified to work with or have any significant experience in dealing with children who have autism. Unfortunately, this is something I have seen over and over again in parent emails and discussions with other families who have children on the autism spectrum and the reason for which I felt I had to include this particular section on my website. Unfortunately, too often, parents assume that "because someone carries a label or title" that that is equivalent to having experience in dealing with children who have autism... and that simply isn't the case. Often, those who carry the label of "therapist" have only very, very limited experience - if any - dealing with these children... and some of those we assume to be "therapists" are often persons who just recently were hired by government agencies to meet the overwhelming demand for help with these children and what the government and/or agencies provide in terms of "training" is often nothing more than a course or two or "workshops" lasting but a few hours, days or perhaps, a couple of weeks. Needless to say, in my opinion, that hardly makes one "qualified" to deal with children who have autism... and again, unfortunately, this is a situation I have seen over and over again in communicating with families... families who simply assumed these "therapists" were qualified and are shocked to find out that "qualifications" of those dealing with their children are very, very limited... and all too often, the so called "experts" know a whole lot less than the parents do in terms of dealing with children who have autism. True, this is not always the case, but all too often, it is! I have received emails from parents complaining their children cried all day in "therapy" programs... and when I mentioned that they should ask for "qualifications", they were absolutely shocked to find out the persons providing "therapy" had no training in dealing specifically with the autistic. A child should not be crying the entire time they are in "therapy"... if they are, I hope parents will have the wit to see that "something may not be right". The "therapy" or "treatment" children with autism are exposed to, in my opinion, is often nothing short of abuse. Let us look at a few examples. First, perhaps my biggest issue with some of the "therapists" out there is the fact that those who practice ABA therapy often want to use a "task completion approach" making use of "positive or negative reinforcements" in order to get the "desired" Pavlov's dog response. The simple fact is that you can not teach "a task" to a child who does not yet have communication skills. These approaches make use of "discipline" methods in children who do not yet have the ability to communicate. How can I "discipline" via "positive or negative reinforcement" a child who does not yet understand WHAT the "discipline" is FOR or WHAT s/he "did wrong" and "why"? YOU CAN'T!!! COMMUNICATION MUST COME BEFORE DISCIPLINE OR "TASK COMPLETION REQUIREMENTS"! Programs that would put "incremental task accomplishments" ahead of communication skills are another example of what in my opinion falls into the APPLIED BEHAVIOR ABSURDITY category! COMMUNICATION MUST COME FIRST! Do we use "positive or negative reinforcements" to teach a lesson to a newborn... no.. the newborn first must be able to understand the communication... be it in the form of eye contact, a smile, a frown, a hand gesture... whatever... the simple fact is.. you don't start out with "discipline" for actions (i.e., negative reinforcements) prior to the child being able to have basic communication skills. Personally, I would drop any "behavior therapist" that would put "task completion" ahead of the establishment of communication skills. These children have enough challenges ahead of them without receiving "negative reinforcements" for things that are expected of them which they too often do not even understand! COMMUNICATION and UNDERSTANDING of the expected must come FIRST! We are dealing with children... not animals like Pavlov's dog! Sure... with enough "negative reinforcement" I can get "a desired response". But what has that child really learned... just how to avoid something negative! Did the child really UNDERSTAND the "why" behind what was expected... probably not. Clearly, to focus on communication skills first has to be key... discipline and/or task completion can then more easily follow! Parents - think this one through... I urge you not to be lulled into thinking "task completion" should come first... COMMUNICATION and UNDERSTANDING must come first... there simply is no other way to put this! For a whole lot more on how so many for so long have so misunderstood so much in terms of language development in these children... and the importance of understanding what we see in these children, I urge you to read "book 4" posted in full on this website (you can access it from the main/home page). This book deals specifically with language in children with autism and I think many a parent will be very much able to relate to what is provided in that text... and will come to see how so much of what we see in terms of language development and communication development in these children just makes so much sense... if we only take the time to look at it from their perspective and from a brain structure and function perspective... something too many a therapist completely fails to do! Also, I once read of a child with autism who was put "in a special room" at school ... the special room was a small room, with one small window... and it was locked when the child was placed in there - basically in solitary confinement - for "misbehaving". Needless to say, the parents were curious about "the special room" and upon seeing it one day when the child pointed it out, they were appalled that a child with autism could be treated this way, went to the papers and sued the school system. Although this is one of the worse I had read about, there are certainly other things going on that make me truly wonder about the treatment being given to some of these children. Another parent mentioned to me that a non-verbal child who had a problem with biting other children was being made to " suck on lemons" when he bit another child. Yet, this same parent was asking what could be done that "worked" because clearly, the "sucking on lemons" was not working... and yet, it continued to be used as a potential "behavior modification" technique - in my opinion, clearly by someone who was rather "clueless" to the fact that it was not a working option and/or solution. True, there are absolutely issues with biting, however, in this case, there are 2 children to be concerned about - and potentially more - the one being bitten and the one doing the biting. Can one teach "discipline" to a child who has so much difficulty with communication... it seems communication must come before discipline... or worse... punishment... which is, in my opinion, what this clearly is. To make a child "suck on lemons" is a form of punishment... and if parents are "aware" of this "technique", I shudder to think about what may be being done behind closed doors to some of these children when it comes to "discipline" issues. Parents who have children who bite find that a casein/gluten free diet can be helpful... as can be digestive enzymes such as Peptizyde (made by Houston Nutraceuticals, http://www.houstonni.com - for more on this issue of behavior issues and dietary changes, consider talking to other parents of children with autism on parent discussion boards such as http://groups.yahoo.com/group/enzymesandautism/). Clearly, things like "biting" and any injurious behavior to self and/or others can result from many things... actual pain/discomfort, frustration, biting of clothing due to the fact that there is gluten in the soap used to clean it, etc., and unfortunately, in my opinion, "therapies" like "sucking on lemons" would only add to that frustration and perhaps only make matters worse, by resulting in a great deal of anger on the part of a child who already faces so many challenges. In such situations, the "trigger" for the biting needs to be understood... and until that happens, there is little hope that the behavior will be resolved - especially in children known to have a disorder that results in obsessive-compulsive behaviors, repetitive behaviors, and children who very much live "via reference" (see books 2, 3, and 4 on this website), etc. In addition, the simple fact is that dietary issues are very much an issue for children with autism. Dietary intervention is credited by many parents as having played a key role in helping their children with autism. Some of the issues with diets include casein (milk protein) and gluten (grain protein) sensitivity, issues with calcium, magnesium, and zinc deficiencies, Vitamin B6 deficiency, iron overload (what some see as "anemia" or think is "low iron" may actually be a sign of IRON OVERLOAD - a huge issue that is very misunderstood by perhaps 99.9% of doctors - for more on that, and the role iron plays in disrupting several key functions in the human body, go to: Redefining The Role Of Insulin (a paper I wrote and posted on this website - note: Iron and insulin modulate one another - a little known fact in the medical community - and a very critical fact indeed!). Thus, there is another critical point that must be made here. Behavior therapists, for the most part, would have little or no understanding of the dietary issues that play into autism. As such, when I see "therapists/teachers/experts", etc. who give children "lemons to suck on" as "punishment", clearly, this only indicates to me the further incompetence we have when it comes to dealing with the autistic. Lemons contain Vitamin C and Vitamin C greatly enhances iron absorption (by anywhere from 50 - 80%). Given children with autism are known to suffer from iron overload (work of Dr. Walsh at the Pfiffer Treatment Center in Chicago - 1/3 of their 3,000 children with autism suffered from serious iron overload) and given iron is a very, very toxic substance), personally, I have huge issues with seeing someone give an autistic child anything with Vitamin C without that person knowing if this child may suffer from such iron overload because that could potentially make that child's metal toxicity much worse - and with increased metal toxicity, there would certainly be the potential for even more damage to the human brain and organs and that could certainly be reflected in a child's worsening behavior (i.e., biting)! Unfortunately, when it comes to dealing with children with autism, every "camp" thinks it has the answers... and perhaps worse, governments provide little if any funding to help with dietary intervention, assuming that "behavior therapy" may be the only way to recover these children. Why is it exactly that dietary intervention is not encouraged and funded? Certainly, there are those who prefer to simply put children on medications rather than address the underlying issues. We could go a long time on "what the government funds" and "refuses to admit" in spite of overwhelming evidence of metal toxicity, gut issues, dietary factors, etc. in these children. Yet, the fact remains, if we turn only to "behavior therapists" or "teachers" as our sources of "intervention" and those "therapists" and "teachers" are not trained in even the most basic of things when it comes to dietary issues in autism, those "experts" we are turning to may simply be making matters much, much worse for these children - just my humble opinion of course based on my many, many hours of research into these issues. Recovering these children can simply no longer involve a piecemeal approach whereby we look at one aspect only (i.e., behavioral issues) in isolation of the many other factors (i.e., dietary issues) that may play into the very thing we are trying to address (i.e., behavioral problems). We need to look at the whole child and see how it all fits together... otherwise, we risk only further damaging these children. :o( Thus again, incompetence and lack of understanding of the issues by persons believed to be "experts" or persons with whom parents place their trust can result in very detrimental effects for the autistic child due to that incompetence or lack of a clear understanding of the issues! You have to understand the issues before you can address them. Thus, the word of caution to families... DO NOT ASSUME THAT BECAUSE SOMEONE HAS A TITLE OF "THERAPIST" THAT THIS MEANS THEY ARE ACTUALLY QUALIFIED OR HAVE ANY REAL EXPERIENCE IN DEALING WITH CHILDREN WHO HAVE AUTISM... IT MOST CERTAINLY DOES NOT!!! I may only be a mother... but personally, I cringe whenever I get emails from parents that tell me about stories such as these... no matter how "wonderful" the school/therapist may appear to be... "being nice" and "friendly" has nothing to do with being qualified... make no mistake about it... and always keep that in the back of your mind as you seek help for your children. And, even in the event that these persons/teachers/therapists are qualified or have experience with children who have autism, I think parents need to learn to do a whole lot more in the area of "questioning" what is going on... especially when we see something clearly is not working and may actually be detrimental to a child - be that the offender or the victim in such situations. Unfortunately, too often, even "the experts" don't know what to do any more than parents do... The simple fact is, there are plenty of children with autism who have major issues with "smells" and the like... and those are things one can use to one's advantage in such situations... just my personal opinion again of course... So, what would I have done... were it my child who was being bitten...? My "normal" daughter was once bitten by a "normal child"... and yes, I was very upset when I saw the bruising... I spoke to that particular child's parent about it... When it comes to children with autism, however, that is an entirely different ballgame than dealing with "normal" children who understand and respond to punishment... clearly... by making a child "suck lemons", you are probably just creating an aversion to lemons and not much else... or helping that child to develop a taste for lemons... as some people clearly do... you really are not doing anything to create an aversion to biting... So, how do you create an "aversion to biting"? When I first received this email from a distressed parent, yes, I understood fully her distress at the fact that her child was being bitten, but you still need to take that step back and look at what needs to be done in the interest of both children... and clearly, punishment is not something I would encourage anyone to use with a child who is nonverbal... in my opinion... my very "unprofessional, mother only opinion" I think such "therapies" only do more harm than good... So, what could be beneficial to both or all children involved? This parent had not provided many details as far as whether or not this was in a "special needs class only", etc., how many children and adults were in the class and so on, and so, I will provide only "my personal opinion" of something else that may be better than having a child suck lemons... The "technique" of using taste and/or smell may be a valid one... because so many of these children have such aversions to so many tastes and/or smells... and so, that is certainly something one can use to one's advantage in my opinion... but again, it must be in a beneficial way... So, what taste and/or smell can be used to potentially help all children involved here... I had to think about this one a while (partly because I was so upset to even find out such punishment methods were being used with nonverbal children... children who obviously have serious communication issues), but the one thing that certainly came to mind was cod liver oil... something that has been shown to be beneficial to these children in the first place and something that could easily be applied to any "exposed skin" on children with autism who are being bit... Note that cod liver oil has not only been found to benefit children with autism, it is also something that can be absorbed via the skin. Of course, parents would have to ok that... and if it were me, I would make CERTAIN that the brand used had been tested for heavy metal toxicity because cod liver oil can have traces of mercury in it... a brand of cod liver oil mentioned by many parents of children with autism on parent discussion boards that discuss issues of metal toxicity and the "better brands" to use, is Nordic Naturals, http://www.nordicnaturals.com/. A child biting others may think twice if he gets a taste of cod liver oil ... but again, it is something parents "hide" and give to their children with autism anyway... and something that has been found to be very beneficial to them... so, again, in my opinion, these are the types of things I would try because it would make "other children" something one would want to avoid "tasting" via biting... again, just my opinion... as a mother. Liquid vitamin B6 (i.e., from Kirkman Labs - maker of supplements for children with autism) is another option I personally would consider - again, just my opinion as a mother - because again, it tastes terrible - actually - it tastes horrible - and because B6 is known to be most beneficial to children with autism. But the point here, is that in my opinion, you want to do something that will not cause harm and will create an aversion to biting not an aversion to "a fruit" that is not even tied to "the victims" in this situation. I suppose one could argue that this could result in an "aversion" to B6 or cod liver oil... well... I have yet to meet a child who likes those anyway... the aversion to these tastes seems to be rather universal already... so, why should this be an issue - especially if this involves an application to the skin? Again, just an opinion ... So, I do think there are things one can try to resolve such issues... absolutely... but, again, it has to be with keeping the welfare of ALL children in mind... physical, emotional and psychological... and as such, even though parents may face difficult situations such as these, I would hope that parents would always put themselves in the shoes of the other child's parents... Would you want your child forced to "suck on lemons" or should you perhaps ask the "therapists" or teachers to try something else when you clearly see what they are doing isn't working at all and may actually be causing harm to all children involved (i.e., due to failure to prevent biting and the very real potential that the "offender" may be suffering much more psychological trauma - at the hands of those who are supposedly there to help!). Things other parents seem to find helpful in such situations are dietary changes (casein/gluten free diets, digestive enzymes, anger management (i.e., enrolling child in karate classes, etc. is something some parents have found quite helpful for their children with autism), etc. Again, the issue is certainly a difficult one... and one that is certainly complicated by "therapists" who may be contributing to the problem or making it worse rather than resolving it. To use punishment such as "sucking lemons" with nonverbal children with autism or any child who is already so challenged, in my opinion, is certainly one of those things I would put in the category of "ABA" alright... what I call "Applied Behavior Absurdity"! Getting back to "therapist qualifications" in and of themselves, however, I encourage parents to be very suspicious of any program that does not allow you to participate/view/videotape, etc. what is going on during "sessions". If these "therapists" are telling you that you can not participate, then, ask to have the sessions videotaped! If they are refusing to do that for you, personally, I would get very suspicious of "what is going on"... This child is your child, and it is you who is ultimately responsible for the safety and psychological wellbeing of that child. Why should a "therapist" object to videotaping of sessions? What are they hiding? Don't be fooled into accepting excuses as to why videotaping is not allowed... because if your child ends up worse at the hands of a "therapist", then, what proof do you have of anything that may have been done to harm your child... Personally, I would steer clear of these organizations/"therapists" who do not allow parents to participate or view what is going on (via videotape, one way mirrors, etc.)... those who consider parents a "hindrance" to therapy (and some will actually tell you that)... well... again, that one falls in the "Applied Behavior Absurdity" category as far as I am concerned... always remember... a label of "therapist" is ONLY that... a "label" and it is certainly NOT indicative of "qualifications" or "experience" in dealing with children who have autism. ALWAYS ASK TO SEE "QUALIFICATIONS", "EXPERIENCE", "CREDENTIALS" and ask HOW MUCH experience these persons actually have... BLIND TRUST IS MISTAKE NUMBER ONE... AND A COSTLY ONE INDEED... DON'T LET IT COST YOU ANY FURTHER BY TRUSTING "THE EXPERTS" SO BLINDLY... I THINK THERE ARE MANY OF US WHO WOULD ARGUE THAT IT WAS BLIND TRUST IN "THE SYSTEM" AND "THE EXPERTS" THAT MADE OUR CHILDREN AUTISTIC IN THE FIRST PLACE! The other thing I want to close with here is the whole line we are so often given as parents by the government to the effect of "Look at how much we are doing... we have added all these people to "special services" to help your children"... Unfortunately, like so many other things in life, it seems to me that the government is seeing "autism" as a "job creation" opportunity. Let me explain why I say that. Recently, a parent of a child with autism (believed to be very high functioning) mentioned to me that there were 8 people in the room to "look at her son"... 8 people... sounds "impressive", right? Well... think about it... 8 people who have very little understanding of autism aren't worth one that is well qualified and experienced with autism. You could have 100 people in the room... looks great from the perspective of "job creation" and the "we're doing all we can to help" perspective, but the simple fact is that all the government is doing is providing "jobs" and "salaries"... not "expertise"... especially not when it is the parents who so often find themselves having to train the experts in autism. Rather than having so many "unqualified experts", personally, I would much rather see those funds going to 1 or 2 well qualified and well paid experts who really knew what they were doing than to see all that money going to just paying salaries and creating jobs for people who are quite frankly clueless when it comes to autism... we'd be much better off giving those funds directly to families who could then best decide how to use those funds (i.e., dietary intervention, having persons with real experience work with their children one on one, etc.). Funding "job creation programs" is not what autism is all about and quite frankly, too often, the children are getting too little of anything. So, again, I encourage you to be critical of what you see during your walk with autism... Titles... letters behind a name... they all mean very little to me now... I have 10 years of university... degrees, letters, etc.... it all means very little... unfortunately, when it comes to autism, the school of hard knox - actually living with autism seems to be one of the best training grounds of all. I've read plenty over the years by people with the letters M.D., PhD behind their name... and often, I sit there and think to myself, "these folks simply don't have a clue"... and now, I too have an acronym for "all those letters" I was once so impressed by, "M.D., PhD"... "Medical Disasters by Pharmaceutical Dummies, et al"... that little "pedestal" that once came with seeing letters behind a person's name crumbled and toppled over a LONG time ago in this family... Take for example the issue of "face blindness" (the inability to RECALL faces), clearly an issue for persons on the autism spectrum and indicated in the second link below - very revealing information indeed! Here's just a glimpse of what a person may see when that person has issues with "face blindness" - something that would never be captured via "normal vision tests"... note the comment on the differences in "what is seen" as it relates to "looking straight ahead" versus "looking from the sides/corners of the eyes" (something we clearly see in autism)... http://www.prosopagnosia.com/main/faces/index.asp For more on the issue of face blindness - including information written by an autistic adult who suffers from face blindness, and an online book on face blindness in which the author states he knows of quite a few people with Aspergers who suffer from face blindness (note Aspergers is also on the autism spectrum), go to my section on: Prosopagnosia... The Inability To Recall/Remember Faces! Implications for Face Recognition, Socialization, Perception of Emotions In Others... And A Whole Lot More!!! And yet, we have all these "therapies" that would force children to "look at me"... more "Applied Behavior Absurdity" if indeed there is a possibility that some of these children have ANY issues with "face blindness" given the eyes and mouth appear to be the most difficult parts of the face to look at/recognize/deal with for those who suffer from "face blindness"... an issue most "experts" appear to be completely "clueless" about as far as this being an issue in autism! Don't you think that maybe such an issue may play into the fact that these children overwhelmingly prefer to use their peripheral vision? That they have issues with "reading emotions", issues with "socialization"... ? Of course it can! But, unless you have a therapist who is aware of such potential issues, the old "look at me" Applied Behavior Absurdity will continue to go on! So, bottom line, when it comes to "therapist qualifications"...
DON'T ASSUME "A LABEL" OR "TITLE" EQUALS COMPETENCE... OR A TRUE UNDERSTANDING OF THE ISSUES... IT MOST CERTAINLY DOES NOT!!!
BLIND TRUST IS MISTAKE NUMBER ONE... AND A COSTLY ONE INDEED...
FOOL ME ONCE... SHAME ON YOU... FOOL ME TWICE... SHAME ON ME!
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