T his book is about the several thousand autistic children we have seen at the Spectrum Center in the last 15 years. We view both the difficulties these children experience as well as the progress we observe through a developmental model. A developmental model pre-supposes that growth from infancy (and even before) to adulthood follows certain predictable stages.


Autism is a developmental disorder and it impacts so many of the abilities that are unique to us a human beings. For this reason it is often referred to as Pervasive Developmental Disorder. It can impact our physical development. Sensory and motor disturbances are often a hallmark of autism. It can impact our communications skills with both receptive and expressive language skills often delayed or unusual in their style. It can impact social interactions, with social isolation and difficulty understanding social cues often the case. The ability to play creatively and develop self-sufficient leisure activities is also effected.


A developmental model is a very useful way to understand the disorder of autism. A typically developing child does not just start speaking in sentences between his second and third birthday. There have been many steps along the way. His brain has made thousands of connections between his sensory perception and his behaviors and actions upon the environment. Even if blessed with a "normal" nervous system this child must still begin with step one and cannot skip any steps between there and step one hundred. He must coo and aw at the world as he lays on his back. As he gets big and strong enough to sit up and hold his head steady, he can then smack his lips together to "ba ba","da da and "ma ma". He must learn to copy your gesture of raising his arms in the air to indicate "up." All these are the foundations for learning to talk. If these foundations of vocalizing, imitation, and motor planning are weak then the higher- level skills of communication will be compromised.


A developmental model is a bottom up approach to intervention. It works on the foundations; not the out come skills. In sensory-based intervention we assume that those foundations are of neurological organizational. They cannot be taught; rather they are potentials that can be elicited. For example the capacity to imitate is based on neurological organization. We don't teach our children to imitate; it emerges as predictably as sitting and walking in a typically developing child. It is often, almost universally deficient in children with autism. In a developmental model we attempt to elicit the capacity to imitate rather than teach imitation. We do this by improving a child's body image and capacity to self-organize their movements toward their chosen outcome. This neurological capacity is call praxis and it is the foundation for all imitative and later original action. If we can elicit this capacity then a child can go on to learn from their environment through their day-to-day actions. This is a radically different approach than trying to teach the" technique" of imitation by moving a child's hand through the gesture of touching their nose in response to your demonstration.


A developmental model is critical to understanding changes or improvement in a child with autism. Waiting for a child to "speak" can be agonizing and unless a parent can be taught to understand the important markers along the way it can be a discouraging process. If a child is talking when can we expect him to tell us how he feels? When will our child be in a mainstream class? What ever our hopes and dreams are for our children, knowing the typical stages of development and how on or off the mark our child lays is an important navigational tool.


A developmental model can also help us understand behaviors that may concern us. For example a child who was always compliant now is sassy and disobedient. It can be easier to tolerate when looked at from the perspective that this child for the first time in his life has the language to try and control his environment. A developmental model can help us understand how to react to new behaviors that are challenging and confusing. Parents of autistic children are often fearful of placing limits on their child in fear that he may "regress" again. It can be helpful to understand that the behavior they are now seeing is typical of a new developmental stage that requires limits and structure.


T reating Autism from a developmental model is very different from a medical model, not to say that these models can't and actually should go hand in hand. Long gone are the days when autism was viewed from solely a psychological perspective. The pendulum has swung the other way in looking for the cause of autism in biology. This has resulted in many interventions that have produced significant results. However on their own they do not steer the child through the development maze of emergence from this disorder. Medical models are much more cause and effect oriented. For example a leaky gut results in opiate crossing the brain-blood barrier and having neurological consequences. From the medical point of view we fix the leaky gut or even look for the cause of the leaky gut. It does not however address the development issues that now exist. The child whose multiple ear infections secondary to a weak immune system, may no longer have ear infections secondary to bio-medical treatment, but how do we address the critical period for language emergence that was missed. Here the developmental skills of occupational therapists, speech therapists, play therapists, and educators as well as the skills of many others are essential.


It takes a village, to coin a phrase :), to treat an autistic child. Right now the village seems dysfunctional however. We seem to be competing over precious resources when there is an epidemic going on. Research is essential yet the therapists in the field are far away from the academic institutions that have the funding. Development is much harder to research. It is not cut and dry and it is often unpredictable. We talk about neurological soft signs and the study of development is a soft science. It is much harder to validate for this reason.


D r. Alfred A Tomatis and Dr. A Jean Ayres devoted their lives to the study of human development and in the invention of original treatment interventions for remediation of these developmental disorders. I thank them every day for their genius and for all the children and adults they have helped with their thinking. The purpose of this book is to discuss their theories and research particularly as it pertains to autism. I hope parents will see their children on these pages and gain understanding. I hope this book can give hope because in working with autistic children for 30 years I know first hand that there is tremendous reason for hope. I know that in every interview on autism that I've seen or been involved in is always predicated by "while there is no cure for autism?" However I've seen miracles more often than I would have ever thought possible but mostly I'm struck by the small miracles, the small steps of human development that add up into the big miracles and by the courage of the families who walk down that road with their children.