Tuesday, January 26, 2010

Play powerful learning tool for children with autism

From The Sacramento Bee:

Most parents never think they'll have to learn how to play with their own children.

But if a toddler is diagnosed with autism, moms and dads can spend years with the child and a therapist, drawing with crayons and playing hide and seek. Research is proving that as parents color and stack building blocks with their kids, they are subtly teaching them to overcome cognitive, language and social delays.

"When we first came in, he wasn't talking, he didn't respond to his name, he wasn't making eye contact," said Cindy Jensen of her son Cooper, who's now almost 3.

After more than a year of specialized play therapy through the UC Davis MIND Institute in Sacramento, Cooper is speaking in seven-word sentences, learning to take turns and initiating pretend play. "It's a lot of training, but it's worth it," Jensen said.

Treatments for autism are geared to children between 3 and 5 years old. Researchers said there is growing urgency – even a sense of obligation – to develop effective intervention for much younger children.

New diagnostic tools can identify autism in kids as young as 12 months, and prevalence of the disorder is reaching record numbers. The federal Centers for Disease Control and Prevention reports one in every 110 children has an autism spectrum disorder.

Researchers at the MIND Institute are conducting a study adapting a specialized program, the Early Start Denver Model, for children to begin as young as 1 year old. The model focuses on building relationships with children and teaching skills through play: 20 hours every week with a therapist, and at least five hours a week with parents.

"What the child learns is that it's more fun to do things with others, rather than alone," said Sally Rogers, professor of psychiatry and behavioral sciences at the MIND Institute. "Kids with autism enjoy playing with others, they enjoy being tickled. They just don't know how to initiate."

Rogers co-authored a previous study, recently published in the journal Pediatrics, which found that autistic children who received this therapy showed significant improvement in IQ, language, motor skills and adaptive behavior compared to a control group of autistic children who did not receive the same therapy.

Some kids improved so much that they no longer met the diagnostic criteria for autism, classified instead as having a less-severe developmental disorder.

"We're trying to identify these kiddos early so they can learn in a typical way," Rogers said.

The coaching channels an autistic child's learning pattern toward eye contact and verbal communication, before autistic developmental characteristics become entrenched.

"This is unique in that parents learn the model," said Vanessa Avila-Pons, a therapist and team leader for the early intervention study at the MIND Institute. Avila-Pons demonstrates play techniques and offers guidance while parents play with their children.

During a recent session, Carrie King played with her 2-year old son Elijah (pictured). King held a plastic toy gun for a game of helicopter.

"Go!" Elijah said. King pushed a button, sending a small plastic disc spinning through the air and onto the table. Elijah was delighted. After a few more times, she handed him the toy. He fiddled with it but couldn't get the same result. He looked up; King reached out her hands, palms up.

"That's good she responded," Rogers said, watching from the other side of a two-way mirror. "For these little ones, eye contact is hard. A lot of parents wait for a word."

Kids don't know that eye contact and gestures are communication tools, Rogers said. By giving Elijah the toy without showing him how to work it, King forced him to ask for help. By holding out her hands, she reinforced Elijah's request for help through eye contact. King had introduced to him a new gesture that means "help" or "give me."

"Push," King said, "push!" The disc flew. King opened her eyes wide and let out a "Wow!"

Rogers nodded.

"She's using simple one-word phrases, because that's where he's at," she said. "The use of the word 'wow,' shows kids that words are not just for labels or requests. It's an emotional word. 'Wow' is social. We want kids to know that words are used in a lot of different ways."

Elijah and King will finish their initial 12-week coaching this week, then move to the 25 hours of weekly therapy over the next two years. King said she was relieved when she enrolled Elijah in the study, soon after he was diagnosed at 18 months.

"It's so great to get a diagnosis, because your life can start," she said.

Four years ago, when her older son Josiah was 2 years old and diagnosed with autism, her reaction was more emotional.

"I remember feeling, 'I don't know my child,' " she said, taking a deep breath.

"When you have a baby, and it has all its toes, and it's apparent to everyone that it's normal, you start to dream for the child," she said, raising a tissue to the corner of her eye. "But when you get a diagnosis with autism, you have to let go of all those dreams. … You don't know if the child will talk, get a job, have a friend. You have to let go of everything."

Now, every time her sons learn a new skill, she said she's filled with pride. "But you still cry."

Josiah and Elijah are part of another autism study at the MIND Institute looking at siblings of children with autism, their risk factors for developing the disorder, and early symptoms among infants.

King said she supports this research so families with autistic children get better care than is available now.

"Nothing will change unless they have documented information over time," she said. "This program is so important. Play is a powerful learning tool."

King looked at Elijah, crayons in hand and beaming. "You see the child become a child."