Therapy: Speech, Occupational, and Otherwise

As I have mentioned before, Elias has been involved in developmental, speech, and occupational therapy for the last two years. He was in Early Intervention (EI) and did speech and developmental therapy (DT) for six months before he aged out at 3 years old. We then took him to a private speech therapist in September 2014 and also an occupational therapist beginning January 2015. We have wrapped up with both of those therapists in the past few weeks as we prepare to transition to his new school where they have all of those therapists (DT, speech, and OT) on site. I am excited for this transition for three reasons: (1) it will be a great change to have all of his therapies in one place from a logistical standpoint; (2) the therapists can and will talk to each other about him and in some cases co-treat but at a minimum opening lines of communication up about him; (3) the type of therapy that they will be doing at his new preschool is different than what he had through the private therapy that we have had him in.

The traditional model of therapy (at least what we have observed and participated in) has been the following (with variations, but this is an example of what we have done in speech):

1. Elias sits down in a small chair at a small table.
2. Therapist brings out a toy (all of the other toys / books are behind her), most often a "preferred" toy to get him warmed up
3. Therapist engages Elias in playing with the toy and encouraging him to use words to request things and labels actions that he does while he is playing
4. Therapist decides when the time with that particular toy is up and asks Elias to help her put it away
5. Therapist brings out another toy, this time a non-preferred toy, like a book or a series of cards with pictures of other children doing things like eating, drinking, or jumping and she will ask Elias where "jumping" is. Elias will point to it (or she will help him, depending on his mood) and she will scramble the pictures and ask where "eating" is, etc.
6. Therapist will bring out another toy, most often a preferred toy. Repeat from step #2.

At any point during this 30 minute session, Elias will get up and get a drink of water from his water bottle, or walk around the room, or try to climb in my lap, particularly during the "non-preferred" action times while we try to coax him back into the chair. It has been a somewhat frustrating process for all of us, though it has helped him and we have seen progress. And some variation of this occurs at OT as well, though there's more movement by virtue of what OT is.

The model that we're moving to by going to this new school is the DIR / Floortime model. DIR stands for Developmental Individual differences Relationship-Based. The premise is to build relationships with the child through Floortime, or play and so it sometimes is called a play-based therapy. It differs from the traditional model that I have just outlined in that they follow the child's interests and interact with them where they are rather than having a preset agenda for each session (though I'm sure that there is an agenda as we will be defining goals for him, but maybe not a micromanaged agenda for each session? I will be curious to find out).

As I've often lamented, the idea of therapy and making decisions about therapies for Elias kind of scares me - mostly that I will make a mistake and put him in a therapy that isn't good for him, Imagine my relief when my favorite autistic vlogger (video blogger) Amethyst at Neurowonderful talked about what kinds of therapies she recommends as an autistic adult and Floortime or other play-based therapies were mentioned! That video is here.

My hope for Elias is that he'll get more out of each session instead of having to be continually coaxed back into a chair or into engaging in a non-preferred activity. He certainly does need to learn how to engage in non-preferred activities, as we all do, but I think that getting more language out of him first may be the optimal way to engage with him when he has to do something he is not as interested in. I have had the same feeling that both his former speech and occupational therapists have expressed: it seems like they have reached a ceiling with him at this point in his development and that he will experience another season of growth by switching to this environment where he will be saturated in a sensory-rich environment with the kind of one-on-one attention in which autistic children often flourish.