| Autism spectrum disorders (ASD) |
| Environmental influences: From the HANDLE viewpoint, the dramatic increase in the number of children diagnosed with an ASD correlates closely to the prevalence of chemicals and synthetics in our environment, because a vulnerable developing nervous system has so much more to adapt to, now. The infant and toddler's immune system may not have sufficient resources to tackle an onslaught of metals and toxins taken even in minute quantities present in our air and water and food. All children must deal with this developmental challenge, and the more vulnerable the child is, the more significant a behavioral or functional effect the challenge will have. That level of vulnerability can be understood as the congenital propensity for an ASD. The phrase "congenital propensity" does not necessarily refer to anything genetic or hereditary. Many neonatal and birth events may affect the vulnerability of the child's nervous systems. And given so many diverse pollutants and toxins in our environment, a disordered autoimmune system results in a disordered ability to process sensory input for appropriate responses. [NOTE: This general statement applies equally to the emergence of many "problem" behaviors previously more of an exception in our industrialized society than the incidence now seems to indicate. Lots of issues -- such as what's known as ADHD -- seem almost common now.] Behaviors: symptoms vs. communication: In the HANDLE paradigm, behaviors communicate body-mind-spirit needs. In the medical model of conventional practice, when there are no consistent or "scientifically proven" biological or electro-chemical markers pointing to a diagnosis, the physician must resort to a diagnosis that sums a set of presenting behaviors. Those diagnostic criteria are considered symptoms needing to be controlled. Most pediatricians diagnose an ASD when they confront the stated combination of behaviors or symptoms. In fact many physicians assume -- and therefore diagnose -- autism when faced with delayed language and any kind of "aberrant" sensory-motor behavior. Certified Practitioners of HANDLE recognize that a diagnosis of ASD always encompasses implicit expectations. That is, since the physician diagnoses according to specific criteria, teachers and therapists expect to find those "symptoms" in the child. But no therapist can treat the diagnosis. Every therapist treats the client according to the premises and practices of whichever theory or approach that therapist has adopted. Therapists who, like the doctor, consider the behavioral "criteria" symptoms to correct or control will plan their interventions to address those symptoms. GET ABLE therapy addresses behaviors regardless of the diagnosis, by (1) identifying neurodevelopmental irregularities that result in behaviors that limit function, and (2) establishing a treatment program aimed at regulating those. The HANDLE observational assessment of children and adults presenting with a diagnosis of autism or ASD usually finds these commonalities, or features: Hypersensitivities, especially auditory (sound) and tactile (touch). The latter may manifest as intolerance for hair care or tooth brushing, rejecting a top sheet in bed, and "pickiness" about clothing fabrics. (These are offered as examples only.) And because each of us protects ourselves for survival, tactile hypersensitivity may actually cause the appearance of insensitivity. That is, the person wards off offending sensation by "blocking" its input. Yet being human, the client needs tactile input so he seeks it by touching a lot -- parents, things -- to provide tactile input within his control. Regarding auditory sensitivity, a common self-protection shows up as the individual creates white noise, such as humming, to block the input and to maintain control. Low muscle tone is a decreased readiness in any muscle of the body to respond to task challenges, and thereafter to modulate or control the extent of response. The first "task challenge" is to sustain an upright posture against gravity. Holding an arm at shoulder height also encounters gravity. Pencil or utensil grasp, in the presence of low tone, defies the individual's capability. The tiny muscles of the eye have trouble sustaining forward direction (which may look like "poor eye contact") and may not be equal to the task of visual tracking. And, because we learn everything in our own bodies first, and low tone limits the versatility of facial muscles for subtle or small changes, the person with low tone has difficulty recognizing non-verbal communication. That is, having no experience of the kinds of motor behavior that demonstrate emotions, the person doesn't know how to interpret it, if she even notices it. [Note that the underlined behaviors are generally acknowledged as "symptoms" of ASD. Less commonly understood is their underlying cause, low muscle tone. At GET ABLE, therapy addresses the cause, not the end-point behavior. As an aside, peripheral vision, a phenomenon often seen with a diagnosis of ASD, involves more complicated neurological connections. That is, it's not necessarily or exclusively a function of low tone.] Speech problems -- not language problems, necessarily. That is, often someone indisputably falling within the spectrum has so excellent a grasp of language that Facilitated Communication enables quite sophisticated conversation, expression of learned facts (such as academics), and poetry with vividly described perceptions. But to articulate speech requires a complex interactive dynamic of auditory processing and oral-motor precision. Auditory processing itself combines multiple aspects, but starts with auditory reception (already established as vulnerable, above) and the throat/tongue/cheeks/lips intricacies require adequate muscle tone (also already established as compromised), and interactive cranial nerve function. Add to that how breathing factors contribute, and it's not so surprising that someone with ASD may have functional language but nonfunctional speech. [In fact a hyperlexic child may fall on the autism spectrum: hyper = too much, lexic refers to words.] HANDLE explains other behaviors often associated with the "lower" end of the spectrum -- notably self-stimulatory hand-waving, jumping and head-banging, rocking forth-and-forth (not back and forth), compulsivity -- relative to disorders of neurodevelopment. Therefore, because they're understood, a HANDLE program addresses their cause en route to resolving the behavior. That is, by treating the cause, the behavior goes away because the body doesn't need it anymore. Nutritional factors affect everyone's behavior. With ASD, often a problem of nutrient malabsorption, with a corollary of heavy-metal build-up in the liver (see below), and/or a veritable allergy to gluten and/or casein -- combined with low muscle tone that affects movement through the colon and affects sphincter control -- shows up as constipation or diarrhea. In addition to HANDLE activities, the Practitioner might route the client family to the work of Lisa Lewis and Karyn Seroussi, founders of the Autism Network for Dietary Intervention (ANDI) and a gluten-free/casein-free diet (GFCF). The website for the ANDI newsletter is www.autismndi.com. Also, Lisa Lewis publishes recipes and advice regularly in Autism-Asperger's Digest. (Also go to the GET ABLE Resources (links) page.) Other dietary supplements or advice may be recommended related to problems with absorption, and/or related to the need to rid the body of a toxic build-up. Among such recommendations: referral to appropriate health professionals. Heavy metals may exist at damaging levels in the cells of someone with ASD. This relates to many things, such as biochemical absorption problems, combined with possible intake of mercury through fish or in vaccinations. If this is suspected, a GET ABLE program would alert the family to this consideration, to explore. There are ways to test for excessively high levels of heavy metals in the bloodstream, and there are ways to ease them out of the body. If such detoxifying methods are recommended -- from the simple, such as eating beets and raw potatoes in small quantities, to the extreme, such as cautious use of activated charcoal -- the Practitioner would always emphasize how the liver and kidneys would have to work overtime to get rid of the offending toxins. Among other things, that means drink more water! The Practitioner might also refer the client family to a health practitioner knowledgeable about chelation protocols, and prerequisite laboratory testing. Similarly, some other supplemental programs may warrant consideration, and therefore be recommended -- but at GET ABLE, only those that adhere absolutely to the logic of Gentle Enhancement®. The Listening Program might be an example for some clients. Yoga and Tai Qi are other examples. Difficulty paying attention (sometimes ADD or ADHD) Environmental influences: In the HANDLE paradigm, the dramatic increase in the percentage of children diagnosed with an attention deficit disorder (ADD) or an attention deficit with hyperactivity (ADHD) correlates closely to the prevalence of chemicals and synthetics in our environment -- because a vulnerable developing nervous system has less of a chance to adapt to the load. All children must deal with this developmental challenge, and the extent of an individual child's vulnerability determines how significant a behavioral or functional effect the challenge will have. Many neonatal and birth events may affect the vulnerability of a child's nervous systems. Add to the increased chemical and synthetic environment, the veritable elimination of organized movement activity in the public schools (Physical Education classes) and a universal surge of sedentary activities in industrialized cultures -- from television to computers, but not much reading for fun (Harry Potter books a notable exception!) -- and there are lots of identifiable contributors to children's heightened level of distractibility and need for movement. Then further add the assumption that children need a lot of visual and auditory stimulation, with resultant use of dramatic colors and patterns, creative mobiles, loud and persistent music or other background noise, starting with the newborn in the crib and continuing into the classroom -- to realize how external input demands adaptation by a body/mind that may have vulnerabilities to protect from such onslaught. A major nutritional consideration relates to the sheath coating the neurons that carry information to and from the brain. The thicker the sheath, the faster the messages get through. Myelin is the substance forming the sheath, and only essential fatty acids, notably Omega 3's, but not the oils and fats common in American diets -- only EFA's can build myelin, in combination with organized movement, which shapes it. Behaviors: symptoms vs. communication: In the HANDLE paradigm, behaviors communicate body-mind-spirit needs. In the medical model of conventional practice when there are no consistent biological or electro-chemical markers pointing to a diagnosis, the physician must resort to a diagnosis that sums a set of presenting behaviors. Those behaviors thus constitute symptoms as diagnostic criteria. Therefore pediatricians use information from home and school reports to infer whether a child's behaviors fall outside the "normal" parameters for ability to attend and for movement level. With that inference the doctor assigns a diagnosis of ADD or ADHD, and -- because to qualify as symptoms the behaviors must interfere with function -- prescribes medication purported to control the symptoms and thereby to permit function. In the HANDLE paradigm, a diagnosis amounts to misdirection at worst, or short-hand at best, and always encompasses implicit expectations. That is, since the physician's diagnosis is based on specific criteria, teachers and therapists expect to find those "symptoms" in the child. But no therapist can treat the diagnosis. Every therapist treats the client according to the premises and practices of whichever theory or approach that therapist has adopted. Therapists who, like the doctor, consider the behavioral "criteria" symptoms to correct or control will plan their interventions to address those symptoms. With this population, diagnosed ADD or ADHD, invariably a therapy plan (1) augments medication, (2) occurs in the school setting, and (3) structures some kind of behavior modification and/or compensatory strategies. GET ABLE therapy addresses behaviors regardless of the diagnosis, by (1) identifying neurodevelopmental irregularities that result in whatever behaviors limit function, and (2) establishing a home-implemented treatment program aimed at regulating those neurodevelopmental issues. Among the usual results of a HANDLE program, one is the discarding of prescription drugs, with physician agreement because they're no longer indicated. In the HANDLE paradigm, there is no actual "attention deficit disorder," but rather an issue of priority. Certified Practitioners of HANDLE treat individuals with an APD: Attention Priority Difference. To follow the HANDLE reasoning, start with understanding the "E" in the acronym: Efficiency differentiates effective performance -- which may be based on spontaneous and not even conscious compensations for weaknesses in neurodevelopmental foundations or building blocks -- from efficient accomplishment of any task. Those instinctive compensations are survival-motivated, to protect vulnerabilities. The difference between effectiveness for which the body/brain pays with an energy drain -- fatigue, distractibility, delays -- and efficiency of internal resources, means that students' attention-priorities (not conscious, remember) can focus outward, on instruction, on social interaction, etc. A GET ABLE assessment identifies what the body/brain needs to prioritize in order to function, and focuses therapy on strengthening those building blocks. When the brain doesn't need to attend to priorities such as a vestibular system unable to support all the demands on it -- upright posture, eye function, spatial orientation, etc. -- because that system has been strengthened, the brain is freed to process external input. What APD looks like: The body must protect its vulnerabilities, and cannot overtax a foundational function without sacrifice, which may manifest as tantrums or just irritability. If the visual system demands more from the vestibular system (which supports muscle tone), because the eyes have so much trouble focusing for a long time, expect posture to slump or even expect the child to fall out of his chair. By the time a child with this problem reaches adolescence, she has probably learned compensations (some of which are described here). To stimulate a compromised vestibular system, the body needs to move, often vigorously or with large movements in multiple directions, and definitely more often than standard public school classroom tasks usually allow -- nor certainly what the business world accepts in an office. If proprioception needs a lot of input into joints just for the brain to feel secure about where the body is in space, expect the child to stretch arms and legs often and routinely, in order to maintain mental alertness and focus on what the teacher says. Consider how often the adult behind a desk extends her legs, squirms, raises arms to "prop" her head in her hands from behind. In fact the predominant computer-mode work station has to include instructions, like for airplane travelers, to remember to move around. At home notice sleep issues, such as needing someone alongside or very heavy blankets, lots of seemingly frantic movement, maybe risk of falling out of bed. In the presence of hypersensitive tactility, expect difficulty sitting still (the thighs and buttocks are often highly irritable), fussiness about fabrics and tags, fierce complaints about hair care and teeth-brushing, and unique pencil grasp and hand positioning for writing. Low muscle tone also shows up in pencil grasp. To really understand how common these sensitivities have become in our synthetic world, notice how randomly-observed people hold the pen they write with. How many fingers do they use to hold their writing tool? Is your thumb on the pen or pencil, or does it point straight up? Do the knuckles on that hand turn white from force? Auditory hypersensitivity reacts to sounds that the less sensitive ignore, such as an airplane passing outside, a classmate's habit of clicking fingernails, just the squeak of a marker on a whiteboard or the slithery noise of silky fabric when someone walks by.. (These are a few examples, only.) Then there are the composite functions such as auditory processing or auditory foreground/background discrimination problems; visual-spatial disorganization or visual-motor incongruities; and many others. So-called "motor planning" itself combines multiple neurodevelopmental elements, so note manual dexterity issues, a difference between the ability to walk up and to walk down stairs, propping behaviors such as leaning on elbows at a desk or difficulty sitting on the floor without more support. Any and all of these seemingly subtle issues unique to the individual is addressed in hierarchical sequence in a HANDLE program. Nutrition All cognitive focus (attention) depends on a healthy biochemical foundation. Many nutritional deficiencies can alter capability, including but not limited to food sensitivities, the sodium-potassium balance, vitamins such as B12... but the two most basic factors affecting our neurodevelopment relate to a culture of eating fats and drinking carbonated beverages. If we only introduced Essential Fatty Acids (Omega 3's) and countered the marketing campaigns for Learning disabilities Myths HANDLE dispels 1. A learning disability is forever. Only the label or diagnosis may last forever, and with it, the self-image of limited options and capabilities. That in turn perpetuates real or sensed dependence on compensatory interventions and/or adaptations provided by the school district or work-site manager. Coming from "I can't," the individual may feel more comfortable with lower goals, and is unlikely to seek remediation of lifelong problems in adulthood. A HANDLE program can intercept the disabling patterns at any age. 2. Learning disabled students require a different teaching approach. Like all students, someone who encounters difficulty with presented tasks needs only the respect that acknowledges motivation. Given trust that the student wants to succeed, the teacher and the student, together, identify what will enable success. To do that requires accurate identification of what impedes the student's performance. A HANDLE assessment not only does that identification as the basis for therapy, but also to enable teacher and student to differentiate performance blocked by sensory-motor or other issues from performance blocked by stubbornness, defiance, or even ignorance. 3. "Learning disabilities," as a diagnosis, refers to deficits specific to a task, such as difficulty reading or writing or doing math. The Disabilities Education Act says a child has a learning disability if he or she manifests a severe discrepancy between intellectual ability and achievement in listening, thinking, speaking, reading, writing, or mathematics. Central nervous system function and intact vision and hearing are presumed. Nevertheless, subsumed in the category "learning disabilities" are specific diagnoses some of which define the task that challenges the individual. [Examples: Dyslexia = difficulty reading, Dyscalculia = difficulty with math, Dysgraphia = difficulty writing.] Other diagnoses subsumed in the category include visual-perceptual-motor dysfunctions and memory and organizational disorders. Any and each of those sub-diagnoses can trace cause to a disrupted aspect of neurodevelopment, which a HANDLE assessment identifies and correlates to an interactive and interdependent dynamic of the systems needed to perform the respective task (e.g. reading, writing, math). 4. Learning disabilities imply low intellectual potential. Actually the opposite may be closer to the truth. Because the diagnosis refers to "a severe discrepancy" between potential and performance, the prevalence of learning disabilities among gifted students would support the HANDLE view of the child's needs. That is, attention to the interactive and interdependent dynamic of systems, with therapy that addresses underdeveloped areas, can rectify what impedes the bright student from achieving according to his and her capability. Furthermore, to dispel this myth, everyone performs better in some areas than in others, and may manifest problems with attention, memory, organization, motor function, sensory acuity, or communication skills -- sometimes or regularly, unrelated to intellectual ability. Behaviors and related concerns Behaviors are the body/mind/spirit's means to convey its needs. Instead of seeking to suppress or control "maladaptive" or "counterproductive" behaviors, the professional community of educators, therapists, physicians, etc., must learn how to translate the language of behaviors, to seek therapy based on neurodevelopmental concepts. A HANDLE program identifies what causes the behaviors, and by addressing those causes, enlists the body/mind/spirit's capacity for healing.itself. When therapy resolves the causes, the behaviors resolve too. 1. Sensory issues interfere with processing input and/or with conveying "output" and therefore are observable in behaviors. Examples (a very incomplete list): a. Tactile hypersensitivity may alter pencil grasp, may elicit actual pain from contact with the tabletop for writing, and that's just considering tactility in the hand. Sitting still when bothered by hypersensitive thighs challenges the most dedicated student or worker. Synthetics may literally repel, not just as clothing fabrics but also things like plastic work surfaces (table tops, wall boards). b. Auditory figure-ground differentiation requires the ability to "prioritize" where to focus cognitive attention. If this skill is undeveloped the individual can't filter out what's irrelevant, which becomes a difficulty or inability to process orally-given instruction of almost any kind in the presence of other noise. Or achieving such auditory filtering requires consistent cognitive effort, with resultant fatigue and stress. c. The very complex visual system affects essentially all aspects of our interactions with our environment. Deficiencies may show up in how both eyes work together (binocularity), whether the eyes can follow a moving target or move across a line of print (tracking), quick changes of focus from near to far and back again (accommodation), differentiating forward-focused vision from peripheral vision, and recognizing spatial relations including depth perception. To those skills add processing and interpretive functions such as matching images with words, retaining images for retrieval and for producing those images manually (drawing and writing), spatial relations ranging from use in math to use driving a car, etc. Problems with related performance areas may show up as visual-motor deficits. Examples of this include difficulty when the hand must follow visual information, such as copying something from a page or from the wall-board, playing almost any kind of ball game or, on a more gross-motor level, jumping in a hopscotch game. 2. The foundational vestibular system may be over-taxed by the effort needed to support compensatory struggles to use under-developed sensory systems. That is, when our spontaneous and natural wish to meet performance expectations challenges whichever input "source" is weak, so that processing that input means we have to work so much harder than our neighbor, the foundation needs to be bolstered too. The vestibular system supports everything we do, starting with muscle tone and proprioception, and with them our body's orientation relative to gravity and all space, and from there on up to visual and auditory functions. Therefore, the individual may need a lot of movement, especially rotary alignments, just to participate in class or work tasks. 3. When bodily resources are fatigued due to the need to work so much harder, available energy sags. If intensive exertion lets someone with visual tracking problems read a paragraph, its content rarely comes along; that is, there is insufficient energy left over for comprehension when the task of reading consumes cognitive focus. (The brain's work does consume energy.) 4. Inter-hemispheric integration shows up in multiple ways, ranging from expressing ideas either orally or in writing, to making relationships between the parts and their "whole" of images, to dealing with transitions. A low frustration tolerance, a need for consistency in structure such as schedules or seat assignment, noticing the proverbial trees without summarizing them into the forest -- all these might signal someone "stuck" in the left hemisphere. Someone who appears dreamy, who often "modifies" explicit instructions, and who understands abstractions but has trouble with specificity and little details -- such a person may be "stuck" in the right hemisphere. 5. According to what interferes with learning, or in what circumstances someone's strengths succeed with the least effort, an astute and caring teacher at school or supervisor at work can identify whether environmental changes improve performance and make accomplishment easier. Examples might include different lighting or desk location. Other accommodation might include permission to move around the room or just stretch in place, when necessary. This is not to say that every teacher or supervisor must make such changes, but rather should notice the indicators of ways to influence performance. Those indicators provide useful information to the individual who may not be aware that anyone else uses input differently; this is especially true of children. And then the information can steer the individual to a HANDLE program. 6. Specific subject-area academic problems may relate to specific issues of neurodevelopment. Examples: Math problems (dyscalculia): often imply proprioceptive issues, because we learn about relativities first in our bodies (See below, "The body as teacher.") Reading problems (dyslexia): not only relate to visual problems, also may relate to vestibular problems, especially for reading script, and may relate to inter-hemispheric integration in the example of reversing letters or as a processing of language concepts Writing problems (dysgraphia): as stated above, often imply tactility issues, but also may relate to low muscle tone; if specific to script, may relate to vestibular problems. 7. Related concerns, or lifestyle effects of persistent (untreated) learning disabilities, besides academic issues, often include any or all of these: a. Emotional difficulties: low self-esteem, depression, anger b. Social difficulties: acting-out aggressiveness, unstable or narrowly-framed peer-group relationships (framed by areas of skills, avoiding areas of difficulties), insecurity in family bonds c. Vocational difficulties: lowered goals with corresponding constrained plans for education or training, stress in using instructions on the job, limited options for advancement d. Community difficulties: juvenile delinquency or recurring conflicts with authority, financial dependence (see c. above) including resorting to welfare rolls e. Across-the-board kinds of issues: expectation that unique needs be accommodated by others, reliance on supports f. Concomitant diagnoses: Attention Deficit/ Hyperactivity Disorder, Tourette's Syndrome, bipolar or compulsivity mental condition, etc. Environmental influences: see Difficulty Paying Attention (ADD/ADHD) above. The issues are essentially the same. The body as teacher: The brain has no interface with the world except the body: the brain learns from the body before it (the brain) can lead the body in anything. An easy example to understand is in the elemental internal function called proprioception, which begins to be practiced in utero by about the 5th fetal month, because it relies on movement. Proprioception tells the brain where the body and each part of the body is in space, which feeds information related to balance and orientation to gravity, as well as providing necessary relativity -- such as how far to reach, finding the mouth, etc. Now the brain begins to abstract from that elemental bodily information: the concept of relativity is born. Not just how far away am I from the door frame, so I won't bump into it, nor how far away am I from my neighbor so I won't bump into him, but even more abstract than that, to grasp mathematics: 8 is greater than 5, etc. Also, proprioception teaches the brain about prepositional concepts. What's behind? If there is no sense of "behind," there is also no understanding of subtraction, in arithmetic tasks. And, if my body can't tell my brain how far away from my shoulder my hand is, I easily and often might hit someone passing nearby when I happen to swing my arm out -- and when accused of willful aggression, insist that I didn't intend to hit anyone. Given resultant punishment, including being called a liar, the child also learns in this example that people don't trust his word, which cycles into interpersonal dynamics far beyond the beginning in a proprioceptive deficit. Similarly, proprioception teaches the brain about boundaries. At the physical level of the infant's definining where her body ends and Mother's begins, on to where the edge of the bed is so I don't fall out when I'm asleep, on to a bigger-world version such as stairs and curbs and clifftops... we easily understand that kind of learning. But the developing conceptual abstraction from that extends into interpersonal "space" as well. Think "get out of my face" when someone pressures you. Extend proprioceptive awareness to your workspace: diminished awareness makes it difficult to share a desk without intruding; affects "messy" disorganization of supplies, and translates into difficulty with supposedly simple boundaries like the end of the piece of paper or a puzzle piece. Learning disabilities start in the body, and therefore can be treated through activities based on neurodevelopment. A HANDLE program enlists the body's role as teacher. Obsessive or compulsive behaviors (sometimes OCD) Seizures Stroke (CVA) residual deficits Traumatic Brain Injury (TBI) Ataxia or balance issues Bipolar disorder |
| Consider this about: Autism Spectrum Disorders (ASD) Difficulty paying attention (sometimes ADD or ADHD) Learning disabilities Obsessive and/or compulsive behaviors (sometimes OCD) Seizures Stroke (CVA) residual deficits Traumatic Brain Injury (TBI) Ataxia or balance issues Bipolar disorders |
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GET ABLE
| How we view behaviors |
Providing HANDLE® programs in Southern California
