Seeing the forest from the trees is sometimes a difficult task when everybody else is excitedly looking at the leaves. Many therapists love to focus on the detail and so I am going to step back and look at the forest. When you work with broad concepts you can develop new insightful approaches rather than fine tune existing approaches. As de Bono would argue it allows us to break out from the slow linear treatment improvements we are currently engaged in.
When you see the forest clearly you can ask yourself the critical question – How would my current treatment strategy differ if I were to address the big conceptual issues?
I have broken the big picture into three standpoints: (1) neurological, (2) functional and (3) treatment goals.
1. A neurological perspective
The core issue with Autism Spectrum Disorder is that specialist regions of the brain are under or over connected to each other.
2. The triad of cognitive functional impairment:
1. A stronger reliance on visual processing of information over verbal processing.
2. Emotional processing deficits arising from limbic system deficits
3. Reduced capacity to abstract information.
3. Core treatment goals
Leading from the neurological perspective the treatment goals are to enhance brain plasticity in order to develop normal neuronal pathways and to restore brain specialisation.
With the exception of detoxification approaches almost all of our treatments for ASD are traditional cognitive behavioural techniques. Techniques that work well with neuro-typical brains where brain plasticity is not a major issue. More effective treatments need to target restoring normal brain connectivity by increasing brain plasticity more directly.
With this in mind perhaps intensive ABA style learning should be coupled with approaches that increase brain plasticity such as pharmaceutics that enhance learning or vigorous exercise programs. With this paradigm in mind the therapeutic approaches used with individuals who have suffered a stroke (cerebrovascular accidents) could be applied to ASD. These techniques include brain stimulation such as deep repetitive transcranial magnetic stimulation.
The detailed focus on specific skill acquisition yields short-term results but perhaps they could achieve greater long-term gains if the skill acquisition was constructed around core treatment goals. A pure behaviourist model seems to inadequately address the neurological goals.