A diagnosis of autism opens the door to a parade of professionals trying to help the child achieve functional communication, life skills, social skills and academic success. Often before a child even has a diagnosis, the work has begun. Who are these people? Here is a quick reference guide to many of the specialties involved and what each has to offer autistic children.
Of all the educational approaches currently available for autistic children, the one with the most data behind it is Applied Behavioral Analysis (ABA). Generally, a behaviorist is an ABA professional who will work with the child, teacher, and family, to establish a program of rewards that encourage desired behaviors. Behaviorists may have a degree or certification in ABA. Often, however, they originally studied a related field, such as special education. Many school systems employ behaviorists as consultants, but they can also be found in early intervention programs or hired privately.
While the process is different from state to state, a child’s case manager is usually assigned by the school district as a liaison between the family and the district. This is not related to a state’s child protection system. The case manager is the first person to approach to request additional services or new evaluations. The case manager may be a social worker or a professional from another discipline. Often the various members of a child study team (see below) split the caseload, assigning each member a group of cases to manage.
Child Study Team
Again, the system varies from state to state, but the use of a child study team is common for school districts. The team brings together several professionals from various disciplines (for example, a social worker, child psychologist and special education teacher) who work together to evaluate new students entering the system, and supervise the provision of services to current students. One of these people may be the assigned case manager for each child.
Child Psychiatrist/Child Psychologist
For a verbal child with enough function to understand his situation, a child psychiatrist or psychologist may be advisable. A psychiatrist can be an alternative to a neurologist or neurodevelopmental pediatrician for prescribing and supervising medications, if needed. This can allow the family to work more closely and frequently with the prescribing doctor than working with a neurologist or neurodevelopmental pediatrician, who may only see the child every few months.
The subjects of much controversy, DAN (Defeat Autism Now) doctors advocate the gluten-free, casein-free (GF/CF) diet and are generally proponents of the heavy-metal theory. They usually recommend a variety of supplements and dietary restrictions aimed at balancing the child’s digestive system because they believe in what is referred to as the “mind-gut connection.”
Because, for reasons unknown, many autistic children have problems with their digestive and gastrointestinal systems, a gastroenterologist may be consulted.
A doctor in one of these specialties is usually the one to make an official diagnosis (hopefully in writing) of autism, autism spectrum disorder, PDD-NOS or Asperger’s. How often this doctor sees the child after that point, and how closely he or she works with the family, varies greatly according to the needs of the patient and whether medications are involved.
Known for their limited menu of preferred foods, some autistic children may benefit from a consultation with a traditional nutritionist. There are also nutritionists who specialize in treating special needs children, as well as some who are trained in the DAN approach (see DAN Doctor, above).
An occupational therapist (OT) specializes in two areas that affect autistic children. First, an OT can help improve the child’s fine motor skills, including handwriting and pre-writing skills. Second, an OT can help a child overcome sensory integration problems. This work includes many hands-on approaches, from deep-pressure massage to brushing.
Paraprofessionals generally have no degree related to working with special needs children. This is a title used frequently by school districts to refer to classroom and lunchroom aides. However, in some instances, a paraprofessional can have training or even a certification in ABA therapy, but still retain the title of “paraprofessional” or “para” because they are not a special education teacher, speech pathologist, or physical or occupational therapist.
Even a special child can catch a common cold. In the best of circumstances, there will be one doctor who knows what everyone else is doing and works most closely with the family.
A physical therapist (PT) helps develop the child’s gross motor skills, such as walking, running, jumping into the air off both feet, stepping reciprocally up and down stairs and kicking a ball. When dealing with delays in cognitive function and impaired social skills, it may seem less important to address issues of gross motor skills. However, physical therapy can help social and cognitive improvement in two ways. First, because many autistic children have low muscle tone, sitting still in a chair for an age-appropriate length of time can be difficult. Improving core strength and balance can help make it easier for them to sit still, increasing their chance of success in school. Second, because most autistic children are boys, increased physical coordination can help them participate with typical peers in a typical way.
Most school systems employ social workers as part of the team of professionals who supervise special education programs, as well as mainstreamed children who receive special services. If a school district uses a system with a child study team (see above), a social worker will be one of the professionals on the child study team.
Special Education Teacher
A special education teacher is, in most states, trained and licensed to teach children with a wide variety of special needs, disabilities or emotional issues. How much experience the teacher has specifically with autistic children varies. The teacher, special education or typical (in the case of a mainstreamed child) is one of most important professionals in the child’s life. A child’s teacher structures and administers the child’s work every day and, as a result, can be the first to notice if a problem arises (such as a change in the effectiveness of a medication). Open and frequent communication with the teacher is essential.
A speech therapist or speech pathologist not only helps a child attain or improve speech, but is also the professional who helps with feeding issues, especially in young children. Speech therapists are trained in all aspects of oral motor function. They can also teach methods of non-verbal communication, such as sign language or PECS (Picture Exchange Communication).
While all of these professionals have skills to offer, some will be more important than others. Some will be a regular part of the child’s daily or weekly schedule, while others will need to be consulted only from time to time. Of course, there are other professionals a family may encounter over the years, who offer more specialized services. For example, one child may benefit more than another from water therapy, hippo therapy, music therapy or adopting a trained assistance animal.
For every therapy, there will be another professional offering more well-meaning advice. It is then up to the parents, the real case managers, to sort through the noise, finding the most valuable pieces from each discipline to help their autistic child.