I stumbled across this article from the Science Daily website: Treating Autism 'Right The First Time' and remembered I had heard about this before. Upon reading the article, I realized that Pivotal Response Training (PRT) is a behavior-intervention pioneered by Robert Koegel and Laura Schreibman at the University of California, Santa Barbara. Dr. Koegel and his wife, Dr. Lynn Koegel were keynote speakers at a recent autism conference in Atlanta that I attended. The presentation dealt with PRT, but focused mostly on Dr. Lynn Koegel's experience on Super Nanny in an episode where the family had a young autistic son.

Within the timing of this episode, Dr. Koegel hit pay dirt. She was actually able to get this non-verbal child to say a couple of words. It not only made for great TV, but was a major boost for the whole PRT movement. As you can see in the Science Daily article, PRT research indicates it is most effective when used with children who showed interest in the outside world and had fewer physical self-stimming behaviors and more verbal self-stimming behaviors.

PRT is an intervention that is taught to the parents to perform at home, in a natural setting. Parents as therapists...hmmm...this got me to thinking...(I'm taking a sharp right turn in this post now...)

In the attachment disorder world (Nancy can chime in), parents quickly learn that the parents as therapists is both necessary and sometimes highly criticized by "traditional professionals" who hold tight to traditional psychotherapy practices - such as weekly sessions of talking and playing with the kids. It seems a bit ironic to me that in a variety of therapeutic arenas - like those treating autism or sensory integration - we find that teaching the parents the specialized interventions and coaching and empowering the parents to provide these interventions at home seem to be a mainstay of successful therapy.

My journey down the autism path is fairly new. LuLu was first diagnosed with PDD-NOS about 4 years ago, but it was within a jumble of the rest of her alphabet soup diagnoses, so it's taken me a while to tease them all out. I felt then, and still maintain, that healing her attachment and pushing for a healthy bond with us was the primary task for our family early on. I am relieved to say that despite her many, MANY issues, her attachment to our family is a healthy one. She is still challenged by anxieties and past trauma triggers, but recognizes our family as her base of safety and much healthier than when she joined us 7 years ago.

One thing that strikes me about autism and attachment disorder is the similarity of the parents' struggles. Both fields are loaded with controversy -- professionals refuting the cause of both disorders, the appropriate interventions, even the actual numbers of children and families suffering. In both cases children are often under identified or not identified as early as possible. The other similarity is in the difficult strain these children's behaviors put on their families. Living with a child who has autism or RAD is extremely difficult. Both disorders require a major shift in the family's focus toward healing this child. Both disorders drain the families physically, financially and emotionally.

The insurance companies complete lack of responsiveness to both disorders is another similarity. Ok, the insurance companies don't pay for much of any disorder, but it is especially true when the disorder is considered "controversial". Another similarity-- the family is often "blamed" for the child's disorder. Thankfully, parents of children with autism are shedding this albatross a bit in modern years - the days of the "refrigerator mom" are over. Autism remains an "invisible" disorder (just like RAD), manifested mostly through behavior...and any of us dealing with difficult behaviors in our children know how parents are often blamed for those behaviors no matter what level of interventions have been attempted. But for parents of children with RAD the stigma still remains in full force. I'm sure families of children with either disorder can tell story upon story of inappropriate comments in the grocery store, family or friends criticizing their parenting techniques, or even professionals implying that the child's disorder was somehow "caused" by the parents inability to change the behaviors.

I watch, with great interest, the developments in both fields - autism and attachment disorder -- because I truly believe that in the next 20 years the neurological and biochemical bases for many disorders, including these, will drastically change the understanding of these disorders.