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Autism and Therapies; “Custom Fit ” versus “One Size Fits All”

I personally have difficulty using behavioral therapies as the “proven” therapies to use for a child who does not have a behavioral problem but rather has a neurological one. I recently saw a video put out by Dr. John Carpente of Molloy College on DIR Floortime and “Play”. Check out this DIR/Floortime Research…thanks Carol Ann LoPinto Blank for sharing this… “… it is a response given(by an autistic child) because they want to, not because they have been conditioned to.”

It seems to me that the “symptoms” of autism have been placed under the “behavioral” category. So instead of treating the difficulty, helping to repave or connect new neural pathways that may not have developed properly, education and insurance have chosen to fund treating the symptoms, or overlook the problem entirely and re-condition the child to behave as if he had developed typically. In my opinion, any “behavioral” therapy, as the defining therapy, implies the wrong answer by it’s very name. Implementing this adjunctly, yes, could be a great asset to assisting the child in the everyday world.Conditioning the responses, however again in my opinion, is not aiding in helping neural difficulties in Autism that make typical functioning difficult.

When I work with autistic clients, I always ask the parent “What is it you want most for your child out of therapy? The unanimous answer they give, apparently not only to me, but also those involved with IEP’s is communication. I ask the parents because I believe the parents most often, know the greatest need (which usually validates what I see.). It is not difficult to establish some sort of communication given the right elements: time, attentiveness and openness. However, not every individual we encounter on the street is given these opportunities when meeting these youngsters. So it is essential, especially in emerging situations, that one is able to communicate to others, not necessarily given those elements. I mention this because it is not only the modality of music, but also it’s relational values, relational applications, and relational communicativeness that nurture health and neural repair. Music Therapy is different for each individual because it is relational, not a specific set of behaviors or formulas.

Here is another way to view therapies we choose to fund. Do we want “custom fit” or “one size fits all?” Custom fit being not only fitting but meeting most our needs. One size fits all is just that, it fits all, but is it flattering what strengths one  already posses? Is it meeting any needs or is it just a reasonable fit? One reasonable application, for a specific need, tested over and over, repeated identically over and over on varying individuals with specifically varying needs is bound to get a result with several individuals . However, one brand, cut custom fit, will get tremendous results for the individual  it is cut for and far less results with others of varying sizes – giving far less in numbers.

Lets look at this from another angle; if you were in a snowstorm without proper attire, would you lean towards a custom fit down coat  with built in form fitting hood, or would you pick the one size fits all plastic, see through rain cape made for wet weather? You are guaranteed it is going to fit your very cold body and will repel water.

Personally, our family has never bought custom fit items, not even the two men in our family that are 6’7″. No cars, clothes, appliances – we can’t afford that. The one size fits all plan works for us. However, when it comes to healthcare, we can’t afford one size fits all; custom fit is all that works. For instance, my oldest son had allergic asthma as a child. He came down with some kind of severe respiratory infection every 3 weeks by the time he started kindergarten. Protocol for administering antibiotics at the time was a) fever over 101, b) green color, and c) symptoms for a specified number of days (the one size fits all plan). Time demonstrated to us that if we waited for all those signs, after antibiotics there was no infection but the boy was so worn down and weak that as soon as he got back to school he picked up the next round of whatever was going around and we did the whole process over. Missing anywhere from 4 days to two weeks of school st a time was typical. He needed the custom fit plan. The other two children, who rarely got sick, could use the one size fits all plan, it worked for them.

Another comparison is the “No child left behind” plan. How did that work out for the non-typical learners?





  • Susan Chase

    Well, said — regarding “one size fit all versus custom made.” I am a drama and movement therapist, but when I work with children with autism, I am constantly tailoring my work as I see how the child responds. I see a client who does not show emotions in life situations, But he is an absolute dynamo when “playing a role.” So we read stories together and then act them out. He is not yet ready to express all those feelings for himself. But I just know that by “playing” the feelings, we are keeping those neural and emotional pathways open and vibrant.

  • anitaB

    I completely agree with the idea that autism intervention is not a “one size fits all”. As first a music therapist—then I became an OTR—I continue to see a foundational need for communication in the context of relationship. In addition to addressing motor skills for children–I implement a “sensory diet” approach to therapy sessions, & my family teaching. I recently treated a young 5 y/o nonverbal autistic child who made tremendous gains to begin language therapy w/ the SLP after several weeks of first addressing his huge sensory processing needs. Unfortunately, healthcare has become so focused on research studies—& behavior therapy lends itself to clear data–so that other important aspects of function are not recognized as therapy that gets results. We must continue to look for ways to keep data in some form, to help identify the validity of a variety of beneficial tools to connect w/ children on the spectrum.

    • Caroline

      I don’t believe in a one size fits all approach simply because every child is different no matter what label they share. I used a naturalistic, holistic approach using the strategies and techniques I learned by staying with my daughter whilst she did music therapy, sensory integration therapy and all the others so, I could extend a consistent approach at home and everywhere we went with her…she has improved and become quite independent, sociable and amazed everyone who knew her at age 2 when she was diagnosed. Here is my link to my approach backed up with that ‘evidence’ which so many researchers and professionals want which was written without my knowledge but mirrors our approach and parenting style… ü

  • Ben

    Have there been any studies showing that music therapy results in neural repair for children with Autism as you claim?

  • Terry Keeney

    I agree with the “one size does not fit all” theory. We are planning to build a family education, resource, and retreat center in Tennessee. God gives everyone a purpose, including the Autistic. The purpose of this center is to bring the entire family for a week of fun & relaxation in TN (65% of the US population live within a one-day drive of this location). Our focus is to help determine a purpose (special gifts or talents) for the Autistic person and provide training and guidance to the family as a team effort within the family to help the Autistic person reach his/her full potential and bring more unity within the family. Music, horse, swimming, and fitness programs with proper diet are a part of the process but also the family will learn time management, finance management, relationship management, and other skills at the center with on-going support when they return home to strenghten the entire family. One of the things we hear from older siblings is “I really don’t have a mother” because so much time is dedicated to the Autistic child. (divorce is also very high, as you all know in Autistic families.

    We hope to be able to refer families to wonderful therapists like Black Mountain in the future in every corner of the US. God Bless your efforts!

    • Antoinette

      I’m am so glad to hear that programs like yours exist, I wish there were some here! When I watch families It seems to me that this isolates them from others often. I enjoy working with these kids and their families because they are some of the most “genuine” people I meet.Good luck with your program. Please keep me posted on its success in your state. And thank you very much for bookmarking my site!

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