Autism and the Happiest Toddler Approach: Why Does It Work?

All children on the autism spectrum have two things in common:  they have difficulty with communication and less social skills than would be expected for their age.  Many, but not all, children with ASD struggle with sensory processing.  The level of struggle is so unique that these kids look very different from one another most of the time.  But when they get frustrated, they all can break down into aggression, avoidance and tantrums that last and last.  I recently attended a professional training where the presenter remarked that those meltdowns were not only a sign of autism but inevitable, and “you just let the child have his tantrum”.   I think that abandons the child when he needs the most support, but is the least available for traditional talk-based or token strategies.  I have also spoken with behavioral-managment clinicians who go straight through to a time-out warning when a child begins to resist or complain.

So why does The Happiest Toddler (THT) strategy work well for children on the ASD spectrum?

At first glance, it seems that it would be less successful than standard behavioral approaches, as it relies on reflecting back feelings and supporting social and self-control skills.  Initiating and sustaining direct verbal give-and-take is often the greatest limitation of these children.  Kids on the spectrum really benefit from the emphasis on non-verbal messages, the repetition, and the indirect teaching that occurs using Dr. Karp’s techniques.  The adult matches the child’s language level at the time of the tantrum, and social interaction matches a child’s skill level as well.  If a child with ASD is able to function above an 18-month level, at any chronological age, then this approach can be very effective in helping him achieve a calmer state and learn self-control skills.

I modify the program to assume that a child will need more opportunities to practice and fewer distractions to use techniques such as Gossiping and Patience-stretching. My target level of repetition, voice volume and language complexity may have to be very fine-tuned for each child.  I may need to select words that he commonly uses, or words that have previously shown a positive response.  I will strive for consistency in my delivery once I have created a plan, and accept that generalization of using THT (expanding this to other situations, or even to the parents and nannies) is going to take longer.

This strategy works more effectively with a “floor-time” model than with an ABA model, but it can be used with any program.  The definitive measure of whether this approach will work is the willingness of adults to adapt their response to a child’s unique emotional and communication needs.

Take a look at the technique demonstrated on a “Good Morning America” segment to give you an idea of what it looks like in action. http://youtu.be/lrxBKvV1p-A

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