The Rationale Behind DEALL
Despite extensive research being conducted on the topic of the cause of Autism Spectrum Disorder (ASD), the exact cause of ASD is unknown. However a general consensus among the scientific community is that the cause is biological, most likely neurological as against the widely held earlier theories of psychological causation. There may be more than one cause or a combination of causative factors. Further we believe that irrespective of the exact biological cause, these children have a range of developmental difficulties. This biological cause, is the reason behind many Sensory Perceptual Disorders – Hearing, Vision, Touch, Smell and Kinesthetic; that are seen in children with ASD.
.Figure 1 – Representation of the core biological cause of ASD
Figure 2 – representations of the sensory perceptual differences in ASD
Sensory Perceptual Issues (Issues with hearing, vision, touch etc)
Theoretically, if one or more senses are not functioning in a normal way, he or she may develop a distorted perception of the environment. It is our position that children with ASD are processing their environment differently as compared to their peer group. Imagine you wearing your grandfather's high power glass. Your vision will alter significantly and if you try to climb down stairs with that glass, you may even fall. Children with ASD have these types of altered hearing, vision, touch, smell and kinesthetic perception. These differences not only differ from child to child but may also differ in the same child from time to time. We prefer to describe these as differences rather than deficits as some of these unusual differences are perhaps resulting in so called ‘savant skills’ or "pocket of smartness". Unusual talent in music can be the consequence of slightly prolonged (by milliseconds) auditory perception. This very same phenomenon could at the same time interfere in processing language through the auditory modality in real time, resulting in poor speech reception.
Motor Executive Issues (Gross, Fine and Oral)
We now know that many children with ASD also have a range of difficulties in imitating and learning motor (physical/body) movements, while some have a few extraordinary motor (physical) skills and coordination in activities such as climbing and balancing. Children with ASD also seem to have issues with motor executive dysfunction, resulting in difficulties in planning, working memory, impulse control, inhibition, as well as the initiation and monitoring of action. This condition is called Apraxia. In other words, Apraxia is the inability to produce a learnt motor movement in response to a command or demand. For instance, you know your child can pick up a plate or say his name but when you ask him to pick up the plate, he can't do it or when you ask him to say his name, he can't say it. The impact on such issues of motor skills whether they involve the whole body, the fine motor movements or the even finer oro-motor movements required for speech, can be disastrous.
Figure 3 – representations of the motor difficulties in ASD
Figure 4 – representation of the issues in communication in ASD
Communication/Social/Emotional deficits as consequences
In our model the communication, social and emotional deficits that are seen in children with ASD are interpreted as consequences of the basic differences in sensory–motor processing rather than being the core deficits. Even subtle hearing differences/deficits would not only impact the real time processing of speech in day to day life, but in a growing child who is still learning language from his environment, this will have a more complex effect on the language acquisition process itself. At the same time it is quite likely that the child with ASD does indeed understand the language spoken around him, including the specific references to him, despite his difficulties in responding to it in real time. It is also unfortunate that we often treat a non speaking child like a non understanding child, leading to even greater negative impacts on the child. It is likely that the sensory processing issues impact the development of social and emotional skills, negatively in a similar manner.
The behavioral issues seen in children with ASD are interpreted in our model as the reaction of the child to the more basic difficulties like sensory-motor and communication difficulties. His inability to meet expectations of those around him, depriving him of the much needed encouragement and support and nurturing environment that a growing child requires, also results in behavior problems. For instance, the tendency among these children to cling to the familiarity of surroundings and their daily routines may be the child’s defense or coping strategy to deal with his ever changing, fluctuating world; that he doesn't understand or is hard to process.
Figure 5 – representation of the behavioral issues seen in ASD
Communication DEALL intervention program targets the sensory perceptual, motor and communication issues in ASD. Communication DEALL program is currently based on a loosely structured framework of our understanding of ASD. The theoretical underpinnings of the Communication DEALL program is that it is caused by a biological, specifically neurological disorder resulting in a range of sensory perceptual disorders and motor executive difficulties. The communication, social and cognitive deficits, in children with ASD are seen as consequences of the sensory perceptual and motor difficulties rather than as core symptoms. In turn the behavior problems exhibited by the children are seen as their reactions arising out of these difficulties rather than being an indispensable part of the disorder. Intervention addressed to ameliorate the more basic sensory motor and communication difficulties are seen to address and reduce the many behavioral issues.
To know more, read The Program Manual by Dr Prathibha Karanth.