Monday, 14 November 2011

Behavioural Therapy - 'Normalization' vs 'Teaching of Skills'

Parents who are considering behavioural (or any) therapy of any kind for their autistic children need to ask themselves a crucial question – what is my motive for this therapy? What is the goal I want to reach?

There are basically two approaches to therapy, and hence two radically different goals: -

1) NORMALIZATION. This approach takes the view that autism is something terrible, a scourge, a deviation from the norm to be eradicated at all costs. All outward manifestations of it must be somehow ‘scrubbed’ from the child’s behaviour, so that the child at least appears normal, and ‘indistinguishable’ from their peers.

To effect this, the goal is to get rid of anything that ‘looks autistic’, in one way or another. This includes the repression or denial or ‘therapising away’ of such things as toe-walking, hand-flapping, monotone voices, long periods of time spent in special interests (categorised as ‘obsessions’, and therefore pathological), long periods of solitude (categorised as ‘anti-social behaviour’, and therefore again pathological), symptoms of sensory overload, the lining up of toys or other possessions, or indeed any kind of stimming.

2) TEACHING OF SKILLS. This approach takes the view that autism simply exists, and is neither good nor bad, but does present specific handicaps that the child can be helped to overcome, by the teaching of useful skills and knowledge.

These skills can start with things like basic communication and toilet training, and how to feed, bathe and dress themselves. The parents or therapists can then move on to teaching the child such things as how to use visual aids, follow school rules, or play with other children. As the child grows older and into adolescence and young adulthood, further skills can be added – how to manage money, interact with the opposite sex, cope with university/college, or live away from parents… The list could be endless, but the point is that autistic children WILL NOT LEARN these things without help, or will flounder severely as they try.

There are of course people who do both these things, considering the teaching of skills as part of ‘normalization’. Still, the general rule applies – they consider making the child ‘normal’ the over-riding goal, and the ‘skills’ are just a part of that. Whereas those who take the second approach, are very little concerned with such outward manifestations of autism as hand-flapping or toe-walking or stimming, and far more concerned with assisting the child to acquire concrete skills to help them cope with the world.

I also accept that the parents who take the first approach believe they are doing what is best for their child, that they act out of concern. But they are starting with the belief that it’s a terrible thing to be autistic, they generally suppose the child must be miserable simply because of being autistic, and so ‘must’ be happier without the autism. There’s a whole weight of assumptions there I won’t go into, but I would ask such parents to consider this:-

Autism is not a ‘layer’ obscuring the ‘real’ child. It IS the real child. Autism is an intrinsic part of themselves. To teach the child to hide/conceal/suppress/deny this real self and all its outward manifestations, is to force them into a foreign mold of ‘normality’, to feel that their ‘core being’ is rejected by those who claim to love them, and to teach them to devalue and even hate that true self. Low self-esteem, depression, and anxiety are virtually inevitable. Some young autistic adults even fall into alcohol or drug addictions, or attempt suicide, as a result. Moreover, if the emphasis has been too much on ‘normalizing’, and not enough on acquiring those skills and information the child really needs to cope, they can fall into the abyss of executive dysfunction (ie not having a clue how to organise or care for themselves), and their lives end up a mess, with consequent despair and self-hatred. Is this really what you hope to achieve?

Autism is for life. Yes, teach them whatever you feel they need to cope with the world, and to improve their lives. But young autistics also have the right, and the need, to go out into the world knowing they are valued and loved as they are, for all that they are – INCLUDING the autism.

11 April 2012 Footnote :- I have decided to call the 'teaching of skills' approach 'maximisation'. I say why here....


  1. I think you could even go further into your description as to how the therapy is provided. Even the life skills can be taught in a very ABA, discreet trial way where the child is more or less trained like a dog. (I'm preparing myself for the possible onslaught of angry moms here) Where everything that a child does that seems out of the NT ordinary or seems defiant is labeled as 'behaviors' and not taken as the very real communication it is.

  2. Yes, (sadly) I'm sure it can be like that! I admit i haven't seen much of it in action, i was going more by the attitudes expressed - or implicit - in what i've read, written by various autism parents, both in books and online.
    And i agree too, that often things the child does is not recognised as a communication in its own way.
    It really is in the attitude *BEHIND* what is done, isn't it?? Rather than the particular therapy chosen. Least that's how it seems to me.