I have always been a big fan of ice cream, however I used to find the parlors that offered 32 flavors to be somewhat overwhelming. My experience while on summer vacation with my nephew, who has a severe egg allergy, makes me grateful for the many options. I’m especially grateful when the employees take our request seriously and indicate which flavors have absolutely not come in contact with egg. Soft serve vanilla appears to be a safe bet in most places but I am sad at his only and somewhat uninteresting option when other kids get to order flavors sounds like they have leaped from the pages of a Roald Dahl story, like Birthday Cake, Cotton Candy, or Moose Tracks.
Flavors and variety was a theme of this trip. The main event of the vacation was a party, the kind of classic summery party I hold in memories of my youth with ample quantities of delicious summer salads, chicken, grilled hot dogs, fruit, fudge and (of course) ice cream. The children romped about the yard, and adults relaxed in the shade, catching up with each other over cold drinks. The reason for the event was my niece’s 4th birthday, but that was merely an excuse for the large cadre of family and friends to gather and enjoy the day.
In addition to the chatter with uncles, aunts and family friends, I stole some time to watch the kids’ interactions. At least three of the 30 plus children attending were diagnosed with an ASD, including my nephew. How were they managing in this melee? Any signs of sensory overload? Anyone feeling excluded from the fun?
When my sister-in-law called the group to engage in assorted of games and activities some children came running immediately. Others in this small tribe looked to each other for cues. Is the game worth joining or would it be better to continue playing in the treehouse?. With multiple flavors of activity to entertain all kids, some children elected to continue their current play in the sprinkler or with the racetrack. This was perfectly acceptable. Especially since the kids playing separately were not alone, and they were not necessarily the children on the spectrum. This was intriguing to me because for the most part, these children did not know each other so the playmates and their individual mannerisms were all new, and not necessarily comfortable.
Children’s contentedness, much like ice cream and also autism, comes in many flavors. All flavors were welcome at this party, of course, but some aspects of the party may have inadvertently favored some over others. One of the “older” boys was quite literally outraged by the party rule that children 6 and older could take only 5 items from the piñata (lest nothing be left for the younger, presumably less effective gathers). Righteous indignation lasted for a good hour, fuming as he watched multiple 4 and 5 year olds carrying more loot than could be held in a small bag, much less enjoyed in a day. I also watched as someone else—another child—offered comfort and agreement that the rule was unjust and should be changed next time.
The child-initiated inclusion, acceptance, and comfort I saw at the party reminded me of a promising peer-based therapy. Connie Kasari, Ph.D. (UCLA) and colleagues have demonstrated the effectiveness of peer-intervention to bring children with ASD into more social interactions on the playground (see more here). The children with ASD in these studies as well as those at the party were in mainstream schools. In considering this and in a broader context “party therapy” for all the kids attending, I thought about how a child with more severe communication and medical challenges would respond to the environment of this party. The many choices of things to do and the sensory riot could be escaped, but with the escape so too would go social interaction. Any therapy or interaction directed at improving social communication is less likely to succeed when other behavioral or medical challenges interfere with learning. Such is also the case when not “therapy” but merely play is the desire of the day.
Autism Speaks has established in its strategic plan for science a specific goal to develop ways to rigorously identify meaningful subtypes of ASDs that predict response to various types of treatment. Our ability to quickly identify the various “flavors” of ASD will speed effective treatments for the affected child.
Having choices is only useful if you know how good each choice is likely to be. The trick with ice cream is easy—simply request a sample of whatever you are considering. With autism therapies, there is no simple trick in choosing, but hope lies in identifying subtypes or “flavors” of ASD so we can match these with the most effective therapies, tailored for that subtype. Much as the list of ingredients that was essential to select the right ice cream for my nephew, the research we support aims to develop the profile of symptoms that results in the best outcome for each type of therapy. By combining research on treating different subtypes with a focus on developing new therapies for subtypes that have yet to have good outcomes we seek the knowledge to allow us to tailor treatment plans to suit each individual’s unique needs, for each and every flavor of ASD.