Editors Note: This is the first in a series of articles that Richard Solomon MD aka Dr

410 Pages·2017·2.6 MB·English

Autism: The Potential Within

The PLAY Project Approach
To Helping Young Children with Autism
Autism: The Potential Within

The PLAY Project Approach
To Helping Young Children with Autism

by
Richard Solomon MD
Copyright Page
Dedications

To my wife Linda, my love of 44 years, and to my amazing children Onna and Gabe without whose
love and encouragement I could not have pursued the mission of serving the children.

To the families and children who have taught me so much about the human spirit and the potential
within each one of us
Autism: The Potential Within

The PLAY Project Approach
To Helping Young Children with Autism

Table of Contents

Dedications
Table of Contents
Foreword
Acknowledgements
Introduction & Overview: Autism: The Potential Within, The PLAY Project Approach to Helping
Children with Autism
Prologue: The Origins of the PLAY Project

Section One - What to Do First: Initial Diagnosis and Recommendations for Jacob and His Family
Chapter 1 Visit 1: Part 1 “Jacob has autism.”
Chapter 2 Visit 1: Part 2 After the Diagnosis: Grief, Guilt, Hope and Action
Chapter 3 Visit 1: Part 3 When You Walk Out My Door: First Steps
Chapter 4 Diet, Biomedical Treatments, Immunizations and Autism
Chapter 5 Visit 2 Early Intervention and Special Education Preschool
Chapter 6 Visit 3: Part 1 Climbing the Language Mountain
Chapter 7 Visit 3: Part 2 OT & Sensory Integration

Section 2 - The PLAY Project Approach Climbing Up Jacob’s (Developmental) Ladder
Section 2: Introduction - PLAY Project and/or ABA?
Chapter 8 Visit 4 Starting the PLAY Project Autism Intervention
Chapter 9 The 7 Circles of the PLAY Project
Chapter 10 Visit 5 Moving On Up?
Chapter 11 Visit 6 The Turning Point!
Chapter 12 Kindergarten: Ready or Not Here We Come
Chapter 13 Visit 7: Part 1 The Path: Imagination and Meaning
Chapter 14 Visit 7: Part 2 Imagination and Meaning: Jacob’s Profile
Chapter 15 Visit 8 Rich Pretend PLAY
Chapter 16 Visit 9 The Seven Habits of Highly Effective Kindergarteners

Section 3 - Daily Hassles: Using Misbehavior to Promote Jacob’s Emotional Thinking
Section 3 Introduction: Jacob Grant - Pain in the Butt!
Chapter 17 Visit 10 The Good, The Bad & The Ugly
Chapter 18 Visit 11 Dr. Rick’s 20 Transition Tricks
Chapter 19 Visit 12: Part 1 The Stone in Your Shoe: Sleep
Chapter 20 Visit 12: Part 2 Jacob’s Terrible, Horrible, No Good, Very Bad Mornings
Chapter 21 Visit 13 Outings and Eating
Chapter 22 Visit 14 Medications?
Chapter 23 Visit 15 Toilet Training
Chapter 24 Visit 14: Siblings With Rivalry!
Epilogue: What is the Potential Within?
Appendices
Glossary
Index
Foreword
by
Lisa Gretchko

When I was a senior in high school in 1972 I took a course in Early Childhood Development and, in
class, we watched an old black-and-white movie that depicted a mother trying to feed her autistic
son. The child in the movie was a beautiful three year old, but he did not speak and he refused to
look at his mother (much less eat the food she offered.) The movie’s narrator explained that the
child was autistic and concluded that he would require institutionalization.

In 1994 when I was pregnant with our first child, I visited a local bookstore and flipped through a
newly published child care book which described (in alphabetical order) the ailments that can afflict
children. As I looked through the illnesses that began with the letter “A”, I noticed that there had
been no development in the treatment of autism because, like the movie I had seen in 1972, this
newly-published book stated that autistic children do not recover and require institutionalization. I
counted our blessings when our first child hit each developmental milestone on time.

Our second child was born in 1998 and his first symptoms surfaced when he was very young. While
feeding him a bottle one night, I realized that he wasn’t looking at me. Instead, while in my left arm
he was focused on the horizontal blinds to my right. So, I put down the bottle to “switch” him to
my right arm. As his face came close to mine in this process, he averted his eyes. In this new position
he focused on the light in the ceiling, because the horizontal blinds were now behind his head. After
a few minutes, I put down the bottle and switched him into my left arm once again and, as before,
he averted his eyes. In that moment, I realized that our son’s gaze aversion was the same as that little
boy’s in the movie I had seen in 1972.

Our wonderful pediatrician was at a loss as to how to help our young son improve. He mentioned
that speech therapy, occupational therapy and physical therapy might help, but questioned their
efficacy because our son was still too young to sit still or focus his attention for a significant length
of time. A nearby therapy clinic tested him and recommended that we immediately start speech
therapy, occupational therapy, physical therapy and sensory integrative therapy. After nine months
of intensive therapies, our son couldn’t utter a word and hadn’t made much progress. The therapy
clinic suggested that we make an appointment with Dr. Solomon—an autism specialist.

I met Dr. Solomon in February, 2001, when our son was a beautiful 2½ year old with bright red
curls and dark eyes that darted around the room and never made contact with my own. He was
vacant and aloof. After observing our son intently, Dr. Solomon confirmed that he was, indeed, on
the autism spectrum. Although my husband and I had strongly suspected autism for more than two
years by that point, my heart stopped when Dr. Solomon confirmed our worst fears. In the next
breath, however, Dr. Solomon offered words of encouragement when he said that our child was
relatively easy to engage and was a good candidate for the PLAY Project.

Dr. Solomon’s explanation of the PLAY Project was like a beacon of hope in a very dark and scary
wilderness. Unlike those books that offered no hope whatsoever, Dr. Solomon unfolded a veritable
roadmap of how to help our child. When he told me that the PLAY Project required twenty hours
of play-based therapy every week, out of sheer despair I replied that I was prepared to do it 24 hours
a day, 7 days a week if it would help our child make progress!
Christy Pratt was our PLAY Project Consultant and her first monthly home visit was in May, 2001.
At that point, our son’s chronological age was 2 years, 8 months, but (years later) Christy told me
that his functional developmental level was that of a nine month old. Each month she recorded
video of my husband and me playing with our son and she took the video back to Dr. Solomon,
who reviewed the video and called (or e-mailed) with explicit instructions on how we should play
with our child in the next month to promote his progress to the next developmental level.

We were the nineteenth family in the PLAY Project, which was then a new program at the
University of Michigan. Although it was considered an experimental therapy in 2001, the play-based
nature of the therapies made sense to my husband and me. At first, it was difficult to figure out how
to “follow the child’s lead” in order to implement the play strategies that Dr. Solomon
recommended. Once we got the hang of it, however, we found the PLAY Project strategies to be
creative, liberating, and fun! Often, my husband and I would craft new ways to implement the
PLAY Project therapies. For example, I created the “Happy/Sad Face Game” to help our son
communicate his emotions before he could speak. (Fear was, by far, his most frequent emotion at
that time.) My husband created the “Swing While Naming his Body Parts Game” to help extend our
son’s engagement time while teaching him the parts of his body.

Our child made progress and, after several months in the PLAY Project, he finally spoke a word—
“Ahkee”. Although nobody knew what it meant at the time, our son was suddenly very expressive in
his frequent (almost perseverative) use of this single word. He began speaking in earnest a year later,
just before his fourth birthday. Shortly thereafter, when I asked him what “Ahkee” meant, he
grabbed my face in his little hands, looked me in the eyes and joyfully replied “Mommy! Ahkee is
Mommy!”

Our family participated in the PLAY Project for three years. Dr. Solomon’s monthly instructions to
us after he reviewed our son’s video clips were insightful, enthusiastic, and reassuring; he always
seemed to know what was going on in our child’s mind, and what stage of his development was
coming next.

Although the PLAY Project is designed for young children, as our son grew older we often used the
“template” of PLAY Project strategies to teach many of the things that typical children seem to
know instinctively or learn naturally, such as imagination, flexibility, focus, empathy, and humor.
Today, our son is seventeen and he speaks and interacts like a typical junior in high school. His
grades are pretty good, and he is a happy, well-adjusted, and remarkably empathetic young man, with
a wonderful sense of humor.

The parents of autistic youngsters experience sheer panic when they realize the enormity of their
child’s diagnosis: the sting of hearing the word “autism” in connection with your child never goes
away. However, the PLAY Project is a beacon of hope in a wilderness of despair for the families of
autistic children, and for the children themselves. I shudder to think what would have become of
our son and the rest of our family without Dr. Solomon and the PLAY Project.

February 8, 2016
Acknowledgements

My office visits with thousands of families and children with autism spectrum disorders over the last
25 years gave me the motivation to put their lives and experiences into book form. So first I
acknowledge ‘my’ families and ‘my’ children who have taught me so much about the human spirit,
the potential within each one of us to grieve and cope, to be overwhelmed and still overcome, to
grow and develop and laugh and have fun together and love despite the challenges.

Next, I owe a debt of gratitude to Stanley Greenspan MD, Serena Weider PhD, and Ricki Robinson
MD, MPH, who have been my mentors and colleagues and inspired me to offer a developmental,
individualized, and relationship-based (DIR) approach to my families and children with ASD. For
decades now, as a society, we have been focusing on how to change the behavior of children with
ASD from the ‘outside in’ using the ABA (Applied Behavior Analysis), Skinnerian, behaviorist
approaches which are the most commonly offered services in the U.S. Though Stanley died in 2010
his foundational work on the importance of the child’s feeling life and functional emotional
development is continuing to enter the mainstream. Serena Weider drew the map that all of us now
follow to help children with ASD become more symbolic and imaginative. And Ricki Robinson was
my model of what it means to be the complete pediatrician for children with autism spectrum
disorders. Stanley, Serena, and Ricki taught me to stand for an approach that honors the child’s
unique potential to grow from within. I could not have written this book without their guidance and
inspiration.

Though the story and characters in this book are drawn from my clinical experience, the PLAY
Project approach, which the Grant family implements as Jacob’s intensive intervention, is now an
evidence-based model founded on rigorous research*. Jim Lyddy introduced me to the possibility of
getting a federal research grant back in 2007. Perri Zimmerman, research manager extraordinaire,
successfully managed all the details of the NIH grant from 2009-2012. Ron Maio DO, helped me
prepare the research manuscript and gave fundamental advice on methodology. My research
colleagues at Michigan State University’s Community Evaluation and Research Collaborative, Laurie
Van Egeren PhD, and Melissa Quon-Huber PhD, rigorously evaluated the program, and finally my
friend and colleague Jerry Mahoney PhD, Professor at the Mandel School of Applied Social Sciences
at Case Western Reserve in Ohio, not only allowed us to use his outcome measures, but gave astute
advice and guidance throughout the research process. Without good research, even wonderful
clinical models, are often overlooked in this era of evidence-based practices.

My beloved wife of 44 years, Linda, supported me and gave me the space to write this book for
hours on end and over long weekend days and through many months. She read the chapters and
gave me her honest opinion as only a wife can and she made the book better. My darling daughter
and work colleague, Onna, was a constant source of support, encouragement, and also critical
reviews and suggestions. I am the father of two adult children and grandfather of four, all of whom
live in Ann Arbor where I live and have my practice. I am so grateful to all of them for
understanding that ‘papa’ has been busy writing his book and will play with them a lot more when
he’s done.

Finally, a number of others have really come through for me to help bring this book to fruition. A
big thanks to Frank Murphy who did the final editing, Nick Vetter who helped with a number of the
technical aspects of publishing the book, and all the folks at Lulu Publishing for making the
publishing process relatively easy.

* Solomon R, Van Egeren L, Mahoney G, Quon-Huber M, Zimmerman P, PLAY Project Home
Consultation Intervention Program for Young Children with Autism Spectrum Disorders: A Randomized
Controlled Trial. J Dev Beh Pediatr. 2014; 35(8): 475-485.

For open access to the complete article:
http://journals.lww.com/jrnldbp/Fulltext/2014/10000/PLAY_Project_Home_Consultation_Intervention.1.
aspx