Approximately one in 1,000 children in the United States has autism, a neurobiological disorder of development, first described in the 1940s, that impacts several areas of function, including language, social behavior, and behavior involving objects and routines.

People with autism exhibit symptoms in several areas. They have difficulties with verbal and nonverbal communication. They are sometimes challenged by social interactions, including empathizing with others, sharing emotions, and being able to hold a conversation.

Also, they frequently exhibit routine or repetitive behaviors, sometimes called stereotyped behaviors, which include obsessions with schedules, exhibiting repetitive play, and arranging items in very set ways. Some symptoms of autism can be identified as early as eight months of age, while the average age of diagnosis is three months old.

Research points to a genetic basis for the development of autism, with current thinking pointing not to a single “autism gene,” but to a cluster of genes spread across chromosomes that lead to the development of different facets of autism. Environmental factors, such as viruses, may also play a role, and some current research is considering the role played by neurological, infectious, metabolic, and immunological factors.

Early diagnosis is important to allowing the child with autism time to develop skills and coping mechanism while their brains are in a more plastic stage of development. But it is also important that therapeutic professionals work closely with parents, who may be doing some adjusting of their own.

Helping the Parent

Roy Sanders, MD, is a medical director at the Marcus Autism Center in Atlanta and author of How to Talk to Parents About Autism (Norton, 2008). He is also the parent of an autistic son, giving him a very complete understanding of how medical professionals should work with the families of children with autism.

“In the early stages, you’re helping parents to understand it [autism] is a chronic disease,” he says. This is a period of adjustment for many parents who had imagined having a child with “normal” abilities to interact. “Parents are grieving significantly for the child they thought they were going to have,” he says.

In the early stages, this adjustment is the primary goal for the family. Parents want to have the emotional interaction with, and feedback from, their child that they expected, and learning to operate on the child’s terms takes some time. But quickly, the focus moves to developing the child’s skills and preserving the function of the family.


“As the child gets older, issues become more practical,” says Sanders. At the same time, “families become more isolated,” as they focus on therapy for their child with autism and seem to draw away from families that are not dealing with autism. This can be a problem, Sanders says, and he recommends that families “get involved in some kind of group outside the family,” perhaps one for families dealing with the disorder. Not only does this provide the family some support, but it helps the child to be included in interactions with others.

Encouraging and facilitating this involvement is one task that can be taken on by therapists working with these families. “Therapists need to be helping parents stay involved in the community,” Sanders says, noting the value to the child in developing communication and socialization skills.

As the child gets older, the family will experience different challenges. “As kids get older, [the focus is on] helping families give the child as much independence as they can tolerate,” he says. This ranges from interpersonal interactions to the development of sexuality to possible entry in the career world, depending on the individual. And along the way, the parent must be careful not to overprotect their child, something Sanders is aware of in his own family.  His son, he says, “has a right to fail.”

At each step, therapists and parents can work together at several key transition points. Therapists are key in helping the parents advocate for the child within the school system, something that begins as early as 3 years old as the school becomes the primary conduit for therapeutic services.

Another key transition point is at 8 years to 9 years old, a stage at which the child is developing social interaction skills. Language skills are fairly well developed at this point, and the brain is developing communications skills, Sanders says.

The next key period is middle school, a prime period for developing social interaction skills. This is a time when parents, school officials, and therapists must help protect the student from bullying, or from bullying others. They must also deal with the nexus between social and sexual development, teaching the child about appropriate boundaries, so that in puberty the child doesn’t become “an inadvertent perpetrator,” Sanders says.

Finally, high school is another transition time in which the focus turns to vocational aptitude. In this phase, the entire team sets short-term milestones to help the child reach long-term goals.

The Experience of the Therapist

Supporting a child with autism and his or her family requires an entire therapeutic team, and this is just what is available at Texas Health Arlington Memorial Hospital in Arlington, Texas. There, a team of therapists works extensively with these families, and each therapist reports their own challenges and triumphs.

One member of this team, Jennifer Gibson, MOT, OTR, explains that none of her occupational therapy goals could be as well met without the help of the family. “Consistency is the key,” she says. “Parental involvement is more important than what we do in therapy.”

Gibson invites parents into her therapy sessions, and she counts on them to repeat and reinforce her therapy activities at home. For example, Gibson works on sensory integration with her patients, by asking them to complete obstacle courses in various body positions and complete tasks that involve jumping, crawling, and swinging, all activities that require body awareness. Her target range for her practice is 3 years to 5 years old, “about when the parent says something is not quite right,” she says.


For older children, Gibson also devises activities that are easy to replicate at home, such as handwriting activities that are needed to complete a school project. These, too, are easily reinforced by family involvement and repetition at home.

Gibson does not work alone. Another member of the team is Patricia Kellum, MA, CCC-SLP, who deals with some of the most common effects of autism, communication difficulties. She establishes a baseline, and then begins to work with the child. Kellum finds that parents are almost always enthusiastic. “They want to have parent-child interaction,” she says.

Kellum uses the Picture Exchange Communication System (PECS) to begin communicating with the child, starting with what the child finds most motivating and moving on to picture discrimination activities, some of which involve the family.

“You want a parent who is eager to help you,” she says, while admitting that sometimes she has to tread carefully to counsel the parent about realistic expectations regarding speed and extent of progress. But Kellum encourages families to be “involved in whatever ways they can be.” Sometimes this means that she has the entire family with the child, including siblings. Kellum uses these moments as social skills interaction training, and she is careful to listen to parental reports about their autistic child. “Parents know their child better than we do,” she says.

Stephanie Kabat, MS, PT, would also like to work more with parents, but she notes that sometimes parents put physical therapy a little lower on their list. “A lot of parents focus on other therapies more,” she says. However, Kabat counsels them that physical therapy may allow another way to interact with their child. “They don’t have any other way to communicate than gross body movement,” she says of some patients.


In her therapeutic activities, Kabat helps children learn to “organize their body enough to sit still.” Work with sensory integration carries over into gross motor activities, and, from a therapeutic perspective, it requires that she do “a little bit of everything as far as therapy.”

Kabat acknowledges that children with autism may not be getting the activity level they need during school, so she relies on parents to integrate therapy into their daily lives. “The challenge is finding the time,” she says, so she devises ways to sneak therapy in. For example, if the child is permitted 30 minutes of television a day, Kabat finds activities that can be completed during the commercial break.

It is true that parents of a child with autism may spend time grieving over the loss of the child they thought they would have. But with a good therapy team and some time spent working together, they are very likely to find that they wouldn’t trade the child they do have.

— Jennifer Patterson Lorenzetti is an Ohio-based freelance technology writer and the owner of Hilltop Communications. Questions and comments can be directed to editorial@therapytimes.com.