How Can We Get Her to Join With Us?

Five-year-old Samantha sat on the floor of my waiting room quietly lining up small stuffed animals into perfectly straight rows. Nothing about the silent, adorable child would, at first glance, have suggested that she was capable of ear-splitting outbursts that disrupt the whole family's equilibrium.     

I shook hands with her parents, Scott and Kimberly, then squatted down beside the child and quietly said, "And you must be Samantha."   No response.

She looked small for her age–almost fragile. Her shiny black hair was cut in a cute bob, and her pink jeans and matching ruffled polo shirt set off her olive-colored skin perfectly. She upended the tote bag and dumped out the rest of the animals. Then, as though she were following some imaginary straight line chalked onto the floor, she lined each of the plush toys in a precise row–an activity her mother had told me occupied several hours each day for Samantha.

I started to reach for one of the toys, then saw her parents vigorously shaking their heads.   Apparently, the toys were off limits for anyone but Samantha.

By the time the three of them had left my office that first day, I had heard their whole familiar and heart wrenching story. Samantha had been diagnosed with PDD/NOS (Pervasive Developmental Disorder) at the age of three. Up to that time, she had done no talking except to mimic words. She seemed incapable of generating any original language.

She spent most of her time playing alone, and expressed no interest or curiosity about the world or the people around her. As long as she was left to her solitary, repetitive play, she seemed content. But whenever anyone else interrupted to impose a different agenda on her, like asking her to come to the dinner table or brush her teeth, she erupted into noisy, dramatic tantrums.

Because of the frequency and intensity of these outbursts, it was impossible for the family ever to go out in public together. Someone always had to stay home with Samantha. Her parents had tried everything, but no amount of punishments or rewards seemed to have had any effect on the child's behavior. Kimberly and Scott were miserable and worn out, and it was clear that tiny Samantha ruled the household. Sometimes there were even unwanted comments from relatives who clearly believed that Kimberly and Scott were giving in to Samantha's deliberate attempts to manipulate.

Samantha had eventually learned to talk after the couple employed an ABA (Applied Behavior Analysis) therapist who came to their home. She learned some rote behaviors, and though she was taught how to maintain eye contact, she failed to pick up on any social cues. She seemed baffled and agitated by other people's emotions.

Samantha attended a preschool for autistic children, but she showed no motivation to interact with anyone else. A child psychologist referred her parents to me for an RDI assessment, with the hope that this might provide the missing social development part of the equation.

While Samantha showed no inclination to interact with anyone either inside or outside the family, her parents were highly motivated to do whatever they could to get help for their troubled daughter. They began to research RDI by watching the DVD, buying the book, taking the RDI parent training, and joining an online parent support group. Finally they were able to attend one of Dr. Gutstein's workshops.

By the end of our first meeting, I knew that Samantha was an ideal candidate for RDI therapy.   During the three-day assessment that followed, we went through a series of play activities, and Scott and Kimberly learned strategies for creating motivation in Samantha. At the completion of the assessment, Kimberly said, with tears in her eyes, "That's the most I've ever connected with Samantha."

The family created an RDI play area in their home, bought bean bags, and literally jumped in with both feet. They saw improvement right from the start. Soon their daughter started bringing things to them for their reactions, scanning their faces for cues, and anticipating fun together. Kimberly and Scott noticed that their play time was lasting longer and taking less effort, because Samantha was participating and contributing more. They were delighted to discover that Samantha was beginning to enjoy novelty, which included outings with the family!

Instructors at the development preschool she attended noticed big changes in her behavior as well, as she started engaging her peers for the first time.

Over the next few months, Samantha outgrew the autism school, and at the end of the term, she was transitioned into a regular mainstream kindergarten. She has left the plush toys behind in favor of interactions with real people. She's traded props for peers.