SpecialNeeds.com

Dr. Gil Tippy, co-author of Respecting Autism and a founder of the Rebecca School in New York, talks to SpecialNeeds.com about his book and the philosphies that the school was built upon, many of them Dr. Greenspan's legacies.

SN: Dr. Tippy, congratulations on the book. I very much enjoyed the way you and Dr. Greenspan make autism accessible to those who do not necessarily understand it or maybe have not had very many experiences with people on the spectrum. 

I wanted to ask you about the title, Respecting Autism. Was your and Dr. Greenspan’s goal in writing this book really about teaching people to respect the way people with autism communicate?

Dr. Tippy: Our notion here at the Rebecca School, and really Stanley Greenspan’s notion, is that everything starts with respect. Respect really means that you’re following a kid’s lead and not imposing what you imagine what the kid needs on the kid. We are a developmental model, so obviously we have an idea of where we think kids develop. But it all starts with asking what is this kid interested in and how can I be in a relationship with him? Respect also means, for instance, we don’t wipe kids noses without asking their permission. We think kids have the same or even better ideas than we have and their thoughts and desires need to be respected in a way that we would respect anybody. So I thought, let’s call it “Respecting Autism.” Let’s put it front and center here and make it the major issue because that’s one of the major ways in which DIR (Developmental, Individual Difference, Relationship-based therapy) differs from other models.

You know, we see everything as a communication or an attempt at communication. I was just lecturing at one of the universities here in New York this morning and someone asked me, how do you say to an applied behavior analyst, what are you going to do with a challenging or inappropriate behavior. I got a chance to say, well, we see every behavior as a communication. It’s more important to us to understand what the child is trying to accomplish or communicate so we can then help them do that so they don’t have to do the behavior any more, rather than extinguishing behaviors. That’s not what we’re about. So planned ignoring or punishing is not what we do.

SN: This book was written during the third year of the Rebecca School. What year are you in now? 

Dr. Tippy: The Rebecca School is in its sixth year. When Stanley Greenspan is your co-author�"he had very high standards. He wanted things to be perfect. I think we’re doing really great work. As we go along the school gets better and better and we know what we’re doing a little bit better. Nobody had done exactly this before, so we started at zero. Dr. Greenspan consulted from the first moment the school was talked about. We have 115 kids. The youngest is 4 and the oldest is 21.

SN: Do you help children transition out of school? 

Dr. Tippy: Starting at 16, we begin transition planning, even if you’re going to be here until age 21. The nature of the program changes. It becomes more of a transition program, which is not to say that we’re not doing DIR, but we’re tackling some of the goals that you need to tackle for kids who are leaving the program. When you hit 21, services drop almost to zero, so you’re not going to get treatment anymore. We see it as our job to make sure that we leave kids in a position where they can make the best use of the resources that are going to be available to them after 21.

SN: How do the kids do once they leave?

Dr. Tippy: The kids who leave here have gone to less restrictive environments and done really well. Kids make a lot of developmental progress here, even the kids who really have slow curves on their development do beautifully well. So I would say in general kids do very well. We’ve had plenty of kids who left here and went back to less restrictive settings, or in some cases typical settings with their neurotypical peers, but we take kids across the developmental spectrum. One of the things we decided when we set up the school was we wouldn’t just take kids who could be classified as higher functioning. So we take kids whose parents would have told you they were blind and deaf when we met them. That’s how unresponsive they were. And we take kids who would probably be the valedictorians of their high school class. So we take kids across the developmental spectrum and we take kids across the socioeconomic spectrum, as well. We didn’t want to be one of those “rich kid” schools. You know, we have families who live in shelters, and we have families who certainly live in the Upper East Side here. That’s been important to us all along and we’ve sort of stuck with that. But the kids do report doing well. 

SN: It was interesting to learn from the book that so many children with autism are diagnosed at the beginning of third grade due to the shift from memorization in school curriculum to more abstract ways of thinking.

Dr. Tippy: Kids are getting diagnosed earlier and earlier, but kids really begin to show up as having struggles�"particularly kids who have sensory processing issues or don’t have autism disorders that are more prevalent when they’re younger�"those kids show up at second and a half grade. The reason is the curriculum really shifts from memory to abstraction. So for us, we think of things developmentally in milestones. The milestone that the kid needs to get to in order to get to third grade or to really function well in a typical American classroom is the level at which he begins to be abstract. That includes fantasy play, opening and closing circles in a relationship with somebody in a much more continuous and problem-solving way. As I said in the book, one of the prominent developmental pediatricians here in New York, after a lecture I gave said, “Oh my gosh, I never realized why everyone was getting referred to me at the end of second grade.” And it’s because these kids aren’t abstract and the curriculum in the third grade requires that you think abstractly and begin to think multi-causally. I see it in my private practice. You see it everywhere: kids who are just very inflexible and don’t want to take on new experiences begin to withdraw at the end of second grade, maybe begin to hit, or become the focus of the attention of the school psychologist. It’s not so surprising when you know a little bit about child development or if you ever met Stanley Greenspan. 

SN: So can all children on the spectrum become abstract thinkers with the right treatment?

Dr. Tippy: You don’t know how far a kid is going to go. Generally we very early make decisions about how far kids will go and that’s the mistake. Because even kids who have not had good treatment, have not had respectful treatment until they’re 15, make tremendous progress with the right treatment program. So it is always a mistake to sell a kid short based on what you think their diagnosis is. Kids do beautifully well. One way to think of developmental challenge is parents get told all the time, you only have a certain amount of time and then the window closes and your child isn’t going to learn to speak. Parents take that to heart. They get freaked out by that. But another way to think of developmental challenge is that the window stays open much longer. So a kid who might have really closed his language window by the time he’s 5 years old�"If he’s developmentally delayed and he’s 14 years old�"he may still be in the mode where we can make meaningful change for him. While I’m not sure every kid will be an abstract thinker, I do think that kids make gains and they can make gains throughout their life. We’re even talking about adults here. Take an adult who has had sort of so-so treatment throughout his life and is living in a group home supported workshop kind of life right now. Those guys will make tremendous change in the right program. So I don’t even think the window is closed for adults. Everybody’s got it inside. We can work on it.

SN: Is the proper treatment toward abstract thinking about implementing choices in everyday life?

Dr. Tippy: One of the things people say about kids and adults on the spectrum is that they have trouble initiating or generating their own thoughts, so one of the strategies you could use is to offer choices. That is not a DIR strategy, that’s just a regular strategy. Parents do it all the time. So do speech and language pathologists. The problem is kids on the spectrum who are using their good memories to get by are really smart about what to say. So even if they don’t really understand how to use language effectively the way you and I do abstractly, they will listen to what’s being asked and they know that the last thing you said is what they should repeat. That’s the concept of echolalia. So if you say to a kid, “Well, do you want a peach or do you want cookies?” The kid will say “cookies” and you’ll think they made a choice. But it is often said that kids on the spectrum have echolalia so Stanley always used to say, give the kid the choice he doesn’t want second and then honor his request. So you might say, “Do you want cookies or do you want to skip dessert?” And the kid would say “skip dessert” and you would honor that request. Then the kid would look at you like, what are you doing? I want cookies! But that’s how you very nonbehaviorally get kids to begin to realize that what they say actually has meaning. 

Fantasy play is how kids develop abstraction. It just is. So when you see your niece or nephew sitting down at the dollhouse with a very elaborate fantasy, going back and forth, it doesn’t even have to be logical so long as there’s a story and it’s fantasy based. That’s where they begin to develop the notion that there are things other than the things directly in front of them. And that is where I think other interventions fail because other interventions spend a lot of time having kids pointing at things and naming them. Kids with good memories are exquisitely good at that, but you want kids to begin to think “Well, what is it that’s not directly in front of me that’s taking place in my brain?” You want them to become a poet of their feelings and you want them to imagine that other human beings also have thoughts and ideas in their heads. It’s not an easy thing to do. Neurotypical kids do it kind of fluidly, but that’s what Floortime is about. It’s about getting down on the floor and playing with the kids with a developmental model in your mind and getting them into the really rich and beautiful world of fantasy, which is how kids figure out abstraction. It’s really interesting.

SN: Dr. Greenspan was known for developing the Floortime method, but I saw a video of you online speaking about how Floortime “all the time” was never his intention.

Dr. Tippy: Dr. Greenspan used to tell parents to do six 20-minute sessions of Floortime a night. And if you think about what modern life looks like, it’s so difficult. I see probably five or six families a week for the first time, and I always tell them, “Ok, Dad, what do you like to do with your son?” And then I talk to him about those very physical aspects that he’s doing like picking him up, spinning him around, tickling him, which might be related to what an occupational therapist would do. Or Mom, I saw that you got down on the floor and you were playing with some toys. But you picked up the cow and said to your son, “What do you want the cow to do?” He has no idea abstractly that he should be playing with these things, but if you would just voice the cow and be the cow, your kid’s going to look at you funny the first 20 times, but pretty soon he’s going to pick up a dinosaur and squash your cow and now you’re in it. So I begin to coach them. You can have some fun here. You already want to be with your children, go ahead and be with your children. Mom, you have to cook breakfast. Let’s make this a Floortime activity. So your child really likes to be around you because they really like to eat breakfast. You say, “Okay, we’ve got the bowl out, we’ve got pancake mix. What are we going to do? What’s next?” Instead of saying, which I think most of us typically would, “Go to the refrigerator, get some eggs, We need eggs now.” The kid really wants pancakes, so why not just say, “What are we going to do?” And it’s that awkward kid-not-knowing-what-to-do but thinking intensely, “There must be something she’s asking me” that is the work. We so want to make things easy for our kids, and even neurotypical kids have lost the ability to think and to problem solve. I used to run the counseling center at a college and kids would call their parents to try to answer my questions. They just didn’t know what to do unless their parents tell them what to do next. So I’m just suggesting we do that with kids on the spectrum as well. Just make the effect big, make it fun. Generate an idea. That’s the work. So you can do it and you don’t have to do formal sessions.

I have a kid in my private sessions right now where I told the mom to take him to the grocery store. He’s having terrible outbursts at school and he’s a very smart kid. He’s 14 years old and what happens now in the special education system is you begin to get into smaller and smaller classes with increasingly severe punishments. All of a sudden you’re on behavior plans and you have a token economy and you have to earn your rewards. I said to Mom, take him to the grocery store with a shopping list and have him push the cart. Say to him, “I’m with you, and I’ll support you but what are we going to do?” Make him negotiate visually and spatially the store. Because his problem is he’s not abstract and he doesn’t even understand where his body is in space. He can see the trees very clearly but he can’t see the forest. So she’s done it and things have really begun to change simply from the kid having to generate ideas. It’s really remarkable how easy all of this is, and you don’t have to invest in one-on-one therapies with guys who are taking elaborate data and doing all kinds of crazy stuff. You can do this work with some support and knowledge because it’s the way we want to treat our children.

SN: Many people are in support of using technology, such as certain iPad apps, to help their children on the spectrum communicate.

Dr. Tippy: We are vehemently against a lot of the electronic stuff. We don’t think there’s room for young kids to have iPads or to be playing as many video games as they are, or watching as much TV as they are. It’s not good for kids on the spectrum. It’s probably not good for neurotypical kids either. Technology needs to interface with an adult, not with a kid. And yet, every school district in this country is being sold on the idea that Apple is somehow going to save them and make things better. In fact it’s just making the kids that I work with, on the spectrum, worse. That’s not a popular position, by the way. But the truth is that the technology is hurting the kids.

SN: I wanted to ask your advice on how to go about disciplining a child on the autism spectrum. Should you discipline them at all, or should you do it in a way that’s different from disciplining a neurotypical child?

Dr. Tippy: You should discipline them exactly in the same way that you discipline neurotypical kids, with this one caveat: You should be paying attention to their developmental level. So if a kid who is 15 years old is only functioning like a kid who can open and close some circles but who’s not really fluid at that, it means he’s not yet abstract. If he’s functioning at that level most of the time, disciplining him with something meant for an abstract kid like a token economy won’t work. It’s nonsensical, but disciplining him the way you would discipline a 9 month old,  well, okay. You can’t go near an electrical outlet. You know, it’ll kill you, so you have to stop that behavior. So long as you’re thinking it has to match developmental level, not age, I think most certainly you have to discipline kids. You should have time outs. There are times were time outs make sense. But the time out has to be appropriate for a kid who is developmentally at an earlier stage.

SN: You mentioned opening and closing circles both in our conversation and in the book. Can you explain a bit more what that is?

Dr. Tippy: The open circle could be a look, a nod, a gesture, a word, a question, any of those communications. Some of them are subtler than others, but they are ways of opening a circle. Kids on the spectrum are better at closing circles than they are at opening them. So usually you’ll say someone’s name, they’ll look at you. Your saying the name is opening the circle. Them looking at you is closing it. Or a kid might just look at you and you know because you’re in it with the kid, “Oh, you want something from me.” The more fluidly you can do that, the higher you are developmentally. You can always get kids’ attention by doing certain things and we can usually get a kid to close two or three circles. But in order tor really function�"well, think about how many circles you and I have opened, right? You ask me questions. I close them. Until you can get to that level of fluidity, there’s a lot of steps in between.

SN: Can people contact you or the Rebecca School for more information about the work you do there?

Dr. Tippy: If you call us and say, please help, we will be glad to do whatever we can. That includes my spending some time talking or trying to find services for you, trying to give some direction to go in to find what you want. We want to be a community resource. From the beginning of the school, we’ve taken it seriously. That’s one of the reasons why we wrote the book because right now we’re full, so it’s not even about us getting kids here. It’s about us trying to get the word out that there’s another way of working with kids.

SN: Have you gotten any feedback on the book yet?

Dr. Tippy: The feedback I get from parents is, “I thought this was just me, but I read about this kid, and it felt like you were telling my story.”

I was glad that Stanley trusted me enough after he passed away to finish this [book] up and put it out there. It’s nice to hear his voice as well, because this is one of the great thinkers in child development.

For more information about Respecting Autism and the Rebecca School, visit their website or call (212) 810-4120.