These numbers are often given to describe the degree or level of a child’s challenges on the autism spectrum. While some professionals think that a Level 1 or ‘mild’ diagnosis means a child just needs a little support or a little help to ‘catch up’ and teach them a few missing skills, the truth is not that simple.  When supporting a child with mild developmental delays that lead to missing skills, the process of learning/growing/developing at a neurological level, not simply teaching new behaviors, requires the same biological process as for a child with more significant delays or diagnoses. 

Neuroplasticity occurs under certain learning conditions that require intensity (around 20 hours per week), consistency (2-4 months), active participation (the child must choose to participate), and ‘thinking’ (problem-solving, creating, adapting, etc.).  Neuroscientist Edward Taub found that a two-week intensive training period of three-hours a day seems to begin the plastic reorganization process within the brain. The only things that should vary within a treatment program for a child with a mild, moderate, or severe diagnosis are,

  • what developmental milestones/capacities should be the initial focus- what is the child’s developmental age and ability (not chronological), and
  • the duration of their program (not the intensity): 3-6, 6-12, or 12-24 months. 

A mild diagnosis leading to a mild program of 1-2 therapy sessions per week to address mild challenges is not always the right path when it comes to strengthening underlying developmental capacities and stimulating neurological growth and development. For example, a child with a mild social communication delay may be recommended speech therapy 1-2 times a week or a social group 1-2 times a week. In these sessions professionals usually teach the child missing skills and words like introducing themselves, sharing, taking turns, etc.  While that may be sufficient for that time in the child’s life, as they get older, they usually fall behind again and usually fall further. While they learned the age-appropriate social behaviors and skills at age 2 or 3, the child’s actual developmental delay was not addressed.  The concepts or core social-emotional capacities that lead to a child’s ability to socially initiate, interact in a reciprocal pattern, adapt their responses, and plan ahead were never actually strengthened.  By teaching age-appropriate behaviors, the professional created the appearance of growth, but the core capacities that would help this child keep moving forward and progress along with their peers were still missing.

Unfortunately, we see this all the time where children receive therapy early in life and seemingly attain close to or at age-appropriate skills levels only to fall behind again once they reach pre-k 4, kindergarten, or sometimes 4th grade.   The main issue is that when children are evaluated, the mild, moderate, severe diagnosis is based on missing skills and a doctor’s awareness of the present symptoms.  These diagnostic sessions rarely consider the child’s full social-emotional developmental profile.  This is not the doctor’s or the therapist’s fault since they are using the tools they were given.  Autism and ASD are symptomatic diagnoses, i.e., they are determined by looking at symptoms.  Looking more completely at the child and identifying the developmental cause of the missing skills or symptoms would uncover the need for a short but intensive program of around 3-6 months.  These types of programs can lead to holistic social-emotional growth and have been shown to decrease or eliminate a child’s need for ongoing therapy and support. 

The brain’s ability to wire and rewire itself for long-term learning involves the same underlying process in the vast majority of people’s brains. Similar learning experiences with similar intensity are necessary for neuroplasticity to occur.   One of the principles of neuroplasticity that applies to all human beings is that intense and consistent practice must be present in order to cause lasting neuroplastic reorganization. They have found that it takes around 20 hours per week for a minimum of two weeks for this process to begin.  It can take 2-4 months for this neuroplastic learning to solidify. This means if you’re trying to learn a foreign language, learn to play the piano, or develop improve social-emotional health, practicing it intensively for two weeks at 20 hours a week, which is about three hours a day, is going to be necessary to create that significant neurological growth. If you want to solidify that growth and learning, continuing that practice for two to four months will be necessary. There are more principles involved in the neuroplastic reorganization of our brain that we can discuss at another time. 

The only difference when providing intervention for these diagnostic labels should be the duration of the program, not the intensity of the program. A child with a mild diagnosis may only need 3-6 months of treatment if it’s done correctly and intensively, whereas a child with a moderate or more significant diagnosis may need 6 to 12 to 24 months of intervention. Unfortunately, we’re finding that children with mild and moderate diagnoses are getting mild and moderate programs, elongating their need for therapy, sometimes falling further behind as they chase the moving target of their peers continuing to grow and develope.   

While ABA got right the intensity of their programs, the American Medical Association (AMA) has now removed references to ABA from their autism treatment recommendations identifying ABA as the main evidence-based intervention due to claims of abuse and PTSD from individuals exposed to ABA.  While every child is different, we do need to be respectful of each individual’s neurodiversity.  The Greenspan Floortime Approach does not force a child to participate in intensive intervention.  However, by respecting a child’s individual profile, identifying and supporting their needs, and finding child-centered motivating social-emotional learning experiences where the child voluntarily and actively participating, we can ensure each child enjoys the experience while maintaining a calm positive outlook throughout the entire process. These are some of the tenants of The Greenspan Floortime Approach® and are some of the necessary conditions for neuroplasticity to occur.

As you think about your child’s program, think about the necessary conditions that all human beings must experience to develop social-emotional health and how we can encourage the brain’s neuroplastic response to learning.

  • The process must be positive where they’re learning to adapt and think, not simply follow predetermined activities or outcomes.
  • These capacities must be practiced consistently and intensively at around 20 hours per week for a minimum of 2-4 months, often longer if there are a number of areas of need.
  • The child must be an active participant choosing to participate because the process is motivating and not simply a reward or praise. 

To learn how to apply The Greenspan Floortime Approach®.  Register for the Professional or Caregiver/Parent Course at Parents and Professionals can also receive Greenspan Floortime® Expert tele-coaching with video analysis and feedback.

For in-person Greenspan Floortime® based OT, SLP, and Social Group programs, and coaching contact The Floortime Center®,