In the United States, one out of 500 toddlers are presently being diagnosed with autism spectrum disorder. Early detection and intensive treatment has been shown to be the most effective way to deal with this pervasive developmental disability. Experts in the field agree that appropriate early intervention can positively affect the child's ability to interact with his family and cope with his environment.
In the case of early intervention, Israel has a gift for us.
In the historic town of Rosh Pina in the Northern Galilee, overlooking the Golan Heights, there is an innovative and effective program for the treatment of autism spectrum disorder. Available to children under age 5, the program is called Mifne, which means Turning Point. It was developed by, and continues to operate, under the astute guidance of Hanna Alonim.
For many families who bring their child with autism to the Mifne Center, the "turning point" has manifested itself in a dramatic and long-lasting change in the child's ability to engage with and relate to family members. Over the fourteen years that the Mifne Center has been in existence, 101 families from the United States, South Africa, Switzerland, Holland, Cypress, Australia, as well as cities and towns in Israel have come for just this purpose.
Bringing a child to Mifne is a serious commitment on the part of the family. The Mifne Center works with one family at a time. Treatment starts with a residential three-week period at the Center. The family packs up and comes to Rosh Pina, staying in a guest house. During that time, the child attends full-day sessions (10 hours per day), seven days per week. Since treatment for autism is considered a medical necessity, treatment continues through Shabbat. While the family is at Mifne, a team of therapists work continuously with the autistic child, his parents (individually and as a couple), and his siblings.
Mifne's treatment approach is unique. It is based on the notion that children with autism are capable of comprehending, acquiring, and maintaining social cues when the environment is non-threatening. This provision of a non-threatening environment and subsequent engagements between the child and therapists and family members has come to be referred to as "Reciprocal Play Therapy." Preliminary data from an independent study of the program's effectiveness indicates that the children improved across the board, and some improvements were statistically significant.
In the majority of the cases treated with RPT, the core symptoms of autism were reduced to where they became mostly undetectable and no longer a barrier to social interactions.
Reciprocal Play Therapy attempts to mobilize the child without imposing demands or issuing instructions. The goal is not to teach, but rather to help the child become aware of his own being; the child is carefully protected, unthreatened, and not under order to perform as he or she might be in strict behaviorist therapy that is currently popular in the United States. The therapist responds to the child's actions, primarily seeking to please him, with the intention of increasing his comfort level. At the outset, the reciprocal interaction is heavily biased, as it is the therapist who maintains a response mode to the child while the child seems oblivious to the presence of the therapist.
In time the child begins to indicate a certain amount of comfort with this setting which is controlled, with limited stimuli and skilled therapists. To the unpracticed eye, the child spends hours in his usual manner. Therapeutically however, the child is helped through unrelenting reciprocal exchanges to trust the therapist. Trust helps the child feel confident. In time, his confidence will provide the courage to relate to the therapist.
Gradually, the therapist is able to initiate interaction and elicit socially adaptive responses from the child. The child then begins to reciprocate to the therapist's initiatives, and will eventually prompt socially adaptive exchanges.
As the treatment proceeds, changes are introduced that subtly alter the therapists' reciprocal behavior. The therapists begin to expect more. The child, feeling unthreatened, will begin to enjoy the pleasure of their interactions -- a pleasure that will give him the courage to respond.
RPT is guided by attempts to strengthen the child's sense of self so that his behavior can become an expression of his will, replacing behavior that was symptomatic. With time, his behavior becomes increasingly cognitively directed, replacing behavior that was previously impulsive.
The intense experience of the 'therapeutic incubator' at the Center causes a shift in the child's perceptions and in the family's interpersonal dynamics. At the end of each session, the therapist completes a questionnaire created at the Center that measures the child's reactions that took place in their interaction during the session.
The therapy takes place in a closed room. This treatment room is purposefully equipped, and toys are strategically placed. Attached to the room is a bathroom. The playroom is maintained uncluttered. A one-way mirror spans one entire wall so that therapists and parents can observe what takes place.
The entire nuclear family participates in the program. During this time they observe their child in therapy, enter the treatment room to work with the child at scheduled intervals, and participate in certain clinical meetings to discuss their child's progress. Family therapy and couple therapy are an essential component of the treatment process during the initial residential phase.
Supervised Home Treatment
Following the residential phase, home care continues for an extended period under staff supervision. Returning home, family members or hired therapists take turns playing with the child individually in a room that they have been helped by Mifne staff to prepare for this purpose. Each month the family films the child in his natural setting – eating, playing with siblings, in the playroom with a parent or therapist. The video is sent to Mifne and is reviewed by the Center's clinical staff who then provide feedback to the parents. This helps parents understand the child's progress, and in some instances, the regression that may be taking place.
In most cases, at some point during the home care process the child begins to attend a regular preschool in the morning. After school, he will nap and then spend several hours each day in the home-based playroom. During this phase the child often begins to show evidence of his ability to interact with peers and to acquire social and learning skills in the company of his peers. As time at nursery school is phased in, time in the home playroom is being phased out. Gradually, when deemed no longer necessary, time in the playroom is terminated. According to preliminary findings, 73% of the children who have been treated at the Mifne Center are presently attending mainstream schools.