A sequential early intervention program for children who were diagnosed on the autism spectrum was developed in Israel at the The Mifne Center. The treatment, that uses using RPT (Reciprocal Play Therapy), was developed over a period of fifteen years of clinical research. Treatment begins with a three week residential segment for the individual nuclear family. Home based treatment follows the residential segment. Parents continue to use RPT at home with the help of a therapist trained at the Center.
The treatment rationale:
The therapeutic approach is based on attachment theory that stresses the significance of human bonding. The bonding process must be nurtured in order for infants to develop the ability to interact with the environment. The family is a living evolving organism whose health and stability depends upon the mutual support and nurturing of each of its members. When one member displays symptoms of maladjustment, the entire family is affected.
The influence of surface behavior does little to help engage the child. For profound change in perception and behavior to occur the child with autism needs to be carefully and sensitively guided toward a relationship with the therapist, parent, sibling. To facilitate the child’s social-emotional development, the method relies on relational therapy.
The therapist who is the primary adult at the beginning of treatment guides the family through changes that are in sync with the child’s readiness to respond to them.
Three criteria determine eligibility for the program:
1. The child must be referred with diagnosis of autism spectrum disorder.
2. The child must be under the age of five
3. Parent must make a commitment to participate in the entire treatment process and to continue with the home based segment following the initial residential treatment
Intervention: reciprocal play therapy (RPT):
Treatment begins at the Center with the child in intensive one on one therapy in the treatment room every day, including weekends for six to ten hours daily. During the residential segment, referred to as a ‘therapeutic incubator’ each family – together and individually is helped to understand their relationship with the child. As treatment proceeds the family is helped to understand how the child’s diagnosis and bizarre behavior impacted on their perceptions, and as the child’s responses change, they are helped to adjust to the progress he* has made.
*The male gender is used throughout for convenience
RPT is essentially adult posturing that encourages the child to discover the pleasures of human contact and communication. It presents the child with opportunities to help him discover his self.
The child is accepted non-judgementally. No expectations or demands for him to perform are made. The child is not trained or taught specific behaviors. RPT creates a non-threatening atmosphere for the child in a controlled, predictable environment with a therapist. The child’s self-stimulatory behaviors initiate reciprocal responses from the therapist. The therapist accompanies their ‘play’ with a narrative that provides a normative context to their ‘shared’ activity.
The child in treatment is free to proceed at his own rhythm. Everything moves at his pace according to his preference. This is intended to be an empowering experience for the child. The child is not directed to behave in a certain manner, but is the originator of the interactions that take place in the room. Everything in the room is potentially a new learning experience that is guided by the child during the first phase of treatment.
An atmosphere is created that is safe for the child, with the understanding that the feeling of comfort and pleasure will lead to stress reduction and will open the possibility for the growth of trust in the adults who spend many hours with him.
Rpt makes no distinctions between professions. Occupational therapists, physiotherapists, psychologists, social workers, speech therapists, etc. are trained to use the specific skills of RPT in the same manner (individual personalities will produce natural differences)
Supervised home treatment:
After the residential segment when the family returns home, parents continue working with the child using RPT. The child’s progress is monitored on a regular basis by Mifne staff who receive videos of the child in his natural setting. With each video, a clinical meeting is held to discuss changes in the child’s behavior. Parents receive feedback from the therapist who is the family’s designated consultant. The supervision helps them alter their responses.to him, and continues until the child is gradually integrated into a regular fulltime nursery school.
An outcome summary indicates that seventy-three percent of the children who were in the program are attending mainstream schools that don’t have integration programs.
The stories of three children are summarized here from interviews with their mothers:
THE B FAMILY: T AND A, DAUGHTER LEE AGE 12 AND SON OSSIE AGE 9.
Until he was 9 months old, Ossie seemed to be a healthy infant. T and A became concerned about his slow development before his first birthday. He started to walk at 18 months, which led them to believe that he was a slow developer. Soon they noticed that he didn’t react to them. A became convinced that something was wrong when he went behind Ossie and banged two metal pots together and Ossie didn’t react. By then T and A were convinced that their son needed to be examined.
At 18 months they took him to the pediatrician who said that there does seem to be a problem, and referred them to the Child Development Center where the psychologist determined that there was a communication problem and booked Ossie for a diagnosis. They were told that Ossie is suffering from PDD. They did an EEG which was normal. The pediatrician confirmed that Ossie’s disorder was sutism.
By that time he had turned 2 Â½ years old. They were told that there was no specific treatment for children his age and that the best program for him would be a clinical nursery that he could join once he reached 3. When they visited the nursery and saw the 5 children in his group who suffered from various disorders, including a 12 year old with cerebral palsy, they were appalled and decided that they would find individual treatment.
They hired a language therapist to teach him speech; a communication therapist who used picture cards to help him communicate; and an occupational therapist. Ossie had therapy 5 days weekly. At times they would hear him make sounds as if he said a word, but it was never repeated. The communication therapist used to corner Ossie to gain his attention and pressure him to mimic her sounds, but Ossie became more and more irritated and his hysterical crying increased. His behavior was bizarre. He had no speech, he would stare into space, he flapped his hands, he would drag his parents to objects he wanted, he didn’t respond to his name, he drank from a bottle, he ate no solids, and he made no eye contact.
After 6 months, when they realized that there was no progress, they stopped everything, and began to search for alternatives.
T was devastated. A tried to support and calm her, and reassured her that they would find a solution. They were both confused, wondering how something like this could happen. There was no history of autism in the family, and they wondered what they could have done to cause the disorder. Most frustrating, said T, was that there was no specific treatment that was being offered, which meant that there was no real hope for Ossie. This troubled her most. Adding to the pain was that their daughter Lee was being sidelined from all the attention that Ossie needed. Since Ossie needed her constant attention, she wasn’t free to socialize. T cut herself off from her circle of friends. Their life as they had known it had ended.
In the course of their search, they were referred to the Mifne Center.
One month after his third birthday, the family started treatment:
T “As soon as we arrived at the Center, we had a strong feeling that we were in the hands of experienced professionals. We received a warm welcome, were served lunch, and were told what the schedule would be. Ossie was taken into the treatment room immediately. For the very first time, we felt that here we would be taken care of. Ossie was in the treatment room with a therapist for 8 hours every day, and I or A would join occasionally when we were not in individual or couple therapy or in session that included Lee, who was in therapy individually with a therapist in the sibling’s room.
During the first few days, Ossie became fixated on hair. He would touch our hair in the room, and roll the strands in his fingers. During the second week, we started to see remarkable results. He used the toilet, and no longer needed diapers, he began to eat soft cheese and other solids, and we heard the very first real word. In our flat in the evenings, he didn’t drag us to objects that he wanted, but would point, or get it himself. I remember our shock when he opened the fridge door to get pudding.
We were amazed that he wasn’t pressured or coaxed into eating. He was in the treatment room, and watched the therapist eating lunch that was brought in for both of them, and he sat beside her to eat from his own dish that was set for him. At the beginning of the third week, I remember clearly that A and I were going to start a session in the treatment room with Ossie. We always knocked on the door to announce that we were entering, but Ossie never responded. This particular day, we knocked, and Ossie ran to the door shouting ‘how are you both’ using the grammatically correct plural. We were astounded (she said, crying). The next day, the therapist brought Ossie close up to the one-way mirror and made a funny face. Then he followed and made a face, and there they were communicating! Another step forward was his expression of fear when the physician who had a thick beard walked into the treatment room for the first time. Ossie had never been afraid of strangers – he never ‘saw’ them. That evening, we took photos, and Ossie smiled for the camera. I also remember that Ossie stroked a cat that week for the very first time.
Part of our therapy as parents dealt with helping us perceive Ossie as a child who with special attention, could respond to us like any other child.
After the residential segment of treatment we went home to continue Reciprocal Play Therapy in a room we set up at home. At the same time, we were advised by Mifne to enroll him in a regular nursery school. Ossie’s time in the treatment room was reduced to 2 hours daily until he was 7 years old.
When we went home, we left the Center, but the support of the staff never left us. We were reassured that we could consult with the therapists over any issue. The program helped us help our son in a professional, humane and comfortable manner. We were informed about every step of the treatment process. Parents who are shunted from therapist to therapist, from professional to professional will understand the acute importance of being in a treatment bubble, where everything relating to your child and family is open for discussion, and available for healing. We are able even now to call and deliberate with Mifne staff.
It is important for me to talk about the supportive, informed, and skilled treatment that we received.
Our lives are changed, our family was saved. The program was the best gift in the world (crying). When I think of the frantic running in all directions that led nowhere, and compare it to the peace and recuperation we found that gave Ossie the opportunity to develop his potential, there is no expression of gratitude great enough to say how we feel. ‘Thank you’ is a gross understatement.”
THE ‘S’ FAMILY:V, N, AND DAUGHTERS ROBBIE AGE 8 & HADAR AGE 3.
Hadar was born Nov 14, 1999. Her mother states the very first month with Hadar was most unusual, and she felt uneasy with this placid baby who never cried, would sleep for 20 hours in the day, and made no sounds at all. ‘V’ felt that if she didn’t wake her, Hadar would continue sleeping.
Within the next few months, the changes that she anticipated as Hadar matured didn’t occur. Extended family members tried to reassure ‘V’ that her beautiful daughter was fine, and that she should consider herself lucky to have an easy baby.
‘V’ couldn’t disregard the increasing strangeness about Hadar who refused to look into her face even while being bottlefed. No matter how strong an effort she made, she couldn’t get her infant daughter’s attention. Hadar would lie in bed awake without making a sound; at 5 months old, she didn’t respond to loud sudden noises; she barely moved; and she didn’t smile. The nurse at the health clinic examined the baby and advised ‘V’ that the child was fine, and that she would react as she gets older.
But ‘V’ couldn’t rest. She understood that babies register discomfort by crying, and Hadar, no matter what the discomfort, was not provoked to cry. She decided to consult prominent child development specialists and came away with their conclusions that the baby is fine, but the mother’s hysteria is obstructing her development. This assessment took hold, and ‘V’ became flooded with guilt, feeling that she had caused her baby’s malaise. She became depressed because she couldn’t find a way to help her child react. Self blame alternated with thoughts that her child was developmentally impaired. This led to tests that included C.T. scan, MMI, and EEG that showed negative results.
The problem became acute when ‘V’ began to alternate between feelings that her baby would never develop normally on the one hand, or that she was somehow transmitting something pathological to her baby that was causing her strangeness. ‘V’ became increasingly anxiety-ridden. She found herself trying to avoid picking up the baby in order to minimize the damage that she was led to believe she was causing.
At one point, considering that her child’s apathy could perhaps be related to a communication problem, she spoke with a friend whose family had been in treatment at Mifne. When she called, ‘V’ was told at Mifne that six months was too early to suspect a communication disorder, but she was asked to send them a video of Hadar at home, being held, being fed etc., and this very unusual case was accepted.
‘V’: “When staff received the video and reviewed it, they said they were surprised to find autistic features in a child so young. They had never had a child that age in treatment, and despite their policy of accepting only children who were referred with a diagnosis of PDD (pervasive developmental disorder) they accepted us. The second element of luck was that my husband, bless him, said he trusted me. He said that if I felt we ought to try a program that offered to treat a baby that age, that he would go along with it. (crying)
Against the advice of our families, we arrived at the Center. I was on the verge of collapse. I didn’t feel confident that we could be helped, I felt that I contributed to my baby’s problem, and that nothing could bring us out of our despair. The feeling was that this was the last stop because other professionals had offered no explanation and Hadar showed no signs of normal development. The feeling was that we had nothing to lose.
We were at the Center for only ten days. Those ten days were nothing short of an awesome wonder. That’s what it seemed to me.
When we returned home and our parents came to visit, they asked what the baby was given ! That’s not the baby that you left with they said. And that is true.
At the Center things started to happen almost immediately. First, Hanna Alonim, founder and director of Mifne agreed that my suspicions were justified, that the baby’s behavior was unusual. Just hearing this gave me the feeling that someone was listening. Someone was going to help. I was in the clouds.
I discovered that my child has potential; I discovered that when she didn’t respond to me, it affected how I responded to her; I discovered that I was trying too hard to stimulate my baby. In short, I discovered that being in treatment with professionals who understood our family’s interactions and could advise about how to proceed to bring about changes that would help our baby was what we needed.
It was at the Center that I heard my baby cry for the first time. Hadar was in the treatment room all day with a therapist, and we had many sessions individually, together as a couple, and in the treatment room with Hadar at scheduled times. She was given lots of stimulation, but at a pace that was gratifying to her and caused her pleasure. I realized that I tried too hard, and that I had to calm down and respond to her new displays of delight. I was also helped in therapy to overcome my guilt and depression.
Changes occurred so quickly. Hadar began to show an interest in what was going on around her. She learned to eat from a spoon and she learned to move her mouth and her tongue. She turned over on her back for the first time. The therapist put her in front of a mirror and she reacted when she was able to see herself as she moved about. We had sessions in the swimming pool where she loosened up and enjoyed being swooshed through the water. She started to make babbling noises. She made definite eye contact with one of the therapists at first, and then with my husband. When I started to feel comfortable with Hadar, she started to look directly into my eyes. I suddenly felt the warmth and enjoyment of giving her a bath.
My feeling is that before treatment my baby was a doll – dolls are beautiful, but they don’t react. At the Center, it was as if my daughter awoke from a coma. The staff believed in her potential and it was there that we were given a chance to enjoy each other.
Mifne is not an ordinary treatment facility. The devotion of the entire staff is communicated in so many ways. Their level of professionalism is beyond reproach. Their readiness to be there for you is exceedingly comforting, yet they have a clear commitment to help their clients avoid the prospect of dependence on the staff. I had a difficult time leaving when the ten days of treatment were over. I felt that I may not be able to maintain the steady pace of progress that took place at the Center -Hanna sensed my hesitation immediately and told me -Hadar has changed, but so have you, and now you can continue at home. What’s more, our daughter Robbie loved it there and didn’t want to leave. We left with the clear message that the staff will be there for us.
Not long after we came home I decided to return to work. One morning as I was getting ready to leave Hadar with my mother, I walked out of the room and for the first time Hadar started to cry because I was leaving. I cried too (crying).
Today, Hadar is a delightful, rambunctious, outgoing, bubbly, assertive little girl who enjoys life to the fullest. She is in a regular nursery program with children who are an average 9 months older than her – and she can manipulate them all! She is the opposite of apathetic. When I take her to the children’s theater, I love to watch her reactions to the actors because she becomes totally involved in the play. At three she already knows the entire alphabet and she counts to twenty. She is sociable, and affectionate and gets on wonderfully with her older sister who loves her.
When we went to the Center, I was filled with fear and nightmares, but we emerged with the freedom to enjoy each other as a family. My relationship with Hadar started when they trusted and supported us. The staff are skilled, and that provides the confidence needed for trust. We flourished there.
I brought Hadar into the world; the ten days at Mifne gave her life.
THE ‘L’ FAMILY: R AND P, DAUGHTER SOPHIE 9 & SON SACHA 7.
R and P immigrated from Russia to Israel in ’91, where both children were born.
R says that Sacha was a normal little boy until he was two, when the family moved in with the grandparents to wait for the construction of their house to be finished. At that time R started to work, leaving Sacha at home with his grandmother. Shortly after, the grandmother started to notice that Sacha was acting strange. He wouldn’t point to pictures in a book, he couldn’t make himself understood, he cried on the floor. He would watch T.V. incessantly. R too noticed that he was fiercely afraid of strangers, he would pull her to an object he wanted instead of pointing to it or asking for it.
When he was two years and three months old they took Sacha to the pediatrician, who told them that though he doesn’t talk, he plays with blocks and can put a puzzle together, and it may not be a serious problem, that they ought to wait and watch his development.
At three, when he started nursery school, he cried hysterically. Within a few weeks the teacher called to say that Sacha should be seen by a psychologist. Sacha was diagnosed with PDD and he was referred to a clinical nursery. When R was told that the family could apply for help for their handicapped child, she was in a state of shock. She had not thought of her lovely son as handicapped. (crying).
P didn’t want Sacha attending a nursery with other handicapped children. He believed that with proper treatment Sacha could be helped. They found therapists to work with him. Five days a week Sacha was in therapy with an occupational therapist and a communication therapist who worked with him using picture cards, and a speech therapist. This continued for six months, but it brought no results. What they did notice was that Sacha was becoming more and more angry, and used temper tantrums to get what he wanted.
Seeing no progress, R started to read about autism. She slid into depression as she realized that the literature did not refer to any treatment that held out hope for good results.
Sacha was terrified of strangers, he was fixated on cars – he loved pictures of cars or driving in cars; he didn’t play with toys but would bite objects, he babbled senselessly, and had no language. He made very fleeting eye contact. This is how Sacha arrived at the Center when he was four years old.
R: “We were not promised much at Mifne, other than being told that the treatment will help us understand his needs.
Looking back now, it is clear that we started seeing results after the very first week. Every day we saw an improvement, and every day he said a new word. I remember him saying ‘chocolate’ and I cried (crying).
The family sessions were so valuable. They taught me how to respond to him, how to set limits without giving in to his tantrums, because I had started to appease him in stores and bought him what he wanted rather than deal with his anger.
The program kept us busy . We had therapy individually and as a couple, and that helped us. Sacha enjoyed playing with the therapists. When I went into the treatment room to play with him, I realized how uncomfortable I felt. I had never played with him – I used to give him a toy and expect him to play with it on his own.
By the second week we noticed that Sacha began to understand abstract meaning. We had a birthday celebration and he understood that it was a happy occasion. For the first time, Sacha and Sophie played together. They hugged and read books together.
One evening we went to a restaurant and Sacha was able to sit with the family. He didn’t speak in sentences yet, but he was able to get his messages across using single words.
As Sacha overcame his fear of strangers and he became familiar with the therapists, he would hug them. At Mifne, Sophie received the attention that she was denied for a long time because of Sacha’s needs, and she blossomed there, and when we returned home, she asked if we could go back.
By the end of the third week, it was a pleasure to watch him play. We could see how he enjoyed playing with the cream on his and Sophie’s faces as they looked into the mirror and saw how funny they looked, and they enjoyed sliding on the creamy floor together. It was interesting to watch how RPT managed to engage our son. There was no attempt to insist that he do things. At Mifne, the pleasure of play is mutual for both the child and the therapist. And they work not only with the child, but they include the family in the entire process.
By the time we returned home Sacha was ready for a regular nursery, and several hours each day were to be scheduled for the playroom to continue with RPT.
Today, Sacha is in grade two. He gets high marks and can read and speak Hebrew and Russian. He participates in class, and after school he does karate and swimming. We can explain things to him, he can play pretend games, and he loves to say things in the reverse and laugh that it’s just a joke. He is still doing RPT for two hours weekly.
We started a new life, and we have a new son. Sacha is an independent and happy child.
Hanna Alonim, founder and director,family therapist
Danny Tayar M.D., medical consultant
Sody Naimer M.D., research consultant
Barbara Schipper B.A.S.W.
The Mifne Center is a registered non profit organization that receives funds from, family’s fees, private donors, and the Israel Government Ministry of Health .
The Mifne program was evaluated by an external team of professionals headed by the chief of the dept of psychiatry at Schneider Children’s Hospital. The paper that is now being prepared for an academic journal reports ” Children showed improvement on almost all items of both scales with differences for some items reaching statistical significance. Total scores on both scales improved significantly after three weeks and after six months. Patients with more severe symptoms at baseline showed greater improvement than the milder cases”.
3b. Picture attached in separate email.
4. Neurodevelopmental Disorders After Thimerosal-Containing Vaccines: A Brief Communication
Geier MR, Geier DA. The Genetic Centers of America, Silver Spring, Maryland 20905.
We were initially highly skeptical that differences in the
concentrations of thimerosal in vaccines would have any effect on the
incidence rate of neurodevelopmental disorders after childhood
This study presents the first epidemiologic evidence, based upon
tens of millions of doses of vaccine administered in the United States, that
associates increasing thimerosal from vaccines with neurodevelopmental
Specifically, an analysis of the Vaccine Adverse Events Reporting
System (VAERS) database showed statistical increases in the incidence rate
of autism (relative risk [RR] = 6.0), mental retardation (RR = 6.1), and
speech disorders (RR = 2.2) after thimerosal-containing diphtheria, tetanus, and acellular pertussis (DTaP) vaccines in comparison with thimerosal-free
The male/female ratio indicated that autism (17) and speech
disorders (2.3) were reported more in males than females after thimerosal-containing
DTaP vaccines, whereas mental retardation (1.2) was more evenly reported
among male and female vaccine recipients.
Controls were employed to determine if biases were present in the
data, but none were found.
It was determined that overall adverse reactions were reported in
similar-aged populations after thimerosal-containing DTaP (2.4 +/- 3.2
years old) and thimerosal-free DTaP (2.1 +/- 2.8 years old) vaccinations.
Acute control adverse reactions such as deaths (RR = 1.0), vasculitis (RR = 1.2), seizures (RR = 1.6), ED visits (RR = 1.4), total adverse reactions (RR = 1.4), and gastroenteritis (RR = 1.1) were reported similarly after thimerosal-containing and thimerosal-free DTaP vaccines.
An association between neurodevelopmental disorders and thimerosal-containing DTaP vaccines was found, but additional studies should be conducted to confirm and extend this study.
PMID: 12773696 [PubMed – in process]
* * *
4b. Picture attached in separate email
5. Exclusive Interview with Dr. William Walsh at the Autism One Conference
Exclusive Interview with Dr. William Walsh at the Autism One Conference
When I asked Dr. William Walsh, founder of the Pfeiffer Institute http://www.hriptc.org/what he thought of the Autism One Conference, he shared that “it was wonderful that 700 delegates had come from far and wide to hear such excellent speakers, representing so many different approaches, with a full range from those based on hard science to those that are soft and speculative. He felt the conference met the needs of concerned parents who are evaluating the myriad of treatment options for their child. Walsh stated that it’s wonderful they had this opportunity to learn at the conference, which provided a “crash course” on the various autism therapies. He pointed out that early intervention is essential in autism-spectrum disorders, and that parents can’t wait eight years for the studies to be formally confirmed and approved by conventional medicine. He also notes that while other conferences have had a very narrow focus in areas of genetics, vitamin therapy, bio-medical or traditional avenues, this conference offered a broad menu of potential therapies, without any apparent favoritism.
Walsh hasn’t always been focused on autism, in fact this reserved gentleman began his career in 1976 in the area of brain chemistry with a mission to reduce crime and violence by trying to help prisoners become law abiding individuals upon their release back into society. While working with the prisoners at Argonne National Laboratory, he compared the body chemistries of violent prisoners and ex-convicts with those of regular law abiding citizens through double-blind controlled studies. By analyzing blood, urine, and hair, it was discovered that there was in fact a definite difference between the body chemistry of the violent delinquents and the law-abiding citizens. The prisoners exhibited levels of lead and cadmium which were three times higher than the controls. In fact, the violent group broke down into two different chemistry types: Type A displayed a nice personality but would flip to hostile when agitated, and Type B persons who were mean and destructive all the time. He was surprised to discover that a surprising number of the prison residents came from regular, economically sound, loving households in which the other siblings turned out fine. Eventually, Walsh’s group discovered that individualized nutrient therapy aimed at balancing brain chemistry and body chemistry was usually effective in changing the lives of young children and teens, this type of intervention was relatively ineffective for adult criminals. To learn more reference http://www.hriptc.org/agressive_behavior.html
After eighteen years working in the fields of behavior disorders, ADHD, depression and schizophrenia, Dr. Walsh’s group began studying the biochemistry of children on the autism spectrum. He discovered that the vast majority of the autistics exhibited evidence of a metal-metabolism disorder involving elevated copper, depressed levels of zinc, and a crippled metallothionein protein system. He also found that most autistics were deficient in B6 and magnesium and were under-methylated.. Walsh has made much progress in the autism field and is highly respected and admired in his field for the work he is doing. You can learn more by visiting his website at: www.hriptc.org or by reading the reference articleâ€¦http://www.hriptc.org/disordered.html.