What is Remediation?

The word “remediation” is very important in the work my colleagues and I do with families affected by autism and other neuro-developmental disabilities, but it is a word that is unfamiliar to many people.  I thought I would take a moment this week to talk about what remediation means in general, and specifically in the realm of autism.

Let’s start with some basic dictionary definitions:

Remediate (verb) - To remedy a problem

Remedial (adjective) - Intended to correct or improve one’s skill in a specific field; therapeutic, corrective, restorative

Remediation (noun) - Use of remedial methods to improve skills; the act or process of correcting a deficiency

Dr. Steven Gutstein’s definition of remediation: Correcting a deficit to the point where it no longer constitutes and obstacle

My definition: Work ON something, not just around it

Whether you are a parent or professional, it is critical to understand what remediation is, and the distinction between remediation and compensation.  Perhaps the most common application of this distinction is in the area of reading problems.  If a child is diagnosed with a reading disability, we typically apply remediation approaches to help them learn to read.  At various points we may use compensations, such as books on tape, to support them.  However, our goal is to remediate, or correct, the problem that is preventing them from reading so they can become functional readers.  In my professional experience, I have yet to come across a situation where adults believe that if an 8 year old child is not yet reading, that we should just compensate for that and give them books on tape to listen to for the rest of their lives.  Remedial efforts are taken to get to the root of the problem and overcome the issues that are preventing successful reading.

Now take this same concept and apply it to individuals on the autism spectrum.  By definition they are struggling in many areas: socialization, communication, thinking flexibly, and the list goes on depending on the person.  What approach do we usually take to these deficits?  By and large, we take a compensation approach.  We find ways to work around these problems so that the students fit into the mold of what we do at home and in school everyday.  Our main motivation becomes applying strategies that help them exhibit what we consider to be “typical” behaviors —sit appropriately in the classroom or at church, learn academic skills, play on the playground equipment, wait in line without becoming upset, greet others when we see them, etc.  While we may also look for ways to support their communication and to improve their relationships with others, we do this on a very surface level without really understanding the obstacles that create those problems in the first place.  And, because we don’t really understand the root issues that create these problems, we resort to compensation techniques rather than remediating the root causes.

When you look at the history of treatments in the field of autism, it has been primarily about compensation.  While research on the brain and autism has continued to move forward and provide us new information, our treatment approaches have stagnated.  The methods we were using 30 years ago are still the methods being used today, despite the fact that we have a whole host of new information available to us. We now have the capacity to take what we know about the disorder of autism and how it impacts brain function, and develop new techniques and approaches that move beyond compensation and actually work to remediate (correct) the primary features of the disorder.  This is one of the exciting things about newer approaches such as the Relationship Development Intervention (RDI)® Program, which focuses on remediating, rather than just working around, the core deficits we see in individuals with autism and other neuro-developmental disorders.

It is time to move beyond thinking about treatment as merely capitalizing on strengths, and begin thinking about how to strengthen areas of weakness.  Research has shown us that autism is primarily a disorder of connectivity in the brain—with some portions over connected and others under connected.  What is so exciting about this is that we know that neural connectivity can change throughout the lifespan.  The human brain has an enormous capacity for developing new connections and changing the patterns of connectivity when given the right types of stimulation.  This is what allows us to look at autism treatment in a new light.  It cannot be merely about strengthening the areas that are already strong.  Effective education and treatment must be focused on building new connections in the areas where connectivity is deficient.  This is the essence of remediation.