Remediation vs. Compensation: A New Paradigm for Autism Treatment

In the modern landscape of autism treatment, a troubling assumption has taken root. It is an assumption that shapes clinical outcomes, dictates educational programming, and places an artificial ceiling on what autistic individuals can achieve. That assumption is that the core deficits of autism are permanent, and therefore, the only viable course of action is to teach the individual how to compensate for those deficits.

The idea that we can actually remediate these foundational areas is still very radical in the autism world. I haven’t found one paper written that talks about the potential for remediation of these areas: of neural remediation, of psychosocial remediation. It is all about whether we can teach people other ways of functioning, or just neglecting the core issues completely.

When we rely purely on a compensation model, we are asking the individual to rely on workarounds. We teach them semantic rules and rote procedures, overcompensating by using the parts of the brain that are already strong, while entirely neglecting the parts of the brain that failed to develop.

It is time for a new paradigm. We do not have to accept compensation as the end point. To truly support individuals on the autism spectrum, we must shift our focus to Remediation—a gradual, systematic process of correcting an impairment, to the point where it no longer constitutes an obstacle to reaching one’s potential for a quality of life.

Redefining Autism: A Pathogenetic Disorder

To understand why remediation is possible, we must first understand what autism actually is. People throw treatments at families without explaining what the disorder is.

Autism is a pathogenetic disorder, and the research is very clear on that. This means that the diagnosis is not defined by a permanent inability to learn, but by early vulnerabilities that result in the loss of opportunities for neural and psychosocial development.

Consider the developmental trajectory of an infant. In the first six months of life, you cannot tell the infants apart in terms of major developmental issues; they are indistinguishable from those who are not going to be autistic. However, by 18 months, and certainly by 24 months, a distinct divergence occurs. What we see in that second year is a detachment from the relationship, which is the lack of parents to be able to guide and develop a mind-guiding relationship.

These early vulnerabilities leave the autistic infant unable to take advantage of the critical learning environment that is the mind-guiding relationship. Because you’ve lost access to that critical mental and neural embedded growth environment, you then don’t develop neurally or mentally what you need to be successful in our world.

The word autism does not address what your permanent limitations are; it only addresses that because of early vulnerabilities, you lost access to this critical relationship.

The Limits of Compensation

When people do not have the benefit of this mind-guiding relationship, their brain does not develop in a way that allows them to function in the real, complex, dynamic world.

Our current intervention systems attempt to solve this through compensation. In a compensation model, you say, “This is all they can do, the stuff on the right-hand side of the brain, so we’ll just develop everything on the right-hand side”. We focus purely on social skills and academic skills based on what we already know people with autism can do, regardless of how their brain is actually developing.

The right-hand side of this neuro-metaphor represents the task control network. It involves semantic memory, deductive reasoning, concept learning, and procedural accumulation. This is exactly what traditional therapies and schools are teaching.

But what happens when we only teach these rigid skills? By the time individuals become teenagers and adults, we see this incredible overcompensation where “high-functioning” people may do well academically, because academics in our day and age only require the task control network. However, they fail to develop at all on the left-hand side—the default network, the experience control area of the prefrontal cortex—and these areas specifically do not develop or integrate with one another.

Neurologically, that person is going to be cut off from all these different areas of function: mental time travel, global processing, empathy, emotion processing, mental state awareness, contextual shifting, and intrinsic motivation. The research bears that out; these are critical, universal impairments that we see in high-functioning people with autism.

The Neurobiology of Dynamic Intelligence

To function in the real world, you must have integration. The neuroscientists have shown that as tasks become more complex and more dynamic, the brain attempts to activate both the experience control area and the task control area. That is where you see neural integration.

Interestingly, in simple tasks, these networks are what we call anti-correlated. When task control areas are activated for simple tasks like tying your shoes or filling out forms, the experience control areas deactivate. Similarly, if you are just imagining things in your head, daydreaming, or being playful without a goal, the task areas shut off and the experience management area network dominates.

Only when both are needed for complex, dynamic problem-solving do you see the brain attempting to integrate them. This integration is precisely what we see not happening in people with autism.

What you need to be successful in the world is dynamic intelligence.

• You need the ability to learn from your past experience to project yourself into the future.
• You need to be able to conduct self-dialogues, look at things from multiple perspectives, and shift your mental focus flexibly when what you are doing is no longer working.
• You need to know how to make plans, knowing that you will have to adapt them.
• You need to learn how to make sense of things that don’t make sense, to develop situational awareness, and to build a mental archive of situations so you don’t have to approach every situation as if it’s the first time.

These are not skills you can teach through a behavioral curriculum. You cannot teach these as skills because they are complex neural network integrations that take years to develop. Anybody who thinks you can just teach this bunch of skills is out of their mind; you can teach pseudo-empathy or pseudo-emotion processing using the task control areas, but the actual neuro function isn’t there, so it breaks down in any kind of real-world environment.

The Stages of Remediation

If compensation is a dead end for true dynamic intelligence, then remediation is our only logical path forward. Remediation is about providing the means for the brain to develop in a more neurotypical manner, allowing access to the entire experience management network.

How do we actually achieve this? Remediation begins with a careful assessment focusing on both the past and present.

• Step One: An initial assessment step involves trying to understand why, and at what point, development was curtailed.
• Step Two: This step has two components. The first involves identifying any current obstacles to progress in the desired remedial area, including psychological defense mechanisms which often emerge following developmental failures. The second component is determining the student’s current EDGE of competence in the remedial area.

Remedial efforts begin at this point to reduce identified developmental obstacles. Once obstacles are sufficiently reduced, remediation moves to a second stage: constructing a developmental staging plan.

• Components Analysis: A first step is to conduct a components analysis to determine the various parts of what is typically a complex, integrated process.
• Developmental Analysis: A second step is to conduct a developmental analysis in which we must deconstruct the typical developmental steps by which the more complex process was gradually constructed.

Now intervention can begin. Initial objectives are set just one ‘step’ from the child’s current EDGE of competence. Each newly developed step becomes the foundation upon which to build the next developmental step in an ongoing process of building greater complexity and integration.

Restoring the Mind-Guiding Relationship

Where is this remediation going to happen? It is very clear that these things are not part of the curriculum in schools. They are not going to be part of ABA, speech therapy, or occupational therapy.

If you are going to obtain this dynamic intelligence for your child, it has to happen where it happens for any child: in the family, with parents, through their mind-guiding relationships. It is about learning mental processes—how to use your mind as an effective tool when you are in real-world situations, which happens when parents are playing with them, learning from them, and engaging in the midst of them.

If we can restore access to this relationship, we almost have to throw out all those expectations of the outside world for a while. We stop worrying so much about grade levels and forcing kids into peer opportunities, and instead give them one-step-ahead challenges, which is how we know children actually develop. Good mind guides try to make sure their kids are not overwhelmed, ensuring they are not in environments that are too difficult or impossible for them to master.

When we establish the relationship and give them the chance to be competent and challenged in environments that are just a little bit ahead, then remediations are possible.

We are not teaching skills; we are rebuilding the foundation of the mind. By abandoning the limitations of the compensation paradigm, we open the door to genuine, lifelong neurocognitive growth.

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