Dr. Nancy Hoff

What pained me most about Alex’s autism was the lack of connection between us. I remember complaining to my husband when Alex was just a baby that he didn’t seem to need me the way other babies need their mothers. The eye contact, the caring to please and the enjoyment of sharing ideas and experiences together were lacking. How do you teach these innate desires - things that are naturally a part of typically developing children?

I had received a FEAT Handbook from the UC Davis M.I.N.D. Institute and searched under “Social Skills Groups/Therapy”. Dr. Nancy Hoff was listed with the description “Dr. Hoff is a board certified pediatrician who provides services for children with behavioral, developmental and learning differences.” It went on to say that she works with children ages 2 – 13 on the autistic spectrum to teach experience and emotion sharing socialization skills.

I’d heard of Dr. Hoff years earlier from some parents I met when we first moved to town. The general consensus was “She’s a great pediatrician – my child loved her!” Unfortunately, she wasn’t practicing pediatrics anymore so I couldn’t take Alex to see her. Little did I know he’d be her client a few years later.

Dr. Hoff provides play and behavior therapy based on the principles of Relationship Development Intervention (RDI). After a long phone conversation with her, I was convinced this was the program for us. My husband and I both agreed that having Alex develop the motivation and tools needed to have meaningful relationships was our number one goal.

The RDI program's core philosophy is that individuals with autism can participate in authentic emotional relationships if they are exposed to them in a gradual, systematic way. The goal of treatment is to systematically build up the motivation and tools for successfully interacting in social relationships, to correct deficits in this area that are thought to be common to all people with autism.

RDI identifies the core deficits of autism as rigid thinking, aversion to change, the inability to understand other’s perspectives, failure to empathize, and “black and white” thinking. Through therapy, parents are provided the tools to teach their child flexible thinking skills and motivation.

After a few meetings to assess Alex through parent interview as well as a few video taped sessions, we were in regular therapy with Dr. Hoff – once a week for an hour at her office in town.

I’ll never forget, after just a few sessions, Alex giving me intentional eye contact. I wasn’t seeing his usual blank gaze but a purposeful glance. He was interested in ME. I know this sounds strange, but it almost scared me. I had gotten so used to him not making eye contact with me that this spontaneous connection was a shock.

I learned so much about what motivates Alex’s behavior and how he is processing his world from Dr. Hoff. I also gained a well-experienced advocate and even mentor who has helped me navigate through the myriad of choices and issues that surround having a child on the spectrum. My learning curve was large and my confidence was low. She worked with my husband and I to obtain the skills we needed to help Alex connect.

At times I felt like we were taking two steps backward. There were some therapy sessions where he’d be so uncooperative – I mean, we’re talkin’ playing cards and plastic fruit thrown all over the place and his body plopped on a beanbag for what seemed like an eternity. Dr. Hoff would point out the positive in even these situations and would be very patient and wait for Alex to come back and reengage. I’ve had to remind myself several times that it’s a marathon more than a sprint.

Alex has been seeing her for a year and a half now and has grown in so many ways. At first he was barely making eye contact, was demanding, uncooperative, disengaged and pretty rigid - it was his way or the highway. Now, he’s wanting to play and share experiences, he takes turns, stays pretty flexible, coordinates so much better that he used to, communicates his needs, laughs and enjoys the play and he’s showing glimmers of caring about what other’s think. At home, he and his little sister are playing well together and truly enjoy each other’s company. The best part is how he wants to connect with others and, of course, that spontaneous hug.

I am awaiting the day when Alex will have such an understanding and compassion for others that he will gaze into her eyes and tell her "Thank you Ms. Nancy...for everything" with a big, genuine smile.