December 19, 2012
October 25, 2012
July 05, 2012
Note: Many of the same characteristics that lead children on the spectrum to be extraordinarily picky eaters can also lead them to be resistant to potty training. In particular, sensory issues and anxiety over new or different experiences can be particularly vexing. These issues then can lead to challenging behaviors as the child attempts to escape and avoid the bathroom if he sees this as the cause of his/her anxiety and fear (Click here to further explore those concepts in Part 1 of Picky Eating.)
But habit training requires rigid scheduling; not only trips to the bathroom, but also times and quantities of food and drink (for health and safety, avoid excessive restrictions or pushing more than 8 -10 glasses per day). For some, watching the clock just doesn’t fit their active lifestyle or family dynamics, so it may be better to strive for more naturalistic routines such as going upon waking, before or after meals, leaving or arriving home etc.. Communicating this effectively, as with a visual cue or part of a schedule, is also critical. Facilitate cooperation with the routine by following it with a preferred activity.
Ensuring adequate fiber is also important. Given the challenges so often faced with eating, using fiber supplements, from gummy bears (not the candy) to natural fiber powders added to a favorite shake or smoothie may be the kind of creativity required to ensure they are getting the amount of fiber needed for more regular bowel movements. If constipation is an issue for your child, your challenges will be compounded by the irregularity of experience and the all too common pain and discomfort the child will associate with it.
Immediate success may not result with habit training but your initial goal is to establish familiarity and routine. The results from a regular schedule of meals and fluid intake may take time to translate into regular elimination patters. It is also true that for many, the erratic appetites and eating patterns that have persisted will be a significant obstacle, but again success should not be expected overnight and persistence with maintaining a routine will, over time, help both eating and potty training. It goes without saying that what goes in determines what comes out!
May 18, 2012
New teachers, new routines and new expectations can bring increased anxiety and stress. And although one can’t plan for all contingencies or anticipate all possibilities, plan we must. A plan – and practical, repetitive practice carrying out that plan – can serve as a strong foundation for when uncertainty and stress enter the picture.
Tips on how to prepare for the transition into adulthood:
2. Try to balance your schedule by incorporating time to have a part-time job.
3. Establish relationships with individuals in your chosen career field to make connections for future employment.
4. Start a professional wardrobe to have ready for job interviews.
5. Meet with career counselors to build a professional resume.
6. Participate in mock interview sessions.
7. Take career assessment tests.
8. Learn and practice effective communication skills to establish good relationships with co-workers and administration.
9. Identify and practice healthy ways to manage stress and learn how to respond to personal set-backs.
April 20, 2012
The following is written by Andrew Nelson, a Positive Behavior Support Trainer for the West Virginia Autism Training Center. In this article Andrew discusses self-advocacy and provides resources and information that may support individuals in learning this important life skill. Please click on words or phrases in blue below to be linked to websites about that topic.
Individuals with autism have been working cooperatively to help one another develop self-advocacy skills and partnerships. Organizations like AUTREAT , AASCEND , the Autistic Self-AdvocacyNetwork and the newly-formed Autistic Global Initiative have made self-advocacy the central focus for individuals with autism and the “culture of self-advocacy” is finally beginning to permeate into the systems supporting people with autism. Sometimes the phrase self-advocacy tends to conjure images of activists marching on governments or speaking in front of large committees to make or change laws. This is only one of the many forms of self-advocacy. In fact, a person telling someone what they would like for breakfast is also a form of self-advocacy!
Generally speaking, when attempting to assess a person’s self-advocacy skills we tend to look at 3 indicators: self-awareness, competence, and autonomy. The following definitions were co-developed with Valerie Paradiz, Ph.D. Self-awareness refers to an awareness of one’s sensory experience and needs, social tendencies, strengths, interests, and general way of being (also includes awareness of legal rights and entitlements). Competence refers to evidence that an individual has tools and strategies to effectively navigate disclosure and advocate for accommodations, according to his/her preferences, interests or strengths. Autonomy refers to the ability to advocate for accommodations in a variety of settings and situations, disclose to protect or foster oneself, use strengths and interests to integrate into cultures, and understand when to assert one’s rights.
Each person on the autism spectrum will have different levels of self-awareness, competence, and autonomy. These indicators provide critical information about what supports are needed to achieve greater success in self-advocacy. For example, a person may not be aware of her senses as being separate inputs or as having a specific label. She may lack strong sensory self-awareness. Teaching lessons can be designed to give each of her senses a name or picture and connect real world smells, sights, sounds, textures, etc. to those sensory names or icons. Once she understands that olfactory or smell experiences are connected to her “sense of smell” she can hopefully recognize and pinpoint those smells that are problematic. Hopefully, she can then self-advocate more effectively by communicating “that smell is bothering me, can we make a change”, resulting in more competence and autonomy as well.
The importance of self-advocacy was recognized in the past, however there were limited resources to help teach self-advocacy skills and teach allies how to support self-advocates. The Integrated Self-Advocacy Curriculum, by Valerie Paradiz, Ph.D., is a comprehensive curriculum that addresses both of those needs. Eleven different units are presented which range from preparing to participate meaningfully in an IEP meeting to understanding the skills needed to manage disclosing one’s diagnosis to others. The ISA℠ Curriculum has both a Teacher and Student manual, making it extremely user-friendly. One unit is dedicated to teaching individuals how to conduct an ISA Sensory Scan™. Individuals learn to scan the immediate environment to identify potential sensory challenges and then develop self-advocacy plans and scripts to address the issue. It is incredible to see people discover they have a degree of control and say in environmental factors that had been difficult in the past.
The state of West Virginia has an active self-advocacy community. Groups like People First of WV and The Arc of WV are helping to develop a strong network of self-advocates across our state, and individuals with autism are shaping that network. Also, the WV Developmental Disability Council offers a class called Partners in Policy Making which helps adults with developmental disabilities and parents of young children with developmental disabilities become familiar with the policy making and legislative process at the local, state and federal levels. On June 14th the WV DD Council is also sponsoring a WV Youth Self Advocacy Conference. Our state has a well-respected self-advocacy community, as was evident at the recent Allies in Self-Advocacy Summit in Baltimore, MD, and those of us in or supporting the autism community should network in earnest with other self-advocacy stakeholders in WV.
Finally, the WV Autism Training Center offers a variety of services and the self-advocacy of people on the autism spectrum is central in our initiatives. Individuals with autism are encouraged to share their dreams and goals during person-centered planning meetings, actively drive their college experiences, lead school meetings, direct their education at IEP meetings, co-train others in their communities, communicate their preferences, and express themselves as freely as possible. We strive to creatively and compassionately support people on the spectrum as they pursue a life of quality.
March 16, 2012
The following is written by Luke Walker, a Positive Behavior Support Trainer for the West Virginia Autism Training Center. In this article Luke discusses strategies to support individuals with ASD in improving their sleep experience.
Many parents and caregivers express concerns over the sleeping habits of individuals with ASD. In my experience those concerns often focus on: the number of hours asleep, the timeframe for falling asleep, sleeping too much throughout the day, not sleeping throughout the night, and assisting the individual in learning to sleep in his or her own bed.
Research suggests sleep problems exist for 44% to 83% of individuals on the autism spectrum, so families that express concern are far from alone. The most common reported sleep problem is Insomnia, which can result in prolonged time getting to sleep, a later bedtime, decreased amounts of sleep, an early wake time, and increased amount of awakenings during a normal sleep cycle. Sleep disordered breathing, arousals from sleep with confusion or wandering, leg movements and daytime sleepiness are other commonly reported problems.
It is important to address sleep issues with individuals on the spectrum; difficulty with sleep can affect daytime behavior, contribute to difficulties with attention, and result in increased anxiety and stress. Following are strategies that may be helpful in supporting a better sleep experience for individuals living with ASD:
A Consistent Bedtime Routine
The best approach to reducing insomnia is to develop a consistent bedtime routine. This routine should be between 20 and 30 minutes in length and occur during the same time each night to help synchronize sleeping rhythms.
Some individuals may get a “second-wind” before bed time and have trouble getting to sleep if it is too early. If it takes more than an hour to get to sleep, try adjusting the bedtime by 30 minutes to an hour.
Keep a steady wake-up time, even if the person sleeps later than usual. Keeping a regular wake-up time will improve the quality of sleep and help maintain developed sleeping rhythms.
To reduce the amount of stimulation and help calm the body and mind, avoid activities centered on the computer and television one hour before bedtime. Use that final hour to practice self-help skills, complete hygiene activities before bed, or read a story together.
A visual support, especially one that uses text and pictures to display different steps in the bedtime process, can aid in building independence around the bedtime routine. This type of support will help reduce the need to constantly prompt for the next step in the routine and allow the individual to know exactly what is required and how many steps there are in the routine. An excellent example of a visual bedtime routine schedule can be found at this link, which takes you to the Autism Speaks document: "Strategies to Improve Sleep in Children with Autism Spectrum Disorders."
If night waking occurs, avoid actions that may look like play to the sleeper. Enter the room and simply state: “back to bed”. Reinforce this desired behavior of sleeping through the night with a reward in the morning. Keep track of how many hours the individual is sleeping through the night so that both of you are able to observe progress. Changes may be slow and it can be easy to overlook small increases in sleep consistent and reliable data.
Adults and children typically wake up for brief periods several times each night to assess the sleep environment and then quickly fall back to sleep. If the individual with ASD cannot fall asleep alone, he or she may visit you for assistance during the night when these awakenings occur. As a result, both of you may feel less rested in the morning.
Allowing a child to use a bedtime pass may also be useful. This is an object or card that can be exchanged (for a hug, a kiss, a drink of water, time with a parent etc.) one time during the night. You can supplement this with a reward strategy for not using the pass, such as gaining a sticker or smiley face for every unused pass and earning a trip for 5 smiley faces.
The Use of Medications for Sleep
Some consider using medication as a sleep aid when behavioral strategies have been unsuccessful. The decision to use medication is a highly pesonal one, so it is important to consult with a physician about the possibility before medication is used. If the decision is made to use medication, it is important to pair the use with behavioral strategies, and to discuss with phsyicians the idea of starting doses at the lowest therapeutic level, as individuals with ASD may be less able to communicate effectively any side effects they may be experiencing. A Melatonin supplement has been used successfully to treat insomnia in individuals with autism; a dietary supplement, Melatonin is easily available and has few side effects.
A Personal Perspective
Embedded below is the video: Insights from an Autistic: Insomnia & Sleep Problems. The video narrator provides insight into why he experiences challenges with sleep, and offers tips on how to overcome those challenges. While these insights and specific tips may not apply to everyone, they reinforce that consistency and a method to reduce anxiety are integral to success.
January 31, 2012
Video modeling is a way of providing a visual to help explain a situation, provide rules, routine, teach a new skill or display important information. It can provide a model to the viewer of how a skill is completed or what a new environment will look like. Individuals that already enjoy watching videos, have basic imitation skills and are visual learners can benefit greatly from a video model. It is a very non-invasive way of teaching new skills and behavior.
Video modeling is based on the principle that many of our behaviors are learned from watching and imitating others. By watching someone who serves as a model, individuals may learn skills needed to obtain a goal or achieve an outcome - and then they may act as a guide to another observer!
Video models are often an excellent fit for individuals with autism spectrum disorders as, typically, computer time is reinforcing, visual learning is often preferred and videos can be individually tailored.
Step 1: Planning
The first step for creating a video model is to plan exactly what you are going to teach the individual. Choose a behavior that is purposeful and meaningful to the individual. Define the behavior you wish to see, e.g. “Fred will brush his teeth before bed."
Choose the most appropriate type of video model you will use for the individual. Who will be the model? Will there be music or narration? Can you use pictures to supplement the video?
Next, break down the skill into steps and plan each different “shot”. Will there be a script for the model to read or actions to perform? What will these be?
Step 2: Filming
Record the video following the steps of the skills you planned earlier. Record several “takes” of each step and don’t be afraid to record more than you need. This will help with editing the video later. Be sure to keep the original footage in case you wish to make changes later.
I personally use a flip video camera for all of my video models. It is easy to quickly record and the image is often bright even in low light situations. I import it through the flip video software when I plug the camera into the computer, onto my hard drive.
Import your video into an video editing software so you can edit and trim the footage to remove mistakes and prompts. I use Windows movie maker for my video models as it is quick and easy to splice together a series of short video clips, loop, add music or narration, text to the screen and a number of other handy features. You will need to convert the video from the flip share program using the options to share it on media sites like youtube and Facebook. Follow the prompts and there will be a choice to allow you to save the file to the hard drive.
You want the video to show the ideal skill demonstrated without help or prompts. Be aware of how long the video is and whether it is suitable for the learner or not. A short video that loops could have more impact than a 2 minute video with many steps. At this stage add a title, text to the video and credits. Personalize the video for the individual so that they can take ownership and excitement in it.
Step 4: Show time
Some things to consider once you have finished your video:
How will it be watched?
- Will you have a computer easily available or a DVD player at home? At school?
- Is a portable DVD player suitable?
- Upload a secure video on a video sharing site?
When will it be watched?
- A set schedule each day?
- Directly before the time the skill is to be performed?
- When needed to correct the learner?
- Can it be shared with parents to be shown at home?
5) Review and tweak
Assess whether the video is improving the skill by taking more footage of the current skill level and comparing to the original footage. Is the individual able to complete more steps than before? Are fewer prompts required? You could show the video and then test the learner 3-5 times at the skill and record the results to see if there is an improvement.
If positive results are not seen adjust the intervention.
- Increase the number of viewings
- Increase video loops
- Change medium
- Show video at different times of day
- Prepare visual prompts from video to aid follow-through.
Be as creative as you wish with the videos you create as long as you remember to personalize them to the individual. There are many different factors to consider and many different decisions to make when creating a suitable video model so get to know the individual’s preferences, preferred learning styles strengths and weaknesses as you plan the video.
Here's one example:
January 10, 2012
Many of the same questions are asked by parents soon after their child has received a diagnosis on the autism spectrum:
Where do we go from here?
What do I do next?
What is the best course of action for my child?
There are answers to those questions, although finding answers to fit the individual needs of a specific child isn’t always simple. The Internet can provide a plethora of information, suggestions, and potential answers. Google "autism therapy" and 32 million hits are found!
How can any one person or family sift through this sea of information?
Fortunately, there are specific therapies that are accepted as best practice for autism. Therapies with this label are considered the best of all available treatments to significantly make a difference. In addition, best practice methods are scientifically sound and empirically tested. Many different scientists, professors, therapists, and other professionals have proven through research that these therapies make a significant difference in the lives of individuals diagnosed with an autism spectrum disorder.
So, what are these best practice therapies? This article will cover some of the better known interventions.
The most well-known of these is Applied Behavior Analysis, or ABA. ABA is a systematic and scientific approach to understanding how behavior is affected by the environment. Through data collection, observation, and interviews of family and teachers, the ABA method allows for a hypothesize to be formed regarding the function of maladaptive behavior; then that hypothesis is used to create an intervention to reduce the challenging behavior. For instance, Sally may often scream out in class at what appears to be random times. After collecting data and observing Sally’s behavior, her teacher notices that the screaming occurs mostly during group instruction but not during one-on-one instruction. As a result, she decides to ignore Sally when she screams out but praise her when she raises her hand. Soon the teacher notices that Sally is hardly ever screaming out during group instruction.
ABA is sometime confused with Discrete Trial Therapy, or DTT. DTT is a type of ABA therapy and it is best associated with the research of Ivar Lovaas, who had success utilizing DTT interventions to teach skills to children diagnosed with autism. DTT can be utilized to teach a child each of the small steps involved in learning a skill in a systematic manner repeatedly to gain mastery. For instance, Billy is learning how to follow directions, so his teacher starts with one-step directions. While sitting at a table one-on-one working together, the teacher says “stand up,” and waits for Billy to respond. At first he needs some help with understanding her request, so she prompts him physically to stand up. After a few more attempts with this specific instruction, his teacher is able to fade the prompts to simply a gestural prompt. Eventually, Billy is able to follow the direction numerous times successfully with his teacher and mother. This skill is considered mastered and his teacher moves on to the next direction and eventually to two-step directions.
Because Billy’s teacher is very well educated about Autism and ABA, she also knows that she must utilize Natural Environment Training, or NET, to truly master this skill with Billy. NET is similar to DTT but takes place in a more unstructured fashion. This helps Billy generalize the skill he has learned across multiple environments (instead of just the table) and people. For instance, now that Billy has mastered the skill through DTT, his teacher may begin to give the direction in the lunchroom, at circle, and at other appropriate moments, or ask other adults at school to also give the direction to Billy in order to generalize this skill into real world situations.
Another best practice technique is Positive Behavior Support, or PBS. PBS grew out of ABA from a desire to be more person-centered and antecedent-focused. PBS utilizes the same behavioral principles established within ABA with the understanding that it is important to focus on improving the individual’s quality of life, creating interventions that mesh well with the family’s value system, and focus more on preventing the things that happen before the behavior (the antecedents) rather than using consequences to reduce the behavior. For instance, if Timmy has been hitting his classmates and a functional behavior assessment (FBA) revealed that he did this in order to get attention, PBS would focus more on teaching Timmy to request attention in a more functional manner, such as using verbal speech, PECS, or sign language instead of using a consequence strategy such as Timmy loses 5 minutes of recess every time he hits another student.
There are some other interventions and techniques that were not discussed within this article that are considered best practice,and perhaps we will cover them in a later article. However, it is very important to understand whether a proposed intervention or therapy is considered “best practice” before beginning treatment. This link leads to a document that includes an evaluation of many common interventions for individuals diagnosed on the autism spectrum. The National Professional Development Center On Autism Spectrum Disorders also provides detailed information on best practice methods and guidelines. That site can be accessed at this link.
It is important to refer to guides such as these so that everyone can be a knowledgeable and responsible consumer. Additionally, it is important to ensure that a variety of the “best practice” techniques is utilized with each individual to ensure skills are learned and generalized across environments and that the individuals life is one of quality.