November 30, 2016

Navigating the Holiday Season: Tips for Parents and Caregivers


WV ATC's Dr. Catherine Goffreda Bailey provides the following tips and recommendations:

Although the holiday season can be a time of joyful memories, comforting traditions, and family reconnection, the inevitable stressors of the season sometimes overshadow these positives. Individuals with Autism Spectrum Disorder (ASD) are especially susceptible to becoming overstimulated by the sensory overload and increased social engagements of the season. Providing early cues of what to expect and practicing moderation are key to enjoying a low-stress holiday season. With mindful planning and understanding of the individual’s needs, the holidays can be significantly more relaxed and enjoyable for everyone.

General Holiday Considerations

§  Family Routines – To greatest extent possible, maintaining a consistent, predictable schedule throughout the holiday season and school breaks will help to minimize disruptions to the familiar routine.

§  Sensory Needs – Parents and caregivers often know the individual’s sensory needs and triggers best. Be mindful that the individual’s tolerance for sensory intake may remain unchanged during the holiday season. For example, blinking lights, musical decorations, or strong-smelling candles could be highly aversive (or even physically painful) to some individuals.

§  Involving Siblings – When developmentally appropriate, siblings could benefit from a relaxed, positive conversation about the individual’s unique sensory, social, and communication needs. It also may be helpful to discuss the family’s strategies for supporting the individual during potentially stressful activities.

§  Holiday Shopping – Crowded, noisy stores in the weeks before the holidays are overstimulating for everyone, especially individuals with ASD. Making a list of items in advance can help to keep trips as brief and organized as possible.

§  Giving Back – The holiday season is an impeccable time for teaching kindness and goodwill. Encourage the individual to help with donating toys, making meals for others, or volunteering for a charitable organization as a family.

Preparing for Special Events

§  Social Stories – Reading a social story together before new events or family gatherings can help the individual know what to expect. If possible, include photos of the people and places he or she will be visiting. The individual may enjoy helping you draw a picture of the event. (Note: See below for examples of holiday social stories).

§  Holiday Calendar – Posting a family calendar of holiday activities in a visible location may also be helpful. The calendar could simply list general events, or be very specific regarding holiday activities (e.g., putting up decorations, shopping for gifts, family movie night, etc.)

§  Fine Motor Skills – Individuals with fine motor skill difficulties could benefit from practicing unwrapping gifts with small, fun items in a “game” format in advance. Consider using colored bubble wrap as a sensory-friendly alternative to wrapping paper.

§  Practice Social Behaviors – Some individuals may benefit from role-playing holiday social behaviors, such as greeting family members or reacting to unwanted gifts. However, recognize that physical affection (e.g., hugging and kissing relatives) should be at the individual’s comfort level and discretion. Explaining this to family members in advance may help alleviate potentially awkward situations or hurt feelings.

During Holiday Events

§  Safe Space – Identifying a quiet room or location in advance during the event for the individual to decompress may be helpful. Packing a small bag some of his or her favorite items can further help to foster comfort with the location.

§  Predictability – Let the individual know in advance where you are going, who will be there, what activities will take place, and when you will arrive and leave.

§  Be Proactive – Recognizing your child’s early signs of anxiety can help to intervene early, before a potential challenge occur. Utilize positive behavior support strategies to the individual adjust to changes.

Ultimately, many parents and caregivers pressure themselves to make every aspect of the holiday season unrealistically perfect. Sometimes the most memorable events serendipitously occur when things don’t go quite as planned. Don’t be afraid to scale back, or even start a new family tradition to replace one that no longer fits your family’s needs. Finally, taking the time to restore your own energy levels and peace of mind during the holiday season ultimately benefits everyone. Wishing you a joyful, memorable holiday season from the West Virginia Autism Training Center!

Free Printable Holiday Social Stories:


Thanksgiving #2:


Visiting Family at Christmas:


Visiting Family at Christmas (Adolescents/Adults):


What to Expect at Christmas:


Hanukkah:


Going to Visit Santa:


Receiving Presents:



October 03, 2016

Happy Halloween!


Halloween is just around the corner. WV ATC's Erin Lash submits the following tips for making the holiday a little more fun for all:

  • Create a visual story of what Halloween may be like for your child, with some pictures or drawings. This will help your child prepare for the day’s activities;
  • Try on costumes before Halloween. If the costume is uncomfortable or doesn’t fit right, it may cause unnecessary distress and ruin their fun;
  • If your child does not like his or her costume, don’t make them wear it. Instead, talk about the situation with your child and try to uncover the reason why they don’t like it. After you talk with your child, they may gradually get used to the costume. Have them wear it for short periods of time and at increasing intervals over time.;
  • Consider a Halloween costume that fits over your child’s regular clothes, such as butterfly wings or capes;
  • Before the big day, practice going to a neighbor’s door, ringing the bell or knocking on the door and receiving candy.
Some Halloween participants like to hand out a card, similar to the one below, to help with saying "Trick or Treat!"


Above all else, enjoy yourself! That's what this holiday is all about!



August 01, 2016

Back To School Tips


WV ATC's Tina Hatfield, a former educator once named Teacher of the Year in her county, provides these back to school tips for teachers and for parents.

Back to School Tips for Teachers

1.    Accommodate the visual learning styles of students with autism. Providing visuals of notes, or other material the student is expected to learn, may improve academic, social, and behavior expectations.

2.    Role playing how to “think it-don’t say it” with a child may help him or her recognize when and how to speak aloud during class.  

3.    Please be very considerate before instructing a student with autism to maintain eye contact with you. Not making eye contact isn’t a sign of poor attention or disrespect. Many students describe eye contact as “painful,” or “uncomfortable.” Their feelings should be respected.

4.    Communicate with the family to learn about your student. Ask what things may trigger a meltdown, what the student likes and dislikes, what he or she is good at. Use a peer buddy for note taking.

5.    Plan for a “safe space” for whenever things get overwhelming. Providing a quite area or another room the student can go to if he or she needs to calm down may help prevent difficulties.

6.    Compliment and provide positive reinforcement even during brief, simple interactions.

7.    Develop a structured class routine. Prepare the student in advance if something in a typical routine must change.

8.    Be considerate of sensory issues. Some smells, sounds, lighting situations, etc. can cause a sensory overload. Be sure to offer self-soothing techniques that the student can use.

9.     Remain calm and patient. We are all in this together and the more support the student has, the more success he or she will have.


Back to School Tips for Parents 

1.    Start getting your child back into the school routine as early as possible. 

2.    Visit the school before school starts so you and the child can meet the teacher and get acclimated to the new classroom.  This may also give you time to talk with a new teacher about effective strategies.  

3.    Understand that not all challenges are related to autism. Your child is still a child. He or she may be acting like any child of that age.  

4.    Believe in yourself as much as you believe in your child. No one knows your child better than you know your child. 

5.    Discuss the unexpected. You can’t know everything that will happen during the school day but using strategies like Social Stories may help familiarize your child with routines, and provide tips for when the unexpected occurs.   

6.    Teach and review school related “hidden curriculum.” Go over the “dos and don’ts” of school expectations.  

7.    Establish communication early with all staff that will be interacting with your child. This is to help prepare you as well as your child for the upcoming year. 

8.    Smile! Your child loves you!




June 17, 2016

Basics Of Supporting Challenging Behavior


Parents of children on the spectrum know all too well the challenge of dealing with behavior difficulties, as well as the judgement they may receive from others during the most difficult times. Understanding “how behavior works” is not as intuitive as many may think, especially when you compound the issues inherent to people with an ASD and the assumption by many that it’s the autism causing the behavior. So what is there to do but whatever it takes to make it stop?
Turns out there is a lot that can be done!   But if you focus just on stopping challenging behavior in the moment, there is a good chance you are in fact helping that behavior to continue. We call this reinforcing it: scream for the candy, get the candy (screaming stops) but next time I will scream when I want the candy, or anything else for that matter! And while this simple example illustrates an important concept, when the person on the spectrum is having difficulties and you don’t know why, or you need them to accept a situation (doctor exam for example?), it’s neither simple nor easy for anyone.

But understanding the root cause is an important first step and this is usually called the “function” of the behavior. And while it can get more complicated when it comes to building the skills necessary to replace the problem behavior, finding the function or purpose usually takes just a little bit of problem solving and can be narrowed down to a few basic wants or needs.
Broadly speaking, you can even break it down do just two needs? Do they want to GET something or do they wish to AVOID something? And then those ‘somethings’ can be divided into just three basic categories: Attention, Tangible, and Sensory. Let’s look at these three concepts individually.

Attention: Most everyone wants positive attention at least once in a while, especially from those they love. But somehow when a person does it ‘just for attention’ we view that negatively and something that should be dismissed. If a child is seeking attention through challenging behaviors it doesn’t discount the very real and legitimate need on their part. With communication and social skill deficits a major part of the very definition of ASD it is no surprise that many wind up turning to inappropriate actions that are in fact very effective at getting attention, even if it is negative!  And again, the social challenges also mean that they may wish to avoid attention.  Hitting and screaming or yelling insults is often the quickest way to turn others away or get sent to your room!
Tangibles: These are items, experiences or activities. They want to play video games or they don’t want to take out the trash. They want to stop at McDonald’s, they don’t want the peas on their plate. This one is often easy to spot but no less frustrating to deal with.

Sensory: These are often particularly difficult to understand because people with ASD have unusual responses to sensory stimuli – what they see, hear, taste, smell, and feel as well as how they experience movement and gravity. And they are key to being able to regulate our emotions as well. And when a sensory need is denied it triggers us to go into the infamous ‘fight or flight’ mode, which often means a challenging behavior is inevitable. Knowing your child’s sensory ‘profile’ and finding ways to prevent or compensate for triggers is often the best way to approach behaviors based on escaping sensory challenges and then also teaching more appropriate and less intrusive methods for accessing sensory needs. If your child has on occupational therapist, they can be a great help in understanding their specific needs.
Once you have figured out the function of the child’s behavior you then have to figure out if there is a better way for them to meet their needs. Functional communication training for non-verbal individuals is a critical step in changing behaviors and reducing frustration. Perhaps it is more a matter of teaching specific social skills or building awareness of typical sensory challenges so that they can more successfully navigate their world.

Remember that ASD’s (and other disabilities) are never the cause of challenging behaviors. What they do cause are skill deficits! And the lack of skill is what leads to behaviors of concern. And it is much more effective and rewarding for all if skill development is the focus rather than punishing or extinguishing behavior.
 Remember if you just focus on finding that magic consequence to change behavior you are likely just setting everyone up for failure. This is because there are three parts to the behavior chain and the consequence is just the last link. You have to look closely at what comes prior to the behavior (antecedents) and focus your efforts on pro-active solutions. These can be simple but effective steps that build predictability, reduce sensory overload, embed choices or simply take into account a range of issues in the moment when setting a boundary or deciding your course of action. Remember, changing their behavior starts by changing ours.

April 15, 2016

Supporting Emotional Expression and Regulation with ASD

Bonnie Marquis is a Positive Behavior Support Trainer with the WV ATC.
 
Emotions can be tricky for many with ASD. Trouble understanding and identifying even some basic emotions both within themselves and in others is more typical than not for people on the spectrum.  So often they seem to from “zero to 60” in an instant. The reasons for that are complex and individual to each person, but on going coaching and support by a supportive parent or family member can be critical to developing this important life skill. How to express emotions and doing so with an intensity level that is appropriate for a given situation can take considerable time and effort but is a foundational social skill necessary for successful relationships of all kinds.
Setting aside a time when both you and your family member are calm and relaxed to discuss this topic can help set the stage for future ‘coaching’ when the time comes. It’s important to stress that his feelings are perfectly valid and legitimate, whatever they may be, but that you wish to help with expressing them in ways that are appropriate and are not going to lead to more difficulties and potentially negative consequences. Try to take a supportive and problem solving approach and avoid judgment as much as possible. For some it is helpful to know this is a very common with ASD and part of how they are ‘wired’.  However, for their own benefit they can and should try to learn effective ways of coping and expressing themselves.

One of the best ways to do this is to practice with role play. For some it might also be helpful to make a visual list of some potential options (just words, words with pictures, or just pictures – let them decide, with guidance if needed).  Pick just 2-3 options and talk about how and when to use them.  For example, “walks/runs with permission” or “jumping on the trampoline” are effective ways to work through anger but are not always immediately available. Try to come up with several ideas with at least one option that can be accessed in just about any situation (deep breaths while silently counting to 10 for example). Again, just a few minutes of practice, discussion and role play will help and may also be an enjoyable experience that strengthens your relationship.
For some children, expressing strong emotions is tied with delaying or escaping unpleasant activities and it is important to be aware of this – if it is truly too difficult then you should reconsider the demands or offer more assistance. If it is merely unpleasant (cleaning up after himself, basic age-appropriate chores) then allow some expression of unhappiness (appropriate choices only) but remain firm in the demands. Maintaining a calm demeanor but insisting on the completion of the task is very effective, especially if it is followed by a fun or pleasant activity when and only when the first task is complete.   

As your child practices these new skills in expressing their strong emotions it is important that you coach them along with prompts and redirection, always accepting the FEELINGS as valid, even if it appears to you to be an overreaction, while encouraging the use of proper choices in how these feelings are expressed and processed. The stronger and more intense they feel the longer and more physically they may need to convey it. Allowing this time does not mean however that you need to ‘feed’ it with attention as that can become its own reward. This is why a visual cue of a proper choice can be helpful. Obviously legitimate major upsets can be nurtured and supported as you would anyone. This is where knowing your child and making judgment calls becomes key.
Discussing intensity of emotion will also be helpful. Many folks on the spectrum have tremendous difficulty with this concept (the “0-60” thing). So if a minor event causes major upset and they are ‘over-reacting’ allow them to first express themselves and validate the feeling, but then try and see if you could ask them if they were really “more irritated than furious” or “a little nervous rather than panicked”. And this mis-match is just as likely to occur with positive emotions as well! Getting overly excited and boisterous about what most would consider a mildly pleasant event can cause them to lose the respect of their peers and further contribute to some social challenges.

The timing of such comments will be important and you may need to make a note for yourself to visit this after the emotions have subsided, otherwise no matter how you phrase it they will perceive your comments as dismissing their feelings and may not be receptive to your efforts to help. You may also want to first focus on making good choices in how to show their feelings before moving on to more reasonably match the trigger to the level of intensity.
Resources such as the Incredible Five Point Scale developed by Kari Dunn Buron can be very helpful by turning this very abstract skill into a more concrete concept. If 5 levels are too sophisticated for your learner, you can adapt it to just include 3 or 4 levels. The ATC library has several copies of this resource for registered families to access.

Everyone has challenging emotions at times and we all find ourselves occasionally overwhelmed. But being ruled by feelings beyond our control on a near daily basis is an additional hurdle no one with an ASD should face without support. Patience, guidance, and understanding of how to work with these issues will improve the quality of life for everyone and can be an important step in sustaining mutually satisfying relationships.