PRACTICAL ADVICES
What to do with your infant displaying signs of pre-autism (for more on recognition of pre-autism click here):
Hold your child on your lap, while you are comfortably sitting on the floor your back supported, with your legs bent, baby‘s feet against your chest so he cannot escape your gaze, face and emotional expressions. Engage in singing, massaging, activating toys such as puppets, toys with light/sounds, playing Peek a Boo, catching each glimpse of interest from your child and building on it. Optimum positioning for the baby implies that her/his body is supported to reduce the difficulty in motor planning, the general discomfort and anxiety. Face her/ him. (Baby on her/his back in bathtub, on rug, in hammock).
Try to engage your baby as often as possible. Impose interaction with your child, at least 8 times a day, for as long as he can sustain the intrusion in his world, or as long as you can creatively attempt to engage your child . Do not talk constantly but vary intonation, tonality, pitch, rhythm in your speech. Be sometimes silent and observe your baby in order to modulate your responses ( be reciprocal as much as possible) . Use massaging, playing in bathtub, bubbles, water mattress, rolling, divers motions with baby's limbs, trying to understand your infant's rhythm and to disrupt it slowly with reciprocal, gentle babbling, talking, silence, gaze tracking. Try blowing air on her/his body, tickling, rocking, squeezing. Vary approaches according to the infant’s reactions.
To reengage a withdrawn or hyper reactive infant takes time, patience, innovative approaches. Do not let discouragement take a toll on you. It is understandably painful to feel rejected by your child . Remember that your infant reacts to his environment the way he does in response to inner difficulty regulating his own perceptions and not due to the fact that you are a bad parent. He needs your help learning to better integrate his perceptions ( of self and of his environment) which will allow him to discover the pleasure of relating.
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What to do with your toddler or your young child diagnosed with autism (for more on autism click here):
Remember that, as for typical children, there are no two children alike and in spite of an Autism Disorder your child is first of all a child and needs your support and love.
He is the one suffering from a disability and he needs even more than a typical child that you become his facilitator to access and comprehend the outside world. His disability is why he is is acting strangely and in a challenging manner. He cannot be blamed for his disability neither can you. He can be helped in order to reach his potential. Children with Autism have to be shown in a very explicit way how to behave. This can be done addressing their various needs and capacities, steps by steps.
Autism being such a complex disorder, is better approached through as many angles a possible. Keep a very open mind but reappraise constantly your child’s needs and monitor the progress and the regression closely. A team approach is much more effective than many parallel approaches. Target which behavior the child needs to enhance or diminish and ask the therapist to develop a strategy for it, which has to be shared with all other therapists. Do not set goals to high, trust yourself as being the one who knows your child best.
- Whatever the therapist, the theory, the child should be engaged in social interaction as much as possible throughout the day. Joint attention has proven extremely effective to increase availability for learning, and social awareness. Due to the brain plasticity of young children , very early intervention is highly recommended..
However remain wary of therapies that could jeopardize your child's health, therapies that have not been subjected to any independent and scientific evaluation, and and overall of extremely expensive therapies. If they had proven useful, their use would have become more generalized and their cost would have diminished.
Words and names are most of the time meaningless for a child with ASD. Use few of them, make few demands. They should be followed by clear, consistent and predictable consequences.
Do not repeat a command more than twice, then help your child comply with it and praise him when it is completed no matter how much you both struggled to do it.
Associate the child’s name with something enticing, or do not use it. He will then start to pay more attention to it being called.
Children with Autism often have amazing and unusual visual processing’s skills. They may appear to have a tunnel-like vision but they often scan their environment very methodically , though not as a whole but as a succession of details . They use small and not relevant details to recognize an object or a person. The child might be fixated to a very small detail to identify the safe food or environment. Always teach your child in a variety of environment to allow him/her to generalize the use of an acquired skill.
Eyes have a very aversive quality for children with autism. Accordingly eye contact is painful to sustain which hinder their ability to learn language and social codes through observation and imitation. Better to ask them to focus on somebody’s nose., or on an object held at face level.
The best way to extinguish an oppositional behavior is to (pretend! to) ignore it. For example: Give no eye contact, no word, while you stop your child from climbing the window sill. Redirect him/her to an appropriate activity and then praise him/her.
Try to be consistent! Celebrate every victory. You sometimes might feel helpless as children with Autism (as well as typical children) grow with regression, plateau, challenging behaviors, but remember they also have wonderful breakthrough, a unique quality of love and they offer another view of the world , of life.
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What to do to improve your child' sleeping patterns (for more on sleep disorder click here)
Severe sleep disturbances experimented by a child impact drastically his/her parents ‘general health and stress level. The child’s sleep disorder can rapidly turn to be a family sleep problem. Many parents of children with autism are severely sleep deprived, which can cause depression, eating disorder, poor and non productive communication with spouses, ( blaming each other….).
Suggestions
Some medical issues to be ruled out:
Sleep apnea: breathing pauses when the airway is obstructed : the enlargement of tonsils or adenoids is a very common cause of the blockage. Some other symptoms could be snoring, sweating, restless sleep, night waking, coughing.
Night terrors and "confusional" awakenings. This could be part of a general sensory processing disorder very prevalent in autism.
Upper respiratory tract infections
Allergies, and gastro intestinal disorder
Environment adjustments:
Temperatures. Your child may have a different temperature appreciation system than yours. Observe what temperature he/she may seek during day time
Tactile sensitivities. ( fabrics, elastic, seams, being covered or uncovered, light or heavy pressure provided by bedding)
Noises. Some sounds can be very disrupting to your child, ( fan, water running). Try providing a consistent sound the child likes. Silence does not exist…
Visual stimuli. Soft light. Avoid moving shadows that are difficult to interpret for your child
Routines:
Use a visual schedule: explain the different steps by showing pictures (e.g., undressing, pajamas,. brushing teeth, going to bed). Have this schedule posted on a wall.
Set bed time ( reasonable neither too early , nor too late. )
Decrease arousing with sensory based activities before bedtime (e.g., soft music, few words, massage with lotions, book reading).
Say "good night"…
Try fading your implication in your child's night awakenings. Your child will not sleep through the night immediately and perhaps not through every night but he/she can feel secure enough to bear with his own awakenings during the night without your presence at his/her side. When your child is upset : wait a few minutes, go into his/her room to check on him/her.
A check is: no longer than a minute, gentle touch, gentle reassurance e.g., ” you are fine, it is bedtime”. Leave the room. Set a number or frequency of checks that you will feel comfortable with ( minimize your guilt and anxiety level), and try to stick to it.
Decrease the checks frequency regularly within four days. Note the length and intensity of cries during awakenings.
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Celebrate each little victory.. With a great night of sleep. You deserve it.
Remember:
It is much harder on the parent than on the child,
It usually gets worse before it improves. ( three to four days)
Trust your child to be able to go through the night by himself. Trust him/her to be able to regulate.
Remind yourself that it is for your child ‘s benefit. Autonomy in the capacity to regulate emotions is a great gift..
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Engaging your child in gross motor activities
Teaching body control through body imitations targeting social skills and communication.
Starting with large motions then expanding with exercises involving fine motor motions to build up the capacity to observe, imitate, plan and control motor response. The last step involves promoting sounds production through imitation which requires control and awareness of breathing and lips, tongue jaws motions. When the sound production is paired with a symbolic representation of the sound (what is means), the capacity to acquire verbal language is triggered.
Movements and language
Body control will allow the child to acquire sign language, and therefore to understand that his own movements production can be a tool to communicate. Participating in organized gross motor motions relieves stress which allows better sensory regulation and attending skills.
Movements and social skills.
Movement control is instrumental in developing appropriate eye tracking which is an important asset in play and other meaningful social interactions. Play skills allow the child to develop the capacity to relate and interact with adults and peers in his environment. Playing requires processing information and constant problem solving, all of which depend, on some degree, upon motor planning and control.
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Play Activities Beginner Level ( non verbal or very restricted use of language, short attention span)
20 minutes/session, as often as possible
Vary the locations: therapy room, child‘s bedroom, kitchen, yard, bathroom in order to generalize the use of all skills.
Goals are:
Promoting attention to others through body imitation and social interaction;
Purposefully playing, diminishing aimless wandering/self stimulatory behaviors, keeping the child engaged as much as possible;
Using communication.
Play has to be fun for the child, at least in the sense that it should create situations in which your child can feel successful and connected to you. Vary the tone of your voice, use few words, sing, be silent then verbal. Do not incessantly repeat your child’s name as she /he will no longer pay attention to it. Use it for praise or to indicate a change in activity or a potential hazard.
Always start with gross motor activities ( 2 of the following) which help the child self regulate. If you lose your child’s attention offer a gross motor activity break as such:
Trampoline
Going through a tunnel
Pushing a loaded cart around the house/yard
Swinging. Stop the swing every 4 swings. Ask the child to look at your nose, and slap his thigh with one hand to indicate she/he wants the swinging to go on. ( “say: Go”)
Roll a ball down a slide, ask the child to pick it up or catch it and give it back to you
Bouncing on a big ball, sit the child on the ball holding onto his feet, roll back and forth, pushing pulling on her/his legs
Walking on a balance beam
Spinning on a ( office type ) chair
Wheel barrow walking
Rolling sideways on the carpet
Piling up bean bag chairs
Climbing on big bag chairs
If your child seeks vibration by constantly humming, provide him with vibrating massages on his joints and his neck, jaws, (massagers are sold for $12 in most office equipment stores).
Use tickles, hugs, blowing air on the child’s neck to re-engage your child if you lose his attention. Don’t be too loud .
Then choose among the following activities:
Book reading:
If your child displays no interest in books start with “sensory books” displaying furry animals. Have your child turn the pages freely. Prompt him to rub his finger on one of the animals, while you produce the animal sound, in a very emphatic way, to capture your child’s attention (hand over hand if necessary). Let the child navigate through the book, follow his lead regarding the page turning while you produce the corresponding sound.
Object manipulation:
Only once per session
Demonstrate/model for the child, ask him to copy you. Name each shape, or color, or item the child is manipulating.
Puzzle
Shape sorter
Music instruments (Shakers, tambourine, bells, xylophone): demonstrate, ask the child to do the same
Ring stacker
Pegs
Write or paint on easel (use silky crayons or paint ready crayons they are easier to manipulate for young children). Vertical, horizontal, circular strokes and have fun scribbling , mixing colors
Draw” Happy faces” and act them. Be very dramatic but silent
Duplo building
Big blocks building, build wall crash with big car
Play dough: tap, roll, put sticks in it, sing happy birthday
Play with moppet: teach your child to feed the puppet.
Play music:
Introduce one song with motion, (e.g. Wheels on the bus, 5 little monkeys jumping on the bed). When your child enjoys the song add another one.
Peek a boo
Hide your child’s face with your hands asking “where is name of child?” Have your face very close to your child’s face, open your hands: ‘Here it is”
Reverse the game hiding your own face with your child’s hands. Ask “where is Mommy/Daddy?”
Cause and effect toys:
Demonstrate how to manipulate, to turn off and on.
Reminder: After 2/3 table activities, It is probably necessary for the child to move. Go back to one gross motor activity, offer choices (Picture symbols the child can point to). Offer to go outside.
Give sensory breaks
Oral motor area
Gentle cheeks massages, vibrating tooth brush on lips/in mouth, tongue depressor with lemon, blowing in whistles,( not all in a row)
Massages on limbs with lotion, joint compression, brush on fingers tips or feet
Rice and beans box ( take shoes off, have the child step in it)
Sand box (summer). Pour water in it, make mud, have your child stomp her/his feet in
Bubbles to catch running, holding your hand
Play chase ( show the PEC /run/)
Water play in the sink
Request that your child use a Picture symbol or a sign when he chooses a preferred activity.
Hide and seek- Objects
Hide preferred objects (food, little toys, item the child is “stimming “on) under various items ( cups , blanket, in boxes, under chair). Have your child find them, help her/him and praise a lot. Try to hide further and further away from the child
Reciprocal play, trying to engage sibling if any
Teach car play. Use a reclined mattress or a board, roll cars taking turn with your child. Redirect so she/he brings the car back to the slide. Reinforce frequently, with edible and/or social praise.
Park the cars, line them up.
Movie watching
As often as possible, watch the movie with your child. Frequently put the movie on pause. Comment, ask your child to indicate she/he wants the movie to resume.) signing ”movie” or with PCS, looking at you while using communication. Use sign language movie for Toddlers, practice the signs with your chil
Communication system
Each time your child is vocal while she/he plays with you, imitate him,
Offer an echo microphone, prompt her/him to use it, initiate a sound imitation game using vowels sounds then simple consonant-vowels sounds, (/m/o/)
Once your child seems to particularly enjoy an activity, introduce the use of a communication tool to label/request the activity (sign or Picture Symbol). Introduce the communication tool, then prompt your child to request with a sign or point to the Picture symbolizing the activity
Request that your child looks at you, even briefly, so he develops the concept that he can obtain reinforcing material or situation from you, more specifically that communication in between 2 individuals takes mostly place in the area of their face.. Indicate to your child that she/he has to look at you /your nose/ (likely less aversive or undecipherable for her/him than your eyes), while requesting
The following listed items are often the first a Toddler is motivated to request. Sign language, adapted to your child’s capacity to organize fine motor movements, or exchanging picture symbols matching these items, can easily be taught to your child. You need to be consistent, use very few words, offer many opportunities for learning as your child will grasp the meaning of communication through repeated exposures, gratifying situations. Be patient. Praise each attempt to communicate.
Me
Movie
Drink
Candy
Cookie
Book
Go
Water
Help
Bubbles
Hug
Computer programs such as Writing with 2X symbols, or Websites such as P.E.C.S. com could provide you with Picture Symbols
P.E.C.S, stands for Picture Symbol Communication System.
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