Autism: Updated Online Version PDF

2022-02-17 Autism 1 Autism is a spectrum disorder If you have met one child with autism, you have met one child with autism. Dr. Stephen Shore 2 1 ...

2022-02-17 Autism 1 Autism is a spectrum disorder If you have met one child with autism, you have met one child with autism. Dr. Stephen Shore 2 1  2022-02-17 Roadmap: Autism Social Skills: Social referencing (eye gaze) Joint attention Theory of mind Social Rules Strategies to Support the Challenges Specific to the Diagnosis Language: Lack of initiation or communication attempts Echolalia Lack of turn -taking in conversation Rigid thinking strategies: routines and transitions Strategies to support expanding interests and accepting other’s agendas 3 Diagnostic Criteria: Revisit i) Social Language: The language used in social interactions delays or differences in how it develops nonverbal communicative behaviors used for social interaction ii) Social Interaction: developing, maintaining, and understanding relationships Understanding of social rules and norms that most people pick up naturally Poor reciprocity (turn taking) iii) Repetitive and Restricted Interests Insistence on sameness, inflexibility repetitive motor movements, use of objects, or speech Highly restricted, fixated interests Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment From: http://www.autism-watch.org/general/dsm.shtml 4 2  2022-02-17 Before you Start: An early childhood educator must support a child’s sensory processing and regulation before addressing anything else: Learning does not happen until the sensory and regulation needs are met Know that repetitive motor movements can be a way that children try to regulate themselves See previous ppt notes on sensory processing and emotional regulation 5 Social Skills in Young Children with ASD Social referencing: Eye gaze to “check in” or share enjoyment with other person Joint attention The sharing of experiences with others You and another person are focussed on the same object or event during a back and forth interaction Unspoken understanding that you are both engaged around this common object or event Look at object, then to other person, then to object again, then to person Can involve pointing or gestures to draw a person’s attention to something 6 3  2022-02-17 Social Skills: Social Referencing & Joint Attention Strategies: Be at the child’s level physically and face to face Observe and follow the child’s lead Join in by: Imitate the child: actions, sounds and words Take a turn Expand on what the child is doing and saying Model Be face to face People Games 7 Social Referencing: People Games Social games played with people instead of toys Facilitates social development in children with autism Turn taking Referencing imitating Easier to focus on each other if other toys are not available Observe what the child likes to engage in, and then develop game from there Usually involve some sort of physical play 8 4  2022-02-17 Social Skills: “ROCK” People Games Repeat what you say and do Offer Opportunities for the child to take his turn Cue the child to take her turn Keep it fun and keep it going! Hanen.org More than Words 9 Social Skills: Turn-taking The serve and return of actions, sounds, and words Does NOT mean sharing Sharing means giving up something Turn- taking means engaging in reciprocity Strategies: Imitate the child Wait silently and expectantly Adult and child each have the same toy so that the child does not need to give his up in order for you to take a turn Consider length of turn, pace of activity, and interests of the child 10 5  2022-02-17 Social Skills: Learning social rules Explicit teaching of social skills Strategies: Explain “Rules” of engagement Simple, short, & clear language Personal space bubbles “Coach” in play Interrupting “think” out loud Reading body language Use visuals Use of eye contact demonstrations, pictures, gestures, timers, social stories, videos Prompt: Consider level and type of prompt needed Model for the child to imitate Demonstration 11 Social Skill: Theory of Mind Perspective taking Being able to think about other’s thoughts and feelings True theory of mind develops around the ages of 4 – 5 Strategy: Intentionally put into words what you are feeling and thinking on a regular basis by sportscasting or thinking out loud Social stories 12 6  2022-02-17 Language Challenges Lack of Initiation or communication (non -verbal children) Echolalia Lack of Turn -taking in conversation 13 Language Challenge Lack of initiation or attempts to communicate Child has limited or no verbal communication Strategy: Use the Picture Exchange Communication System (PECS) to support the child’s expressive communication This process must be overseen and introduced by a trained speech language pathologist 14 7  2022-02-17 Language Challenge: Echolalia The child imitates the language heard around him exactly as it is used May be repetitive in nature Strategy: Prompt from behind the child with the exact words you would expect him to say This works best if there are 2 adults – one to offer something and another to cue from behind i.e. instead of saying “ Do you want a cookie” say “ I want a cookie” as the child will imitate exactly what you said 15 Language Challenge: Limited Turn-taking in Conversation Often these children do not have a language delay, but engage in social communication differently than most Dominates conversations Does not wait or allow for others to respond or take their turn in the interaction Reflects the lack of perspective-taking May talk about preferred topics constantly Reflective of the repetitive and restricted interests Strategies: Directly teach the social rules of conversation Use prompting or cuing to support the skill development Use visuals to demonstrate “your turn” “my turn” to talk Use a timer to indicate how long a conversational turn could be Social stories 16 8  2022-02-17 Rigid Thinking Children with ASD often are on their own agenda Have a strong need for control Repetitive interests and behaviors Black and white thinking is often demonstrated Patterns may develop over time that are difficult to change up later Be intentional in the routines that you engage in and ensure that they are appropriate May demonstrate interests in unusual items or topics Figure out what interests the child and use those interests as motivators 17 Rigid Thinking: Strategies 1. Routine, structure and predictability 3. Offer Choices Time expectations may need to be adjusted 4. Branch out and challenge the Visual supports to be clear rigidities systematically Goals should be set out in the 2. Set basic expectations and carry them IEP out consistently Stretch rigidity 80-20 rule set priorities Consider motivations for Consistent consequences rigidities Ensure your expectations are Be mindful of the child’s appropriate sensory needs 18 9  2022-02-17 Rigid Thinking Strategies 5. Provide warnings: prior to changes to routines 6. Use “First___, then ___” statements 7. Redirect his attention to what the child CAN do when s/he gets “stuck” on an activity or idea. 8. Use visual cues to support understanding of expectations 9. Positively reinforce expected behavior Shaping 19 Choice Boards Choice Board First – Then board 20 10  2022-02-17 pixabay 21 Steps to Take: What to do * Regulate first Need alerting or calming? What zone is the child’s behavior typically in? Establish routines and structure in day Use visuals to enhance understanding of expectations Work on social referencing through: People Games Follow the Child’s lead and get to the child’s level Imitate the child: Actions, sounds and words Expand on what the child is doing and saying Work on Social Language Initiation, echolalia, turn taking, or social rules of communication Manage behaviors that result from rigid thinking Support expansion of interests or acceptance of other’s agendas Find motivators – interests of the child Positively reinforce expected behavior - Shaping Systematically work on rigidities Explicitly teach expected behaviors, social skills and play skills 22 11  2022-02-17 References Autism Speaks Canada. Retrieved from https://www.autismspeaks.ca/ Dunn, W. (2009) Living Sensationally; Understanding Your Senses. London, UK. Jessica Kingsley Publishers. Sussman, F. (2012) More than Words. Toronto, Canada. Hanen Centre 23 12