Friday, November 22, 2013

My Top Ten List





Lately I have been starting lots of new cases, which means I am doing the intake process over and over again. I’ve been noticing similarities and patterns in what each client needs that cuts across age, level of functioning, and even abilities.  It seems there are certain key strategies or interventions that many homes need, but do not have in place. I will call these strategies:  “The Essentials”.

There are certain things that should just be common practice and implemented in the home of every child with Autism. Now of course I am generalizing a bit in this post, so if something doesn’t apply to you or your child’s needs feel free to skip it, but in my experience these things do apply the majority of the time. The main deficits of Autism mean that there will be similarities of needs and/or problem behaviors across individuals (e.g. wandering away from home, little to no communication, not toilet trained, etc.). However, there are always individual differences to be considered.

If you can already have these things in place before you start ABA services (whether you use a company, or do your own in home program) you will be SO far ahead of the pack. …and your Consultant will greatly appreciate having less to do :-)

The main reason for implementing these strategies is to make your own life, and the life of your child easier, decrease stress, teach skills, and reduce problem behaviors. Just putting these systems in place in your home, even if you do not currently receive ABA  services, could make a dramatic difference in your childs ability to successfully manage their day, transitions, know expectations of behavior, and communicate their wants and needs.
  I guarantee you if you look around any quality ABA classroom you will see some, or all, of these systems in place. So pop quiz time: if the school needs these systems in place to successfully teach and care for children with Autism, then don’t you think you need them in place at home too? (The answer is Yes!)

I recommend implementing these strategies as soon as possible, the younger the better. However, if you have an older child or care for an adult with Autism, these strategies would still be very helpful.

So, drum roll please……




My Top 10 List of “The Essentials”!

  1. Structure /Routine in the home: Consistency and knowing what to expect helps kiddos with Autism manage their day. Create a routine for your home, and stick to it. Bedtime should be the same every day. Dinner time should be the same every day. Outside play time should be the same every day. Big, sweeping, dramatic changes from day to day or moment to moment are a good way to cause your child with Autism to dissolve into behaviors or meltdown mode. Create a routine based on activities that happen daily, so your child can begin to learn it and feel more in control of their environment.
  2. Visual schedule/Daily schedule: See how impossible this strategy would be without a routine in the home?? A visual schedule is essential if you want to teach independence. How can your child learn to independently transition from morning routine, to breakfast, to the school bus? Simple: create a visual schedule. Do you find yourself having to give a demand 2, 3, or 85 times a day? Create a visual schedule. Does your child finish an activity or task, and then just wander around, filling their time with problem behaviors or self-stimulatory behavior? Create a visual schedule, and use it to redirect them to what they are supposed to be doing. Visual schedules help these kiddos know what they are supposed to be doing, what is coming up next, and what is after that. Heres a tip: please do not use written schedules with kiddos who cant read. That isn’t helpful at all. Use visuals instead.
  3. System of communication: I have a post about teaching communication skills, and this is something you want to begin working on as soon as possible. Maybe your child communicates with sign language, or an Ipad, or PECS, etc. What is important is that everyone in the home agrees to reinforce and only accept the system of communication. If the child is verbal, then reinforce and require words. If the child can sign, then reinforce and require signs. What I usually see in homes is the child has multiple ineffective or weak modes of communication, and that is a simple problem to fix. Start reinforcing one communication mode, and make sure everyone in the home is on the same page.
  4. Restricted access to reinforcers: No “free reign” or “grazing”. Free reign would look like a child who just “loves” Dora DVDs, and is allowed to sit and watch Dora for hours and hours each day. Grazing would look like a child who just “loves” pretzels, and when he wants some he climbs up onto the kitchen counter, opens the cabinet, and grabs a handful. If your child has free, no limit access to the things he/she enjoys the most, then what is left for you to use as a reinforcer? Reinforcement is critical for learning, and when I usually hear “She just doesn’t have any reinforcers!”, what that often means is the child has no reason to work for anything because they have free access to it all day.
  5. Elopement pro-active strategies: Elopement is a huge safety concern for many kiddos with Autism, especially those who are nonverbal. From a young age, you can teach your child that eloping is not ok. Along with the house routine (see how important that is?), there should be rules for the household. An elopement rule could be something like “Ask Mommy before going outside”. Create visuals and place them near all the doors, that say things like “Stop & Ask”. When the child gets to the door, they will be reminded that they cannot go outside alone. Teach them to come find you, and using their system of communication (PECS, sign, Ipad, etc) to request “outside”. I suggest covering up the visual at night, to indicate going outside is not an option. Or you could put up a different visual, such as “Wait”. Then explain to the child that they must wait until the sun wakes up to go outside. 
  6. Choice board: Making choices is a skill I always like to teach my kiddos. It’s such an important human right that is often forgotten about when it comes to kids with disabilities. Many problem behaviors can be reduced or completely extinguished if the child is simply given more opportunities to choose where they want to sit…..what movie they want to watch…..do they want juice or milk? To help kiddos make choices, I usually create a visual choice board of their preferred activities, foods, or items (this can also be done on an IPad if you have one). Then at multiple opportunities throughout the day I show them the choice board and have them pick what they want to do, eat, or play with. Depending on the child, the choice board may have to vary frequently if they get bored with reinforcers quickly. I also like using a choice board because it teaches scanning, and choosing from multiple items. Especially for a nonverbal child, instead of running around trying to figure out what they want as they tantrum and scream, they can be taught to request things using their Choice Board.
  7. Toileting pre-requisites: This is a big strategy, that so many homes need but I almost never see. Even if your child is too young to begin toilet training or isn’t ready yet, you can begin working on the prerequisite skills now. Only change your childs diaper or pull up in the bathroom, have them assist with dressing/undressing, throwing away the soiled diaper/pull up, and washing their hands. You are teaching the whole toileting routine, just without requiring the child to sit on the toilet. The child is becoming familiar with the bathroom, and learning multiple skills they will need later (e.g. unzipping pants). Use a visual to help with complex tasks, such as handwashing. When your child has accidents, they need to participate in the clean up, get a new diaper/pull up, and still go to the bathroom to wash hands/throw the diaper/pull up away.
  8. Multi-modal sensory items: This relates directly to reducing repetitive, self-stimulatory behaviors, or decreasing hyperactivity. For kiddos who spend their free time stimming, parents often ask me how to reduce that. Well, stimming serves a need for your child. So my suggestion is to redirect it, not to stop it. Place things in your home that your child can manipulate or interact with to gain sensory stimulation, so they do not have to walk around the house humming, handflapping, or pacing all day. Suggestions include yoga balls, trampolines, sensory boxes, fairy lights, sound machines, finger paints, etc.
  9. Independent activities/Work station: One of my favorite programs to teach is Task Completion. I love this program because it teaches leisure skills (my kiddos almost never have appropriate leisure skills when I meet them), and independence. Do you have to entertain your child all day long? If you need to take a phone call, do the laundry, or send emails on your computer, can your child keep themselves busy? If not, then I suggest teaching independent activities. Set up a small area, place a few activities in it, and set a timer. Direct the child to engage in the activities until the timer goes off, and provide huge praise and reinforcement for compliance. Over time, the work stations can be added to the daily schedule (see how important that is?) and the child will be able to independently have snack, clean up, do 2 work stations, start homework, etc.
  10.  Cool down area: This is another one that I wish I saw more, because it is often very much needed. Kiddos with Autism often become overwhelmed or overstimulated throughout their day, and dissolve into tantrumming, whining, meltdown mode, or self-injury. What I often see parents do is take responsibility for the childs emotions. This could look like picking the screaming child up and rocking or cuddling them until they calm down. For one, that could be reinforcing problem behavior. For two, we want to teach the child from an early age that they need to control their own emotions. Select a quiet area of your home and place calming items in the area (pillows, koosh balls, etc.). When your child becomes upset or overwhelmed, explain to them that they need to calm down, e.g. “You are crying and throwing toys. You need to go calm down”. Direct the child to the cool down area and silently prompt them to do calming strategies, such as taking deep, slow breaths, or counting to 5. Use visuals to help show them the steps they can complete to calm down.  Over time, you will be able to tell the child to go calm down, and they will be able to independently go to their cool down spot, practice their exercises, and come out on their own.  The calming strategies visuals can be taken anywhere, and used in any setting.  It isn’t the location that matters; its teaching the child the steps to self calm.

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