Its common, its common, its common.

That is the first thing that needs to be said to any caregiver who ended up here while researching "picky eater" + Autism. You are not the only one experiencing this.

Autistic individuals (because this is not just an issue for children) exhibit higher rates of food refusal, and a more limited food repertoire, when compared to typically developing individuals (Bandini et al, 2010).

Examples? Sure.

Across my clients, I regularly see issues with:

Rigidity around meals (where to sit at the table, what plate to eat off, which spoon to use, must have the tablet in order to eat)

Food refusal challenging behavior (throwing plates, flinging cups to the floor, spitting food out, tantrums, pouring liquids out onto the floor)

Highly selective food intake (daily diet consists of less than 10 foods, likes chicken nuggets but only from a specific fast food place, will only take specific liquid from a specific sippy cup or bottle)

To define the term, a picky eater can be described as regularly refusing foods, or consistently only eating the same foods with little to no variation permitted.

Many parents of toddlers deal with a picky eating phase at some point or another, and often the child outgrows it.

So, what is the critical determining factor when it comes to Autism that tips the scale from someone who is just "picky" to a serious health problem/eating disorder and concern? Usually, it is a combination of variables that must be examined and weighed:

How old is the individual? If out of the toddler phase, how frequently is this issue happening (weekly? daily? or only at holiday meals?)

Does food refusal occur with challenging or aggressive behavior?

Is this impacting school/daycare, or the ability to go into community locations?

Will the individual skip several consecutive meals (refuse to eat across more than one day)?

Is this impacting the individual's weight, organs, toileting/digestion, skin, hair, or nutrition? Is your doctor concerned?

The key factor for seeking out intervention for this issue is when the food selectivity is causing harm to the individual. When any specific behavior impacts the health/body of the person exhibiting it, that is clinically referred to as a "self-injurious" behavior. Self-injurious behaviors should not be ignored, and often require intervention and treatment.

So what to do? 

 It may be helpful to reframe the way we view picky eaters. Sometimes families can view this behavior as their child willfully choosing to make meals a dreadful adventure. Choosing to be difficult and fling plates across the room in order to cause chaos. However, challenging behaviors often occur for complex or multifaceted reasons. Some Autistics use the term "sensory eater" and not "picky eater" to describe this issue, and explain it like this:  

"Picky eaters don’t like a variety of foods, much like the sensory eater. However, when picky eaters try new foods, it doesn’t cause a sensory overload....There is a sensitivity to textures, where children can only handle one texture, such as smooth, pureed foods. In this case, they might be able to eat yogurt, however, hand them a bag of chips or a slice of turkey and they immediately begin to gag" (www.researchautism.org).

If a specific food texture, smell, sight, or tactile experience is causing significant distress, if there are tooth or gum issues making eating painful or uncomfortable, if the individual has trouble swallowing, or if unknown allergies are present, making digestion painful or uncomfortable, doesn't it make sense for the individual to refuse a food (or eventually, any food that looks like THAT food) or exhibit excessive selectivity? Now, imagine the individual has no means to communicate how food makes them feel. Doesn't it make sense that they may cry, spit, hit or punch, or fling a plate onto the floor? 

When seeking out Feeding Intervention (which is a clinical specialty), it is important to first obtain medical rule out. This means first speaking with your doctor to discuss the issue, and see if the individual's health has been impacted. The doctor may also be able to make a referral to a qualified specialist.

Not every professional will be trained in feeding interventions, so this isn't as simple as just asking the current therapist to also target feeding. I see families do that a lot, without also asking about the therapist's qualifications to address this issue. 

It probably doesn't need to be said, but feeding challenges can have serious health complications and you don't want to gamble on unproven treatments, untrained professionals, or questionable practices. Not only could they harm your child, they could worsen/ingrain the problem even further.

SLPs, BCBAs, OTs, Healthcare professionals, and Multi-Disciplinary clinics or facilities, can all incorporate feeding intervention into therapy goals. The Children's Healthcare of Atlanta recommends the following step-by-step process for initiating feeding intervention/feeding therapy:

• Medical Screening
• Behavioral Evaluation
• Nutrition Assessment
• Oral-Motor Skills Assessment

 Remember, before seeking out therapy or treatment talk to your doctor first. Also, any feeding intervention that occurs on-site will need a caregiver training portion where the parents are taught how to implement the procedure at home/in the community.

*Further Reading:

Autism Feeding Issues

Kinnaird, E., Norton, C., Pimblett, C., Stewart, C., & Tchanturia, K. (2019). Eating as an autistic adult: An exploratory qualitative study. 

Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, Maslin M, Must A. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. 

Autism & Picky Eating

Problem Eating

Assessment & Treatment of Pediatric Feeding Disorders

Feeding Problems in Children with Autism

Eating Disorders Can be a Sign of NeuroDivergence

Read more »

Tameika Meadows, BCBA, Blog Author

 

"If you want to see competence, it helps if you look for it"

Douglas Biklen

To presume competence is very important considering the work that many ABA professionals do with highly vulnerable populations who may be unable to reliably communicate/self-advocate and could also have high support needs on a daily basis.

It is important to always place a high value on dignity and self-determination, to whatever degree is possible for the individual (your child, student, client, etc.). What do YOU want to eat (and absolutely NOT want to eat)? Where do YOU want to sit? Is that shirt comfortable? Do you like this school? Are you feeling okay? Are you hungry...tired....ill...bored....sad?  

It may not be possible for the individual to answer questions like this, but to presume competence is to assume that the individual absolutely has an opinion on these matters, even if they are currently unable to communicate that opinion to anyone. Make sense?

Here are more tips on how professionals/teachers/caregivers can work toward intentionally presuming competence:

- Always ask before giving assistance and let the person tell you what you may do to be helpful (for those who cannot tell you, read body language/cues for removal of assent).

- Treat adults as adults. Use a typical tone of voice, just as if speaking with a friend or co-worker. 

- In general do not assume a person can’t read, but also don’t assume they can.

- Speak to the person directly, not the support person, parent, or companion. 

- Don’t assume a person who has limited or no speech cannot understand what is being said around them, or to them. People usually understand more than they can express. 

- Never pretend you understand what is said when you don’t! Ask the person to tell you again what was said. Repeat what you understand. 

- Do not try to finish a person’s sentence, or cut them off. Listen until they have finished talking, even if you think you know what they might say. 

- You might not be able to see someone’s disability. All disabilities are not visible. There are many disabilities that are hidden within a person. 

- Avoid using stereotypes in your thinking. We all have different personalities and our own ways of doing things. To find out what a person prefers, ask them directly (when possible). 

- Offer compliments but avoid giving a lot of praise when people with disabilities do typical things. 

- Avoid speaking for others. Encourage a person to speak on their own behalf. If you must restate something, be careful not to change the original meaning.

- Be mindful of your body language, tone of voice, and other gestures that may influence a person’s decision/desire to please those in authority. 

- A support person should be low-key, almost “invisible” to others. Don’t “over-support.” 

- Let a person make their own decisions. Don’t take over and make decisions for them. It can be difficult for some with disabilities to make quick decisions. Be patient and allow the person to take their time. 

- Focus on what a person CAN do, instead of hyperfocusing on deficits. 

- Find ways to include a person in a conversation. Do not talk about the person to others as if they’re not there/not in the room.

Link to Reference: Curriculum for Self-Advocates

Read more »

Tameika Meadows, BCBA, Blog Author

"Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:

1. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day)."

Source-  www.CDC.gov

It is part of the diagnostic criteria for Autism to struggle with Rigidity.

What is Rigidity? It is an inflexibility, an inability to tolerate change or unexpected events, to varying levels of difficulty.

This is something many of my clients struggle with, and it can be quite life impacting in negative ways. Issues around rigidity can affect the school day, relationships/social ties, life at home, transitions, community integration, and vocation/employment success (for older clients).

Some examples can include:

- Difficulty tolerating a change in teacher

-Difficulty staying calm if something breaks, loses power, or the battery dies

-Difficulty staying calm if mom or dad drive past Wal-Mart but we don't go inside 

-Insistence on the same routine every day, Monday-Sunday

-Refusal to change eating habits, clothing choices, etc., from one day to the next

-Difficulty sleeping if traveling, away from home, or the bedtime routine is different

As rigidity is a core characteristic of Autism, treating or intervening on it must be approached carefully. The goal should not be to turn an inflexible person into a flexible person. The goal should be to help the learner adapt to an ever-changing world that will NOT stay constant, and increase the learners coping skills to accept what they cannot control. 

To a degree, most of us are creatures of habit. We buy a certain brand of makeup, we brush our teeth a certain way, we park in the same place when we go to work, we always sit in the 2nd row for our college lectures, etc. It isn't inherently a problem to like sameness and predictability in your life.

But.

This does become a problem when the reaction to the routine being disrupted, is explosion, aggression, self-harming, etc. For example, I have specific restaurants where I order the same thing every time I go. If I went one day and that item wasn't available, I'd be dissapointed, annoyed... I might even leave and go eat somewhere else. But I would not become a danger to myself or others, and I would not perseverate on that annoyance for hours or days.

So how do we help our clients, students, and loved ones calmly accept life's inevitable changes?

ABA provides many, many strategies to teach flexibility and tolerance to change. Let's discuss a few:

1. What are we teaching instead? This should be priority #1, it is truly that important. We cannot just rip away established patterns and rituals, we have to first identify the replacement behavior(s). This could include teaching the ability to request ("I wanted the red cup"), to wait ("We will go to Wal-Mart, but I'm stopping at Wendy's FIRST"), to self-manage anger and disappointment ("I can see you are angry. Let's do our deep breaths, okay?"), and/or to problem solve ("Oh no, your tablet's battery died. How do we fix that?").
2. Do we have rule out for underlying issues? It is not uncommon that Autism co-occurs with other diagnoses. Is the learner just "rigid", or are they OCD? Or struggling with an undiagnosed Anxiety disorder? 
3. Intentionally, and systematically, introduce change. I work with so many families who try to skirt this issue by avoiding changing things in their child's environment, giving in to the rituals, even driving out of the way in the community to avoid passing places that will trigger the child. I know this seems like the easy way to manage this problem, but in reality it will make things worse. It is almost presenting a lie to the learner to act as if nothing in their environment need ever change. That just isn't real life. We need to help the learner by introducing small, intentional changes (start super small) and then helping them tolerate that change. Speaking of tolerate....
4. Help the learner develop a "plan of action" when they are triggered. This will be highly specific to the individual learner, so I cannot give a recipe for this. What is most important is to utilize function based intervention to teach a strategy to the child for de-escalation. For example: When there will be a substitute teacher at school, inform the learner. (If possible) Talk about how they feel about this change. Empathize with their distress, and do not minimize it. Engage in action steps such as pacing, squeezing a stress ball, humming, and deep breathing with closed eyes. Remind the learner of the things they can control/the things that are unchanged. For example: "I know you're angry that Mr. Walker is not here today. That's disappointing. We can go in the hallway and take a break, and when we come back in you let me know if we're doing our writing journal or sight word folder first. Okay?".
5. In Step # 4 I referenced "Empathy". I know it can be frustrating and stressful when your client/child/student explodes over a moved seat, a different bowl at breakfast, or a broken toy. You might think "WHAT IS THE BIG DEAL?!". Well, do you like change? If we're honest, most of us do not like unexpected, unrequested change. It makes us angry, and we feel annoyed. So even if you can't fully relate to the size of the explosion, you can relate to the feeling, right? That "relating" is empathy. Put yourself in the learners shoes, and treat them the way you would want to be treated if you were that upset and agitated.

**More resources below:

Rigid Eating Habits

Food Selectivity

Inflexible Thinking

Use Inflexibility to Teach Flexibility

SuperFlex Curriculum

Intentionally Changing Routines

Poljac E, Hoofs V, Princen MM, Poljac E. Understanding Behavioural Rigidity in Autism Spectrum Conditions: The Role of Intentional Control. J Autism Dev Disord. 2017 Mar;47(3):714-727. 

Read more »

Tameika Meadows, BCBA, Blog Author

I don't work with adult clients often, but I do regularly work on life skills/building independence, and pre-vocational training stuff with children and adolescents.

The thing about adulting is that trying to shove a bunch of information and life lessons into your grown child is a bit too late. Especially if we're talking about Autistic adult children who may or may not ever live independently, may or may not hold down steady jobs/have a career, and may or may not attend college or technical school.

Wayyyy before you think you need to start teaching this stuff, is when I recommend teaching this stuff. :-)

For any parent, its a hard thing to look at your 10 -year- old and start thinking about teaching them to do laundry, independently grocery shop, change a flat tire, or shop online. But, if you expect your child to do all these things one day as an adult, then yes, absolutely start teaching it early.

Your teen or adult child can start learning today, to do things like:

1. Personal care/Hygiene/Grooming
2. Shopping & Money Management
3. Electronic Use & Internet Safety
4. Vocational Training (*which should be a natural extension of interests, hobbies, or strengths)
5. Driving or Navigating Public Transportation
6. Time Telling/Time Organizational skills
7. Employment Seeking (resumes, interviews, etc.)
8. Self-Advocacy/Assertiveness ---- probably my #1 Adulting 101 skill to teach

For children with disabilities (not just Autism), it may take more time, more repetition, and more real-world practice for these skills to be taught. Which means starting sooner rather than later is the way to go. Think about your own adulting for a second-- when you first left home, did you know how to scramble eggs without burning them? Or manage a credit card responsibly? Or negotiate with a pushy salesman when buying a used car? If you answered "yes" to these questions, then you were far superior to most of us! 

The reality is that whether your child will ever be able to live separately from you or not, as a parent I'm sure you want to help them be as independent as possible, and be able to make decisions about their life/have a say in their own life. Teaching some common 'Adulting 101' type of skills can be the way to do this, and be sure to combine that instruction with actual real world practice. Despite what we may like to think, school will not teach our children everything they could possibly ever need to know by graduation day. Nope.

What do I mean by real world practice? Well, I've worked with high school age clients before who received vocational/life skills training at school, or through a special program that helped them get part-time jobs. The problem was, these skills didn't generalize outside of those settings. If Charles learned to cook chicken breasts at school with Ms. Larson, that did not automatically mean he could cook chicken breasts at home, with Mom and Dad. If Kacey helped out in a local daycare classroom every Tuesday afternoon, that didn't not mean she could successfully baby-sit her younger brother at home.

Like any other skill, life skills need explicit, intensive instruction, as well as multiple generalization opportunities in real world situations. Multiple generalization opportunities means that the instructor/supervisor needs to differ. The setting needs to differ. The materials/items used need to differ.

Don't just teach your child to wash/load the dishes at home. Let them practice at the neighbor's home, at Grandma's house, etc. The steps of the skill will vary a bit as it is generalized across opportunities, and that's a good thing! There are very few adulting tasks that are done the exact same way, every time. We also know that many Autistics lean towards rigidity and sameness of routine, which can be a good thing or can be highly detrimental to learning if it gets in the way of doing something differently. For example, if the sink, dishwashing liquid brand, or the equipment used (e.g. type of dishwasher) change, can your child still wash the dishes?

It is hard to look at your children when they are young and know with certainty what their future holds. That has nothing to do with Autism, I think any parent would agree with that. Since we don't know what the future will bring, it makes sense to start preparing our children for an uncertain future now.

You may be wondering, "How young is too young to focus on this?". It may surprise you to learn that I start teaching life skills (Adulting 101) with clients as young as 2 or 3. Yup, its true. 

A toddler can learn to clean up their toys. A toddler can learn to put their empty cereal bowl in the sink. A toddler can learn to pour their own juice. A toddler can learn to put dirty clothes in a washer, or pull clean clothes from a dryer. Why not?? If your children are young and you don't know where/how to start with this, just start with teeny-tiny baby steps:

• Let your child help as you complete household chores.
• Slow down before leaving the house, and let your child put their own shoes on, or put their own coat on, or grab their own bookbag.
• Cooking is a life skill. As early as you can, introduce no-heat recipes such as making a sandwich or fruit salad.
• When in public settings, help your child pay for their own meal, or hand the cashier money for purchases. Let your child place items on the conveyer belt at the grocery store, or teach them to shop by giving them a visual grocery list.
• Allow older children to have some responsibility for younger children. Let your 6 -year-old help you care for the 1-year-old.

There are SO many resources out there for teaching life skills and increasing adaptive functioning. This doesn't need to be hard or overwhelming! 

Ask your child's therapists for help and ideas, or talk to their school and see if there are any specialized trainings, classes, or programs available for students on the Spectrum. Most school districts have far more programs and community connections than most parents know about.

You got this!

RESOURCES- 

Functional Skill Training

ASD Life Skills

Essential for Living  Assessment Tool

TACA Life Skills

Total Spectrum Life Skills

Teaching Everyday Life Skills

Spectrum News: Severity predicts autistic children’s ability to learn life skills

Organization for Autism Research: Transition to Adulthood

The Assessment of Functional Living Skills

The Life Skills Lady

Transition to Adulthood Research Findings

Read more »

Tameika Meadows, BCBA, Blog Author

Related Post: Structure in the Home Setting

For pretty much any parent the summer break from school will require some decision making and planning to keep the kids busy and engaged over the summer months. While this is a universal parenting concern, for parents with special needs children the loss of a daily routine/structure when school is out for the summer can bring anxiety, fear, and frustration, for both the parents and the children. 
A characteristic of ASD is difficulty with changes to routine, or a need for sameness to make sense of the environment. So if the child is used to getting up at 7am to get ready for a 6 hour school day with Ms. Bailey, and now suddenly they are just at home all day, this is a situation ripe for challenges.

It doesn't HAVE to lead to challenges though, as long as some strategies are put in place after careful planning and preparation.

With my clients, around this time of year I see tons of problem behaviors re-emerge, new challenging behaviors pop up, families stress levels increase, and due to everyone vacationing or needing to shift schedules around, often the one area of sameness over the summer break (the therapy schedule) can fluctuate quite a bit.

It would be great if both the parent and the therapy team could keep the same schedule (or possibly even increase hours) over the summer months, but this does not always work out. 


So with the consistency of both home and therapy being subject to change, how can a parent help their ASD child maintain routine over the summer? Glad you asked:

1. Planning begins wayyyy before summer starts- With most of my clients I like to start talking about summer planning around the top of the year. What is the family's plan for the summer break? Will therapy hours continue, reduce, or increase? What activities will the child participate in? Just asking these questions gets everyone thinking about how best to prepare the child for the upcoming break, and allows enough time to prepare the child using repetition. Depending on the ability level of the child, this preparation may need to include skill acquisition, a revised daily schedule, visual supports, and/or conversation about the fact that school will be on pause for a few months.
2. Work with the treatment team to decide what to focus on- The treatment team could be the child's teacher, the IEP team, the ABA team, etc. Whoever is working with the family to help the child learn and gain skills, should be considered a member of the treatment team. These professionals can give valuable information about what to focus on over the summer. Should reducing problem behaviors be the #1 goal? What about academics? Or self-help skills? For lots of my younger clients, we target toileting heavily during summer break because of the increase in time to practice but also it's hot so wearing less clothes means it's easier to spot accidents.  
3. Minimize "time off"- I know, I'm Debbie Downer. But ask any teacher about what happens to children's math and reading skills over the summer break. For most students, the beginning of a school year has to include "catch up" time to focus on what was lost over the summer. For special needs children who may have extra difficulty either gaining new skills or retaining known skills, this is an even bigger problem. That means that the intentional planning must keep in mind the big picture (long-term success and progress). Therapists know that a huge decrease in consistency will effect progress, so while it's fine to start the day later or end the day earlier --it IS summer after all-- I definitely don't recommend taking off for vacation for a month, stopping therapy entirely, or allowing the child to engage in solitary play or with electronics all day long. 
4. Consider amping up the structure in the home-  I think it's safe to say that the child didn't spend their school day playing on an iPad, watching YouTube, and eating Popsicles. There was probably structure in place, where low-preferred and high-preferred activities alternated, and academic demands occurred daily. To switch from such a structured setting to a non-structured setting, can be very upsetting and jarring. Instead of thinking about summer break as a time to just "hang out", think about ways to incorporate structure into the home setting. Nope, I am not saying that every parent needs to make a mini-classroom in their living room. Your child may not need quite that much structure. But, it is very likely they do need more structure in the home setting, more transitions, more instructional time, and more time interacting with people instead of with objects.

Lastly, a super-colossal-important tip is to be very intentional about selecting summer activities. Most of the clients I work with are in a ton of summer activities, from Lego camps to gymnastics to karate, and on and on. Unfortunately, just because my clients attend these activities does not mean that they participate. And of course if the child is just placed in the room like furniture but not actually participating, then the activity is not likely to beneficial.

What I often see is that these settings are simply not equipped to help my client benefit from being there. When I say "benefit from being there", I mean: my client doesn't wander around the periphery of the group, they don't stare up at the sky while everyone else is playing basketball, and they don't spend all of craft time crying under the table.


Focus on placing your ASD child in summer activities where staff are either knowledgeable about ASD & behavior, or they are open to a trained facilitator attending with your child. Emphasize that you expect your child to be a part of the group, not just in physical proximity to the group. Explain how your child interacts socially, their communication style, and what their biggest motivators are, as well as the specific skills you want your child to gain from the group. For example: "We enrolled him in this basketball camp not just for gross motor and physical activity, but also because he struggles to interact with other kids his own age and we really want him to work on that. Please help him to take turns with the other kids and respond when the children talk to him".



*Resources:

Strategies for a Successful Summer Break

Preparing a Child With Autism for Summer Vacation

(Video) Making the Most of Summertime for Kids With Special Needs

Read more »

Tameika Meadows, BCBA, Blog Author

Activity schedules are amazing tools that can benefit a household in many different ways:

1. Ease transitions
2. Promote independence/Self-management/Leisure skills
3. Teach play skills (particularly independent play)
4. Prompt behavior without a therapist/adult being present
5. Decrease unsupervised "free time", which is often filled with problem behaviors
6. Teach following a schedule/teach routines
7. Signifies when reinforcement is available
8. Teach choice making

I love, love, love activity schedules. A common recommendation in my behavior plans is to "keep the child engaged". Most of my clients exhibit their worst problem behaviors outside of therapy sessions and school. Why is that? 

It's often because the home environment does not provide the same level of routine and structure as school and therapy sessions. For most of my clients, down time is not their friend. Down time is usually filled with behaviors that Mom or Dad do not want to see increase, like eating carpet lint, dumping out the dog's food bowl, or sitting on top of the refrigerator.

If you are working with an ABA team, ask them if this is something your child could benefit from. If you don't have the support of a team, then keep reading and I'll explain how you can make one yourself.

Firstly, parents often say to me "Is this really necessary? Will he/she always need to have a photo schedule to follow? Won't this be inappropriate when he/she is a teen or adult?". My response to that question is to inquire if the parent ever uses some type of planner (including digital ones) to organize or structure their days. Roughly 80% of the time they tell me they do. I then explain that a planner is a glorified activity schedule. Don't believe me? Okay:

Activity schedule with photos----->Written schedule with no photos----->To Do list----->Organizer/Planner/Scheduling app

Now that you know even adults use a version of an activity schedule, how do you know if your household could benefit from one? If any of these scenarios ring true for you, consider implementing activity schedules:

1. Afterschool/on the weekends/after therapy sessions the child's problem behavior skyrockets
2. Breaks from school/3 day holiday weekends are just the WORST, and your child seems to amp up their problem behaviors day by day
3. The child must be constantly supervised or they will break, climb, or destroy something in the home
4. The child has no leisure skills, and lacks the ability to just "go play" (these words mean nothing to them)
5. Telling the child "stay in here" also means nothing, and they tend to just wander all over the house
6. Mom or Dad cannot do laundry, take a phone call, respond to emails, have company over, or cook dinner unless someone else is home to keep the child entertained/busy
7. Toys sit around gathering dust, because your child only interacts with them for a few seconds before losing interest
8. Other children in the home rarely get their share of parent attention or time 
9. The child will only sit and attend to electronics (TV, iPod, tablet, etc.). Books, toys, puzzles....nope.

Are you starting to love the idea of an activity schedule yet? :-)


Now for the fun part: Making one! *Puh-lease do not buy an activity schedule online. For one, it will not be individualized to your child. For two, it's super easy to make

Decide which part of the day you want to introduce this visual support  (I suggest picking the part of the day that is currently the MOST difficult to keep your child entertained)

Decide what you want the child to do instead of wandering around, being glued to an electronic, or engaging in problem behavior  (Puzzle? Read? String beads? Sensory tub?)

Create a visual display of each step. The schedule can show one activity or multiple activities (On a piece of cardboard or thick paper, tape a photo of each separate activity in the order they should be completed)

Consider the use of a timer and reinforcement  (Timers help ease transitions, and reinforcement is behavior superglue)

Prepare the area (Have all materials organized and nearby, tape the schedule to the wall)

Teach your child to follow the schedule  (You will need to prompt and reinforce)

* More information:

Book: Activity Schedules for Children with Autism-Teaching Independent Behavior 

Research: Use of activity schedule to promote independent performance of individuals with Autism and other Intellectual Disabilities

Read more »

Tameika Meadows, BCBA, Blog Author

Photo source: www.kasheringyourlife.co.za, www.todaysparent.com

ABA therapy can be used to teach/increase a variety of adaptive skills, such as tooth brushing, toileting, hair brushing, shoe tying, making a bed, etc. My favorite definition of an adaptive skill is anything that will have to be done for the learner, if the learner does not learn the skill. So if I don’t teach my child how to dress him/herself, then I will have to dress my child.

A common concern many of my clients have around adaptive functioning is the dreaded Morning Routine. Since my clients are usually school age, I have ample opportunity to help families target issues that regularly pop up during that frenzied time in the morning of trying to get the child out of the door on time. Issues like: task refusal, off task behavior, prompt dependency, skipping steps of the routine/completing the routine out of order, etc.

ABA interventions should always be individualized, but some of my most effective strategies for simplifying the morning routine include:

-          Visual supports are your friend :-)

-          Use of auditory cues (timers)

-          ORGANIZATION

 With some simple tweaks here and there and adding in more supports, the morning routine can be less stressful, more efficient, and require less intrusive prompting which equals more independence for your child.

Let’s jump in:

-          Add visuals: I say “add visuals” and not “add more visuals”, because usually what I see is that families who struggle the most with the morning routine are not using any visual supports. If you are regularly struggling during the morning routine but you already have visual supports in place, then that’s a gold star for you. You are ahead of the game. If you are new to visual supports, just keep reading. Think of a visual support as a way to minimize prompting or assistance. If you have to stand in the bathroom doorway, physically assist your child, or keep giving the same demand over and over (“Make up your bed Evan ……. Evan, did you make your bed?”), then you definitely need to add some visuals. It is much easier to fade the prompt of a visual, than to fade your voice or your presence. Or to put it another way, do you want to have to stand in the doorway to make sure tooth brushing happens when your child is 25? Here are some awesome examples of visual supports, all were found on Pinterest.

-          Auditory cues: The use of a timer can be such a helpful addition to the morning routine because time is usually of the essence. We have to go, and we have to go now. For many of my defiant kiddos, those with attention issues, or those with lots of escape maintained behaviors, the simplest demand  (e.g. “Put your socks on”) can take ages and ages to actually happen. Decide on a specific amount of time for the skill to occur, and then set a timer. If the child can beat the timer, then allow them to contact reinforcement. Depending on the child, this could mean a treat, getting to pick what they wear that day, 2 minutes of TV time, etc. Make the concept of “hurry up” more concrete by helping the child understand how quickly tasks needs to be completed.

-          Organization: This tip is more for you than the child. Organization or proper set up for the morning routine does not begin that morning, it begins the night before. Part of the bedtime routine can include setting up items for the next day. This could mean lining up the soap, facetowel, toothpaste, and toothbrush by the bathroom sink. Or this could mean putting the backpack by the front door, so there is no frantic search for it in the morning. How you organize will depend on the specific issues you are having in your home. The point is to set the child up for success. For younger children (especially if you want to increase independence) line up needed items/materials in their correct order so your assistance is not needed. For example, in the bedroom line up underwear, socks, pants, shirt, and shoes. In the kitchen, line up the bowl, spoon, and cereal box. For some children you may need to put number cards on each item (e.g. put a "1" card on the underwear). Any step you can do the night before will save precious time the next morning, and the materials being visible helps serve as a prompt of what to do next.

*Bonus Tip: A good way to practice the skills required for a successful morning routine is to incorporate weekend practice. If these skills are only performed M-F with a time crunch, then you’re setting yourself up for lots of frustration. On the weekends, still have your child go through the morning routine. Use this to fine- tune skills, or provide more repetition than is possible on a Monday morning. If tooth brushing is always a struggle, consider modifying the visuals or making them larger/more detailed. Try removing yourself, and only checking on your child periodically. If the child is older or needs less support, try implementing a checklist that the child completes. As they perform each skill, they check a box. When all the boxes are checked they bring the checklist to you for review.

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Tameika Meadows, BCBA, Blog Author