Everything Autism

Autism Activity Week: Activity 1: A Multi-Modal Auditory-Visual Integration and Language Primer

2013-12-11T20:46:00.001-08:00

Age Range- 0-10 depending upon skill level of child

Materials: Hear-Say English Language Program by Donald S. Rivera., CD player

I came up with the idea to use this program when my daughter and I were in a library near my son's treatment center. She and I spent a lot of time in this library because it was so close and the treatment center was 50 miles from our house, which made it impractical to return home for the 4 hours a day he spent there. While browsing I came across the Hear-Say English program and saw a lot of potential in the program for kids with autism and typically developing children alike. This activity quickly became one of my children's favorite activities. I'm not suggesting you necessarily buy the program as it is quite expensive, but try checking with your local library or other resources to see if they've got it (two different library systems I use had it).

The program is very simple. It has a workbook and an audio CD. Play the audio CD and it will have several categories of English words (also available in other languages). For example, the "animals" page in the workbook has pictures corresponding to several everyday animals (e.g. donkey, frog, etc.). The audio CD will play an actual sound a particular animal makes, not someone making a "woof woof" sound in English, but (in most cases) an actual real-life sound such as how a dog's barking. This is immediately followed by the word for the sound.

Practiced by itself, I think this program can have several benefits for a child with autism. Right off the bat, the most obvious benefit is speech and language development. The program pairs an image (nice since kids with autism tend to be visual learners), auditory representation, and the verbal example of the thing together. I'm not an expert, but I would guess that this pairing of sound, word and image are particularly helpful to a child with autism in developing a vocabulary and a more complete understanding of a particular word/idea. A second benefit is that the program by putting the words into categories such as animals, In The Garage etc., it provides children with autism another opportunity to learn to categorize words. Learning to categorize words is a building block to speech development and abstract thinking.

My Modifications

After trying the program at home, I decided that I could make a few changes and make the program a little more fun, and add some additional skill components to it. Instead of using the work book provided with the program, I made my own work book. Here are the steps I followed, I'll explain why I chose to make my own work book afterwards:

I did a Google images search using "Free clip art images" [specific vocabulary word from Hear-Say English Program].
I put the category title (e.g. animals) at the top of each page, and chose the best clip art picture available.
I put a text box with no background on top of each clip art image and typed the vocabulary word in each text box so the word was write on top of the image.
Lastly, I mixed up the images all over the page instead putting them in order of how the sound-word pairs are presented in the audio CD .

The Hear-Say English activity book has the images in order of how they are presented, this might be nice for the first few times the learner listens to the program. However, by mixing the images up on the page I believe I improved the value of the program, and helped make it into a game. This simple modification turned the program into a look and find game and added a visual discrimination/visual attention task to the program. Some children with autism are thought to have difficulty with visual discrimination and attention tasks. Visual searching tasks are thought to be beneficial for learning to visually discriminate objects and visually attend to a task. Making this one modification to the program not only adds a game component to the program (making it a bit less boring), but also engages another brain process in the activity. The reason for adding the text across the image modification was to increase the literacy component for those kids that are in the process of learning to read.

Regardless of whether you use the regular workbook or make your own, the reason I most wanted to use the program was for the sensory component. The program is a natural auditory integration activity. The program is full of every day sounds that our children need to learn to process, and many children with autism have difficulty processing auditory information. Some have very strong reactions (covering ears, meltdowns, etc.) to hearing the sounds of some of the things covered in the program. I believe the activity can help a child make sense of and better process some of the sounds they hear on a day to day basis, and maybe even make some of them less frightening. I think this activity is great for developing more comfort with these sounds in a fun and controlled environment, giving you control over the when and where, and the volume of the sounds. That being said, do not use this activity if you feel it would be too stressful or otherwise harmful to your child. I hope your kids get as much enjoyment as mine do.

Note: These activities are meant to be fun and potentially beneficial activities to do with your child at home. They do not take the place of professional treatment or advice. Be sure to ask a professional whether these activities are appropriate for your child if you have any concerns.

Autism Activity Week: Fun and Beneficial Activities Parents can Do with Their Children

2013-12-08T12:23:00.001-08:00

This week I'm writing a series of posts designed to give parents ideas of activities they can do at home with their children that are fun and easy for children with autism, or typically developing children. Many of the activities I'll be writing about involve little preparation other than choosing the right kind of activities. I've mentioned in previous posts how I feel that parents should not let treatment stop outside of the treatment center. There are numerous activities/games parents can play with children on the spectrum that continue or supplement the therapy children with autism receive from mental health professionals, speech language pathologists, occupational therapists or school staff (etc). I hope posts this week will give you at least a few new ideas of games or activities you can try, or perhaps give you confidence that the games and activities you play with your child with autism are more than just a game. The simplest of everyday games/activities, some with no changes or a few minor changes, can make "therapy" at home effortless and fun. Maybe you will see how some of the games you play with your child with autism are naturally beneficial, and play them just a little more frequently.

Research Article Review-New Recurrence Rates?

2013-12-07T09:40:00.001-08:00

Article Citation:

Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., Zwaigenbaum, L., Bryson, S., Carver, L. J., Constantino, J. N., Dobkins, K., Hutman, T., Iverson, J. M., Landa, R., Rogers, S. J., Sigman, M., & Stone, W. L. (2011). Recurrence risk for autism spectrum disorders: a baby siblings research consortium study. Pediatrics, 128; e488-e495.

A few months ago we went in for Owen's yearly "checkup" with his developmental pediatrician, the same one who gave Owen the original medical diagnosis of autism. My wife and I usually discuss what questions we will have for a particular specialist ahead of time so we don't forget to ask. My wife is/was pregnant with our 3rd child (due in a month now) and we knew it was a boy, so we thought we should also get the developmental pediatrician's input on the likelihood of the child having autism. He said the chances were roughly 3-10% with girls being on the 3% side and boys being on the 10% side. This information was consistent with various other sources of information I recollected so I didn't initially question it. However, we started discussing and thinking about the topic on our way home and compared it with our own percentages we could tally by observing all the families in the autism day treatment program that we knew had other children.We concluded that a lot more than 3%-10% of the siblings of children in the autism day treatment program had autism. Knowing that our observational research was far from scientific, I decided to start looking for actual published research studies to hopefully give me an accurate idea of the chances that our son will have autism. This article (cited above) was the end result of my research, and I believe the most accurate article so far due to having a large sample (largest so far) from various populations, and a generally honest attempt at obtaining unbiased, reliable data on the likelihood that a younger sibling of a child with autism will also be diagnosed (recurrence rate).

The Nuts And Bolts

The authors used data from a network of 12 independent research sites in the United States that used similar enough procedures and measures to allow them to pool the data. All participants were biological younger infant siblings of children with a diagnosed autism spectrum disorder (Asperger's disorder, autistic disorder, pervasive developmental disorder). The autism spectrum disorder (ASD) of the older sibling was verified using well respected standardized tests (e.g. ADOS). Various data was collected on the families, sibling with an ASD, and participant. At 36 months, each younger sibling participant was tested for an ASD using the ADOS and The Mullen Scales of Early Learning.

What They Found

Overall Recurrence Rate:

The overall rate of recurrence found (percentage of siblings in the study that met the criteria for an ASD at 36 months) was 18.7 %. Of the 132 sibling participants that met criteria for an ASD diagnosis, 54 received an autistic disorder diagnosis (the more severe form of ASD), and 78 received a pervasive developmental disorder diagnosis (less severe). This is significantly higher than the general recurrence rate of five percent our developmental pediatrician has routinely given.

Relationship of Demographic Factors to Diagnosis:

Next, the researchers examined whether various demographic factors were linked to an autism diagnosis in the sibling participants. Race, ethnicity, mother's education level, father's education level, birth order, maternal age at birth, and child's age at study enrollment were all found to be unrelated to whether a sibling participant received an ASD diagnosis. Interestingly, there was a "nonsignificant trend for paternal age at birth. This may not seem surprising since there have been a number of studies finding a relationship between father's age and a child having autism. However, the relationship found is that usually older fathers are more likely to have a child with autism. This study found the opposite. Fathers of sibling participants that received an autism diagnosis were slightly younger (on average) than fathers of sibling participants not receiving an autism diagnosis. Although this is an interesting finding, it is probably best to not read too far into it. The result was not significant, but a trend worth noting because it contradicts what has been found to be a factor in previous studies.

Gender

Not surprisingly, the gender of each sibling participant was a predictor of whether the child was more likely to have autism. Male sibling participants were more likely to be diagnosed with autism (26.2%). Additionally, 9.1% of female sibling participants received an autism diagnosis. Again, this should not be surprising since it is well known that males are more likely to have autism than females, but it might help you get an idea of just how likely your male or female child is likely to have autism (if an older sibling already has autism).

Multiplex Status

This was the most interesting part of the study for me. They divided the participant families into one of two types simplex or multiplex. A simplex family is one in which only one older sibling has autism. A multiplex family is one in which multiple older siblings are affected by autism. This analysis indicated that 32.2% of sibling participants in multiplex families were diagnosed with autism, and 13.5% of sibling participants in a simplex family were diagnosed with an ASD.

Now, there is an obvious problem to this analysis when the family with 2 children, one of which is the older sibling with autism, and the other child being the sibling participant is considered. In this example, the family has not yet had the opportunity to potentially fit the definition of a multiplex family (the sibling participant having 2 or more siblings with autism) because there are only two children. The study authors therefore provide a more stringent definition of the two categories for a supplemental analysis. The authors restricted the analysis to families with three or more children, and defined simplex as having at least one child without autism aside from the original child with autism and the sibling participant. For example a multiplex family of three would include the sibling participant and two older children with autism. A simplex family of three would include the younger sibling participant, and one child both with and without and ASD. The results were very similar to the original analysis with 32.2% of sibling participants in multiplex families receiving a diagnosis and 20.1% in simplex families. It is unclear why the percentage diagnosed increased from 13.5% to 20.1% in the simplex group during the supplemental analysis. However, the sample size decreased from 619 for the original analysis to 380 in the more stringently designed group (families of 3 or more with simplex having one older sibling without autism), so it could be attributed to either sampling error or something fundamentally different about those families with only two children. Insufficient information is given to offer us any clues on this.

Other Interesting Stuff

The researchers also did some analyses looking at some of the other factors often thought to be related to an autism diagnosis. Proband gender is one of these. Proband is a term in genetics for the individual in a family that first has the disorder. So, in this study the proband is the originating child with autism. The analysis of proband gender looks to see if the gender of the older sibling with autism had an influence on whether the sibling in the study ended up with an autism diagnosis. Surprisingly, in this study, no relationship was found between the gender of the proband and whether the infant sibling received an autism diagnosis. This contradicts what was believed by many, with some research to back it up, that if the proband is a female, then subsequent children in that family are more likely to have autism.

Lastly, the researchers looked at another variable thought to be related to an autism diagnosis-Proband Level of Functioning. Whether a child with autism is "high" or "low" functioning can be a touchy subject with parents and a difficult concept to define. It is thought by many that the severity of the autism symptoms in the proband (older child with autism) is linked to the likelihood and severity of an autism diagnosis in the subsequent children of that family. The researchers in this study used the proband IQ scores, and the social-communication score on the ADOS as the measure of functioning level. There was no relationship between either the proband's IQ or ADOS social-communication score and whether the infant sibling ended up with an autism diagnosis. It should be pointed out though that an IQ score was available for only 30.6% of the probands, and ADOS scores were available for only 54.5% of the probands.

Concluding Thoughts...

Going back to my original question which was-what is the likelihood my recently-arrived son has autism? It is always important to remind ourselves that this is just one study and it takes lots of studies done by lots of researchers to get things closer to what we call fact. That being said, the results of this study suggest there are two main factors I should be considering: multiplex status and gender. First, because I have one child with and one child without autism that came before my newborn, we are a simplex family. That decreases the likelihood my newborn having autism than if I we were a multiplex family and both of my previous children had autism. Secondly, my newborn is a male. This increases the likelihood he will have autism (percentages noted above). As opposed to if he were were a female. My last message to you the reader is that it is far better to not worry about these things with your newest child. It is absolutely important to be vigilant and get your child treatment as soon as possible if you do have concerns, but don't let it occupy your mind to the point of lowering the quality of time you spend with your child. A child raised in a loving, fun, and social household will do well with or without autism.

Disclaimer: The information discussed in this article is completely the work of the authors and publishers cited at the top of the article. I have no connection to either the publisher or authors. The article is only attempting to explain the results and discuss them, not to make claims about the truthfulness of the information or take credit for it in any way.

Research Article Review: Comparing Developmental and Behavioral Naturalistic Interventions

2012-12-13T08:30:00.000-08:00

The Point of the Study

Researchers compared two types of naturalistic interventions for children with autism. A naturalistic intervention is one that doesn't use a formal teaching environment, but instead uses a more natural, usually play, environment to treat the child. Naturalistic interventions typically involve "following the child's lead" and teaching/treating the child as they are involved in meaningful and naturally rewarding activities. Thus, the children are highly motivated and emotionally invested in the learning process. So, within the broad area of naturalistic interventions, which pretty much most interventions used today already use or are moving toward a naturalistic model, two different approaches are compared in the study.

One approach is termed: naturalistic behavioral intervention. The authors define the naturalistic behavioral intervention treatment as those using direct prompting and rewards in natural contexts to teach specific communication skills. Although the authors do not explicitly mention ABA or discrete trial training, those familiar with these therapy/treatment types will recognize these approaches as similar.

The other approach compared in this study is the developmental social-pragmatic model of intervention. This type of intervention focuses on improving the adult's responsiveness to the child and making the interaction more of a two-way, back and forth exchange between the child and adult/practitioner. This particular model is similar to other developmental models of autism treatment such as DIR (floortime) and relationship development intervention (RDI).

Although the purpose of the study is to compare two types of naturalistic interventions (behavioral and developmental social-pragmatic), the authors note some similarities between the two approaches. The main similarities are that treatment is performed using "meaningful activities in the natural environment," the child takes the lead in selecting activities used for treatment, and natural reinforcement is used by the adult in response to communication.

The Nuts and Bolts

The experimental design is within-subjects which means that each child received all types of treatment and then the levels of communication they exhibited during each treatment were compared. The authors used a sample of 5 children with autism with ages ranging from 36 to 66 months old at intake.

This is where it get a little confusing. Remember the original purpose was to compare two naturalistic autism interventions: behavioral and developmental social-pragmatic. Well, for the actual study the authors changed the names a little bit and added a third type of treatment- a combination of both behavioral and social-pragmatic approaches. Perhaps the reason they changed the name is because they were not really providing either naturalistic behavioral or developmental social-pragmatic treatment. Instead, the treatment they provided for the study was just one main technique within each intervention. The authors refer to the three conditions as responsive interaction (developmental social-pragmatic consisting of language modeling and expansion), milieu teaching (behavioral- consisting of prompting), and combined (language modeling and prompting).

They measured a baseline level of total language during a play session for each child as well as the following categories: prompted requests, spontaneous requests, prompted comments, and spontaneous comments. Additionally
Then each child received three weeks of each treatment condition (responsive interaction, milieu teaching, and combined; see also above paragraph) with each week consisting of two treatment days of three 20 minute sessions. Finally, a one month 20 minute follow-up measurement was taken for each condition to determine whether communication improvements remained.

What They Found

The results indicated that the milieu condition (behavioral) and the combined condition (behavioral and developmental social-pragmatic) resulted in more total language displayed by the children in the study when compared to their baseline. At the one month followup, rates remained similar in the milieu and combined conditions, but children that benefited from the responsive interaction did not maintain language gains.

As far as the specific language categories, results were mixed. The clearest result was an increase in prompted requests when the children were in the milieu and combined conditions.

In general, children scored higher in levels of social engagement in all of the conditions, but, surprisingly, only the milieu and the combined conditions resulted in significantly higher levels of social engagement.

Commentary

The study provides some support for the effectiveness of naturalistic interventions, and more specifically behavioral naturalistic interventions. However, I think it is hard to conclude that the developmental social-pragmatic model is ineffective based on this research. Firstly, the therapists treating the children in the study only used one technique within the developmental social-pragmatic model (responsive interaction) and can't be said to have been implementation of the full treatment model. This is also true of the behavioral intervention.

Another issue, as noted by the authors, is that this study used a very low intensity and short-term treatment strategy. Each child received approximately 2 hours of treatment per week and only 3 weeks of treatment for each treatment condition. It is not unusual for a typical child with autism to receive 20-40 hours of treatment per week for several months. It is possible there is a minimum therapeutic threshold for the responsive interaction (developmental social-pragmatic) interventions to be effective, and that this research design did not use enough for the technique to be effective in increasing language.

Nonetheless, despite these and limitations noted by the authors, this area of research is incredibly important for at least two obvious reasons. First, there are numerous new and old treatments for autism. Many of these treatments have limited to no empirical evidence to indicate they are effective. This study provides one more piece of evidence and gives added strength to the philosophy that naturalistic interventions involving natural play environments and following the child's lead are effective for children with autism. Secondly, there are currently several treatment models that have already combined or are in the process of combining multiple techniques and strategies from a variety of theories. Studies like this one help point to strategies that are effective and should be considered for incorporation into these ever evolving models.

Reference

Ingersoll, B., Meyer, K., Bonter, N., & Jelinek, S. (2012). A comparison of developmental social-pragmatic and naturalistic behavioral interventions on language use and social engagement in children with autism. Journal of Speech, Language, and Hearing Research, 55, 1301-1313.

New Blog Element: Autism Research

2012-12-05T06:01:00.000-08:00

I am trying to make this blog work better for me. I've been very lazy about posting, so I'm going to combine a few blogs together into this blog. One of the other topics I blog about is autism research.

The first topic will be scientific studies that compare the effectiveness of autism treatment methodologies. Knowing what current research is telling us about the effectiveness of the different autism treatment models would be among the most important topics we can discuss when it comes to autism. Specifically, I will be looking for studies that compare the effectiveness of nonbiological treatment models for children with autism. Examples include relationship-based, behavioral (e.g. ABA), and developmental treatment models.

Before I make my first article post on the topic, I must confess to having a bit of a bias in favor of developmental/relationship models. My son currently attends a Autism Day Treatment program that tends to operate from a mostly developmental and relationship-based perspective. I will do my best to remain neutral. Expect the first post within a few days. If you wish to suggest a future topic, please click on the Suggest A Topic link.

Suggest A Topic

2012-12-05T05:57:00.000-08:00

Please comment below if you have a future autism-related topic of the week. If chosen, I will research 5-7 research articles on the topic during the month your topic is chosen. Thanks for participating!

Disclaimer and Letter of Welcome

2012-11-29T09:02:00.001-08:00

Hi and thank you for visiting my site!

This is just the part where I note that I am not an expert on autism and I am not qualified to nor am I intending to give you advice on autism treatment. If you or someone you care for has autism, please do not use this site for any treatment advice. The site is for entertainment and discussion purposes only! Consult a competent and qualified medical professional before trying any particular idea or treatment discussed on this site. Remember that just because there is research in support of a particular idea/treatment etc. does not make it a fact, and just because something worked for me or my son, does not mean it will work for you or is safe for you to try. I am not responsible for treatment choices or the results of such choices that you make for yourself or others. I am also not responsible for any choices you make that are related to comments made by readers. Accept everything on the site as opinion and not fact, and seek competent medical advice first.

Research Summaries and Discussion

I will do my best to present unbiased summaries of published research in the autism field and accompany this with my opinions about the particular research or topic. My intentions are not to offend anyone or to give out advice. If you feel I have done either unintentionally please leave me a comment and I will review the post. I am a parent of a child with autism and am using this blog as an opportunity to learn as much as I can about the research. By reading, summarizing, and discussing the topics in this blog I am attempting to gain in-depth knowledge of autism. I am not the author of any study discussed and it is not my intention to take any credit for the original research or ideas discussed in the studies. I merely wish to provide summaries and opinions on interesting research in the autism field. Each post will have a citation for the research summarized and discussed at the end. Additionally, if you feel I have misrepresented a particular study or it's results, inadvertently violated a copyright, or if a study has been retracted. Please leave a comment and I will attempt to re-word or delete the post (if I agree with you).

Advertisements

Yes, I do have some ads on the site. I figure, why not earn a little money for a hobby that takes up several hours of my time each week. However, I do not personally promote or endorse any product advertised on my site. If you should use a product or treatment advertised on this site, know that you do so at your own risk and that I am in no way attempting to convince you to do so. As previously noted, seek competent medical advice prior to trying any treatment for your self or for a child you are responsible for.

Please enjoy the site, comment and discuss. I look forward to learning with you.

The Pros and Cons of Apple's IPAD for Children with High Functioning Autism

2012-10-30T08:15:00.000-07:00

There is a lot of rosy language on the web touting the benefits of having an iPad for children with Autism. I even think that some parents feel guilty for not having an iPad, as though they are not doing enough to help their child with autism if they don't buy it. It's been about 6 months since we finally broke down and bought an iPad for Owen (who has autism), so I think I've given it enough time to be able give an honest opinion of how it works for him, and review some of the good and potentially not so good parts about using an iPad for children with autism.

In the title of this post I put "high functioning autism." I am not particularly fond of this language because it doesn't feel right to imply the existence of "low functioning" autism, but I kept it in there because it is the most commonly used terminology for someone "less severely" affected by autism. Secondly, since my son most closely fits this type of child with autism, I felt I could only give an honest opinion about the iPad based on our experience with him. Lastly, I felt that enough people had written about iPads and classical autism, and that it is fairly well established how nicely it works as a nonverbal communication device (with tons of different communication apps to facilitate), it is time for further discussion of potential benefits and drawbacks of using iPads for children with high functioning autism.

Video Modeling and Behavior Review

One of the biggest, yet least foreseen, benefits of the iPad has been using it as a video modeling device. Video modeling is most frequently associated with teaching children with autism social skills. Basically, social behaviors are recorded using a role model (peer, parent, adult etc). The child with autism then reviews the "tape" with a parent or practitioner, and practices the behavior. Due to there visual thinking style and need for breaking behaviors into parts/sequences, video modeling has been show to be effective for children with autism. Owen is perpetually amused when we show him videos of ourselves or our daughter modeling behaviors and social skills, and it seems to work.

When there are two of us around, we often use the iPad o videotape Owen when he is having a tough time (meltdown or negative behaviors). One of us tries to work him through the current issue (e.g. not having a favorite food as an option at the table), while the other records the incident. We then review the video with him later to talk about the emotions he was feeling and to discuss what behaviors were "ok" and not "ok" when he was feeling mad or sad. He is fascinated by watching himself on the screen and really "gets into" the particular incident under review.

Apps For All Occasions

The vast number of iPad apps available for both neurotypical kids and kids with special needs has been well established, so I won't go too far into it. Absolutely there are a ton of apps that can be downloaded to work on any number of specific academic, language, cognitive, or social skills. Many of these are free, and are limited unless you buy the full version. Nevertheless, there is an amazing number of potential apps to choose from and most are pretty cheap.

Splinter Skills and Generalization

Time for discussion of the first drawback (in my opinion). Many of the apps available for the iPad really focus on one particular area, and sometimes I worry that there is too much focus on very specific skills and not enough on the holistic picture. There is definitely a place for many of the skills some apps work on (letters, numbers, etc.), but my concern is that there gets to be so many apps that we end up struggling to maintain a focus. For example, we've downloaded several apps that teach site words. Each app has a slightly different list of words it works on. I have no idea which words Owen knows and which he doesn't. Additionally, Owen often plays one app for about 3-5 minutes or less, and then switches to a different app with a different purpose. I don't know if there is a long enough focus on each app to really process and learn the skill covered. I also frequently ask myself if learning in this way leads to enough generalization (knowing the information outside of the context of a game/app) to make the time spent worthwhile. Children with autism typically have trouble generalizing learning to multiple contexts, so it could be that having several apps working on a similar skill is helpful in generalizing that info. Or, it could be that much of the skills do not generalize beyond the game. I don't have an answer to that yet. My solution so far has been to categorize the apps and try to limit apps to one category each day, and then follow that up in my home treatment program with other non-ipad-based skills practic in that same category.

Screen time

I always worry about whether my kids get too much "screen time." We purposefully cut our cable when we had kids so that we were not tempted to have the television on. However, computers and iPads also count as screen time. Research has suggested that too much looking at screens of any type can have detrimental effects on children's attention and overall health. Much of this stems from the fact that when kids are watching TV, playing computer/iPad, they are not doing those other things kids should be doing like playing with objects, physical activity, and social activities. I try to limit Owen's overall screen time to 1 hour or less per day. This seems to be a good conservative limit, but I always wonder if the benefit of the screen time outweighs the potential benefit of those activities that are skipped because of it.

Getting Stuck- Rigidity

Another issue we often have with Owen is a tendency to get stuck on particular apps. He has a hundred or more apps available and he wants to play with the one that he doesn't need. He would likely be still playing with an app that counts from 1 to 40 (something he mastered years ago) if I didn't delete it long ago. So, choosing a really good app is a great first step, but getting a child with autism to really give it their full attention takes work. I often use a visual timer to indicate when Owen can switch from the app of my choice to the app of his choice, and back again.

Conclusion

In my opinion, the iPad has both benefits and drawbacks and you need to actively plan for how the iPad will be used for your high-functioning child with autism. Without active management of some of these concerns, the iPad could turn into more of a babysitting tool that provides little benefit, but otherwise can be a great help. If you actively think about how the iPad can fit into your child's home programming as one strategy among many, then the device can be of great benefit. I am certain though, that the world will go on if you choose not to buy the iPad.

Note: All content within the above post, represents the author's opinion only and is not a recommendation for or against the Apple iPad products.

Different Wavelengths

2011-04-07T07:57:00.000-07:00

Ever notice how the people that should have a basic understanding of the limitations autism can place on a child's ability to navigate the outside world often do not?

I'm not talking about the "model parents" rolling their eyes and shaking their heads when your child is having a meltdown a the supermarket, or even the 70 year old cashier who sneers "Doesn't he talk?" after her aggressive attempts at getting a response to grandmotherly questions is ignored. I'm talking about the surprising number of people in the medical and nursing field that seem to at best have a limited understanding of what to expect from the patient with autism.

It usually starts with the person asking him a question that is beyond his ability to understand and respond to. I then typically answer the question for Owen. When the expectations continue to go beyond what can reasonably be expected and I see his stress level rising, I tell them he has autism. More often than not, I'm reminding them he has autism (he's a frequent flyer, and it's in the chart!) Yet after explaining it, the problems tends to persist. I've recently taken to providing a short explanation of the difficulties associated with autism with improved results at subsequent visits.

My explanation usually goes like this: He has autism and has difficulty understanding and responding to complex sentences or instructions. He prefers to have less direct interaction with strangers until he gets used to them.

I know this is one of those things I have to just accept as coming with the territory and hope my explanations lessen the issue over time, but man is it irritating.

A First "Joke"

2011-02-19T11:53:00.000-08:00

Children with autism tend to struggle with the concept of joking. A variety of factors may be involved including their tendency to interpret language in a literal and concrete manner. Another factor is the difficulty children with autism typically have in understanding the unspoken intentions of the other person (theory of mind).

Last week Owen learned his first joke. He really enjoys bringing me the balls from his ball pit to shoot into the small basketball hoop designed specifically for them. He has always been very stuck on colors; although I'm sure many of you know what I mean by "stuck," I'll explain. He frequently is compulsive about needing to label the color of nearly everything he comes into contact with. Often he is unable to continue playing until he brings the color to me or his mother and announces the color and we say the color as well. If we try to ignore him in the hopes that he will become unstuck, he will follow us around the house repeating the color until we give in and repeat the color.

Well anyway, he was going about one of these "compulsive color episodes" the other day with the balls from his ball pit. I decided to change it up a bit. Here is how it went:

Owen: "Red ball."
Me: "It's a green ball?" (With a silly smile on my face)
Owen: "It's a red ball"
Me: "I think it's a green ball?"
Owen: "It's a green ball." (Smiling as though he knows he just said something really funny)
Me: "Is it a green ball??"
Owen: "No"
Me: "What color is it?"
Owen: "It's a red ball."

At this point I wasn't real sure he had got the "joke." But he proved he got the joke by bringing me a purple ball and saying:

Owen: "Is it a yellow ball?" (smiling)
Me: "Yes, that is a yellow ball"
Owen: "No, it's a red ball."
Me: "NO what color is it?"(shaking my head and smiling)
Owen: "Purple!!!"

This game went on for a few more balls and the exchanges became increasingly more complex and lengthy. Then he took the joke to another level by bringing me a ball and saying "Is it a fish?". It has been about a week since first learning the joke and let's just say he doesn't quite know when to let a good joke rest. He has generalized the joke to just about every object in the house. Sometimes using the joke on the food items on his plate, sometimes pointing at mama and saying :"Is it Grampa?" or me and saying "Is it Lily" (Lily is our dog). Still, we aren't complaining because we see it as a nice stepping stone from the purely concrete definitions of things into the abstract.

The Reformed Snack Thief

2010-11-29T14:17:00.000-08:00

Owen was for several months a habitual snack "thief." He ate his snacks faster than his sister and would routinely take her snack (or at least attempt). In the case of a mixed snack, we would frequently catch him switching the less desirable items in his snack (typically the healthy stuff) with the more desirable items among his sister's snack.

Sharing and turn taking can be very difficult for children with autism, and Owen is no exception. I believe his difficulty with only eating his own snack stems from the same problem that makes sharing hard for him as well. However, it certainly isn't uncommon for any toddler to have trouble sharing, but I wouldn't expect most toddlers without autism to have as strong a reaction when their parents attempt to prevent them from taking their sibling or friend's snack.

Our attempts to interrupt and/or prevent Owen from taking his sister's snack were typically met with fierce and aggressive resistance. Sometimes the result was aggression towards mom and dad, sometimes toward his sister, and sometimes he would have a complete meltdown.

Well, I cannot say whether it was our attempts to change this behavior, the autism day treatment center's attempts, or just a natural change, but last week he made a remarkable change.

I had sort of noticed that snack time had been going better than usual for the last few weeks. Yet, it hadn't dawned on me why snack time was going so well. Now I realize the reason is that Owen hadn't been having meltdowns during snack. It wasn't until last Friday that I realized how big of a change he had made somewhere along the way.

Last Friday I gave goldfish crackers for snack. This is one of Owen's favorites, but not particularly well liked by his sister. Owen woofed down his crackers and said "more crackers." I noticed that his sister hadn't touched her snack and had left the table (she is about 22 months old). I decided that I might as well give Owen some of her crackers and slide about half of her pile in front of him. In retrospect this probably wasn't my best ideas since there was a good chance that she would be angry with me for giving away her new found "favorite" snack.

But Owen would have nothing to do with his sister's snack. He got up from his chair, slid the crackers back to his sister's pile, pointed in his special way at her pile (using all 5 fingers) and said: "Thea's snack."

He then walked back to his chair, sat down, looked me in the eye and said: "More snack please." I was dumbstruck and ran to the cupboard to grab him more crackers from the box.

I am happy to report that Friday was not a fluke. He continued to show no interest in his sister's snack throughout the weekend and snack time has been reclaimed as a time of fun and relaxation for all. It goes to show how sometimes you think a situation is beyond repair and suddenly your child makes a huge leap forward.

Functional Communication Improvements

2010-11-24T13:19:00.000-08:00

It isn't always easy to see progress, but when I think about it, Owen has progressed immensely from less than 2 months of autism day treatment. The program uses a combination of daily speech, OT, and Mental Health Therapies (floortime, RDI, and cognitive exercises). Here are some of the favorite phrases I hear Owen say at mostly contextually-appropriate times:

"I want [object]" frequently saying the color of the object in place of the actual object, but it is generally obvious what he is referring to.
"Owen's turn", and "my turn", sometimes even: "Daddy's turn."
"I'll try some"--at the dinner table
"Help"

These are huge advances for us and we really believe these phrases have drastically reduced his frustration at critical times. One of the techniques that seem to work for the staff is to begin with those words that are in our son's vocabulary and gradually use activities that build important phrases into his vocabulary using those areas of strength. For example, Owen has always been good at colors. The staff play games that force him to say "I want red." Although we have tried to force communication from him by delayed responding, the staff are far more talented at this.

In short, the staff are doing an excellent job and we have seen numerous other progressions in him since starting the program. I wish this program was available everywhere. They provide it all. In addition to the actual autism day treatment they also include as part of the program: family therapy, in home weekly visits designed to help the parents transfer the skills, parent education classes, and separate parent and sibling support groups. This is the sort of treatment every family with a child with autism should get.

Music and Meltdowns

2010-11-06T05:32:00.000-07:00

Music is very powerful for my son. Many of you would say you that you also can be profoundly affected emotionally and cognitively by hearing your favorite song. But, I would wager that if you were screaming at someone; hitting them; slamming your head into them; scratching at their face, your favorite song would probably not be the compelling force causing you to stop. Perhaps it would be the fear of the legal system or sense of morality that would fire those neurons responsible for quelling your emotions. For Owen, it is music.

When he was an infant, Carrie Underwood songs could stop his crying in seconds. Now, he listens to a "Silly Song With Larry" veggie tale song to calm down. He also really enjoys the "Bounce" series which were created by a music therapist specifically for children with communication disorders. It doesn't always work, nor do we always have it available, but the right song can truly work beautiful magic on meltdowns.

Music therapy has long been known to be a very effective therapy for helping children with autism learn and regulate their emotions. I imagine it is at least partly related to some of the auditory sensitivity that is so common in children with autism. Whatever the reason, music is a powerful force for Owen.

The Plight Of A Younger Sister

2010-11-05T13:30:00.000-07:00

Recently, Owen's younger sister has had some very concerning behaviors. She appears to have picked up on some of his less pleasant behaviors. She is about 21 months old and has always been among the most happy and interactive children I've known. Strangers often comment on how she lights up the room with her smiles and are often delighted with her interactive antics.

We have also, to be on the safe side, had her checked out by the early childhood intervention evaluators and an autism specialist. They all agree that she does not show signs of having autism. I agree with them except for the behaviors she has learned from Owen. I never thought my 21 month old daughter would be hitting and headbutting me (ever so softly) when she was angry at stopping a fun activity. Nor did I think she would hit her head into the floor or wall when otherwise angry. It is amazing how she acts so completely like Owen in these times. If she were my first child I would be having her checked out by every doctor under the sun, but her behavior is almost perfect imitation of the exact behaviors her brother uses in a more serious and destructive manner. Now I am more saddened than ever to see her staring at us when we are trying to help Owen calm down (she used to cry during his meltdowns, now she just stares intently). It is natural for someone her age to learn by example and is probably the most vulnerable member of the family to the potential secondary affects of autism.

Don't get me wrong, we are very concerned about these behaviors. Mostly though, it has given us pause to think about how to best shield her from witnessing these behaviors from her brother and how to best respond to her when she displays the behaviors. Experts tell us not to give her any attention for it. This would be called "extinguishing" the behavior in the behavioral psychologist's terms, but I don't believe that is all we should do. I hope to stop by initially ignoring it when possible, but also being stern enough for her to understand it is not the right behavior to show her displeasure. Additionally, we are going to try to religiously remove either her or her brother from the room when he is having a meltdown. Other ideas anyone?

The Angry Word

2010-10-30T12:45:00.000-07:00

Owen is always choosing new angry words. What is an angry word you ask? An "angry word" is what I call that word Owen says when he is frustrated and has a temporary inability to communicate in any other manner. It started as "milk," then a few months later it was "yellow." Lately, the word has been "bike." How he chooses the word I do not know. I originally thought it was related to specific melt downs that involved the particular word (not getting milk when he wanted it), but now realize it is more complicated than that.

His "angry word" both alerts us that he is about to have a melt down and is also the word he typically screams over and over when he is having a melt down. He loses verbal and nonverbal means of communicating and instead and resorts to screaming his "angry word." I am thankful for the word some days for the warning it provides, and some days I hate the word for the fact that even with the warning I couldn't stop the melt down. I would give anything to figure out a reliable way to defuse the situation when I hear his angry word, but these meltdowns are a mystery. It seems I can successfully prevent one meltdown, but not successfully return Owen's frustration level to zero. A few minutes later, he will have a meltdown about something else.

Children with autism have difficulty regulating their emotions, and Owen is no exception. My next several posts will discuss ways I try to help Owen learn to regulate his emotions.

Have a great weekend.

How We Made Our Home Autism Program

2010-10-27T14:05:00.000-07:00

Many of the parents of kids in my son's autism treatment program discovered their children had autism only just a few months ago. Since a few of them were interested in the different therapeutic techniques I used at home, I thought I'd write a quick post outlining how I designed our son's home treatment program (activities my wife and I involve our son with at home).

I am going to qualify this post by stating that I am in no way an expert on autism. I share what I share in order to provide an example for someone interested in the subject, not because I feel I am qualified to do so. In this post I want to share with you how I developed our home autism program for Owen. The program was not designed to be substituted for more professional and intense autism treatment. We developed it to supplement the treatment he receives from professionals and to fill in the gaps on days he does not get treatment.

Here are some suggested steps you can take:

Step 1: Outline the child's strengths and needs. Using a combination of our own parental expertise and the different evaluations/assessments completed (e.g. Speech, Occupational Therapy, Medical, Early Intervention), we determined what areas our son most needed help with.

Step 2: Research therapies and potential treatment activities. We asked Owen's evaluators to give you ideas of specific activities we could do with him at home to improve his skills. We also spent many hours researching different treatment models that we thought might be capable of doing at home (floortime, RDI, Miller Method). A good place to start might be the treatment area of the autism speaks website.

Step 3: Create specific goals that are appropriate for your child's at home treatment. We next aimed to create goals for Owen that were simple, measurable and achievable. We also tried to make sure our goals were not duplicating any goals the professionals treating him had.

Step 4: Create a list of treatment interventions/activities that are designed to target each goal. Again, be sure these are activities you are comfortable doing at home and are designed for the goals you have written.

Here is an e.g. excerpt from the interventions section of our Owen's home program:

DIR/Floortime: Owen will participate in at least four floortime sessions per day. Floortime is a play therapy developed by Dr. Greenspan that focuses on fundamental developmental milestones typically absent or delayed in children with autism. It consists of 20-30 minute sessions in which the parent follows the child's natural play interests and attempts to expand upon their play to elicit more two-way interaction, engagement, shared attention, purposeful behavior, and problem solving. Although time will be set aside for floortime, it can also be considered an opportunistic intervention in that as parents we will always seek to expand upon Owen's activities in unstructured settings as well.

ABLC: Owen will participate in at least five Affect-Based Language Curriculum (ABLC) lessons each week. The ABLC program was developed to be used with the Floortime model as a means for a parent to provide intensive, in home speech therapy. Several areas of communication are addressed in the ABLC program including: imitation, two-way reciprocal interactions, receptive language, expressive language It combines systematic instruction of specific communication skills with applied floortime activities that give the child an opportunity to practice several skills at once in a natural play-like activity.

Relationship Development Intervention (RDI) Activities: Owen will participate in at least one scheduled RDI activity daily and additional opportunistic activities when possible. The RDI program was designed to improve the ability of children with autism to form relationships and friendships. The parent acts as a relationship coach/trainer in various activities starting with those activities promoting the most basic needs in building a relationship, and slowly advancing into activities designed to teach advanced relationship building skills.

Peer Play Dates: Owen's parents will attempt to involve him in at least 3 play dates per week with preference given to those with just one other peer.

Sign Language: Sign language will be paired whenever possible with spoken language. The use of sign language in conjunction with spoken language has been found to be more effective than the use of spoken language alone.

Delayed Responding: When appropriate and safe we will delay responding to Owen's attempts to enlist our help in obtaining something with the goal of motivating Owen to verbally communicate his wants.
Narration: Narration is a general strategy used in The Miller Method that involves describing each action a child is doing while performing an activity. The narrator is intended to sound similar to a sports announcer describing the actions of a game, and use very animated and excited vocalizations when the child has achieved something. This is believed to improve receptive language by continuously pairing the child's current action with words describing the action, and increase the child's self-awareness.

I really recommend that you type or at least write out the goals and interventions of your treatment plan. Writing it out gives you something to refer back to and build on in the future, and helps keep you focused. We also added a list of specific interventions that were recommended by the OT and speech therapists, and enlisted their thoughts on the other interventions we had chosen.

Step 5: Create an activity schedule.

Step 6: Review your child's goals and activities regularly. We choose a time each month to discuss the progress (or lack of) we are having meeting each goal. This also gives us a chance to change the plan when necessary and make sure we don't get stuck in a rut of doing the same thing over and over without challenging Owen.

Of course you should individualize your home program to your own personal style. Some of you are better at improvising activities from one day to the next or perhaps may just want to use one treatment philosophy. Most of the parents I've talked to haven't really taken the time to write out goals and interventions targeting each goal, but I find it clarifies my thinking and gives our time at home a stronger focus.

The Spectrum

2010-10-25T16:15:00.000-07:00

Getting to know the parents of the other children in our son's autism day treatment program really caused me to wonder at the huge range of "symptoms" of autism. I've heard someone say that specialists in the field of autism often use the saying that "when you've seen one child with autism, you've seen one child with autism." The more I talk to parents and hear about their own child's strengths and needs, the more I am amazed at how the symptoms can be so different.

Here are some examples of the strengths and difficulties a few of the children in our son's program have (names have been changed):

Andrew just turned three years old and needs to be carried "kicking and screaming" to therapy most days. He has numerous melt downs during class.Verbally, he has memorized the labels for hundreds of objects. However, Andrew is unable to use any of these words in a functional manner. He cannot ask for anything he wants or needs and lacks many of the needed social communication behaviors such as eye contact. Amazingly, this boy is three years old and can read books with no difficulty, and has memorized numerous songs on piano. Andrew sleeps 3-4 hours per night no matter when his parents put him to bed.

Michael is another boy in our son's class. Michael actively avoids eye contact of any kind, and uses less than 10 words total. Michael is constantly seeking sensory input through spinning. He sleeps for roughly 7 hours per night and eats an extremely restricted diet.

There are clear similarities between all of the children, but a huge range in severity of symptoms. On one autism-typical behavior (such as restrictive eating pattern) one child will have mild to no problems compared to another with severe symptoms. Yet the same child with such severe symptoms in one area may be the child with mild symptoms regarding a different autism-typical behavior.

It is of course pointless to compare one child to another, but thinking about the differences on our long drive home gave me a new realization and appreciation for the difficult task the therapists have in trying to both individualize the treatment and create group activities relevant to all the kids in the program.

Autism and Sick Don't Mix

2010-10-20T13:09:00.000-07:00

We just finished up three days of the stomach flu. The whole family had it, and it would have been hard enough to be sick ourselves and care for two sick children without autism, but throw one child with autism in and it is an entirely different experience.

It started on our way home from a trip to my parent's house. Owen had fallen asleep for the first hour of the car ride, but suddenly woke up crying and screaming with a look of terror on his face. This was followed by him vomiting several times. We pulled over, stripped him down to a diaper and cleaned him up. We then raced home and he vomited a few more times. He spent much of the first two nights awake, when he wasn't vomiting he was most likely screaming for milk.

We at first gave in and let him have his milk, but this invariably followed with another episode of nausea, so we decided to only allow him to have small amounts at one time. It is pretty much impossible to explain to a three year old with autism what is going on with his body (he was so scared) when they are throwing up, but we also couldn't begin to explain why he couldn't have his milk when he asked for more. I'm not sure he has ever had so many tantrums in a single day or night that were related to our attempts to limit how much fluid he drank at one time.

Well it is over, and I am happy to say there was one positive result from the experience. Owen learned how to tell us his tummy hurts. He now grabs his stomach and says "ouch." It is a beginning that we can work with and hopefully expand to other areas.

First Week Of Autism Day Treatment

2010-09-10T13:32:00.000-07:00

I could not have asked for a better outcome from Owen's first week of autism day treatment which we refer to as "school." Owen and his sister had to wake up one and a half hours earlier than their accustomed wake time. They both looked very dazed and confused, but we all ate breakfast and ran out the door on Tuesday without a hitch.

When we arrived at the treatment center the first day, Owen was a bit like a deer in headlights. He allowed the staff members to lead him into the classroom and seemed unconcerned the first two days. Yesterday and today he had a difficult time thought. He held on tight to me and crying "daddy" over and over. I finally had to put him down and let the staff lead him into the classroom. Yesterday this was followed with a tantrum, but today he recovered very quickly.

Despite some bumps along the way, each day the staff told me that the majority of the time he was very well behaved, followed directions, and had already begun to use his words to communicate his wants and needs. Today, to end the week I was really happy to hear the lead therapist tell me that Owen is a role model to the other kids in his class.

A Belated Update

2010-08-27T12:49:00.000-07:00

It has certainly been quite a while since I have posted. I don't have a good answer as to why. I think I've been a little burned out on the autism topic. Nonetheless, the break has been good and I'm happy to be in the posting mood again.

Owen has been making some pretty exciting developmental gains over the last few months. His receptive language skills have vastly improved, and he is able to consistently follow several one-step directions and a few two step directions. Among my favorite new developments with Owen is his artistic ability. If I had handed him a crayon or paintbrush a few months ago he maybe would have made a few marks on the paper, but most likely would have had nothing to do with it. Recently he made so much progress he will independently sit at the table with several markers or paints and draw several lines and circles with each color in front of him. He may even sit there for 15-20 minutes content to make his marks with each color.

Owen's speech therapist has been raving the past several sessions about his ability to follow here directions and even remain seated at a table to do activities with her that are probably not very exciting to him. So I guess he is making progress.

We of course still have days where it seems like we take two steps back, but in less than two weeks he will be starting an intensive autism day treatment program. The staff at this program are amazing. It is clearly not about the money for these people. I have had 45 minute telephone conversations with several of the staff and our assessment appointments have often gone over the time limit by a half to a full hour just so they could answer all of our questions. I am sure he will make amazing progress.

Autism Does NOT Lead to Higher Divorce Rates

2010-05-28T16:00:00.000-07:00

You've probably heard that parents of children with autism have a divorce rate of 80%. I've heard if from my son's doctor, I've heard it from his grandparents, and I've even heard it from his social worker. Trolling my favorite news source (MPR) for autism related news I found an interesting blip.

Here is the link: http://minnesota.publicradio.org/collections/special/columns/news_cut/archive/2010/05/autism_and_divorce.shtml

A study done in 2008 by Easter Seals (page 39) found that parents of children with ASD were less likely to have been divorced (30%) than parents without (39%). Finally, some encouraging news. I was so sick of people bringing up the 80% divorce rate. If you haven't already read the study, I highly recommend it. The study had a large sample size of and provides some interesting demographics and, unfortunately, much of the other findings depict how anxious and concerned parents of children with ASD are about their child's future.

Well worth it study to read.

The other study quoted by MPR was released a few days ago. This study used a huge sample size and found only a 1% difference in divorce rates between families with a child on the spectrum and a families without one.
I'm glad that the next time someone gives me the old 80% talk, I've got empirical research to fight it with.

A Visit to the Autism Day Treatment Center

2010-05-13T12:54:00.000-07:00

We got a call last week that Owen will be able to start autism day treatment at one of two facilities in the area that provides this type of treatment. The developmental pediatrician that diagnosed Owen with autism said autism day treatment was probably the best choice of treatment for Owen. We were very excited to get him in because both places providing it had told us it would be at least one year on the waiting list before getting into one of their classrooms. Now, they are looking at starting him in September so about 6 months on the list. This is assuming he qualifies. To qualify he has to have a medical diagnosis of autism, and qualify for occupational therapy, speech and mental health services. Owen has the medical diagnosis, is already qualified under the speech assessment completed by his speech therapist, but still needs to qualify for the mental health and occupational therapy in order to be admitted.

Yesterday, we had the OT assessment and were relieved that although his motor skills are somewhat high functioning in comparison to his age-equivalent peers with autism, the assessor felt that there was enough room for improvement to qualify him for the program.

While we were there we had a chance to tour the facility and the director of the autism day treatment programs met with us for about an hour and a half to discuss the program. The day treatment is 4 hours per day Monday through Friday (8:15-12:15). There are 6 children in each classroom and each classroom has a Clinical Psychologist overseeing it, a mental health practitioner, an Occupational Therapist, a Speech Therapist and two paras. Additionally, a music therapist does activities three times a week. So, it is generally a 1:1 ratio and involves a very comprehensive group of professionals. The program is very structured but does not use ABA. They use principles from the Floortime, RDI and TEACCH models as their primary program philosophy.

Because of the number of professionals involved in the day treatment it is very expensive, but so far it looks like our insurance company will pick up most of the bill. It will be hard work as it is 40 miles away through a pretty heavy traffic area. Our plan will be to try to get Owen into another preschool special education class in the afternoon and get him to that class just in time. Life will be busy.

We have the first part of the mental health assessment and are keeping our fingers crossed that he will pass (or fail depending on how you look at it) that part of the evaluation and get into the program. I can't imagine that after all this, they wouldn't come out of the mental health assessment agreeing that he does in fact have autism.

Wish us luck.

The Pros and Cons of the Affect-Based Language Curriculum (ABLC)

2010-05-05T09:35:00.000-07:00

The Affect Based Language Curriculum is a book and CD ROM combo that was developed by Greenspan and Lewis. Stanley Greenspan is a well known autism expert and developer of the DIR/Floortime treatment approach for autism and other developmental disorders. Coincidentally, I learned that he recently passed away; it saddens me when someone passes away that has contributed so much to the treatment of autism. Diane Lewis is a speech language pathologist. The curriculum was intended for parents, teachers or speech therapists of children with autism or other communication disorders.

I've now had a chance to read through the book, complete the checklists, and design a program for Owen. Creating a program is somewhat time consuming, but relatively painless. There are several skill checklists you have to go through and see what level your autistic child is at in the different areas associated with language such as imitation, back and forth interactions, receptive language and expressive language. Next, you have to decide which skills you want to start working on, and how many skills you will work on at a given time. When you are working on particular skill (for example waving goodbye) you are doing what they call systematic instruction.

There are various "foundation activities they suggest for the different skills that involve ways to get your child engaged with you before teaching a particular skill. It will be difficult to get your child to participate in the systematic instruction part if your child isn't first engaged in the activity and attending to you. After you are through with each of the systematic instruction skills, you are supposed to do "applied floortime" activities. These are play activities that focus on using several of the systematic instruction skills at once in a more non-instructive, play setting.

After trying it out for a few months now, here are my Pros and Cons:

Pros:

The program is very thorough and covers the entire spectrum of skills necessary to be an effective communicator and develop language. As you work your child through the skills in the 5 levels of the program you begin with very basic language skills in the areas of : 2 way interactions, imitation, receptive language, and expressive language skills. You end with pragmatics and very advanced play and interactive skills every child needs to fully engage with their peers and environment.
You can easily individualize the program to your specific child's strengths and needs. The program has very thorough checklists that determine where your child is in each skill area. You can then choose specific skills to work on based on your individual autistic child's needs.
The program can be done by anyone. Although it will take some time to learn and adjust from a "play with your child" mode to "play to teach" mode, the program is designed for parents, teachers or speech therapists alike.

Cons:

The program could be considered overly complicated and takes a while to learn. The book itself is 380 pages long (many of which are the checklists and skill activities). If you are wanting something you can start immediately without putting in much start up effort, this book might not be for you. That being said, it isn't that bad and once you read the book and get comfortable with it, you'll realize it is giving you the power to provide intensive, at home, speech therapy to your child.
The activity examples used for systematic instruction of the skills are a bit too specific. I'm all for details, but some of the examples use very specific toys that could instead be described using more generic terms. For example, instead of telling you to use a "Dora" doll, they could describe how to do the activity with any generic doll you have laying around the house. However, I found it pretty easy to substitute toys and objects I had already for most of the activities instead of going out and buying all the props their examples use.

Overall, I think this is a really great program to use if you are looking for a very comprehensive, yet usable home speech therapy curriculum for your child with autism or other special language needs. However, you will need a fair amount of patience to both learn and stick with the program.

Back to the Blogging Again

2010-04-30T15:24:00.000-07:00

Well, it has been a long time since I have posted anything. Things did not go well the past few weeks with Owen. He has had a 3 week long cold, and 4 doctors visits, 3 ear infections, and 5 different types of antibiotics later--I think he is over it. His routine is completely messed up and we have endured numerous almost sleepless nights and endless tantrums. So, I have been without posting ideas or energy.

Today, I hope to start a new set of blogging and hopefully we are past the worst of this episode of autism wars. I should be adding several posts over the next few days based on some ideas I have had over the last few weeks, but lacked the energy and emotional surplus to fulfill.

In the mean time, all the gains we seem to have made in speech therapy and our own home program regressed during Owen's sickness. He didn't make any functional requests such as "more milk" during his illness and now we are slowly in the process of building him back up. His "independence" skills have also regressed. He has become very clingy and reliant on us to solve all of his problems.

Another new development is that we have decided to nix the gluten free casein free diet. We only saw the negative effects of the diet: restricted eating, loss of weight, financial expense and an inability to easily eat out. I know there are a lot of you out there that think the diet is effective, so I'm just going to say it didn't work for us but I'm glad it works for you.

The worst part of the last few weeks of bloglessness, and perhaps the real reason why I've been too tired or depressed to blog is that we are starting to see signs of autism in our 1 year old daughter. Two major symptoms have come up and they are reduced eye contact and a sudden lack of response to her name being called. It is amazing because just a few months ago both the early intervention evaluator and developmental pediatric specialist noted how interactive she was and that she will be a great play companion to Owen.

I'm really hoping we are just being paranoid parents on this one.

Routine Stubborness

2010-04-01T20:42:00.000-07:00

It seems that as time goes on, Owen is getting more and more stubborn and rigid about his routine. As a baby, he was pretty flexible with a change, and rarely fussed in response to a change. Now, I wonder whether it just seems that he is more stubborn about his routine because I know he has autism, or was I blind to it before I was aware of his disability?

I'm pretty sure he is getting more stubborn. Last summer we went on daily walks together. He never showed concern over a different route. This spring we have started up the daily walks, but he has a "minitantrum" anytime I decide to change the route. It got so bad today that he didn't know what he wanted to do anymore and simply sat on the sidewalk refusing to budge. I ended up having to carry him and his tantrum home. When the neighbors want to stop and chat, I have to tell them I can't because he doesn't want to stop the walk. I think I will quit walks for a week and do some other outdoor activity to replace it.

Transitions seem to be getting worse too. Switching from one activity to another seriously stresses the boy out. We have been trying to use the PECS program to help communicate what is going to happen next, but we can't get him to attend to the pictures.

We have a neighbor's birthday party to go to this weekend. I wonder how that will go.