The Autism Angle

To Be Continued.........

2011-10-28T16:22:00.001-04:00

With great sadness, our posts must be suspended for the time being. Please stay tuned as we hope this will only be a temporary pause in our goals for awareness, understanding and fun. Our dedication is unwavering and we hope to continue soon.

-Abby and Molly

Adding Fun to Food: Revisiting the Autism Food Fight

2011-10-17T18:56:00.000-04:00

As discussed previously in our post about picky eaters, mealtime is a huge battle for those on the spectrum. This leaves parents/teachers frustrated and individuals with autism even less apt to try new foods. There are many hurdles so incorporating new ideas and trying a variety of things is important.

Make it an Activity
Having the individual participate in making food is a way to make it more fun and the child can be part of the activity rather than on the 'sidelines'. Snacks and mealtime can be more of a fun learning time.

-Simplify directions - Simple step-by-step instructions using objects/food items, picture or short words depending on the level of understanding.

-Pre-measure - If numbers, fractions, etc are stressful, eliminate that from the cooking task. Measure out items and label bowls so that it will not include any stresses.

-Use Interests - Lots of fun food recipes are available online, beyond what is included below. Make it specific to your child's interest in trains, animals or cars. Use cookie cutters to make letters, dinosaurs, etc. Ice cube trays to mold jello into fun shapes or other foods. Create 'faces' on food with raisins, pepper strips, marshmallows, etc.

Visually Appealing Recipes
The Internet is a source of great recipes. Visually appealing food can make it more interesting to kids and hopefully catch their interest enough to give a try. Here are a few a the fun recipes we have found:

Cheesy Chums (http://www.familyfun.go.com/)

Ingredients

mini cheese round (such as Babybel)
small pieces of red bell pepper, scallions, carrot, and olives

whole wheat crackers

Instructions

Use a sharp knife (an adult's job) to trim the wax covering from a mini cheese round, then add facial features with small pieces of red bell pepper, scallions, carrot, and olives*. Serve with a short stack of whole wheat crackers.

Tips: We used cocktail straws and drinking straws to punch round eyes from olive halves.

Garden Octopus (http://www.familyfun.go.com/)

Ingredients

2 bell peppers
Dip or hummus

Black olives

Instructions

For the octopus's body, remove the pepper's stem end and scoop out the white ribs and seeds. For the arms, slice a second pepper into strips.
Place some dip or hummus (we used French onion dip) in a shallow bowl, and arrange the octopus as shown. Use a bit of dip and sliced black olives to give your creature eyes.
Serve with extra veggies, such as carrot sticks, fresh green beans, lightly steamed broccoli spears, sliced cucumber, and jicama sticks.

Breakfast Smiles

Breakfast for lunch or dinner is also an option.

Use eggs, fruit (of your choice) and meat (bacon, sausage, ham)

Cheesy Ham Shapes (http://www.thatsmyhome.com/)

6 Flour Tortillas

2 cups shredded Cheddar Cheese

1 cup diced, cooked ham or 6 slices of ham lunch meat

1/4 cup sliced green onions (optional)

Remove tortillas from refrigerator. Let stand at room temperature for 10-15 minutes. Preheat oven to 375° F.

Place shredded cheese, ham and green onions, if desired, onto bottom half of tortillas. Fold tortillas in half over filling.

Place folded tortillas on a lightly greased baking sheet. Bake 8-10 minutes or until the edges are golden brown and the cheese is melted. To serve, cut in half for triangles or use cookie cutters for fun shapes.

Macaroni and Trees (http://www.thatsmyhome.com/)
salt for pasta water, plus 1/2 tsp more for cheese sauce

4 cups broccoli florets
8 oz Tri-Color Fusilli (about half bag)
3 TB unsalted butter
2 TB all-purpose flour

2 cups whole milk
pinch black pepper
pinch cayenne pepper
2 cups shredded cheddar cheese

*Warm Cinnamon Pear Compote
2 ripe pears, peeled, cored, and diced
1/4 cup raisins
1/3 cup organic apple juice

1/4 tsp ground cinnamon
pinch ground nutmeg
2 tsp butter (optional)
1 TB cider vinegar or red wine vinegar
black pepper
To prepare the Macaroni and Trees
Preheat the broiler. Bring a large pot of well-salted water to a boil. Add broccoli, return to a boil and cook, uncovered, until al dente, about 4 minutes. Remove broccoli with a slotted spoon, leaving the water in the pot. Boil the pasta in the reserved water until just tender, about 10 minutes. Drain.

Meanwhile, melt the butter in a saucepan over medium heat. Stir in the flour and cook gently for about 1 minute. Whisk milk, salt, pepper and cayenne. Bring milk mixture to a simmer, reduce the heat, and cook for about 5 minutes until mixture thickens. Stir in two thirds of the cheese. When the cheese is melted, remove saucepan from heat and set aside.

In 2 quart, ovenproof dish, combine the pasta with two-thirds of the cheese sauce. Add the broccoli to the remaining cheese sauce in the saucepan. Encircle the pasta in the dish with a border of the broccoli. Sprinkle remaining cheese over the top and broil for about 3 minutes, until cheese begins to bubble.

To prepare compote
Combine pears, raisins, apple juice, cinnamon, nutmeg and butter in a small saucepan. Cook, uncovered over medium heat, about 10 minutes, stirring occasionally. Add vinegar and black pepper and continue to cook about 5 more minutes until juice is reduced and pears begin to fall apart. Cool 5 minutes. Serve on the side with Macaroni and Trees.

Serves 4

SHAKE 'N BAKE® Chicken Nugget Kabobs (http://www.kraftrecipes.com/)

1 to 1-1/4 lb. boneless skinless chicken breast halves, cut into 1-1/2 to 2-inch pieces

1 pkt. SHAKE 'N BAKE Extra Crispy Seasoned Coating Mix

2 cups KRAFT Cheddar Cheese Cubes

1-1/2 cups cherry tomatoes

1 can (8 oz.) pineapple chunks

12 (9-inch) wooden skewers

Make It

PREHEAT oven to 400°F. Moisten chicken pieces with water. Shake off excess. Shake 3 or 4 pieces at a time with coating mix. Discard any remaining coating mix. Place in ungreased or foil-lined 15x10x1-inch baking pan.
BAKE 15 minutes or until cooked through.
ARRANGE 3 cooked chicken nuggets, 3 cheese cubes, 2 tomatoes and 1 pineapple chunk on a wooden skewer. Repeat with remaining skewers. Serve with 1/3 cup KRAFT Barbecue Sauce or 2/3 cup KRAFT Ranch Dressing.

Mini Taco Bowls (www.kraftrecipes.com)

8 flour tortillas (6 inch)

1 lb. extra-lean ground beef

1 cup TACO BELL® HOME ORIGINALS® Thick 'N Chunky Salsa

1/2 cup KRAFT 2% Milk Shredded Cheddar Cheese

2 cups chopped lettuce

1 tomato, chopped

1/4 cup KRAFT Ranch Dressing

Make It

HEAT oven to 350°F.
MICROWAVE tortillas on HIGH 30 sec. Line each of 8 muffin cups with 1 tortilla. Carefully fold back edges of tortillas, leaving opening in centers for filling.
BAKE 10 min. Meanwhile, brown meat in large skillet; drain. Stir in salsa; bring to boil. Simmer on medium-low heat 10 min.
SPOON meat mixture into tortilla bowls; top with remaining ingredients.

TACO BELL® and HOME ORIGINALS® are trademarks owned and licensed by Taco Bell Corp.

Ants on a Log

Celery

Peanut butter or Cream cheese

Raisins

Get Extra Veggies, Fruits and Vitamins

When necessary, hide the veggies and add nutrients where you can. Sometimes getting those with autism to try new foods seems close to impossible. The preference is to have kids learn to like a variety of foods but sometimes masking them is the only way to help those picky eaters.

Pureed Vegetables & Fruits -

Baked squash, sweet potatoes and carrots along with blended berries, apples and peaches can be added to foods to add nutrition. A cup of veggies into mac and cheese or spaghetti can be hidden.

After cooking & blending, pour puree into ice cube trays

Add frozen puree (carrots) to meal (spaghetti sauce)

Vitamins -

ALWAYS consult a doctor for nutritional supplements. Omega-3, Flax seed and Brewer's Yeast are a few of the easy ways to add powdered or liquid vitamins to food. Fish Oil can be a stronger taste/smell and may be harder to hide but many ground supplements have little to no taste.

Pour powdered supplements (such as flax) into sauces, casseroles, yogurt, etc

Small Changes -

Changes are difficult but not impossible. With foods, we need to incorporate new foods on a regular basis but not change everything at once. Slower changes in added nutrition, new snacks or a unique fruit/veggie, will be easier to accept.

-Abby

ACTIVITIES ON THE ANGLE: Rewards and Motivation

2011-09-19T07:58:00.000-04:00

Reward systems, praise and motivation are not always a perfect match for individuals with autism. Using rewards that are more understandable and meaningful can take a little creativity and patience. A few things to keep in mind when making these systems more understandable can go a long way. We talked previously about behavior difficulties that can occur with those on the spectrum. We want to go more in depth with the motivation so that some of these difficulties can be avoided.

Tips for rewarding:
Make it Visual: Show through pictures, objects or short written information.

More Immediate: Make sure the time from the reinforcement (such as TV time at home) is not too far from when the action (such as cleaning up at school) occurred. There are a lot of students that can understand rewards at the end of the day or week but there are just as many that do not make this connection.

Individualize the Reward: We aren't all motivated by the same thing and it can change for all of us as well. Stay on top of what is the current interest to help things from getting stale.

Don't Take Away: Removing rewards that are earned are not recommended. It is confusing enough trying to make the connection between what 'to do' and the end result.

Systems to Use:

First-Then Sequence
Through pictures, objects or words (depending on your child's current level of understanding), you can visually show first 'this' happens and then you receive 'this'. Starting out very slow with contingencies is important, in other words, we want the child to understand that this behavior = this outcome. We don't want to jump to complex reward systems that may be confusing and therefore not meaningful.

First brush teeth, then TV time

First put your jacket on, then you can play outside

Puzzle Pieces
This system can be used for TV time, toy or other treat. Simply cutting up a picture of a specific item of interest can help create a reward system that is specific to that child's motivation.

This child earns pieces of a tractor and then gets to go visit his Grandfather's farm.

This chart is earning 3 pieces of a treasure box and then the individual gets to chose one item out of the treasure box.

Reward Charts
Lot of samples can be found of these online. Specific characters can be used to help motivate the individual. Whether it is 'Thomas the Train', 'Dora' or 'Sponge Bob', charts can be found at various sites to incorporate the interest.
-A few sites we have found:

Token System 'I Did My Chores'
I lucked out finding this at a consignment sale. This system is like a token system/economy. It can be too complex for some students, so use a system that you have assessed to make sure it is understandable to the individual.

This system can be purchased online: http://www.chores-help-kids.com/index.html

Choice Board
Also, using choices of rewards allows for flexibility with what is available but also giving the individual control over what they want.

Creating motivation for your child or student can greatly increase compliance, interest and enjoyment. We are looking forward to finding new ways to motivate individuals on the spectrum and always looking for new ideas!

-Abby

Moving from an Object to a Picture Schedule

2011-09-11T09:41:00.000-04:00

Abby recently posted on object schedules (go to post) and stressed the importance of using a schedule that is sensitive to the child's understanding at the current moment. She's right, we often jump too quickly to using an icon/word schedule with children who might not yet be identifying pictures, so how do we know when they're ready to use pictures?

One way to access a child's understanding of pictures is to see if they can match them.

Start with actual photographs first. This is less abstract than icons and may be more easily understood. See if your child can match exact photographs to each other

Also see if your child receptively understands the picture. So, you may want to sit him/her at a table (to help with focus) and ask your child to "point to the playground," for example to see if they can identify that photograph and distinguish it from others. Some children may still recognize that the picture represents a place, however, so even if he/she cannot identify the picture of the play room by pointing to the picture, if they still take that picture to the area and recognize that play time is next, than that's o.k. The key here is to look at what your child understands independently (without anyone having to lead them to the area on the schedule item).

If your child is showing skills in this area, then you may want to start using photographs. In this transition you can also put the actual photograph on the object and then gradually just use the photograph.

Similarly, with icons start by seeing if your child can match icons to each other and identify the picture. For beginning readers, you can also include the word on the picture but if your child is still very young and not yet recognizing letters, then it's not necessary to have the word on the picture.

Using pictures for a schedule can certainly be overwhelming for parents in knowing where to start and where to find these resources. Just remember, it does not need to be beautiful, it just needs to be visual. So, if you can easily sketch a picture on a sticky note, that's perfect! For me personally, I can barely draw a stick-figure so it makes things a bit complicated..... so, where can you go for easy and free pictures?

Here are a few websites:

Examples of icons on Do2Learn Website

Google Images-- www.google.com (click on images and just type in what you want to find). Especially if your child understands photographs better, this is a great site and even if your child is using icons (at school, for example) and understands those, it's still o.k to use actual exact images-- they will still be understandable! You can easily print out schedule items that you are likely to use on a daily or weekly basis, such as errands you run (Target, Grocery Store etc) or activities at home, like Dinner Time, Getting Dressed, etc.

Do2Learn-- http://do2learn.com/. This site has tons of printable icons for free. They are mostly in black and white and you can print them either with or without words. I love this site because it has tons of pictures for daily living skills and activities in the home and the community. It's a great resource for parents!

Autism Buddy- www.autismbuddy.com. You will have to join this site, but it's free and then you can download many visuals and other activities. They have many clipart images that you may also be able to get on your computer.

Visual Aids for Learning- http://www.visualaidsforlearning.com/index.htm. This is a great website for free images as well. You can download complete packages, such as the "Early Childhood package" or "School package", even a "Toilet Training package" with tons of images related to these categories.

Board Maker: This program is super expensive (check it out), but if you work with lots of children or for a company that would pay for it :), this is a nice program where you can type in what you're looking for and it will produce an color icon that you can then print out. I would recommend checking out the free websites before investing in such an expensive program first though!

Again, it can often be overwhelming to know where to start in using a schedule

with your child and I think picture schedules can often be the most intimidating.

Here are some points to keep in mind that might make it easier:

It does NOT need to look beautiful. You do NOT need to laminate. Card stock or contact paper are other options for more sturdy cards

It's o.k to simply draw something out and put it on a stick note-- or use stickers, whatever is easy!

Get out your camera and take pictures! Digital camera make this a lot easier this day and age!

If you do not have a picture handy, use an object to aid in understanding. For example, it's time to get in the car and you don't have a picture and your child is reluctant to transition. Grab your keys and hand them to your child and say, "time to go in the car."

You do not need to run out and buy a bunch of velcro. You can use paperclips on a sheet of paper to present the pictures in a top-bottom or left-right fashion.

Don't try to initially schedule the ENTIRE day. Just start with part of it. Once the child is used to using the schedule and understands it, then just start with using a schedule at home during the most difficult times and you can always add to it!

Stay posted for future posts on why we use schedules, how much info to include on schedules, and how the person with ASD can interact with or manipulate the schedule!

- Molly

First Concerns, Signs and Red Flags of Autism

2011-09-02T10:02:00.000-04:00

Being that we have the pleasure of working with lots of families throughout the year we are exposed to many different circumstances leading to the spectrum. Pediatricians are often thought to be the first line of defense. What if delays aren't recognized?

"He's just a boy", "All children develop at different paces", "His/her older sibling just does the talking for them", "Call if there is still a problem in a year", etc are some of the things parents are being told. Children not speaking any words at 3, 4, 5 years of age is not something that should go unnoticed but it does. This is NOT all pediatricians or only happening only at these offices but the fact that it happens at all is concerning. How can we help get the word out about signs? There are subtle differences in some children that are rarely picked up until later but what about the obvious/clear delays?

Thanks to the Internet, many families have been able to seek out information on their own. Autism Speaks Videos are a great way to see red flags at an early age to see if they apply to your child. There are great books such Does My Child Have Autism? and even screening tools that parents can download on their own: http://www.firstsigns.org/downloads/m-chat.PDF.

What a few of the red flags?
*Communication difficulties; with or without language delays
*Limited/Poor eye contact
*Echolalia; repeating other's language immediately or later on (such as repeating scripts from TV and movies)
*Little gesturing; pointing, describing by showing, etc
*Difficulties getting along with others; especially peers their own age
*Difficulties with imaginary or creative play
*Repetitive behaviors/movements
*Sensitivity to sounds, lights, clothing, food, etc.

These are only a few of the signs to look out for and should be followed up with an evaluation rather than diagnosing on your own. Even if your child initially is labeled 'Developmentally Delayed' this can be a great way to access services. It is concerning that recently in the news some of the Screening Tools were in the press for possible alerting too many families to autism. We are missing many children early on, therefore, seeing screening tools as a hindrance rather than a guide is a problem.

We have had a couple of our families share their story on our blog regarding their experiences with the diagnosis and would love to hear more. Improving our communication among professionals is important to identify children as soon as possible. We have added a survey to the right of the main page to find out who is alerting families. What were your first signs? When were you concerned? Who helped identify red flags?

We would love any input!!

-Abby

Fun Feeling and Emotion Games!

2011-08-25T20:00:00.001-04:00

I am always looking for fun and interesting games to work on social and communication skills with kids This is called "Funny Faces" and it's perfect for young kids-- 3 years to I'd say first grade or so.

How the game works is that you set out the game board and pick three different colors of cards to use. Set all the cards (a total of 15) on the board and then pick out the same color cards from the drawing deck and set them aside. One player will draw a card and without showing anyone the card will make the same face. Then, the other players will guess which face the person is making and will put their chip on the corresponding face on the game board. The quickest person wins that round. Also, it's adorable because the child can use the little mirror that comes with the game to help him/her make the expression.

Using facial expressions to convey emotions as well as reading other people's emotions is a skill that can often be challenging for individuals on the autism spectrum and I love this game because it helps teach these skills and it's not overly complicated for little ones. If you're looking for ways to help structure turn-taking, then check out our earlier post of how to create a visual turn-taking board to make waiting easier:

http://theautismangle.blogspot.com/2011/06/trouble-taking-turns-struggle-sharing.html.

I fell victim of these online sale websites again and purchased a whole bunch of these tiny stuffed feeling guys. The brand is "kimochis" and you can check them out at http://www.kimochis.com/. I just thought they were so much fun-- I got a little carried away and bought like four packs, but I think I paid $7.00 a pack so you could chose which pack might be most useful for you. Again, talking about emotions and feelings can be hard for the kiddos we work with and what I love about these is that they are so visual so even if expressive language is difficult for some to get out in a time of frustration or excitement, the child can show how they feel through one of these kimochis.

If you need to create a new emotion, then you can also use one of these pens to draw a new face!

Many of the emotions are very abstract and so you may want to begin practicing the more basic emotions. Also I think these are great to use with siblings, play dates etc as way to start a conversation about feelings when things get rough. I've also seen similar little toys used in social groups to help all the kids be more aware of their feelings and the feelings of the group in a less threatening way. Anyway, there is just so much you can do with these little things-- oh, and they are small-- probably only 3 inches big all the way around. Have fun!

- Molly

Before Pictures: Autism and the power of objects

2011-08-18T07:27:00.000-04:00

Individuals with autism are often, unfortunately, given strategies that are attempted to be one size fits all. Trying to fit persons into techniques that are not at their level of understanding can be disasterous and overwhelming. There are many different areas of teaching and therapeutic strategies where this is done. One specific teaching misconception is that by making things visual for individuals we always use pictures, but this is not always the best idea. Pictures are not always as clear as we may intend them to be.

Visual information can be more understandable to those on and off the spectrum. Not all types of visuals are best suited and we must individualize as much as possible. We often immediately go to pictures and icons rather than first assessing where the information is most meaningful for that person. Objects can speak volumes to so many and it can be forgotten that this can be an important tool in giving information as well as teaching communication.

Communication Exchange:

Picture Exchange Communication System (PECS) developed in 1992 by Andrew Bondy made exchanges for communication more widely understood by parents and professionals. Boardmaker, by Mayer-Johnson, also changed the field to make pictures quick to make and use. It is rare that I walk into a special education classroom and don't see these icons. This is great that it has become more mainstreamed BUT not everyone with autism understands pictures and icons as a means to communicate.

Pictures and icons are more representational/abstract. It is difficult for many individuals to make the connection between a symbol and the item or activity that it is meant to represent. Objects are great to try with those that aren't quite showing that level of understanding in the area of pictures. Molly gave great examples on how to set-up communication with objects. Using the actual item helps to understand exactly what item is being requested.

When making a communication exchange, whether with pictures or objects, it is important to focus on the back and forth/give and take. Many individuals have trouble directing their language or requests to another person. Handing a picture or object (such as a bubble wand) to someone else and then receiving the item (container of bubbles) helps them to understand the power and purpose behind these requests.

Transitions:

Understanding what is going to happen is very important for us all. Not knowing expectations of a situation can many times cause difficulties for those with autism. Schedules or transition information can be so helpful to know expectations.

When using objects, keep it simple! Objects to represent a change in activity naturally occur on a daily basis. We hand a child their blanket and take them to bed, direct them to their shoes and take them outside or get their bookbag before going to school. Using these items in a more systematic way at school, in the community and at home, can be just like a schedule of knowing what is going to happen next.

Simple objects can be used for letting the individual know what will happen next.
In this picture:
Pull-up = changing your diaper
Ball = Play in the backyard
Toothpaste = Go to bathroom to brush teeth
Duck = Go to bathroom to take a bath
Doll = Go to bed
Cup = Time for lunch

Think about the objects in your environment and make it specific to that child.

Handing an object, such as this bath duckie, let's the child know that we are going for a bath. This is important to be specific since we can go to the bathroom to use the toilet, bathtime, brush teeth, etc.

Once the individual takes the item, such as the bath duck, to the location it then can be used functionly; as part of that activity.

These are meerly a few suggestions to get you started in understanding the information behind objects. Another wonderful blog, written by parents, shares lots of ideas specific to their child and home. Check out one of their many posts regarding their child and use of an object schedule

For additional ideas on how to structure without giving too much information to overwhelm your child check out the book More than Words by Fern Sussman

-Abby

"The Devastating Effects of Autism on My Ego, or the amazing reality of being autistic before people knew it was a thing"

2011-08-11T07:43:00.001-04:00

Middle school was rough. I was thirteen and still liked to dress up and then carefully arrange my dolls. I was obsessed with Buffy the Vampire Slayer, collecting every piece of media I could find that might be vaguely related and stockpiling it (for what, I still don't know). I had only learned to wear jeans in seventh grade, the fabric harsh and too unyielding to be properly comfortable, but the bullying for my preferred stretch pants was even less comfortable.

I was in eighth grade English when my teacher made an announcement. The school was going to be trying an integration program, with a classroom for artistic students who would be in our elective classes but not the core curriculum ones.

I seethed. How could I not have been invited? I was familiar with semi-integrated education already; I had been invited to go to a separate school for the Very Special Needs academically gifted kids. I was the best artist in my class, for sure! Had I not drawn and redrawn the same picture for most of fourth and fifth grade? That picture was amazing! Every one of the hundreds of copies! How dare they ignore me?

Later I found out the teacher had actually said "autistic." She was from New England and I'd never heard the word before. It's funny now.

It's funny because I am autistic. I'm apparently what they call "high-functioning," but I don't like the term very much; the division feels artificial and the inherent value judgement is off-putting. I'm not less autistic, it's really just that I communicate in a way allistic people seem to understand most of the time.

There are as many ways of being autistic as there are people on the spectrum. Autism is described in the medical model of disability as a series of deficits, things that make us deviations from Regular People, but I don't think that's true. Autism is a neurodevelopmental difference, a way of experiencing and thinking about the world that is certainly different, but not inherently bad. The disability part enters into things because the world was not designed by or for us, and as a minority group we are expected to conform to the majority, not the other way around. Autism accounts for the parts of me I dislike--low frustration tolerance, perfectionism, difficulties making friends, my propensity for depression and anxiety, my propensity for lists and em-dashes--and the parts I like a lot--loyalty, determination, artistic talents, a gift for learning, my propensity for lists and em-dashes--because you can't separate out autism from me. Autism didn't sneak into my room when I was small and steal me away. It's just a word to describe how I interact with the world around me. Just a word. I sometimes think autism makes me inherently existentialist.

Being autistic means that I experience the world differently than most people, and not in a solipsistic way. There are sensory overloads, a world too bright and loud and full of textures, touching and grating and soothing. Things other people seem to find effortless, like reading facial expressions and making eye-contact, are difficult or distracting or downright painful. I can spend hours engrossed in reading about a favourite topic, unaware of pressing physical needs like hunger, and I communicate my enthusiasm in hand-flaps and wiggles and relevant echolalic quotes. My particular blend makes learning music by ear effortless and by written sheet music nearly impossible, while I prefer written instructions for academic or job-related things and watch TV with subtitles whenever possible (autism, by which I mean me, definitely has a sense of humour). It can be hard to make friends, but I keep the ones I have close, and love them dearly. I keep a planner without the school or high-powered career to warrant it, lists and schedules and therapy appointments all crammed in together because I invariably will not remember them--but my planner will. I get overwhelmed and scared and ecstatic and furious and many more besides, though I struggle to find the words for them in the moment. Words spill out onto my computer screen even when I can't sustain a spoken conversation or get lost in the pattern of the wood grain behind my interlocutor.

I was asked to write about what it's like to be autistic, with the guidelines of the DSM to focus the prose. It's hard, now, because I don't think going point by point for all the ways I can be seen as damaged is a wise way to build my identity or to speak of it to strangers. I am not a broken allistic person. I am not a collection of deficits wrapped up in skin. I am autistic and I use that word deliberately in the adjective form.

I am just like you. Only, maybe, not.

- Ali St. James

Please see comments below to hear Ali's description of the term "allistic"

Autism, Aspergers and Mainstreaming in Middle School: Let's Ease the Transition!

2011-08-03T19:33:00.001-04:00

Most parents and students have anxiety at the start of school. For those families with an individual with autism, the stress can be compounded. We can't eliminate nor predict every area of difficulty but at least plan for as much as possible. Middle school is a time of change. Organizational skills are put to the test, hormones are raging and socialization reaches a new level of complexity. How can we prepare?

Become Familiar with the School - Visit the school ahead of time. Walk the halls, determine where classes are and try to meet with teachers on a one-on-one basis. This is often a new environment but also different due to the fact that this is many times the first time the individual has had to change classes. Gaining the schedule ahead of time with the classroom numbers/locations can help in practicing how to navigate the hallways.

Use a Map - Put a map of the school in the front of the individual's notebook. Highlight classrooms and put time period to go to that room. Also show where the locker, cafeteria, library and other important places are.

The Locker - The dreaded locker can be a challenge in itself. Try to get a heads up where the locker will be located and the combination. Practice ahead of time how to open; this can be very stressful. When writing out reminders of the combination, be very specific.
Example:

Turn the locker dial to the right two times to reset
Turn the dial to the right and stop on '0'
Turn to the right and stop on number '25'
Turn to the left and stop on '10'
Turn to right and stop on '22'
Pull down to open

Schedule Locker Breaks - Often on a student's schedule I put the specific times they need to go to the locker. This eliminates making judgements about when there will be enough time. Also, putting what specific books to get and put back.
Example:

Arrive at school
Locker - Keep English and Math books; put other books in locker
English Class - room 205
Math Class - room 400
Locker - Put English and Math books away; Get History book and lunch
Lunch
History - room 300
Study Hall - in Library
Locker - Get books for homework classes
Go to bus

Extra Books - Consider getting an extra set of books for your child/student. Many schools will provide two sets; one to keep in each class and one for home. This avoids the locker chaos that can be anxiety provoking due to time but also social demands.

Designate a Safe Place - Students on the spectrum often need a 'base'. This can be a guidance counselor's office, homeroom teacher, resource teacher, coach, etc. This can help them know where to go during times of stress or where to get more clarification for their day. Middle School and High School are when this becomes very important since they are changing classes and teachers frequently.

Organize Materials - It is very difficult for students with to keep papers, assignments, notebooks, etc organized. Setting up a system for them, helps to know where things go. Try to put most materials in one large notebook.
Notebook should include:

1. Daily schedule

2. Homework assignment sheet

3. Sections for each class period

a. Materials needed for that class

b. Place for “finished” work

c. Rules for social behavior for that class

d. Academic tips or strategies needed for that class

4. Rules for school behavior in various situations

5. Extra paper and pencils/pens for written communication in time of stress

6. Needed school information

a. Calendar

b. Locker combinations

c. Lunch number

d. List of items that should always go home with student

Communication - There is always room for improvement when it comes to sharing information between parents, teachers and others. Knowing what is going on a daily basis at home and at school is important. In our earlier post we talked about ways to make it easier to keep a daily communication log.

Additional Preparation - Reading from those on the spectrum can help those on and off the spectrum become more understanding. There are lots of great resources including books specifically for middle school girls and teenage boys on the spectrum.

This is a tough milestone for parents and students on the spectrum. Preparation can help so much in starting the year out right and decreasing anxiety for all involved.

-Abby

ACTIVITIES ON THE ANGLE: Structuring Beginning Learning Skills

2011-07-28T19:29:00.000-04:00

Children with autism often excel at beginning learning skills like numbers and letters, but they sometimes have a hard time showing us what they know when activities are not structured in a way that makes sense to them. Oftentimes materials are cumbersome to deal with so we strive to make the organizational pieces easier to manipulate to make sure we are teaching the concept.

The goal of the activity to the left is to sequence making a person and here we simply put the magnetic pieces on a baking sheet and provided a little visual structure to indicate where the pieces go. If the person also needs a sample of how it goes together, this set comes with pictures of the finished product that you can chose to use or to leave out depending on the skills the person has.

These are great sequencing cards that you can find at most educational stores. Sequencing actions can often be challenging for individuals on the spectrum (young ones, for example may have a hard time knowing that we put our underwear on before not after we put our shorts on) so here I just velcroed the cards on the left and the provided spaces for them to go on the right.

I love these puzzle piece activities to teach concepts because there is already structure in place. For individuals on the spectrum, however, it's helpful to use velcro to secure the pieces down and present it in a left to right sequence. In this example it's clear where the pieces go and we've included only the necessary matches so the person doesn't have to hunt through the entire box!

You can use this same box and change out materials to teach all kinds of different concepts. In this example we're teaching identifying opposites.

Again, I found this letter matching activity at a place called The Bargain Box for not even a dollar and it's a favorite of many young ones on the spectrum-- after all, it is Thomas! You can arrange this activities where the goal is to find the letter that corresponds with the picture or you can put out all the pictures and the child finds the letter that goes with it. Using high interests are a great way to teach more academic kinds of tasks in a way that makes it fun and exciting!

- Molly

Simplify Chores for Success

2011-07-23T11:18:00.000-04:00

The word Chore doesn't give any of us the best feeling. Looking to the definition of Chores, it uses words like unpleasant, hard work, difficult and boring. This pretty much sums up how a lot of us feel about it. Try looking at the positive side of it within a family. It helps to contribute to the household, gives the individual a sense of accomplishment and often can lead to a preferred activity or an allowance.

"Go clean up!" involves a lot of abstract concepts for individuals on the spectrum. Clean up what or where? What does clean mean? How do I know it is 'clean'? If you think about your idea of clean it can be quite different from someone else's. It often is a judgement that we each make with this abstract description. Many individuals with autism feel overwhelmed when they are asked to complete tasks that they don't fully understand. Trying to just know where to start can be hard to determine.

We are constantly looking for new ways of making the abstract more meaningful and understandable for those on the spectrum. Here are some things to keep in mind:

Use a visual system (objects, pictures, written list) to break down the activity.
Simple directions that are to the point.
Organize items so that there is a system to follow (ex: Labeled bins for toys so they know where to put things, pictures on clothes drawers for items, etc)
Make it obvious when something is clean. It takes practice to learn how to determine clean so initially we have to make it very clear what isn't.
Lots of patience, practice and persistence!

Make a List: Short directions with exactly what to do and add pictures to help with understanding.

TO DO:

o Make bed

o Books on Shelf

o Dirty clothes in hamper

o Legos into box

o TV time

Organize Toys and Clothes: Use pictures on bins or drawers so the individual knows what goes where. Also, taping an 'example' of what is in the box on the outside; for instance, taping a lego on the outside of the lego box.

Make it Obvious: Dirty vs. Clean is hard to determine for many individuals on the spectrum. Trying to make it more clear when something is clean is important.

Using a dry erase marker on mirrors or windows to show where to spray cleaner and wiping until it has disappeared.

You can also use dry erase markers on other surfaces to show that you wipe until it is gone.

Baking soda on carpet helps to also make it clear where to vacuum and when it is done.

Simple Responsibilities: Even the most basic of chores or responsibilities can teach contribution to the family. Think about breaking down activities so that the individual can do it on their own and feel that pride in their accomplishment.

Even something like pouring premeasured pet food into a bowl can be considered a responsibility. Think about making activities less complicated and therefore less frustrating.

These are only a few examples of activities individuals can complete on a daily or weekly basis to help feel that sense of responsibility. Trying to make the chores/tasks less complex is important to meet each individual's level of understanding.

-Abby

ACTIVITIES ON THE ANGLE! Communication Exchange Tasks

2011-07-14T19:06:00.001-04:00

We did an earlier post on communication tips to help structure reciprocal

conversation skills in particularly verbal children with ASD (click here

to go to the link) and there are countless other ways to help

facilitate communication for our younger or more beginning learners.

Firstly, think about what's motivating to the person with ASD. Is it a

favorite toy or a favorite snack? We hear stories from many parents

of two or three year-olds about how independent they are in getting

what they want, when they want it. Even though in some ways it's good

for kids to be independent, for children with autism, they are often so

independent because they are not always recognizing how other people

can be helpful to them . It is not exactly safe for little ones to climb

on top of the fridge to get the oreos, for example so we need to be

creative in helping to give them a way to express these needs and

wants even when the person may not have the words to do so.

One idea illustrated in the above picture is to put snack items in small,

clear containers that are sealed or taped shut so they cannot open them.

Then the idea is for the child to take the container and hand it to mom

or dad, or whomever it may be to get the snack for him/her. Do not expect

that by just puttingthe containers on a table and storing the snack items

high on a shelf the child will come over and initiate this exchange;

it has to be taught. Start by sitting across from the table from each other.

Then, you may need an additional person to shadow or sit behind the child

to gently move his or her arm to demonstrate how the exchange will go.

Then, once the child hands the container, he or she will receive the

chosen snack. We always advise that while teaching this concept,

only put out a few goldfish or desired snack option so that the child

has multiple opportunities to ask. You can also work on generalizing

this skill of asking in an exchange to many other tasks, such as the ones

shown below.

In the above example I simply photocopied the puzzle pieces and then

set them in the inset to make it more visually clear which animal went

where. Also I used the pictures as a way for the person to ask for the

puzzle pieces. Notice that because

there are several animals in this puzzle, it provides numerous

opportunities to ask use this communication system to help teach the

power of communication.

If the person with autism simply grabs for the pieces across the table, help

model for them the purpose of the task by saying "I need________"

if they understand language or by using a shadow.

Again, think about what mode of communication you think your child or

student best understands, such as objects, pictures, or even written words

and use that same method in teaching communication skills. Even very verbal

children often need to learn the POWER of communication in this very specific

exchange. By handing a object, picture card, or written word to someone

else it helps to teach the skill of directing communication, which is a difficult

for individuals across the autism spectrum, regardless of IQ or verbal ability, etc.

The photo to the right is simply another example of a way to structure materials to make it a communication activity. We made this for a child who loved play-doh and we wanted to use this motivating activity to help increase communication. Here we have a product sample or photograph of the item we'd like for the person to build and again the idea is for him/her to take the photographs and hand them to the person across the table to get the item needed to finish the task. You can always continue to change what type of animal or structure the person builds but this way he/she can practice asking for what is needed.

We'll continue to post ideas of ways to help teach communication and social skills, which are more difficult areas by definition when diagnosing a child with autism. I think that automatically we assume that if an individual has speech, then the communication difficulties will go away, but with autism the problem is more than just language, it's about communicative intent and we need to think about ways to teach the meaning of communication and its purpose in more straight-forward, structured way. With time and practice, kids surprise us all the time on how quickly they pick up these routines!

- Molly

Two More Awesome Books by Catherine Faherty!

2011-07-06T20:24:00.000-04:00

Similar to her book "Asperger's What Does It Mean to Me?" this book by Catherine Faherty is a great resource for individuals with autism and Asperger's and their communication partners. The focus of this book is to help clarify miscommunication that inevitably happens in life, especially between people with two different communication styles. With her work with individuals of all ages, Catherine found that it is just as important that we, "neurotypicals", adjust the way that we communicate and get our point across. She sets up a contract consisting of five agreements-- one set for the person with autism and a set for the neurotypical communication partner. These contracts can be used between parent and child, teacher and student, spouses, colleagues etc. I love how Catherine encourages us to take a look at ourselves and not always assume that the communication breakdown is a result of communication difficulties for the person with autism; we need to remember that it takes two to communicate and we all can learn how to communicate more effectively.

The five agreements she details for the neurotypical communicator are:

#1 "Wait. Don't expect (or insist on) immediate verbal responses from your communication partner with ASD

#2 "Speak literally and concretely. Avoid hinting and indirectness. Say what you mean, and mean what you say. Less "chat" is better."

#3 "Provide information. Do not assume that the person "knows" what you think "everyone knows."

#4 "Help your communication partner's self-expression. Provide tools: paper, pen, computer keyboard, and/or Communication Forms to facilitate authentic communication."

#5 "Realize that the autistic style of communicating is different from-- not inferior nor superior to-- the widespread, familiar communication style that you and most neurotypical communicators expect."

The five agreements she sets up for the person with ASD are:

#1 " I will try to express myself to my communication partner."

#2 " I will try to ask for help when I need it. Another term for asking for help is self-advocacy. Sometimes I will try to offer help to my communication partner, too."

#3 " I will try to say "thank you" or write "thank you notes" when someone has helped me, or given me something."

#4 "My communication partner may have different thoughts, ideas, and opinions from mine. This is natural. A first step in understanding him or her better, is to ask about his or her thoughts, ideas, and opinions."

#5 "I realize that my natural communication style is in some ways different from- not inferior not superior to-- the more widespread and neurotypical style of communicating."

Catherine then goes on to explain each agreement thoroughly as well as to provide activities and communication forms to assist in the process (for example, ideas for people with ASD of how to ask for help). Also included in the book is a CD so you can print out the worksheets yourself! This book is relatively new to me, but it's one that I've used with some with my older, more self- aware clients and it has been a great tool in starting a conversation and using concrete strategies to help each of us understand the other's perspective. I would absolutely encourage parents, teachers, employers etc to try it out! I will say that in order for these strategies to work, you have to stick with them, be patient, and remember that it may take a while to go through the entire workbook and to understand all of its components. If you take the time, however, it'll be well worth it in the end!
_____________________________________________________________________

Death and illness are extremely sensitive and difficult topics to broach with any child, and due to the abstract nature of the subject, it can be especially hard for individuals with ASD to wrap their heads around. In this book Catherine Faherty clearly explains terms associated with death and illness, feelings that may be associated with them, as well as different associated beliefs and practices. Again, she provides checklists to help individuals decide for themselves what is true or false for them in regards to their thoughts and beliefs as well as an opportunity to write and ask any questions they may have.

The book is broken up into the following chapters:

Illness and Injury
Recuperating and Healing
Death and Dying: Who, What, When, Where, and How..
When Someone is Dying
Communication
What Happens to the Person Who Dies
Putting Pets To Sleep
Rituals and Traditions
Taking Care of the Physical Body
What People Say and Do
Taking Care of the Soul: More Rituals and Traditions
Continuing a Relationship
People's Reactions after Someone Dies
More Names for Emotions
What Does it Mean If Someone Says....
What People May Learn About Life When Facing Death
Being Inspired: Role Models and Mentors

This is a great resource for parents and therapists. It is important to assess where the person is in regards to his/her understanding and the questions he/she may have and then you can take different sections of the book and go through a little bit at a time. I think it's a fabulous resource, not only for individuals with autism, but anyone who is struggling to understand what all of it means. The last chapter of her book is also dedicated to additional resources that families may be interested in contacting to help during these difficult times.

- Molly

ACTIVITIES ON THE ANGLE: Melissa and Doug, Let's Play!

2011-07-02T10:59:00.000-04:00

'Melissa and Doug' is a company with great ideas, quality products and good customer service. I have always been very happy with their learning toys and constantly wanting to see what they will come up with next. Being that they are so durable, they really stand the test of time. When I have purchased these items, new or used, I have been amazed at how engaging they are for children.

Being that I have been very happy with many of their items, I thought I would share some of my favorites. Also, there are several of the items that are quick and easy to adapt for those with autism to suit the needs of the individual.

Puzzles

One of my favorite puzzles for beginners! I love the large handle for hands of all sizes and the pictures underneath are perfect for those not yet visually differentiating between shapes. Very sturdy puzzle that will last many more years to come!

This shape puzzle is great to help with those starting to differentiate shapes. The colors are an extra visual cue to help complete correctly. Stabilizing puzzles on cardboard (such as this copier paper box lid) is a good way to have everything contained. Also, standing the pieces up with Sticky/Ticky-Tack (used for hanging posters) is a good way to help the individual grab one puzzle piece at a time.

These blocks make the sound of the corresponding animal when the two halves are matched correctly. Being that there are different animals on every side of the cubes, it could be overwhelming initially to some. Covering up several of the animals with paper at first can help the child gain the concept before moving on to all the animals.

These are fun puzzles that take a little more attention to detail. Each piece can fit in the cars or animals it is not intended for. Therefore, it is important to look at the colors and patterns. To adapt this, you can color copy the pieces and tape them underneath to give more visual information. Also, stabilizing the puzzle to a box lid is a good way to keep everything organized and easier to complete.

This puzzle, and many similar ones through 'Melissa and Doug', makes the animal sound when matched correctly. The pictures are underneath on this item so it helps with matching. If you are unfamiliar with sound puzzles, be forewarned that they can drive you bonkers! Many times the puzzle will make noises even when just sitting on a shelf. Luckily many more recent puzzles have on/off switches to avoid this annoyance :)

Another favorite! These individual inset puzzles help with spelling some of the first words. It can be adjusted easily to suit each child's needs. Limiting the number of letters for only a few word puzzles at a time can help initially.

Adorable boat with animals, two by two

Each animal fits into a space on the boat on either side, top or bottom. For readers, the animal name can be placed above the hole where that animal fits. The same can be done with a picture of that animal for non-readers. The wooden animals can be used for matching to one another, counting or other activities.

Blocks

Great set of sturdy blocks for endless uses. Color matching, counting or building come easy with this set!

These blocks are a hit! They are fun for stacking but also can build on skills as the child grows and develops more mathematical abilities. Each block features quantities of each number (Such as four dolphins for the number four block). Additionally, the number is on one side and the number word is on another.

A few ways to adapt:

Direct match of the numbers; 1 to number 1 with Velcro
Number word matching
Addition and subtraction; having the objects on each block helps when finding the answer
Putting into the correct sequence within the included wooden box; each number can be printed on the box under each block to start out

Miscellaneous

Whack a ball

Fun activity and it excites kids to see where the will pop out at the bottom. You can work on receptive language by asking the individual to "Hit the red ball", "Hit the yellow ball", etc. Also, color coding at the top of the ball toy for color matching is easy with construction paper.

Stacking Rings

To help build the tower in the specific sequence, a picture of the completed toy can be used to refer to. Also, coloring the wooden stick for where each color will go can make it a color matching activity.

Farm Maze

This farm maze has animals that can be moved around the board but not removed. Each animal, and farmer, has to be taken to their corresponding 'home'. It can be kind of confusing for some kids on what to do so I have had to structure it a few different ways.

I printed out pictures of the animals on the board, glued them to index cards and put them on a metal ring. Flipping through the cards, the child can take each animal to it's home one at a time. I used clip art images of each animal but you can also copy or scan the pieces to be more of an exact match. Also, the pictures can be taped on each item's home on the board to help initially understand the concept.

Trash into task! Using an unwanted piece of cardboard, the pictures can be used in an interactive 'Old MacDonald' song. Not the prettiest activity but functional. Working with a parent or teacher, the child sings the song and the adult moves each animal to the right. Then, the cow or other animal can be moved on the maze to their home. When each animal is done, it is put into the envelope and the next one is moved over.

Using paper clips on a sturdy surface, such as cardboard, is an easy way to organize materials. Taping the paper clips on the back of the board helps them from moving around. A simple envelope with the flap folded in can be taped onto the board. To open the 'pocket', use an Exacto knife after it's been taped.

Food Groups

'Melissa and Doug' have lots of wooden food sets and this is one of them. The four wooden baskets are included.

Teaching food groups can be a fun sorting activity. Taping images found online on each basket shows where each food can go.

For this child, it was not an independent activity and teaching about the different food groups will take some practice. Also, other play foods can be added in to give more examples of each food group.

Hopefully you can gain a few ideas for structuring activities at home. You may have some of these items or feel free to adapt another toy in a similar way! We have several companies that are great for task materials and this is definitely one of them. We would love to hear what has worked for your child as well so feel free to comment or email us!

-Abby

Summertime fun for individuals with ASD!

2011-06-22T20:43:00.000-04:00

Happy first official full day of summer! Although I'm sure that many of you reading have been excited about the summer months ahead, it can also be a daunting task to come up with enough activities and things to do to entertain the kids when school is out. I've recently come across a few websites that give some helpful hints of things to do to keep kids from bouncing off the walls!

Summer Camps: Summer camps can be a great way to provide some structure when school is out, but it can also be hard to find camps that tailor to children with special needs and ones that are affordable during these hard economic times. On the Family Support Network of NC website, they came up with a list of questions that parents may want to ask when looking into various camps and deciding on one that would be best suited for their child. Go here for more information. Included among some of the questions mentioned were: What is the experience of the camp counselors? What will happen in the event of an emergency (is there a nurse or doctor on staff)? Are activities organized and structured around age or developmental level?

Museums: Children's museums and science centers are always fun and entertaining places to take kids year round. Think about making a schedule ahead of time so the person with autism can see which parts of the museum you'll visit that particular day-- at the science center you may only have time to see the fish, the dinosaur exhibit, and the reptiles, for example so show him/her in an understandable way what to expect. For readers, simply make a checklist that the person crosses out as you move through the exhibits-- for individuals who understand digital photographs, try going to the museum's website ahead of time and print out pictures of things you're going to see so there is no confusion and inevitable tantrum when it's time to leave such a fun place!

The pool-- There's nothing wrong with sticking with the tried and true, like the neighborhood or community swimming pool. It's a great place for the kids to get exercise and work on their gross motor skills, for you to get some sun :) and to pass many a summer day. Many swim clubs offer private swim lessons or have swim teams if you would like something more structured, or just bringing lots of fun pool toys and a pair of goggles may be more than enough to provide plenty of entertainment.

Try a New Activity: Think about the person's interest and see if there are any organized groups in your area to make this interest more social and more of an activity or outing. Autism Speaks has a great resource guide for families (based on location) to find out about what is offered in your area. Go here for more info. A couple of things that caught my eye on this website were the American Special Hockey Association and Equine or Horse Therapy opportunities. On the Hockey Association webpage go to Member Programs at the top, scroll down to your area, and click on the team closest to you for more info. I recently worked with a elementary age kid whose parents recently put him in one of these leagues and they and the child absolutely love it! This particular child was originally in a very competitive league, which made the experience too stressful for him, but he now thrives and has a real passion for playing the sport with a little additional support. There are also numerous horse therapy groups that can be very calming for individuals with ASD. Many of these groups also participate in the Special Olympics, which is another great recreational and social outlet.

Go to a Sensory-friendly Movie: Getting the family together to go to a movie is always a great way to spend a summer afternoon or evening, but for children with ASD, it can be a really overwhelming experience. Now there are certain theaters that will play "Sensory Friendly Films" where the lights remain on, the sound is lowered, and it fosters an environment where it's not a problem if you need to get up and walk around etc. Although I have not been to one myself, I've heard wonderful things about them. For more information on AMC Movies Sensory Friendly Films go HERE to get a listing of theaters near you.

Try Some Activities At Home: Of course there is also a lot of down time at home on the weekends and during the summer and it's not always an option to go out. We hope that you've gotten some ideas of activities to structure from previous posts and also from other website links we've mentioned. On education.com I came across a list of 10 fun activities for children with autism. Check it out. There are lots of fun arts and crafts projects and sensory activities.

Stay tuned and we'll post more fun activities to make your

summer fun and entertaining for all!

- Molly

Happy Father's Day!

2011-06-19T10:32:00.000-04:00

Happy Father's Day to all the wonderful fathers out there and especially for those with a child on the spectrum. It is at time a thankless job and we want to thank all of the amazing Dads out there.

Father's are at times quietly dealing with the varying emotions in handling the challenges of having a child with autism. It can be challenging to express the day to day struggles they face. We salute all the Dads out there that have begun writing about their experiences! One of our favorite blogs features the real emotions of a mother and a father writing about their lives: Both Sides of the Coin Here is also a great compilation of Father's Day Essays to celebrate this day.

Enjoy your day, Dads!!

-Abby and Molly

Early Screening for Autism Coming into Question

2011-06-17T21:52:00.000-04:00

Canadian researchers are questioning whether early screening is in the best interest of the public. On Monday of this week, an article was published in the journal Pediatrics against these tools. They have seen these measures as premature and not coming to the correct diagnostic conclusion.

"We don't have research evidence to show how well screening works and whether we do more good than harm," Dr. Jan Willem Gorter, a pediatrician at McMaster University in Hamilton, Canada, told Reuters Health.
While many screening tests exist—usually based on simple questions about the child's use of eye contact and gestures—none of them are very accurate, Gorter and colleagues report in the journal Pediatrics.
Often the tests will misdiagnose healthy kids, such as one recent test that yielded false positives a quarter of the time, or they will fail to detect autism.
"The potential burdens on families of receiving a misdiagnosis (either a false-positive or a false-negative) may be enormous," the researchers write, "and there might be labeling effects that can be hard to remove."
Read more: http://www.foxnews.com/health/2011/06/13/study-recommends-against-autism-screening/#ixzz1PaHdJToF

I have to say that I was dumbfounded reading this article. The earlier the diagnosis, the sooner the intervention, right? It truly can be challenging to diagnosis at an early age, especially with those on the higher end of the spectrum. However, it is important to start looking at red flags when first noted. With autism rates soaring each year, taking a step backwards is the last thing we need to do. I was quite relieved to see that experts in the field have since stepped up to share their concerns with this journal article. From Autism Speaks:

"By screening for autism at an early age, children are able to begin intervention as soon as possible," said Geraldine Dawson, chief science officer for the Autism Speaks advocacy group. "Studies have shown that early intervention results in significant increases in cognitive and language abilities, and adaptive behavior, and gives children the best chance for a positive outcome."

The journal article also made some additional strong statements:

"little support for the effectiveness for speech and language therapy for people with autism,"
"applied behavior intervention did not significantly improve the cognitive outcomes of children"
"screening is pointless, and almost certainly unethical."

I feel that this article may have set us back rather than pushing us forward in the field of autism. The statements made against screening and interventions seems more harmful than what was highlighted in this journal. Using terms such as "pointless" and "unethical" are astonishing statements to make for any diagnostic tool.

I would love to hear other people's thoughts on this issue. Should we call into question our screening tools or does this cause more problems in the long run?

-Abby

Read more from the full articles:
http://www.cnn.com/2011/HEALTH/06/13/canada.autism.study/index.html
http://www.foxnews.com/health/2011/06/13/study-recommends-against-autism-screening/

Trouble Taking Turns? Struggle Sharing?

2011-06-11T09:18:00.002-04:00

One of the first things we want our kids to learn is to share and to take turns.

After all, these are crucial concepts to learn in life, but I think we need to take

a step back and think about the typical time that kids learn these skills and think

different ways to teach kiddos on the spectrum these concepts.

Firstly, typical three year olds have a really hard time understanding how to

share and take turns. It is not until four or even sometimes five years of age

where kids have a pretty good grasp and understanding of what it means to

share and how to take turns. So, if your three year old is fighting over toys with

his/her sibling, breathe a sigh of relief in knowing that kids are supposed to struggle

with this skill at that age!

Now, we may verbally emphasize the importance of sharing and facilitate

turn taking with our little ones, but what's going to happen when we're not

there to tell them? Let's think of a strategy where we can back ourselves out

of that process and help kids be more successful when they are participating in

center time at school, for example, and the teacher is not always part of the

group.

Below are so ideas of how to make this concept more clear:

For kids who are reading or recognizing familiar names we can simply jot the participants

names down and use an arrow or highlight the name to indicate whose turn it is.

I made one of the wheels for a family who needed help figuring out a way to show

whose turn it was to pick the DVD on car trips. The child I was working with thought

he should always be the one to choose and had a meltdown when this was not the case

so we used a more visual way to clarify the expectations for him.

These two methods are also great visual ways to indicate the turn taking process.

You can use either digital photos or poker chips where the person manipulates

it by taking the photo/chip and putting it in the finished pocked at the bottom once

the turn is taken. This way kidscan see ahead of time how many times they will

be able to go and help them understand that when it's the other person's photo

or chip, then it's his/her turn and the expectation is to wait.

These are just a few strategies you may try to help teach kids what it means

to share and take turns. Before you know it, they may get the hang out it

and be doing it spontaneously! Hope everyone is having a great weekend!

- Molly

Social Thinking Curriculum and Comic Books

2011-06-07T17:08:00.000-04:00

You Are A Social Detective! Explaining Social Thinking to Kids by Michelle Garcia Winner and Pamela Crooke is a fun way to introduce appropriate social skills to kids struggling in this area. The book is written in comic book style with thinking bubbles to illustrate the character's thoughts. The book is intended for elementary age students or older, less mature individuals. It's divided into three sections:
1. School vs. Social Smarts and Expected Behavior
2. Unexpected Behavior, and
3. How to Be a Social Detective

The authors recommend using this book as a springboard for discussion with kids and in my experience, I agree. The book covers several topics that need to be separated out. I think it would be overwhelming to teach all of the concepts in one sitting. I love how visual it is and it's not overly wordy. It teaches the concepts and skills in a clear and straightforward way. Also, in the text certain key words or concepts are in bold to help point out the most important information. This book is also intended to be read as a precursor to the Superflex Curriculum described below:
________________________________________________________________________

SUPERFLEX..A Superhero Social Thinking Curriculum
also by Michelle Garcia Winner and Stephanie Madrigal is an

awesome resource for parents, teachers, and therapists. The book is comprised of 13 lesson plans to teach in social skills groups of elementary age children. The first set of lessons introduces the social thinking concepts and the characters through which the skills are taught, then the next series of lessons is designed to help kids gain awareness of their social behavior and ways to modify inappropriate behavior, and lastly this section is dedicated to self-monitoring strategies. Although I have not used this curriculum myself, I have seen it in action through one of our local social skills groups and the kids seem to have a great time with it! The group facilitator did share that as kids get older, however, they are not as interested in the superhero characters. Although the Social Detective book can easily be read on its own, this social curriculum really is intended for group use and several other comic books are used with the curriculum as well, like this one:
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SUPERFLEX: Superflex takes on Rock Brain and the Team of Unthinkables written by Stephanie Madrigal is a cute comic book that can be purchased as part of the Social Thinking Curriculum package. It helps to introduce the characters and provides a fun way to frame social smarts through superheroes so that the children in the group do not feel like they are necessarily singled out. The premise of the comic is that The Team of Unthinkables are trying to take over Superflex and his town and through this story, kids learn specific strategies on how to overcome the "Team of Unthinkables." The book is a little busy , but I think it's a nice supplement to the Social Thinking Curriculum. Again, it's meant to be a part of the curriculum and not a book to buy by itself.

If parents familiarize themselves with the characters and terminology as well, it's really nice to use the lingo at home-- for example: "do you think you're being a Space Invader" (one of the "Unthinkables) or the "WasFunny Once" character for kids who seem get stuck on an inappropriate jokes/topics and repeat them over and over again, etc. In general this curriculum seems to be a nice, light way to talk about social skills in a kid-friendly way. Have fun with it and if your child or student has used this curriculum in some capacity, we'd love to hear what you think!

- Molly

ACTIVITIES ON THE ANGLE: Teaching Pretend Play

2011-06-03T07:05:00.001-04:00

Many individuals on the autism spectrum have some difficulty with pretend play. Some children on the spectrum have extremely vivid imaginations and are extremely creative; however, we often find that some of our kids get in a rut when it comes to branching out in play themes and it's a struggle for many to know where to start in playing with toys.

We hope to give a few ideas of how to make this abstract concept more concrete for our kiddos! Again, we do not always think about teaching these skills, but many children on the spectrum may be attending to details in the environment that may distract them from watching others to learn how to imitate them, which really is how typically developing children usually begin pretending. We sometimes see kids on the spectrum begin acting out scenes from television or movies, which is a great start and we want to help them expand these skills and to be more flexible.

Firstly, think about what may be motivating or interesting to your child, student, or client and use those toys to structure an activity. I will include an example of a play activity I just structured using an adorable little vet kit that I found on one of those online sale websites (they get me every time)! Most people have those beginning doctor's kits too, right? You could use one of those with the child's favorite character-- (an Elmo stuffed animal, for example) so he/she could learn to play "doctor" with Elmo.

Next take photos of different pretend actions-- so here I took photos of me taking care of this puppy at the "vet"-- looking in his ears, checking his temperature, giving him a bone at the end of the "vet visit" etc.

Then, print the photos out-- I used 4 to a page so they were around regular photo size. I happened to purchase one of those overpriced laminating machines (Abby and I are working on a few other things to be debuted on the blog soon), but generally more sturdy paper, like card stock works great or you can even glue the printed photos to more sturdy folders-- whatever works, it does not need to be fancy or difficult!

Cut the photos out and hole punch the corner of each photo.

Then make a "flip book" by using a key or book ring so the child can flip through the pages to see what pretend action to perform. This is a concrete way to teach these pretend play skills and to increase flexibility, we encourage you to continuously change the order of the photos so the person does not memorize what to do and become rigid and insistent on only doing it that way... sound familiar anyone?

You can use this strategy with so many toys, just always remember to make it visual when teaching these extremely abstract concepts-- this will help make it more meaningful for the person with autism who is first learning these skills, and of course you can and should still engage in play with them and have fun during this process!

- Molly

Vacations on the Spectrum: Improving traveling for those with autism

2011-05-31T21:36:00.001-04:00

Summer is approaching, school is ending and vacations are beginning. I received a wonderful email from a reader regarding vacations. She has been through some struggles in the past and trying to avoid future disaster with her 7 year old child with High-Functioning Autism. There is no way to perfectly prepare for vacations. Changes in routine, transitions and sensory overload are a few of the problems at hand. Each child needs to be met at their level of understanding. The following strategies will be too much information or too abstract of concepts for some and perfect for others. Hopefully what we can emphasize is that we must prepare the individual, make things visually clear and reduce as many stresses as possible. Easier said than done but let's try to tackle the issues.

Questions from our reader:

Recently he's been getting impatient in the car and won't seem to accept the answers we provide... like "we'll be there in 20 minutes." He just keeps asking even though he's very capable of telling time on the clock

The verbal battle of "Are we there yet?" can go on forever! Make the passage of time more visual. Giving him a picture/written (if he's a reader) list of what will take place before you get to the location. If he is watching movies in the car, showing him that he will watch 'Shrek' and 'Toy Story' and then he will arrive at the hotel. Also, for those interested in maps, road signs, etc. use this interest! Let him be the navigator, show him map quest directions and look for exits. Rather than saying "A few more minutes", say "What's next on our directions?".

We live in Orlando and usually just travel to the beaches. We stay in timeshares, sometimes large "hotels", sometimes small condos. Either way, it's super hard for him to settle down and get to sleep at night- even harder than at home. I know this is common with people, but it's just so extreme with him.

Unfortunately sleeping problems cannot be left at home! The individual that struggles with the sleeping routine at home will have even more trouble when away. We talked previously about sleep issues and what to do when at home but on the go can be even more challenging. First, prepare for the new environment as much as possible. Many times hotels have great pictures online of the room and it's layout. Reviewing this ahead of time can prepare the individual for this new space. Second, try to recreate your home 'sleep hygiene' or sleep routines as much as possible. Winding down is a process and even more so for those with autism. Lastly, eliminate as much noise and light as possible. Earplugs, sleep masks, calming music and white noise machines can all help to subdue the environment and hopefully lull to sleep.

We occasionally have the opportunity to travel overseas, but I cannot envision doing this. He hates crowds (airports), loud noise, has lots of anxieties, always has trouble getting to sleep, can't tolerate people speaking anything other than English, etc, etc. He also has no concept of what's embarrassing, ex: people watching him fuss about something that makes no sense to typical people. He will loudly blurt out whatever is on his mind, regardless of how it might sound to others. He's often negative and very grumpy, so his comments out in public are usually very unbecoming. Add the stress of travel and it just exacerbates everything.

Overseas travel can involve an entirely new set of issues! Using 'Social Stories' with pictures to prepare for things like having to take your shoes off at the airport, being around new people, the airplane bathroom, etc can help to alleviate some of the anxiety that may occur. Also, reminding of rules of what TO do rather than what NOT to do. Whisper in my ear or write down in your notebook if you want to say something about what's going on around you. Blurting out that the person in front of them doesn't smell good can sometimes be steered towards writing mom a note. Also, airports are LOUD and full of people. Using something such as 'Noise Cancellation Headphones' can help to subdue the noise around him and make it more manageable. *Tip: these can be bought at construction supply stores for much less; usually around $5 or so.

Waiting in a restaurant is often not tolerated well. when he's ready to eat he wants it NOW, and when he's done he wants to GO, regardless of whether others are eating or not.

Waiting is another abstract concept that is meaningless to those on the spectrum, and many of us as well! Having a bag of tricks is important for periods of inactivity. Books, origami, fidgets, or other items of interest are great for having during times that there may be waiting involved. Also, practicing and teaching 'waiting' when we aren't in the moment is important. Starting with short segments of waiting time to prep for the sit down dinner can make it a little more manageable.

He also has ADHD, so is no help at all as far as getting his stuff together, pulling his own weight, etc. In fact, often his younger brother assists him with some tasks like bringing toys to the pool, to the beach, making sure they have their goggles, etc.

Bring in the visuals! Have a beach checklist of things that he is responsible for. Show him by writing or using pictures of things he needs to bring and have him check each one off as he puts each item into the bag he is carrying. Sometimes individuals don't know where to get started so they don't start at all.

Additional Traveling Strategies:

Sequence of Events

Understanding the 'when' can many times be confusing. Impending events, can be misunderstood as to how far into the future they will occur. Using a calendar can help many individuals see when things will happen and in what order. For this particular child, the entire month was too overwhelming. We took it day by day to show what day it was and pictures of the big events that would occur.

Picture Book

Carol Gray, as mentioned in a previous post, designed amazing strategies to prepare children for a wide range of situations. Using her strategies around Social Stories, helps the student to know what to expect of a situation and better prepare for any changes.

In preparing a child for a trip, some of Carol Gray's 'rules' were put into play. I designed this story to help the child deal with an airplane ride, waiting at an airport, going on a ship and various events that may take place. Although this is not a 'Social Story', I kept it in first person, focused on the positives and did not use terms of absolute such as, "never" and "always". Using pictures specific to this vacation, allowed us to prepare the child for the rooms they might be staying in, what things there would be to do on the ship, etc. These are a few of the pages in the photo book:

Decreasing Stimulation

Traveling can have a lot of over-stimulation involved. Trying to take into account for areas you may need to reduce noise can be especially important. Having music to listen to, noise cancellation headphones or ear plugs can help with these areas.

Daily Activities

Often at the beginning of the trip we give kids a mountain of toys, books, games, etc. and they become bored of everything quickly. Dividing art supplies, games and books into daily bags can help stretch your entertainment and have things to look forward to each day. Crafts and games can be found at dollar stores or dividing up some of your existing games, DVDs, books, etc. can help in know what to do on certain days.

Familiar Items

Making it more comfortable for a child with autism many times means feeling familiar with the environment. On a trip, this doesn't happen easily. Bringing along a favored cup, toy, blanket or even their own pillow and pillow case can ease the transition.

Happy travels this summer!!

-Abby

Autism and OCD; Comorbidity or Misdiagnosis?

2011-05-26T21:33:00.000-04:00

Autism is a diagnosis that can be missed or mislabeled. In reviewing evaluations, I rarely see a child, adolescent or adult with only a diagnosis of autism. OCD, ODD, ADHD, Anxiety, Depression, Bipolar and/or Conduct Disorder are only a few of labels that are given to the individuals with autism. It is overwhelming for families to know what direction to go and what might be the primary or all-inclusive diagnosis.

Obsessive Compulsive Disorder (OCD) is one of many labels that is given to individuals with autism and not always for appropriate reasons. Comorbid is defined as, pertaining to a disease or other pathological process that occurs simultaneously with another. (Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved) Comorbidity, or having multiple disorders, is not always as common as it appears.

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), OCD is defined as such:

DSM-IV Obsessive Compulsive Disorder (OCD) Criteria

A. Either obsessions or compulsions:

Obsessions as defined by (1), (2), (3), and (4):

(1) recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions as defined by (1) and (2):

(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.

D. I another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

At the 32nd Annual TEACCH Conference, we had the pleasure of attending presentations that helped to update Molly and myself regarding a variety of topics. Every year we are impressed with the information shared and this year was no exception. Jonathan Abramowitz, PhD., presented his expertise in the area of Obsessive Compulsive Disorder (OCD). OCD, can often be confused with a number of disorders, including Autism Spectrum Disorders.

Obsessions for those with OCD, cause great distress for the individual. They recognize that they are thoughts that they shouldn't have or that they are unrealistic. Compulsive behavior is performed to combat these thoughts and to help reduce anxiety in relation to their obsessions. It is quite upseting for individuals with OCD to experience these obsessive thoughts and they try to get rid of them.

Why is autism sometimes confused with OCD? Those individuals on the autism spectrum can display repetitive behaviors or thoughts. Although on the surface they may look similar, they are quite different. Those with autism aren't necessarily upset by the repetitious behavior they engage in. In fact, often those on the spectrum enjoy these behaviors and find them to be calming.

Dr. Abramowitz, presented some of the important distinctions between OCD and autism. This is a simplified description of the differences but important to analyse behaviors and their source. It can be a confusing area for parents and professionals to find the 'right' diagnosis. Asking questions, researching and finding specialists in those areas is most important.

-Abby

Social Success with Social Stories

2011-05-23T18:30:00.000-04:00

Last week Abby and I had the pleasure of attending an autism conference with a number of very talented and interesting speakers. In the next few posts we hope to update our readers on some of the things we learned there!

Some of you may have heard of Carol Gray. She is the founder of Social Stories and President of The Gray Center for Social Learning and Understanding (http://www.thegraycenter.org/social-stories). She was one of the conference speakers last Friday and it was very enlightening to hear her perspective.

The Definition of A Social Story, according to The Gray Center, is:


Gray's Latest Social Story Book

"A Social Story™ describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format."

"The goal of a Social Story™ is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Half of all Social Stories™ developed should affirm something that an individual does well."

"Although the goal of a Story™ should never be to change the individual’s behavior, that individual’s improved understanding of events and expectations may lead to more effective responses."

I wanted to write out Carol Gray's definition of a Social Story because so many people out on the internet and even people publishing information use the term very loosely and probably are not using Social Stories in the way that Gray intended.

During her presentation, Carol Gray stressed the importance of writing social stories in the context of the situation if at all possible and providing the most basic information first, and then adding more specifics if necessary. The goal is not to overwhelm the individual with unnecessary wordiness. Also it is very important to use less definitive terms, such as "I will try," sometimes," or "usually" because there are always exceptions to the rules and as we know, our rule-followers may take the language quite literally and it could wind up backfiring on us!

The beauty of Social Stories is that anyone can write one and Gray pointed out that they compliment any intervention strategy you may be using. Gray's book "The New Social Story Book" (shown above) provides many examples of common social situations and pre-written stories. By reading these stories you may also get more of an idea of how they're written so you can begin writing your own based on specific difficulties of your child, student, or client.

NOT a social story, just a funny comic! We'll talk about Gray's Comic Strip Conversation Strategies soon though!

One question that people often have about Social Stories is when is it appropriate to use them with individuals (what age or level of understanding)?

Although some Social Stories have been shown to work for young children who are not yet reading, they are typically intended for individuals who can read the stories for themselves. Having said that, however, Gray suggested that if you write a Social Story for a more beginning learner and for someone who is not yet reading a lot, then it's important to provide a general picture that depicts the concept you are trying to teach. A lot of times teachers and other professionals (myself included) have added several pictures to encapsulates several of the words, but this strategy can be very visually overwhelming to individuals and the person may focus on an irrelevant detail so she cautions us to keep it simple and again, to include one general picture rather than several specific ones.

Also, it's important to note that as individuals get older, they may start to view Social Stories as more juvenile, and therefore, you can use "Social Articles" and "Comic Strip Conversations," but we'll save those for another post! In the meantime, check out The Social Story website and Carol Gray's new book for lots of ideas and examples!

- Molly

ACTIVITIES ON THE ANGLE: Feed me!

2011-05-16T16:38:00.002-04:00

Pretend and creative play is something that we often have to teach children on the spectrum. Finding ways to make these play skills more understandable is important in gaining abilities in this area. Pretending is a very abstract concept so our goal is to make it more concrete and therefore, more meaningful.

Feed the Character

Using interests is always a good way to capture a child's attention. When purchasing kids' shoes, they often come with an adorable box featuring that character. Dora the Explorer was featured on the box that I used to make this task. You can also print out pictures of Thomas, Barney, etc and adhere to a plain box. To hold Dora's stick "food", I used foam packing material to hold each stick upright.

We put some animal stickers on the end of the Popsicle sticks, another interest for this little girl, which you can do with or without. Depending on fine motor abilities, you can cut the hole for the mouth for a certain size. This is great for strengthening fine motor skills, eye-hand coordination and emerging pretend play.

Also, cutting out a 'door' in the back of the box makes it easier for retrieving the sticks afterwards.

Feed the Puppet

Puppets can be engaging for many kids however, knowing what to do with them can be tricky. Start the individual with 'feeding' the puppet while stabilized. This puppet did not have a mouth, so I cut a hole the size of the various food items. I covered a pretzel box with paper (so the label wouldn't be distracting), put the food in a container and held the puppet in place with an empty paper towel roll down inside the box.

I secured (with Velcro) a plastic baggie inside the puppet to catch the food items.

Once the individual is more familiar with the items it can be removed from the container. At that time, another person can hold the puppet and work together at feeding the puppet. This can make this activity more engaging and interactive.

Have fun!!

-Abby

Hygiene Hysteria!

2011-05-12T17:46:00.000-04:00

In a recent post Abby mentioned the importance of teaching hygiene skills early on. The goal is for our kids/adolescents to be as independent as possible in activities of daily living so that parents can gradually back off from prompting through all the steps to complete a certain task. In previous posts we've tackled topics such as toileting and brushing teeth, so today I'm going to give some ideas about showering/bathing!

Many people, especially those on the autism spectrum can become completely distracted and off task during showering/bathing times. The steps of how to "get clean" are often not intuitive to them and so we have to specifically teach these skills. Time and time again parents share with us how their adolescent child will get in the shower and be in there for 30-45 minutes and come out looking just as dirty as before getting in! At this age parents do not feel that they should have to give constant reminders and prompts of what to do, plus we often hear that they tell their child time and time again to remember to wash their hair or use soap etc. but some how it's not all sinking in! So, let's try another strategy-- let's make it visual! The beauty of writing things down or showing in another visual way (whether it be with pictures or with objects) is that we can back ourselves out of that process and the steps are still outlined for them to be independent.

Ideas for Young Children: At an early age we can get our kids involved in the process of bathing. Bath time can either be a dreaded or a favored activity, but first we need to make it clear to the child where it is that he/she is going by using an object to get them there. So, think about a toy that your child loves to play with in the bath and hand him/her this toy every time it's bath time. Your child will then take the toy, for example a rubber ducky to the tub and eventually begin to associate this object with that activity.

Next, have all the items you are going to use to "get clean" in a container. I love the product below that can be found at amazon.com:

This way you can arrange the items in the order (from left to right) of which ones you're going to use first, second, and so on. After you have used the soap, for example which may be the first item, then your child can put it in another container, maybe a bucket to signify that you are "finished" with the soap and you can then move onto the next step. Eventually, as your child becomes more familiar with this process, then he/she will be more independent in performing these steps independently.

Ideas for Older Children/Adolescents: As kids get older, they are going to move into taking showers, but even older kids need to be reminded of exactly the steps required to get clean. For individuals who are reading, show them when they are required to bathe by writing it on their daily checklist. After all, this may not be a top priority to many and your child may feel that he/she only needs to shower once a week, so let's make this clear again by writing it down! Then, once in the shower, we need to have written lists of what to do to avoid having to constantly call out, "did you wash your hair?", "did you wash your face?" etc! One strategy we've used is to make a laminated flip book detailing each step that the person can flip through to make sure not to leave anything out.

Note the additional visuals-- we have showed this person how much shampoo to use by giving a example (the red dot). We've also used some pictures to help explain concepts such as rinsing your hair by putting your entire head under the water.

* Some individuals may not be particularly motivated to use these systems, especially if there is a lot of written information, however. Therefore, we can always use more of our basic systems even if the individual is reading. We all use our own systems in the shower, and I know for me personally that I often wash my hair twice because I've zoned out and forgotten whether or not I had already done it! So, another idea is to use a basic shower caddy and organize our shower materials in specific ways.

Make it Simple: Here arrange the shampoo, conditioner, soap etc in this shower caddy moving from top-to-bottom and again the individual can put the product already used either on the edge of the bathtub or a basket on the floor of the shower. That way the person remembers what they have already done.

If you notice that your child does not seem to know how much shampoo or condition to use, etc., then another thing you can do is to:

Write instructions on the bottle (in permanent marker). For example, "use 1 squirt of shampoo."

Measure out ahead of time: If you still notice that your child has used way too much or too little shampoo, then you may just want to pre-measure and put the products in small containers to make things easier.

* Remember the goal is for you to back yourself out of this process so that you don't have to record verbal instructions of what to do for your child to take with him/her to college! And don't take anything for granted-- you may need to teach things you've never even dreamed of having to teach. Just because you say "put your deodorant on," you may have to specify where it goes. I've heard one story of a teenager going off to college who saw a commercial for deodorant where they showed how clear it came out by using someone's arm and that's where he put his deodorant for several years!

Try out several things and find out what system is easiest and stick with that. The first thing you try may not work, but keep trying and I promise you will find something that makes sense for your child and you can rest assured that you won't have to be the constant reminder until the end of time! Anyone else try a strategy not mentioned that works for you? We'd love to hear from you.

-Molly