1. 4 Skill Development


1.1. The Emotional Toolbox

Adapted from Attwood, T. (2008). The Complete Guide to Asperger’s Syndrome. Jessica Kingsley Publishers, London, UK.

Tony Attwood, a well-known psychologist in the field of Autism Spectrum Disorders (ASD), conceptualized the Emotional Toolbox. It represents a collection of tools (strategies) designed to help people deal with negative emotions. The Emotional Toolbox for individuals with an ASD is designed to increase the number of strategies available to prevent and manage negative emotions such as anxiety, anger and sadness. The Emotional Toolbox aims to do two things: reduce the intensity of the emotions being experienced and help the person understand the role thoughts play when one is faced with anxiety-producing situations. There are eight types of tools, each of which is defined below.

Physical Tools: physical activities that quickly release emotional energy

  • Jump on a trampoline, on the spot or on a big ball
  • Go on the swing
  • Take a walk, go for a run or a bike ride, dance, swim
  • Play sports or do exercises
  • Do house work
  • Watch a comedy (to laugh)

Relaxation Tools: slowly release emotional energy and help to calm and lower the heart rate

  • Retreat to a quiet place
  • Do progressive muscle relaxation (tension-release)
  • Draw or paint
  • Do crafts, read, listen to music
  • Rock gently
  • Access fidget items (e.g. stress ball, stones, soft objects, worry beads)
  • Organize personal belongings or do relaxing chores
  • Watch a television program, favourite film, look at a photo album
  • Listen to a recorded message from an important person in one’s life (parent, grand-parent)
  • Ask for a break and incorporate breaks into the day

Social Tools: help manage emotions and change moods through interaction with a person or an animal 

  • Go see a person you trust
  • Talk to a friend, teacher, parent, grand-parent, counselor or support person
  • Show altruism – help others or do something for someone
  • Volunteer (help classmates, students in another classroom, in the library or office, at a local pet store)
  • Spend time with a pet

Thinking Tools: capitalize on intellectual strengths to teach how to change thinking and manage emotions

  • Replace poisonous thoughts with antidotes (positive self-talk)
  • Create a mantra (positive and calming statement)
  • Imagine a calm, positive or happy scene or area
  • Imagine a positive result through visualization or Cognitive Picture Rehearsal
  • Use logic and facts to put the situation in perspective
  • Engage in an academic task that helps one calm down and feel successful
  • Keep an object that symbolizes calm
  • Create a “happy book/album” of successes, fun activities, talents and strengths
  • Peruse “self-help” information
  • Refer to strategies on the 3-point or 5-point scales, emotional thermometer, etc.

Special Interest Tools: provide pleasure, relaxation and serve as an ″off switch”

  • Engage in a special interest for a specific amount of time (make time more concrete with a timer, watch, etc.)
  • Incorporate special interests into the schedule
  • Incorporate special interests or talents into the curriculum, employment or volunteer work

 Medication: used to treat mood disorders

  • Work collaboratively with health care professionals
  • Follow the physician’s instructions
  • Record any side effects (positive and negative) and discuss with the physician
  • Understand that medication is a tool but that it should not be the only tool in the toolbox

 Other Tools: reduce anxiety or effects of negative emotions but do not belong in a specific category

  • Read biographies and autobiographies of people with an Autism Spectrum Disorder (ASD)
  • Develop self-advocacy skills
  • Educate others about strengths, needs and accommodations necessary for success
  • Self-reinforce for using new tools
  • Identify sensory tools that allow avoidance of certain negative sensory stimuli or minimize their effects
Inappropriate Tools: tools which are harmful or counter-productive; it is crucial to identify inappropriate tools so that they may be replaced with more appropriate tools 
  • Substance abuse
  • Prescription or illicit drugs
  • Alcohol
  • Self-harm or suicidal ideation
  • Violence, aggression and revenge
  • Promiscuous behaviour

It is imperative to start filling the Emotional Toolbox at a young age. Learning is a lifelong process and it is important to regularly add tools to the toolbox, examine the tools to make sure they are still useful and remove harmful tools or any tools that negatively impact the well being of the person with an Autism Spectrum Disorder. Have an open-mind and discover the limitless possibilities for tools that can be added to the Emotional Toolbox.


Key words: Anxiety, Emotions, Relaxation, Self-regulation

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.2. A Bird’s Eye View of Our Cooking School for Persons with Autism

By Penny Gill  

There are 4 students in a class, each at his or her own cooking station in one large kitchen, each preparing one or more recipes different from the other students’ recipes, and each with individual support from his or her own cooking coach (or teacher). Together, all these recipes form a well-balanced meal that we share at the end of our two-hour class. During that meal the coach sits beside her student and uses some innovative techniques to foster social/communication skills.

 

Who are Our Students?

Age & Diagnosis: Our students all have a diagnosis on the spectrum of autism disorders. We give priority placement to people who are at least 18 years old, with no upper age limit. We have served students over 50, as well as those as young as 14. People under 18 years can register for a term, if no one 18 or over is available to take the spot.

Profile: Students need to be literate because we use the written word so much as an instructional tool during both the cooking portion and the eating portion of classes.

Because we work with the full range of kitchen utensils and appliances, students cannot exhibit behaviours that could put themselves or others at any risk. Anyone who might push or hit people, throw things or engage in any aggressive behaviour would not be suitable for this class. With chopping knives lying on counters, pots of boiling pasta being carried to sinks for draining, and 450 degree ovens being opened, maladaptive conduct could result in serious injury. We have had no injury of any sort since we began the cooking school in 2002 and intend to maintain that record.

No prior cooking experience is required of students, but those who have already done some cooking are welcome. Students are assigned recipes suitable to their skill level.

Both genders attend our cooking school.

Catchment Area: We do not restrict our catchment area. Some students travel long distances to attend our classes. As long as they can arrive at class on time and can bring along the utensils they will need to use during a particular class (a list of which will be supplied to them beforehand), we will not disqualify them from attending simply because they live far away from the Town of Dundas, Ontario where our classes are conducted.

What is the Registration Process? 

Inquiries about registering for the cooking school can be made by e-mail to autism@bell.net. If there is a waitlist when you first make contact with us, it is still worthwhile going through the intake process because we do offer some service to those on the waitlist. When any student registered for a term is absent from class we contact someone on the waitlist to attend that class instead. This is an excellent way for incoming students to “test the waters” and decide if this is a group activity that suits them, before committing to a full term. Potential students are also welcome to observe a class in session before starting the registration process. Observing beforehand may help them better determine if they want to participate in this program.

The formal intake process begins with a telephone conversation, usually with a parent or guardian, during which basic information about the applicant is gathered. Then a face-to-face meeting is scheduled with the applicant and a parent or guardian to review a long list of foodstuffs to find out what the applicant likes and dislikes. This enables us to schedule recipes for students to prepare that they will find appetizing when they attend our classes.

When and Where are Our Classes Held?

Classes are usually held Friday evenings from 5:30 to 7:30 PM in the Town of Dundas, Ontario. Each term is 8 weeks long. We have 3 terms per year: an autumn term, a winter term and a spring term. We do not have summer classes.

Our facility is not wheelchair accessible.

Who are Our Teachers?

All our teachers, or cooking coaches as we call them, have had prior, verifiably successful experience working with people on the spectrum of autism disorders before they start working at our cooking school. Some have full-time jobs in the autism field. We give them training specific to our cooking school as well as opportunities to attend suitable workshops about autism. We have had both genders serve as cooking coaches.

What are Our Goals and Methods? 

We teach students how to cook delicious, healthy food from scratch, using fresh produce, poultry, fish, whole grains, lean meat and so on, rather than using commercially processed ingredients. Students can use this skill wherever they live -- whether in the family home, in an independent or semi-independent living arrangement, or elsewhere.

Cooking coaches use modeling, verbal prompts, and a lot of hand-on-hand guidance to teach cooking methods. We task analyze recipes, breaking them down into tiny, manageable steps, expressed in simple language and supplemented by instructional line drawings and graphics.

Students begin with recipes that are easy to prepare. Gradually, as their capabilities expand, we have them prepare recipes that are more complicated, never confronting them with something that will be too challenging.

Although our cooking school is not a vocational program, some of our students have marketed their cooking skills in the workplace environment and have secured remunerative jobs in restaurant kitchens preparing food.

We instill sound eating habits by having our students consume a well-balanced meal at our classes week after week, and by explaining to them what elements make a particular meal healthy. We also have some interactive tools for students to use when they finish their recipe earlier than others – interactive tools that teach in a graphic, visual way about sound eating habits and that indicate the degree to which a student is meeting the standards of healthy eating.

We augment social/communication skills during both the cooking and the dining periods of our classes. During the cooking part of class, there are plenty of opportunities for interaction between students -- for example, when they are using the same ingredients in their different recipes (“Are you finished with the flour yet? Can I use it now?”), when one student finishes cooking quickly and can offer to help someone else clean up, or when a student simply inquires of others what they are each cooking that day. Cooking coaches are always on hand to give whatever support is necessary – such as modeling or prompting – so that students negotiate these interactions successfully.

At mealtime, placed in the middle of the table, is a stand with a few easy-to-read general questions (visible wherever you are seated) that are suitable to start conversations. This is the “Conversation Menu.” It gives participants ideas about ways to converse with others. The cooking coach may quietly encourage her student to use one of the questions to start talking with someone else, or may help students give more detailed answers to questions put to them and can model how to pose follow-up questions after answering someone else’s query. In other words, coaches help students develop a sense of the rhythm of a conversation, of the back-and-forth pattern necessary for chatting with others.

Different questions appear week by week in the Conversation Menu, with some reappearing from time to time, so that students will more easily remember them to use outside the cooking school. 

What Role Do Parents Play? 

Parents (or the principal caregivers) of our students are welcome to visit our classes at any time without notice. We solicit feedback throughout the term, and are genuinely eager to learn anything that will ensure our classes are an enjoyable, successful experience for our students.

Parents are not obliged to attend any classes, but at the end of every term we do ask students (sometimes with the help of parents) to complete an evaluation of our classes. We use this feedback to make any adjustments that can improve our school.

To ensure that students generalize their cooking skills outside of our cooking school kitchen, we do ask them to prepare something at home once during a term and then to tell us about how it went. This can be a recipe they’ve cooked with us, or a favourite family recipe. They can prepare it independently or can get whatever support they need at home. We give plenty of notice by what date the cooking-at- home assignment is to be completed, and parents often play an important role in encouraging students to fulfill this expectation of the course.

What Do Our Cooking Classes Cost?

Our classes are currently in the range of $37.00 per class. They are likely to rise gradually in the next few years. For anyone with Special Services at Home or Passport grants, our fees can be refunded.

Students are not required to supply any groceries, but we do ask them to bring from home the utensils they will need to prepare their recipes each week. This allows them to learn how to use the utensils they will ultimately be working with independently at home. There is a wide variation between different models of kitchen utensils, so it makes sense to learn how to use the particular implement you own. 

End-of-Term Celebration

The last class of each term has the usual cooking and eating portions of the class, but we also include a celebration of the achievements of each student that term. Each coach pays tribute to her student by presenting the student with a certificate of achievement and a gift of a new kitchen utensil. Parents and friends of students are welcome to join the party.

Assisting Others to Adapt Our Cooking School Model in Their Own Communities

Our program is easily transportable. We are happy for others to copy or adapt our program to meet their own needs and are prepared to help them do that. For this reason, we have published a cookbook, Coach in the Kitchen, with 290 pages of our task-analyzed recipes. It also includes a 26-page manual and toolkit setting out everything you need to launch and operate a cooking school like ours. Details of how to purchase the cookbook and toolkit are on our webpage at www.cookingwithautism.com.

We also offer a workshop entitled “Teaching People with Autism to Cook Really Well for Jobs, Health & Friendship”. The workshop shares tips that can be used at home, in school, in residential settings and elsewhere to ensure cooking with someone on the spectrum is as successful as possible. More details about the workshop can be found on our website as well.

 

Keywords: Cooking; job-readiness skills; adults; adolescents; communication 


 

 

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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.3. Simple Strategies that Work

(For more able students with Autism & Asperger Syndrome)

Smith Myles, B., Adreon, D., & Gitlitz, D. (2006). Simple Strategies That Work, helpful hints for all educators of students with Asperger Syndrome, high-functioning autism, and related disorders. Autism Asperger Publishing Co. Kansas: Shawnee Mission. With permission. 

These strategies are a good general guideline when providing support for students but they are also important to remember at home and in other settings.
  1. Operate on Asperger time
    1. Twice as much time, half as much done
    2. Modify requirements – focus on essentials
    3. Reduce or eliminate handwriting
    4. Avoid rushing
  2. Manage the environment
    1. Prepare for change
    2. Incorporate the student’s preferences
    3. Build in relaxation
    4. Provide choices
  3. Create a balanced agenda that conserves energy
    1. Monitor demands
    2. Engage the student in a familiar or calming activity early in the school day to prepare him or her for work
    3. Incorporate special interests into assignments
    4. Alternate difficult and less difficult tasks as well as interchange non-preferred and preferred activities
    5. Provide “down time” in the schedule
    6. Use calming and alerting activities
  4. Share the agenda
    1. Use visual supports to provide information and encourage independence
  5. Simplify language
    1. Watch for literalness
    2. Teach the “hidden curriculum” (unwritten social rules)
  6. Set a calm, positive tone
    1. Model acceptance
  7. Live out loud
    1. Verbalize your actions
  8. Be generous with praise
    1. Foster attribution and understanding (for the student)
  9. Listen to the words
    1. Seek and offer clarification
  10. Provide reassurance
    1. Reduce uncertainty

  

Keywords: Teaching Strategies, Asperger Syndrome, Education

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.4. Understanding Social Challenges in ASD

 

This article is an excerpt (pages 8 to 10) from a full report published by Autism Ontario in 2011: SOCIAL MATTERS: Improving Social Skills Interventions for Ontarians with ASD. Click here to view the full report: http://www.autismontario.com/Client/ASO/AO.nsf/object/SocialMatters/$file/Social+Matters.pdf


 

Autism Spectrum Disorders (ASD), also referred to as Pervasive Developmental Disorders (PDD), are believed to be caused by neurological differences in brain development with possible genetic origins. Although there is significant research exploring the neurological and genetic causation of ASD, we are still a long way from truly understanding the cause for autism symptoms in any individual.

In 1943, the term “infantile autism” was first coined by Dr. Leo Kanner to describe the most severely affected children who showed extreme social withdrawal. Today, the Diagnostic and Statistical Manual of Mental Disorders (4th Edition Revised, American Psychological Association, 2000) used by physicians and psychologists to make diagnoses includes five variants of Pervasive Developmental Disorders: Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder and, for those whose autism symptoms do not quite meet the criteria for one of those four disorders, Pervasive Developmental Disorder – Not Otherwise Specified. (For more information on PDD diagnoses see:www.autism-society.org/about-autism/diagnosis/diagnostic-classifications.html).

For all individuals with diagnoses under the PDD umbrella there is agreement that people with ASDs share challenges in three domains:

Social Interaction
Children and adults with ASDs have difficulty interacting with other people. This will likely include challenges in initiating, responding to or maintaining interactions or conversations, and will present differently depending on age and cognitive level of functioning. In the most severe cases, the individual will actively avoid interactions or may appear oblivious to others’ presence. While at the other end of the spectrum, they will demonstrate a desire to interact, but lack the appropriate skills to make social interactions effective.

Communication
All individuals with ASD have qualitative difficulties in how they communicate, both verbally and non-verbally. These challenges will range from a lack of language and gestures in the most severe cases, to the use of complex language that may be odd or inappropriate in those who have Asperger Syndrome (AS) or high functioning forms of Autistic Disorder (AD) where speech and intellectual abilities are within the normal range.

Behaviour
For individuals with ASD of all ages and abilities, they may show one or more highly repetitive and often non-functional behaviours (e.g., hand-flapping, spinning objects). This could also include inappropriate and/or inflexible routines within daily activities or play or a highly restricted range of interests within play or conversation.

While all individuals with ASD have some sort of difficulty in each of these areas, the specific difficulties vary from person to person. It is important to remember that no two individuals 

will share the exact same pattern of difficulties. This is why autism is now commonly referred to as a spectrum disorder to represent the broad range
of abilities and challenges found among those with autism.

What are the social challenges faced by Individuals with ASD?

Preschool

Social challenges for most children with ASD are detectable in early childhood or even infancy (Wicks-Nelson & Israel, 2006). For those with autism, problems with eye contact, responding to their name, sharing attention and imitation skills are some of the earliest signs of social challenges. These signs may persist, especially for those with more severe cognitive challenges, and they may remain socially indifferent or even socially avoidant. At the other extreme, toddlers and preschoolers who receive a diagnosis of Asperger’s Disorder or Asperger’s Syndrome (AS) or Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) may have social challenges that initially go undetected because they are very similar to the behaviours seen in typical children going through the “terrible twos” (for example, defiance, tantrums). What may distinguish children with ASD from typical two-year-olds is the extreme social inflexibility, insistence on sameness, and severe tantrums or “meltdowns” associated with change in routines, transitions or any situation where the child is not able to control the situation or get what he or she wants. These highly inflexible patterns that lead to meltdowns are quite common in children with ASD of all ability levels. For verbal children, such as those with AS and High Functioning Autism, their inflexibility often shows up as a strong need to control and direct the play or activities of siblings and peers, and they may be unwilling to follow someone else’s direction or example. The impact of extreme inflexibility and frequent and persistent upsets is to stigmatize and further isolate the child from peers and potential friends.

School-Age

Without effective early social intervention, the problems of early childhood are likely to persist and may escalate with the increased social demands of school. Children with ASD often have limited play abilities and show minimal interest in play with peers. However, when there is interest in peers, which is more typical in children with some language development, these children usually lack the appropriate skills to initiate play, to respond to the play invitations of peers, or to learn to play through observation of peers. Their attempts at social interaction may be immature and may include intrusions into personal space, inappropriate touching or even aggression. For many children, their confusion about the social world and failures in interacting or making friends may lead them to avoid social interactions altogether. When they do have friends, their friends tend to be very accommodating children who acquiesce to their need to control play. Maintaining friendships as they get older can be very challenging given that typical children become less tolerant of the one-sided nature of the friendships, especially when the conversational skills of the child with ASD are limited or the topics of conversation are restricted to special interests that don’t match the peer’s.

Adolescence

As children with ASD move into junior high and high school, they are likely to be increasingly isolated from peers. For those who have severe autism or significant cognitive challenges, they are likely to persist with the same interests and play patterns of early childhood, which may lead to stigmatization amongst peers. However, the school’s efforts to create an environment of acceptance and inclusion may help to minimize stigmatization and increase the potential for peer friendship. For those with higher language abilities, they may have greater awareness of their differences and greater potential for learning how to fit in. However, it is common that by adolescence they will have experienced social rejection or bullying, as well as the social anxiety that would naturally accompany these stressors. Anxiety Disorders or Obsessive Compulsive Disorders are more likely to be diagnosed in adolescence, to some degree a product of the increasing social pressures. Not surprisingly, these teenagers gravitate toward spending more time with adults who encourage them in their special interests, or they spend more time on their own, strengthening their knowledge or skill in areas of special interest or ability.

Adulthood

The challenges of adolescence persist into adulthood and are exacerbated by growing demands for independence beyond high school and, in most cases, fewer supports or services for building social connections and friendships (as pointed out in our past publication, Forgotten: Ontario Adults with Autism and Adults with Aspergers). As identified in our Forgotten report, socialization challenges include, “being overwhelmed by the presence of too many people, and/or by noise. They may be unable to concentrate sufficiently to learn new skills or participate in group activities. All of the above can lead to misunderstandings, frustration and behavioural issues” (2008, p. 11).

In the Forgotten report, it is suggested that, for some individuals with ASD, they may not have received a diagnosis until their late teens, meaning that they may have struggled through adolescence and early adulthood without appropriate services. As well, some young adults may have received an incorrect diagnoses or a diagnosis that no longer fits their profile. Without an appropriate diagnosis, the individual may not have access to any social skills interventions. To date, we have very little information on adult social skills programming for those with ASD.

Key words: Social interaction, social skills, diagnosis

 

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.5. What to Look for When Choosing Social Skills Programs for People with ASD


This article is an excerpt (pages 26 to 28) from a full report published by Autism Ontario in 2011: SOCIAL MATTERS: Improving Social Skills Interventions for Ontarians with ASD. Click here to view the full report: http://www.autismontario.com/Client/ASO/AO.nsf/object/SocialMatters/$file/Social+Matters.pdf 

In choosing what components to look for in a social skills program, whether you are designing your own child’s or student’s program or evaluating the best options available in your community, we are recommending that you consider the following:

1. Social Skills Curriculum

Of all curriculum-based models, the PEERS model for teens (Laugeson et al., 2008) and the Children’s Friendship Training (CFT) model for children (Frankel et al., 2010) have the strongest research evidence to support their use for individuals with ASD. The use of these manualized friendship-training programs will require appropriate training from those who have been trained by Frankel, Laugeson and colleagues, as well as ongoing evaluation to ensure effectiveness and generalizability of skills to real life situations. Other Social skills curricula that have some research support are listed in Appendix A.

2. Ongoing Program Evaluation 

In evaluating the implementation of any social skills curriculum, parents and professionals are encouraged to collaborate with researchers or those trained in program evaluation to ensure that the evaluation provides an accurate and comprehensive assessment of the program. Social skills assessment tools to be used in the evaluation can be drawn from the research studies listed in this literature review. Several assessment tools that may be useful are listed in Appendix C.

3. Choosing Social Skills Interventions
If you choose to design your own social skills program rather than using a pre-existing curriculum, you have a range of intervention strategies to choose from that research has shown to be evidence-based or promising.

a. Evidence-based practice. Video modeling is the only social skills intervention that has sufficiently strong research support to be considered suitable for inclusion as an “evidence-based practice”. Despite the strength of the research on video modeling procedures, ongoing research and evaluation is needed to determine how these procedures can be used with individuals of different ages and ability levels.

b. Promising Interventions. The following intervention strategies have sufficient research support to consider them promising and worthy of using in your social skills program with persons with ASD: 

  • Social skills training groups
  • Parent training
  • Cognitive behavioural therapy (CBT) strategies 

More research is needed on these interventions to determine the conditions under which they are effective (for example, with which age groups or developmental levels). Ongoing evaluation at the individual level will be needed to ensure effectiveness and skill generalization.

c. Interventions with insufficient research or variable results. For the following interventions, there is either insufficient research or the results across studies have been variable when the intervention was applied to teaching social skills to persons with ASD: 

  • Self-management training
  • Activity-based interventions
  • Peer-mediated interventions
  • Social Stories™. 

It is recommended that further research be carried out to clarify under what conditions these interventions are efficacious or effective. At this time, the inclusion of these strategies in social skills programs is questionable and, if used, should be closely monitored for effectiveness.

4. Focus on Skill Generalization and Maintenance
Very few research studies included opportunities to directly assess whether skills learned during social skills training actually generalized to real life social situations and led to better social functioning. As well, few studies incorporated follow-up assessments more than a couple of months following intervention to assess long-term maintenance or the need for “booster sessions” to re-establish gains if needed. Strategies for generalization and maintenance of social skills are provided in Appendix D.

5. Focus on Larger Social Goals
Making and maintaining friendships was one of the primary goals that parents in our survey had for their children participating in social skills groups; however, 46% of parents reported poor outcomes in maintaining relationships following intervention. It will be important for any social skills program to not only look at how to promote generalization and maintenance of specific social skills, but to consider curriculum models that promote these larger social goals. Details on the PEERS model for friendship development can be found in Appendix A.

6. Strive for Quality Adaptation of Social Skills Curricula
Material translated into French can vary greatly in terms of consistency of terminology, accuracy of autism related language, quality and universality of the French. Material must be adapted, not simply translated, and reviewed by people knowledgeable in the field of ASD to ensure quality and applicability. When using translated material, it is recommended that regionally relevant language be used to facilitate generalization to the natural environment.

 

Keywords: Social Interaction, social skills, instruction 

 


 

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.6. Ideas for Promoting Generalization of Social Skills

This article is an excerpt (pages 35 & 36) from a full report published by Autism Ontario in 2011: SOCIAL MATTERS: Improving Social Skills Interventions for Ontarians with ASD. Click here to view the full report: http://www.autismontario.com/Client/ASO/AO.nsf/object/SocialMatters/$file/Social+Matters.pdf

What is generalization?

Generalization refers to the transfer of what is learned in one setting or situation to another setting or situation without explicit teaching or programming in the second transfer setting.  In Applied Behaviour Analysis, when we talk about generalization, we are often talking about teaching skills in one setting or situation and having the person naturally start using those skills in another setting or situation. For example, if a child learns to tie her shoes with her mother at home, she will naturally be able to tie her shoes when at school in the presence of her teacher or on her own. In typical development, generalization is assumed to be natural and the norm, to be expected.

Another kind of generalization that we often talk about as behaviour analysts is the generalization of treatment effects. If in the home, a parent uses time-out to punish aggression between siblings and rewards the children for using their words to ask for what they want, we would expect to see aggression decrease and verbal requesting increase. When this happens consistently in the home and is maintained over time, we would say the intervention was effective. To say that generalization had occurred, we would have to see the children reduce their aggression and increase their verbal requesting with other children (e.g., peers in daycare) without having to set up the same reward and punishment contingencies in the daycare. From this example, you can see that even in typically developing children, generalization may not happen naturally. We need to program for generalization – that is, we need to arrange the environment so that generalization of skills or treatment effects is more likely to occur.

Programming for Generalization
In the early years of Applied Behaviour Analysis, two prominent behaviour analysts, Dr. Trevor Stokes and Dr. Donald Baer wrote a paper on generalization (Stokes & Baer, 1977) that has guided the thinking and actions of behaviour analysts and behavioural researchers over the past three decades. After reviewing 120 studies on behavioural intervention, they identified eight general techniques that had been found effective in promoting the generalization of treatment effects, including the reduction of behaviour problems and the increase in adaptive behaviours and skills.

1. Train and Hope: Training and hoping that we will get generalization of social skills to new settings or situations are our typical ‘default technologies’. In many cases, social skills may generalize naturally, especially in typical child development. However, for individuals with autism and those with related intellectual disabilities, we are less likely to see generalization happen as predictably. Therefore other technologies are needed to increase the chances.

2. Consistency of strategies across settings, people and situations: It is common that we will first find teaching or behaviour change strategies that are effective in one setting. Then we will observe how these changes generalize to new settings or situations. If generalization does not occur, we will need to add in the effective intervention strategies to see behaviours improve or skills generalize.  Although this may be common practice, it may be inefficient to wait and see if generalization will occur, especially in working with people who have demonstrated challenges with generalization.  Working form the start to have consistent intervention across different settings, people, and situations is preferred. If the same social challenges or social skill deficits are occurring in the home, school and community, parents, teachers and ASD professionals will want to work together to come up with strategies that can be applied consistently across settings. These strategies include environmental changes, teaching and prompting strategies, and behavioural contingencies. This most basic strategy of consistency will go a long way to promote generalized skills and behaviour change.

3. Introduce to Natural Maintaining Contingencies: When we are first teaching social skills to people with ASD, they may have very little motivation to learn as they’ve never found social interactions very rewarding. In fact, social interactions may be confusing, anxiety provoking and aversive. So in teaching social skills, we are likely to add in some “extrinsic” rewards to establish the social skill, such as giving token rewards for approaching peers or initiating play with peers; these tokens are later traded in for a high preference activity not necessarily related to the social context. Sometimes (not all the time), it is only through the use of extrinsic rewards that we can get past the anxiety and motivate the person with ASD to engage with peers; and it is only after having lots of engagement and positive experiences with peers that the person’s anxiety will reduce and he/she can begin to enjoy what most of us love about being social (such as, the pleasure of people smiling at us, including us in play or conversation, sharing high preference toys or interests). If we need to use artificial rewards to get the interactions started, we will want to fade out these rewards as quickly as possible - as soon as we see the person is starting to experience pleasure from just being with peers. Social behaviour that is maintained by these natural social contingencies of reinforcement (smiles, praise, sharing, being included, etc.) has a much better chance of generalizing to new situations because most people in the other settings will be naturally trained and able to provide social reinforcement.

4. Train Sufficient Exemplars: When we teaching any new skill, if we only teach with one example, we cannot expect the person with ASD to generalize the skill to novel situations.  So it is important when planning your social intervention (e.g., a social skills group), that you consider how to give the person lots of practice with many different social partners, across many different settings, and in many different social contexts, real or simulated. For example, if we are teaching someone how to ask questions of a peer to show interest in that person’s interests, we would want to provide a wide range of general questions and comments that can be applied to conversations with people with diverse interests (e.g., “What do you like to do?”, “Do you have a hobby?“, “That’s interesting! That sounds fun. Tell me more”, etc.). With this set of generic questions, you may then train through role play across at 5-10 examples (a.k.a., exemplars) with different kinds of interests before the person with ASD could generalize to conversing with a new person about his or her novel type of interest.

5. Train Loosely: We have a tendency in teaching social skills to people with ASD to use scripts to ensure consistency of training and to make it easier for the person to learn the new skill. One of the limitations in using scripts is that the person with ASD may end up sounding stilted or robotic in their responses, or get stuck and not know what to do or say when people in natural settings don’t follow the training script.  We need to train a wide range of responses that give the person many response options. We also need to ensure that there are lots of opportunities to practice using these options. For example, if we train the person with ASD to use several different ways to initiate an interaction (e.g., sitting beside someone and smiling at them, waving from a distance, saying “Hey do you want to play?” “What are you doing?”, “That looks interesting”, “Can I join you?”), they will have a better chance of finding something appropriate to say or do in novel situations.

6. Use Indiscriminable Contingencies: When we are teaching a new skill or trying to increase a low rate behaviour, we know that it is most effective and efficient to be consistent in reinforcing every attempt to use the new behaviour – learning happens faster!  However, the social world doesn’t work that way – we don’t always get rewarded every time we engage in an appropriate social behaviour. In fact, sometimes we are ignored. So how do we teach so that the person becomes resilient to being ignored or not getting what they want every single time? As teachers, it is our job to quickly move from “continuous reinforcement” to what is called “intermittent reinforcement” where not every response is rewarded.  Intermittent reinforcement makes it difficult for the person to know when he or she will get rewarded. Rewarding the person randomly after several appropriate responses would make the learner more attentive and have him/her work harder to get the reward. Typically we start with high rates of reinforcement (that is, reward after every appropriate response or every couple responses) and gradually and systematically “thin” our reinforcement until the person cannot predict when the reward is coming. In social skills training, rewarding the person during natural interactions with peers may be too disruptive to the interaction. So we often use delayed reinforcement. For example, we might video play interactions or conversations with peers in natural settings (with permissions, of course!) and play the video back to the person or group later so they can identify when they were using the specific target social behaviours and get praise or other rewards; also they can see where they were not using the appropriate social behaviours and get feedback and practice on this social skill.

7. Program Common Stimuli: When teaching social skills in a formal setting, such as a therapy group or in a special room in a school, we will want to consider how similar or different the setting is to the generalization settings where the social skills will be needed.  What are some “common stimuli” that could be included across training and generalization settings to promote generalization? We could include same peers, teachers, toys, activities, equipment, physical space, room set up, or contingencies (e.g, use of token system). The more similar the people, activities and environments, the easier it will be to get generalization in non-training settings.  In fact, for people with severe challenges in generalizing, we may want to avoid any type of simulation and only train in the same settings as where the social skills will be needed.

8. Mediate Generalization: Any time the person practicing social skills sets a goal for using a newly acquired social behaviour in a natural setting and then goes ahead to actually engage in that social behaviour, we can say that this was “mediated generalization”.  The promise or goal setting is the mediating variable that can help to promote generalization. Mediation might involve self-report; for example, where a child states before the play session starts what behaviour she is going to engage in with peers (usually a behaviour that has just been taught) and then, at the end of the generalization session, she reports on and is reinforced if she engaged in the target social behaviour.  The correspondence between saying what we will do and doing what we say is a learned behaviour that is not always present in young children; however, it can be taught through explicit reinforcement for correspondence between self-report and report from an adult observer. For example, the child might be taught to share toys and then asked to report on whether she shared her toys; if she says yes, and the teacher observed her sharing as well, she would get reinforced with praise or a tangible reward.

Train “To Generalize”: Most of the time we are teaching and reinforcing very specific target social behaviour.  This could put limitations on the range of behaviours the person with ASD might engage in.  If we were to explicitly ask the person to generalize (e.g., “I want to see you use what you learned today in social skills group when you are in your classroom or at recess”) and then we were to set up contingencies to reinforce trained behaviours when they happen in the non-training settings, then we are likely to see generalization.  This is somewhat different than the goal setting described above as, here, we are talking about reinforcing diversity of social responses.  Diversity could be related to one specific context, for example, in learning conversational skills, the person would be reinforced for saying new things or asking new questions, while repetition of a question or comment would not be reinforced. Diversity of response could also be reinforced across various social context, for example, within a social skills group where there are many targets taught sequentially, participants can be reinforced for generalizing any of the previous targets to natural interactions. Parents in the home and community and teachers in the school could be trained to watch for and reinforce instances where any of the targeted social skills were observed.

These nine strategies for promoting generalization provide a foundation from which we can increase the chances that the social skills we teach will actually get used in real life situations. We have a long way to go in perfecting social skills interventions. The one thing of which we can be confident is that programming for the generalization and maintenance of social behaviours from training settings to natural environments will greatly increase the opportunity for sustained social growth for our clients, students and loved ones with ASD.

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Stokes, T.F. & Baer, D.M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10 (2), 349-367.

Keywords: Social Skills, teaching

 


 

 


 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.7. Experts in Social Skills Interventions for People with ASD

This article is an excerpt (pages 31-33) from a full report published by Autism Ontario in 2011: SOCIAL MATTERS: Improving Social Skills Interventions for Ontarians with ASD. Click here to view the full report: http://www.autismontario.com/Client/ASO/AO.nsf/object/SocialMatters/$file/Social+Matters.pdf

 

Information is provided below on seven of the best-known experts on social skills interventions for persons with autism spectrum disorders (ASDs). All of these experts were referenced in the Professional and Parent Surveys. This information is provided as a resource to parents, educators and professionals seeking materials for teaching social skills to their children, students and clients.

Expert’s Name

(Alphabetical) 

Social Skills Contributions to the ASD Community

Important Publications/Resources Written by the Expert*

Tony Attwood

Dr. Attwood is a clinical practitioner who supports children and adults with AS, an international lecturer, and an adjunct associate professor and supervisor to post-graduate clinical students at Griffith University in Brisbane, Australia. Dr. Attwood’s work is focused on improving individuals’ social understanding, managing anxiety and anger, strategies for reducing bullying and teasing, helping children understand and cope with being different, as well as educating and training caregivers in increasing the quality of life for individuals with Asperger’s Syndrome. Dr. Attwood has also been highly involved in academia and clinical practice focused on the use of Cognitive Behaviour Therapy (CBT) to decrease anxiety symptoms and manage anger in children with ASD.

Asperger’s Syndrome, Vol. 2 DVD Anger Management, Teaching Teachers, and Teenage Issues: Future Horizons Inc. (2003)

Exploring Feelings: Cognitive Behavior Therapy to Manage Anger: Future Horizons Inc. (2004)

Jed Baker

Dr. Baker is currently providing social skills training for students with ASD in Milburn Public Schools in New Jersey, as well as serving on the ASPEN professional advisory board and directing the Social Skills Training Project. As Director of the Social Skills Training Project, which uses a cognitive-behavioural approach to social skills training, his goals are:

To provide relevant social skill instruction that will generalize into daily routines.

To make socializing fun so that students want to socialize.

To help “typical” peers and professionals become more understanding, accepting, and engaging of those with social difficulties

No More Meltdowns, Future Horizons Inc. (2008) (Southwick)

Social Skills Training for Children and Adolescents with Asperger Syndrome and Social-Communication Problems. Autism Asperger Publishing Co. (2003) (Smith Myles)

Fred Frankel and Elizabeth Laugeson

Dr. Frankel is the Director of the Parenting and Children’s Friendship Program at UCLA, in Los Angeles, California, which offers empirically-based parent training and social skills training to children and adolescents with ASD. Dr. Frankel has conducted research on parent training to decrease behavioural difficulties and increase social skills in children and adolescents with ASD. As well, he is the Principal Investigator of the Parent-Assisted Friendship Training in Autism project which focuses on increasing friendship skills in children with HFA who are included in typical elementary school classrooms from grades 2-5. In partnership with Dr. Elizabeth Laugeson (at UCLA),Frankel has adapted the Children’s Friendship program for a teenager population and called it PEERS – Program for the Education and Enrichment of Relational Skills. The parent component, which runs concurrent to training for both children and teens, addresses how parents can support their children in using what they learn in group to make and keep friends and to be accepted by those within their age group.

Children’s Friendship Training: Brunner-Routledge (2003)(Myatt)

Friends Forever: How Parents Can Help Their Kids Make and Keep Good Friends: Jossey-Bass (2010)(Frankel)

Social Skills for Teenagers with Developmental and Autism Spectrum Disorders- The PEERS Treatment Manual: Jossey-Bass (2010) (Laugeson & Frankel)

 

Carol Gray

Carol Gray is the Director of The Gray Center for Social Learning and Understanding in Grand Rapids, Michigan. Carol Gray is best known for developing Social Stories and Comic Strip Conversations, intervention tools which are used by parents and educators to share accurate social information to an individual with ASD in an easily understood manner with the intent to help the person understand not only what is expected behaviour in specific social situations, but why the behaviour is important and what difference it makes for future interactions. She has written numerous articles, books, resources, and chapters on the subject of increasing social skills in individuals with an ASD and has over 20 years of experience in working with students in this population in public schools as a teacher and consultant.

My Social Stories Book: Jessica Kingsley Publishers (2002)(White)

New Social Story Book- Revised and Expanded 10th Anniversary Edition: Future Horizons (2010)

 

Steven Gutstein

Dr. Gutstein developed and directs the Relationship Development Intervention (RDI) Program for ASD at his Centre in Houston, Texas. The RDI Program is described as “a tailored set of objectives, extending from the Family Guided Participation Program and intended to target the core deficits of individuals with the diagnostic distinction, Autism Spectrum Disorder. More specifically, the program operates as a comprehensive set of developmentally sequenced steps, committed to re-building the Guided Participation Relationship as the cornerstone for neural development. It also helps families construct opportunities for the child’s neural growth and support their children in forming reciprocal friendships, mature emotional relationships, engaging in flexible/adaptive thought and mastering problem-solving abilities necessary for job attainment and success in the modern world.

Relationship Development Intervention with Children, Adolescents and Adults: Social and Emotional Development Activities for Asperger Syndrome, Autism, PDD, NLD: Jessica Kingsley Publishers (2002)(Sheely)

Relationship Development Intervention with Young Children: Social and Emotional Development Activities for Asperger Syndrome, Autism, PDD and NLD: Jessica Kingsley Publishers (2002)(Sheely)

Brenda Smith Myles

Dr. Smith Myles is an associate professor in the Department of Special Education at the University of Kansas where she co-directs a graduate program in ASD. Dr. Smith Myles has sat on many advisory boards across North America involved in conducting applied research, providing direct services or education, raising awareness to caregivers and the community, and addressing mental health challenges associated with an ASD diagnosis.

Dr. Smith Myles is best known for her work on The Hidden Curriculum, in which she makes explicit the myriad of social rules and conventions that are not taught in schools and without which one cannot survive in the social world.

 Dr. Smith Myles has many publications and writes about topics including: managing anger and rage cycles, bullying, practical classroom strategies, social inclusion and the use of visual supports.

The Hidden Curriculum: Practical Solutions for Understanding Unstated Rules in Social Situations: Autism Asperger Publishing Co. (2004)(Trautman & Schelvan)

Asperger Syndrome and Difficult Moments-Practical Solutions for Tantrums, Rage, and Meltdowns: Autism Asperger Publishing Co. (2005) (Southwick)

Michelle Garcia Winner

Michelle Winner is the director of the Social Thinking Centre based out of San Jose, California. Michelle Winner, Speech Language Pathologist and creator of Think Social Publishing, has developed a comprehensive Social Thinking curriculum and a myriad of resources to teach the kind of thinking that is foundational to learning social skills. Her ILAUGH model of social thinking assists teachers and parents in teaching concepts needed to process and react to social situations in order to succeed in solving social challenges. In their clinical work, Winner and her colleagues Pamela Crooke and Stephanie Madrigal work with small groups matched for age and social cognitive level to provide broaden social understanding and practise social skills within clinic and community settings.

Thinking About You, Thinking About Me: Jessica Kingsley Publishers Ltd. (2003)

Madrigal, S. Superflex... A Superhero Social Thinking Curriculum Madrigal & Winner (2008) (Note: This resource is not written by Winner, but is published through Think Publishing )

Socially Curious, Curiously Social Think Social Publishing (Crooke) (2011)

 

 

 

Keywords: Social Skills

 

This article is an excerpt (pages 31 to 33) from a full report published by Autism Ontario in 2011: SOCIAL MATTERS: Improving Social Skills Interventions for Ontarians with ASD. Click here to view the full report:

http://www.autismontario.com/Client/ASO/AO.nsf/object/SocialMatters/$file/Social+Matters.pdf

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.8. The issue of Eye Contact

Leslie Broun, M.Ed., ASD Consultant

As society has developed a deeper understanding of Autism Spectrum Disorders (ASD), we have access to more information about the issue of eye contact, much of which has come from persons with ASD who have been able to report on their experience:

 

  • “I can look at you or I can listen to you, but I can’t do both”.  Jean Paul Bovee, 1998
  • “When I look someone straight in the eye, particularly someone I am not familiar with, the feeling is so uncomfortable that I cannot really describe it. If I don’t look away, then whilst someone is talking, I find myself staring really hard and looking at their features and completely forgetting to listen to what they are saying.” Luke Jackson, 2002
  • “Making eye contact with a speaker can result in a breakdown of communication. How much easier it is to hear someone if you can’t see his or her face. Then words are pure and not distorted by grimaces and gestures. I can listen better to the tone of someone’s voice when I am not confused by the unwritten words of their facial expressions.” Wendy Lawson, 1998
  • “With people having autism and Asperger Syndrome, the nonverbal component can be so difficult to decode that it interferes with getting meaning from the verbal channel. As a result, very little, if any communication occurs.” Stephen Shore 2001

 

Usually, the need for eye contact belongs more to the neurotypical person than the person with ASD, particularly in the context of social interaction. Social situations and conversations are the contexts in which neurotypical persons expect eye contact therefore encouragement and training for play and social interaction may be the most appropriate starting point.

 

  • Clarify what is meant by eye contact. Parents and instructors need to be in agreement about what this means:
    • Establishing eye contact?
    • Sustaining eye contact? For how long?
    • Alternating looking between the other person’s eyes and mouth area?
    • Establishing eye contact and then looking at an object or in another direction?
  • Analyze your own degree of eye contact. Most people do not sustain eye contact with a communicative partner. Eye contact may be established and re-established many times in neurotypical conversation.
  • Observe the child to see if he or she tends to look more at the mouth than the eyes. Many persons with ASD find communication easier if they look at the mouth of the communicative partner as it allows for “lip-reading” which may help with language processing. The mouth and positions of the lips also convey many messages to the listener/observer.
  • If eye contact is the instructional goal, use familiar and comfortable materials and activities. When in the early stages of instruction, use the same partner. Often, as a child becomes familiar with a social partner and the sound of their voice, he or she may be more likely to look at that person comfortably.

 

During instructional interactions, the goal is for the student to learn how to do the task, which may mean that there is no eye contact involved. Do not assume that if you request and get eye contact, that the student will be able to follow your instructions or understand your message. Establishing joint visual attention with learning materials or a book will be more important than the social aspects of an instructional interaction.

 

  • A student may need to look down at his or her desk or at the wall or even close his or her eyes in order to process the auditory input of verbal instructions. When sharing information or instructions verbally, provide a visual support, such as a sheet of instructions, a diagram or a sample of what a finished product should look like.
  • Allow time for the student or child to redirect his or her attention. Research has shown that many persons with ASD experience difficulties with shifting their visual attention: looking from one person or thing to another in social and learning situations.
  • Do not physically manipulate or turn a child’s face to force him or her to look at you. The child may find this to be overwhelming and may then do this to other people.
  • Creating and using a story written to increase social understanding may be very useful in helping a student learn why and when people usually establish eye contact. It is important for individuals with ASD to understand that people generally like it when a speaker or listener looks at them occasionally during an interaction.

 

When considering the work that must be done by the person with ASD to live in the world of the neurotypical, we must ask ourselves to what extent we can respect and accommodate individual abilities and preferences when it comes to the issue of eye contact. The ultimate goal is communication. If we insist on eye contact, we may prevent the person who has an ASD from deriving meaning from the experience.

 

 

 

Keywords: eye contact, social interaction, instruction, joint attention

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.9. Teaching Social Skills: Peer Network Interventions in Inclusive Elementary School Settings

By Suzanne Murphy 

It is a well-known fact that people with an autism spectrum disorder (ASD) face significant challenges in the areas of social skills and social interactions. This is a real concern for parents, school staff and community service providers alike. Deficits and social differences are evident from an early age. Individuals with an ASD can show a range of social characteristics, from aloofness and avoiding social situations to a desire for friendships and actively seeking social interactions although usually lacking the skills to do this successfully.

Social deficits and the failures that result from them impact the short-term and long-term well being as well as quality of life of individuals with ASD. Where to start? What to teach? What is the most effective level of intervention? How to ensure generalization of skills from one environment to another or from one person to another? These are only some of many questions that arise when attempting to address the multiple social needs of individuals with ASD.

Another type of question touches upon peer involvement in social learning.  How can the importance of peers in social learning be underlined?  What structures are necessary to fully benefit from this naturally occurring social network?  During her presentation at the 2012 Association for Behavior Analysis International (ABAI) Autism Conference, Debra M. Kamps (Ph. D.) associate director and senior scientist at the University of Kansas clearly presented the necessity for social intervention starting at a young age. Peer mediated interventions are a key strategy for social learning. Circles of Friends and social skills groups made up of children or youth with ASD and neurotypically developing peers are two examples of this type of intervention.

According to Kamps, neurotypical peers interact with one another about 40 percent of the time, which is not the case for children and youth with ASD. She shared results of research which examined the impact of peer networks, defined as small groups of peers with specific roles including offering support and assistance, tutoring or acting as reinforcing agents with the students with ASD.  Intervention based on peer networks differs from other interventions in two important ways: training of peers and peer involvement in the choice of activities and goals. Seventeen studies involving forty-five participants attributed progress in social communication and exchanges to the length of interactions between the student with ASD and their peer network and to the fact that peers considered themselves ‘agents of change’.

Reasons for training peers are many, most notably that they are part of the natural environment. Peers spend the entire school day with the student with ASD and they move up together from year to year. However, the fact of being physically in the same classroom offers no guarantees of successful interactions or positive attitudes towards students with special needs. Furthermore, students with special needs are more likely to be victims of bullying than their neurotypical peers. Peers play an important role in social learning, but without guidance they may unknowingly encourage interfering behaviour of the student with ASD or fail to reinforce desired behaviour.

Results of a five-year longitudinal study, carried out by Kamps and her colleagues, demonstrated the positive impact that peer networks can have. The study followed forty-five students with ASD in elementary school and each student was part of one to four peer networks per year. Peer networks included social groups or games, peer tutoring sessions and recess or lunch groups and were active three to four times per week. Results showed significant differences in interactions between the students with ASD and peers who received training in comparison to interactions with unfamiliar or untrained peers.  Interval recording demonstrated interaction in 30% of intervals with unfamiliar peers, 40% of intervals with familiar peers but almost 70% of intervals with trained peers, an impressive increase. 

Kamps noted a few key evidence-based features of interventions based on peer networks:

 

  • Sessions and activities are structured and include one student with ASD and two to four peers;
  • Direct instruction is used to teach communication and social skills;
  • Visual supports are used and include graphics and words;
  • Scripts are used for the student with ASD and with peers;
  • Peers interact with the student with ASD. The role of the adult is to encourage peers to prompt the students with ASD to participate;
  • Reinforcement is incorporated into the intervention.

 

In addition to these features, Kamps underlines the following:

 

  • The ‘30 second rule’ is in effect. This means that if the student with ASD stops participating for more than 30 seconds, the adult prompts the peers to encourage participation. Peers can prompt the student with ASD a maximum of two times. If this does not result in participation, the adult intervenes directly;
  • Peer networks can exist with different frequencies.  It is not necessary for them to occur every day. Having said that, Kamps adds that a ‘dose’ of regular interaction is a way to overcome challenges related to autism;
  • Peer networks increase social interactions, can contribute to improved language and provide tools useful for better functioning in society.

 

It was also noted that although peer networks are effective, teaching staff struggle with incorporating them into the school schedule.  Kamps ended with a vision for moving forward and some questions to ponder:

 

  • How does one adapt interventions based on peer networks so they can be less intensive and less costly?
  • What might peer networks look like at the secondary school level and in adulthood?
  • What are target skills within community contexts?
  • What teaching strategies are essential to include?
  • What are the priorities to achieve significant results?

 

Although research can lead to additional questions, results of research to date support implementation of peer networks. It is impossible to negate the characteristics of ASD, the complexity and enormity of the social realm and the need to include a social component to programs designed for children with ASD.  The National Research Council (2001) recommends using peer mediated techniques to improve interactions and promote social development of children with autism.  Essential elements of peer networks are evidence-based and generally have a positive impact on the student with ASD as well as on the peers, two key parts of successful interactions.

Suzanne Murphy is consultant with over thirty years of experience in the field of child and youth work.  She specialises in the fields of autism spectrum disorders (ASD) and behaviour.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.10. Increasing Social Involvement

Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: Increasing Social Involvement

By Barbara Muskat, PhD, RSW & Jason Manett, M.A., Ph.D. (Cand.), The Redpath Centre

Social involvement and friendships are important contributors to quality of life. Individuals with friends enjoy greater psychological well-being and have a greater sense of self-worth (Bagwell, Bender, Andreassi, Montarello, & Muller, 2005; Bukowski, Motzoi, & Meyer, 2009; Gupta & Korte, 1994; Voss, Markiewicz, & Doyle, 1999). Conversely, individuals who lack peer relationships experience loneliness, boredom, lower self-esteem, and negative mental health outcomes including depression and anxiety (Bagwell et. al., 2005; Carbery & Buhrmester, 1998; Orth, Robins, & Roberts, 2008; Whitehouse, Durkin, Jaquet, & Ziatas, 2009).

Struggles with social interaction are among the diagnostic criteria for Autism Spectrum Disorder (ASD) (APA, 2000). While these difficulties are commonly first observed in childhood, they may become embedded and more complex as individuals with ASD enter adolescence and adulthood. During this period, individuals with ASD may become increasingly aware of their social and behavioural differences, more motivated to engage in relationships, and develop more sophisticated understandings of friendship (Kanner, Rodriguez, & Ashenden, 1972; Szatmari, Brenner, & Nagy, 1989). Nevertheless, adolescents and adults with ASD continue to have few social opportunities and friendships (Barnhill, 2007; Engstrom, Ekstrom, & Emilsson, 2003; Jennes-Coussens, Magill-Evans, & Koning, 2006).

Individuals with and without ASD demonstrate similarities in the meaning they assign to long-term friendships (Bauminger et. al., 2008; Locke, Ishijima, Kasari, & London, 2010).  Consequently, those with ASD are significantly affected by feelings of loneliness and isolation when they fail to form them (Frith, 2004; Howard, Cohn, & Orsmond, 2006; Locke et. al., 2010; Tantam, 1991). Therefore, addressing the poverty of social opportunities and experiences among adults with ASD is critical from both a quality of life and a health perspective.

Very little is known about social interaction trends among youth and adults with ASD.  An early study of peer relationships and participation in social and recreational activities by adolescents and adults with autism who live at home found that the likelihood of having friendships, peer relationships, and participating in social and recreational activities was low (Orsmond, Wyngaarden Krauss, & Malik Seltzer, 2004). A more recent study (Liptak, Kennedy, & Dosa, 2011) found that many youth had not gotten together with friends in the previous year, nor had they talked on the phone with a friend. The study concluded that numerous adolescents and young adults with autism become increasingly isolated over time. 

Qualitative research examining the experiences of youth and young adults with ASD about their experiences with social relationships and friendship also reveals responses ranging from retreating from friendships to feeling ambivalence about friendship to pursuing friendships (Marks, Schrader, Longaker, & Levine, 2000). Others, interested in socialization, have described using a technique of "masquerading" (Carrington, Templeton & Papinczak, 2003), to mask/hide social difficulties in an attempt to conform and fit into their high school social scene. 

Studies with adults with ASD found similarly divergent points of view (Jones, Zahl & Huws, 2001). Internet sites of adults with ASD reveal that participating individuals expressed a sense of alienation from society, frustration with the world, feelings of overall depression, and a pervasive sense of fear.  In contrast, more positive themes were found by Hurlbutt and Chalmers (2002) where adults described valuing support systems offered through family and spiritual communities. Howlin, Goode, Hutton, & Rutter (2004) also found adult socialization outcomes were variable with some individuals having meaningful social relationships and others remaining isolated and dependent. 

In our recent Ontario study of 480 youth (16+) and adults living with ASD (Stoddart et al., 2013), individuals with ASD and family members responded to questions about their social involvement. The findings support what was already described in the literature and highlight the lack of progress made in assisting young adults with ASD to become more socially involved. In open-ended questions about social activities and involvement, both family members and individuals expressed a desire for more social interaction juxtaposed with reluctance to participate in social activities, as well as feelings of social isolation. The majority (81.8%) of respondents indicated they had difficulties taking part in social activities; 73.7% stated that they did not find it easy to make friends; 60.9% indicated they did not have as many friends as they would like to have and 59.1% said that they did not find it easy to keep friends.  A further 57.3% noted they did not have a “best friend”. Almost half the respondents (43.6%) noted that there were limited or no social programs/groups for adults in their community.

Of those respondents who reported social activity, 33.1% said that they engaged in on-line social networking; 32.1% reported they have had a romantic or intimate relationship in the past; and 14.9% stated they were currently in a romantic relationship. Many respondents reported a desire to be social and to have and maintain friendships. Individuals with ASD and communication challenges were even more limited in their social participation, as their limited verbal and behavioural repertoire acted as barriers to successful socialization. Participants’ responses indicated that the programs that do exist for this population tend to be part of day programs, or tailored to those with developmental disabilities, which are not suitable for individuals with ASD and higher cognitive ability. Finally, respondents indicated that the family served as the primary social network for many adults with ASD.

Challenges:

  • Lack of early support for youth with ASD to prevent and address negative social experiences
  • Lack of community-based opportunities for small group socialization for individuals with ASD at all levels of cognitive ability
  • Lack of sufficient community-based leisure activities that can accommodate the special needs of adults with ASD
  • Limited therapeutic supports to help young adults with ASD cope with social anxiety and take social risks
  • Increased dependence on un-monitored on-line social interaction

 

Recommendations for the Community:

  • Create a centralized resource guide of social opportunities for individuals with ASD
  • Provide government funding for the creation and facilitation of small interest-based groups for individuals with ASD
  • Expand funding opportunities to hire support workers who assist individuals with social integration in the community
  • Create residential programs with an assisted living component that include facilitated social opportunities for adults with ASD with multiple, complex needs
  • Create residential programs for students with ASD in post-secondary settings

 

Recommendations for the Individual and Family:

  • Recognize that many appropriate social opportunities for adults with ASD can be found outside of treatment-based resources
  • Prioritize participation in extra-curricular activities for individuals with ASD at all ages
  • Identify social opportunities that capitalize on special interests (www.meetup.com is one resource)
  • For students in post-secondary education, identify social groups for students with ASDs at the institution, frequently run through the Disability Office
  • For students in post-secondary education, encourage participation in peer mentorship programs
  • Encourage young adults with ASD to gain employment and/or participate as a volunteer in settings that include social interaction with others

 

References

See attached pdf.  

About the Authors:

Barbara Muskat, PhD, RSW is Child and Adolescent Therapist at The Redpath Centre, Director of Social Work at the Hospital for Sick Children and Assistant Professor (status only) at the Factor Inwentash Faculty of Social Work, the University of Toronto. Her clinical and research interests include: addressing the social and emotional sequelae of Learning Disabilities and Asperger Syndrome, group interventions, and development and evaluation of programs to support parents of children with neurodevelopmental disorders.

Jason Manett, M.Ed, PhD (Candidate) is an Academic and Life Skills Coach at The Redpath Centre and Disability Counsellor at Accessibility Services, University of Toronto. He is also a doctoral candidate in the Human Development and Applied Psychology program at OISE/UT. His clinical and research interests include children, adolescents and adults with ASD, learning disabilities, ADHD, mood and anxiety disorders.



 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.11. Importance of Life Skills

Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: The Importance of Life Skills

By Priscilla Burnham Riosa, PhD & Claudia Accardi, MSW, RSW, The Redpath Centre

This article summarizes some of the information contained in the report entitled: “Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: Complex Needs in Unprepared Systems”.

Whether youth or adults are ‘mildly’ or ‘severely’ affected by an Autism Spectrum Disorder (ASD), deficits in adaptive skills (also called ‘life skills’ or ‘functional skills’) present challenges which are not well-understood or sufficiently addressed in our service system. Studies and clinical practice show that learning and use of these skills are problematic for individuals with ASD because of difficulties with generalization of learned skills from one setting to another, behavioural inflexibility, sensory sensitivities, gross and fine motor difficulties, mental health struggles, difficulties with executive functioning, lack of interest, and perceptual challenges (Kanne et al., 2011; Smith et al., 2012; Stoddart et al., 2013). Moreover, daily life skills challenges affect not only the life of the individual with ASD, but also his or her family and couple relationships (Stoddart, Burke & King, 2012).

Although research on life skills in youth and adults with ASD is relatively scarce, existing studies show life skills development needs to start early, transition planning is required, and continuous support in the young adulthood years are crucial (Smith et al., 2012; Kanne et al., 2011; Hendricks & Wehman, 2009; Thomson et al., 2011). With the acknowledgement of the significant role that functional life skills play in good youth and adult outcomes along with provision of appropriate life skills services and supports, functional skill development can continue throughout adolescence and into adulthood. A recent study investigated the trajectories of daily living skills for adolescents and adults with ASD and found that “skills improved during adolescence and the early 20s, plateaued around the late 20s, and began to decline in the early 30s” (Smith et al., 2012, p.629).

In our study of 480 youth (16+) and adults living with ASD in Ontario (Stoddart et al., 2013), we gathered information on whether or not the individual required help with twelve life skills including: planning and preparing a meal, managing finances, attending to personal care, remembering schedules, arranging or attending appointments, using transportation, and finding and using services and supports. Overall, we found that services and supports in the area of adaptive skills were lacking and that an increased focus on family-centred supports is needed. Specifically, 81.1% of the participants reported that they always or sometimes required help with finding and using services, compared to only 15.8% of participants who did not. This finding not only speaks to the need for increased services for youth and adults, but also for supports to find and use services, and improved system navigation and self-advocacy skills.

In the same study (Stoddart et al., 2013), more than 50% of the participants reported that they always required help in several areas, including “paying and managing finances”, “doing basic household repairs”, “arranging and attending appointments”, “dealing with mail and letters” and “shopping for clothes and groceries”. These results reinforce the idea that when support for basic life skills is in place, the individual with ASD will be able to function successfully in his or her daily life, which also means being able to manage medications, maintain a healthy lifestyle, seek and maintain employment, and pursue an independent life. The development of daily life skills is critical for successful outcomes for adults with developmental disabilities (Smith et al., 2012), and when planning for supports and services they must be individualized and needs-driven (Hendricks & Wehman, 2009).

Acquiring life skills is a life-long process that requires persistence, perseverance, and regular practice. Different strategies have been used to teach life skills to youth and adults with ASD, including: verbal, gestural, or physical prompting, reinforcement and/or praise, task analyses, error correction procedures (Thomson et al., 2011); role-playing social situations, scripts, making use of a hands-on “life coach” or “organizational coach” (Stoddart, Burke & King, 2012); pictures and videos prompts (Laarhoven et al., 2010).

Challenges for the Development and Maintenance of Life Skills:

  • Sensory sensitivities, gross and fine motor challenges, and other diagnoses such as mental health problems may make participation in essential day-to-day activities challenging
  • Participation in daily life activities traditionally motivated by social pressures may not appeal to individuals with ASD in the same way as those without ASD (e.g., household chores, personal hygiene)
  • Dependency on family to support and perform many life skills may create chronic stress and worries related to the future of the individual with ASD

 

Recommendations for the Community:

  • Increase person-centred funding and programs for functional life skills services and supports for individuals across the entire range of adaptive abilities seen in ASDs
  • Create life skill resources, tools, and social networking opportunities for families and professionals to share knowledge and life skill training resources that include recommendations on how to foster basic and advanced independent living skills
  • Provide a lending library that includes user-friendly life skill resources such as teaching tools, curricula, and assessment measures that can be easily accessed by individuals with ASD, family members, and professionals
  • Enhance training for teachers, educational assistants, support workers, behaviour therapists, and other professionals on how to teach adaptive skills with a specific focus on promoting personal independence
  • Emphasize functional life skills as critical to success in the classroom and beyond; weave and highlight life skills training programs into academic programs and transition planning
  • Conduct longitudinal research on the effect of functional life skills on individual and family quality of life
  • Increase access to integrated residential and life skills support models

 

Recommendations for the Individual and Family:

  • When choosing functional life skill goals, select ones that are personally meaningful to the individual and his or her family, and teach them early so that there is time to learn the skill (e.g., teach shaving before facial hair becomes coarse and long)
  • Create goals that are appropriate given the individual’s strengths, personal preferences, and interests
  • Select skills that are relevant to the current situation as well as geared toward potential future living situations
  • Teach self-advocacy skills (e.g., asking for help, navigating and accessing services, safety) early on to promote choice-making and personal independence
  • Teach functional life skills in the natural environment whenever possible to avoid challenges with generalizability
  • Use individualized supports to learn and teach self-management and independence-related skills – e.g., activity schedules (pictures, text, video models), personal organizers, electronic devices, and apps
  • Consider using the services of a life skills coach trained in task analysis and behaviour supports
  • Seek assistance of friends and family members; however, distribute your requests to different people whenever possible to minimize the stress upon each individual in your support network (e.g., ask one person to help with managing finances, and ask another to help with remembering appointments)
  • Employ professional supports when feasible, such as a bookkeeper for help with financial needs, or a cleaning person/organizational coach to help with cleanliness and organization around the house

 

References:

Hendricks, D. R., & Wehman, P. (2009). Transition from school to adulthood for youth with Autism Spectrum Disorders: Review and recommendations. Focus on Autism and Other Developmental Disabilities, 24(2), 77-88.

Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in Autism Spectrum Disorders: Implications for functional outcome. Journal of Autism and Developmental Disorders, 41, 1007–1018.

Laarhoven, T. V., Kraus, E., Karpman, K., Nizzi, R., & Valentino, J. (2010). A comparison of picture and video prompts to teach daily living skills to individuals with Autism. Focus on Autism and Other Developmental Disabilities, 25(4), 195–208.

Smith, L. E., Maenner, M. J., Seltzer, M. M. (2012). Developmental Trajectories in Adolescents and Adults with Autism: The Case of Daily Living Skills. Journal of the American Academy of Child & Adolescent Psychiatry, 51(6), 622-631.

Stoddart, K.P., Burke, L., Muskat, B., Manett, J., Duhaime, S., Accardi, C., Burnham Riosa, P., and Bradley, E. (2013). Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: Complex Needs in Unprepared Systems. Toronto, ON: The Redpath Centre.

Stoddart, K.P., Burke, L., & King, R. (2012). Asperger Syndrome in Adulthood: A Comprehensive Guide for Clinicians. New York, NY: Norton Publishers.

Thomson, K., Walters, K., Martin, G. L., & Yu, C.T. (2011). Teaching adaptive and social skills to individuals with Autism Spectrum Disorders. In J.L. Matson, P. Sturmey (eds.), International Handbook of Autism and Pervasive Developmental Disorders: Autism and Child Psychopathology Series (pp. 339-354), New York, NY: Springer.

About the authors:

Priscilla Burnham Riosa, PhD is Clinical Research Coordinator at the Hospital for Sick Children, Research Assistant, The Redpath Centre and a Behaviour Consultant supporting children and youth with ASD. She is also a sessional instructor at the University of Guelph-Humber and Brock University. She has worked with individuals with ASDs and their families for over ten years.

Claudia Accardi, MSW is Research Assistant at The Redpath Centre and Factor-Inwentash Faculty of Social Work, University of Toronto. Among various research projects, she is currently involved in a project examining the marital relationships in families of children with ASDs. Her interests include program evaluation, the use of technology in counselling, and research in ASDs, developmental disabilities, and learning disabilities.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.12. Sexual Education for Adolescents and Young Adults with an Autism Spectrum Disorder: Themes and Adapted Steps

The Sexual Profile

 
By: Isabelle Hénault, Ph.D.  Psychologist & Sexologist 

There is remarkably little research and clinical knowledge on the sexual understanding and profile of adults with Autism Spectrum Disorder (ASD). One hundred thirty-one subjects living in Canada, Australia, France, Denmark and the United States completed the Derogatis Sexual Functioning Inventory (DSFI; Derogatis and Melisaratos, 1982). The DSFI examines a range of aspects related to sexuality including knowledge and experience, desire, attitudes, affect, role, fantasies, body image and general sexual satisfaction. It provides a comprehensive assessment of behavior and attitudes relevant to sexuality.

The results suggest that individuals with ASD have levels of sexual interest and drive comparable to those of the general population.  On the other hand, the communication difficulties that they experience combined with their lack of social skills serves to increase the likelihood that symptoms of depression and inappropriate socio-sexual behaviours will appear (Hénault, Attwood & Haracopos, 2010).

When these difficulties arise, individuals need understanding and support from their partner, family, friends and relationship counselling agencies. This support should be open-minded, positive and based on adapted services. The remedial programs on social cognition, particularly in the areas of friendship skills and empathy that begin in early childhood, continue as the person matures and include information and guidance on puberty, dating, sexual knowledge and identity and intimacy. The goal is to provide greater knowledge and positive experiences to contribute to better decision making and self-esteem. The programs must accommodate the person’s circumstances and the cognitive profile associated with ASD. The author has developed a socio-sexual program for adolescents and adults with Asperger’s syndrome (Henault, 2005).

During adolescence and young adulthood, several subjects need to be addressed.  These constitute the basis of sexual education. Here are some examples (Sex Information and Education Council of the U.S., 1992):

Sexual organs of both sexes: names, functions and concrete descriptions

Bodily changes that accompany puberty

Self-esteem

Information on nocturnal emissions

Values and steps in decision-making

Intimacy: private and public settings

Sexual health: behaviours and initial examination of sexual organs/gynaecological examination

Communication about dating, love, intimacy and friendship

How alcohol and drug use influence decision-making

Sexual intercourse and other sexual behaviours

Masturbation

Sexual orientation and identity

Birth control, menstruation and the responsibilities of child-bearing

Condoms, contraception and disease prevention

Emotions related to sexuality should be included in discussions since they motivate many behaviours.

The first step in intervention and sexual education programs involves teaching general knowledge, which is tailored to the individual’s chronological and developmental age.  This information allows the individual to make informed choices.  It also enables the person to better understand the limits within his learned behaviours that can be explored and experienced, while respecting his own values and those of others.  The goal of the intervention is to both provide a structure for appropriate sexual behaviours and offer many opportunities for learning and obtaining enriching experiences. 

The following themes, which are adapted to the reality of more able adolescents and adults with Autism Spectrum Disorder, cover as a whole, the characteristics linked to their social and sexual development (Hénault, 2006):  

Information on nocturnal emissions

The value of, and stages involved in making decisions

Intimacy: both private and non-private parts of the body; different environments

Sexual health and initial examination of genital organs – or gynecological exam

Communication: interpersonal, intimate, love, and friendly relationships

The effect of alcohol and drugs on the ability to make decisions

Sexual relations and other sexual behaviours

Self-stimulation (masturbation)

Sexual orientation and identity

Planning for pregnancy, menstruation, and parental responsibilities

Condoms, contraception, and the prevention of sexually transmitted diseases (STD’s)

Hygiene

Friendship: recognition of abusive/unfriendly relationships

Dangerous relationships: age difference, intention, bullying, aggression

Qualities of a healthy relationship: sharing, communication, pleasure, interest, respect

Intensity of relationships: finding a balance and learning the limits

Social skills: presentation, interactions, reciprocity, sharing, etc.

Boundaries and the notion of informed consent

Conclusion

Sexual education has both short and long-term goals. In the short term, it allows adaptive sexual behaviors to emerge with respect to communication, emotions, and interpersonal relationships. Over the longer term, adolescents and adults with ASD will be in a better position to understand what interpersonal relationships consist of and will engage in appropriate behaviors in a variety of relationship contexts.  They should also be able to explain what is meant by a sexual relationship, how it unfolds, and the circumstances (time, place, appropriate individuals) under which it is possible for one to take place all while conducting themselves in a manner that is consistent with the situation.  Finally, these individuals will understand what is meant by informed consent in the context of a sexual relationship (Tremblay, Desjardins & Gagnon, 1993).  The ultimate goal is to allow individuals with ASD to fully experience social integration, healthy sexuality and access a better quality of life.

 

 

 

 

 

 


 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.13. Pointers from the Pool

By Micole Ongman, Program and Aquatic Supervisor, Town of Whitchurch-Stouffville

Swimming instructors and lifeguards are taught many principles that may be appropriate and transferred easily to those working with children with autism. It is most important for instructors and lifeguards to understand whom they are working with, that each child is different, that children want to trust their teacher, to have fun and to enjoy their experience. Here are 25 pointers that have applications well beyond the pool.

 

  • Safety is always first and foremost
  • Establish rules right from the start and associate them with a picture/visual if possible. Pick the important ones and keep it simple
  • At each class, go over the rules again. Dont expect them to be remembered. Point or the visual if the rule is broken so that they understand why the rules exist
  • Be aware and be prepared for medical concerns
  • The water may be very intimidating, take progressions slowly
  • Dont miss out on successes. What you think they should be doing for success may not be what they are actually able to accomplish and many of their successes go unseen. For example, the instructor may be frustrated that the child may be focusing on the water, getting to know the texture and feel. For them that is a huge success
  • Praise successes based on personal bests and skill building. Dont compare them to the other kids or to the criteria on the worksheets. There is always an accomplishment. Sometimes you need to look really hard and understand the child to recognize it.
  • If you think they arent listening, you are probably wrong.
  • Learn from parents who their favourite characters are, then relate learning activities to that character. They mat not be able to do something because they are shy or overwhelmed but they might be able to do it as Dora the Explorer, etc.
  • Follow their lead and try to get what you want done inserted into what their focus is. Work with their focus rather than expecting them to keep up with you.
  • Lead transitions smoothly. If you are at one end of the pool blowing bubbles and need to go to another area, do walking bubbles or something that links the activities.
  • IF they are focused on an activity and doing well at it, ask yourself if you really need to move on to the next thing right now or can you go with the moment and allow them to do this longer
  • Establish routines that do not change. Always meet at the same place for the beginning of the class. Start with the same activity to get them comfortable. End the class with the same activity to end with a success and to allow them to be aware that the next step is going out of the pool and class is over
  • Be consistent
  • What works for one child may be a disaster for another. Dont try to do canned lessons. Read in the child what works and what doesnt and adjust lessons as necessary
  • Use one command/direction at a time. Keep it simple. If they dont do it, it probably means that they need it explained again in another way
  • Everyone must respect the others personal space. Before you touch them to assist with a float or skill, let them know what you are going to do and that you need to touch them. Deomonstrate on someone else if possible
  • Skills that are usually broken down into two or three steps may need to be broken down to 10 or 20 steps
  • Assist children from the change room
  • Use their names whenever possible. Make sure you introduce yourself in any situation. Children are usually much more comfortable once they know your name
  • If there is a problem between two children, there is usually a reason and it is often in response to something once child did. Find out what the trigger was. It may be helpful to ask caregivers what types of triggers there may be and avoid those situations if possible
  • Rules and consistency are very important. They need to be clear, to the point, vusla if possible and explained
  • If necessary, have a dry run of a visit to the pool. Bring the child in with their parents, siblings, etc. And let them practice or role play how to obey pool rules
  • Have a plan in place on how to deal with issues. If a rule is broken or they are not listening, have a meeting place that they are asked to go to so that things can be discussed, they can calm down, etc.
  • It is too distracting to yell out directions or questions when they are in the pool. Devise a hand signal to alert them of the need to come to the side. Practice that with them over the course of the swim.

 

Be creative and have fun. Dont let their personal achievments slip by your notice. There is always something to praise.

About the Author: Micole is very active in Autism Ontario York Region chapter and has a young son with ASD. She brings personal experiences to her professional work. Micole also sits on the Council for the Lifesaving Society, Ontario Branch.

(From: The Autism Newslink, Summer 2006).


 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.14. Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: Accessing and Finding Services and Supports

By: Claudia Accardi, MSW, RSW & Priscilla Burnham Riosa, PhD, The Redpath Centre

This article summarizes some of the information contained in the report entitled: “Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders:  Complex Needs in Unprepared Systems”.

Information regarding effective and necessary services and supports for the broad spectrum of youth and adults with ASD is lacking (Piven & Rabbins, 2011; Shattuck et al., 2012; Stoddart et al., 2013). Development of this knowledge base requires recognition of the diverse presentations of ASD and an understanding of their complex bio-psycho-social needs in a variety of areas including:  living arrangements and residential care; recreational and social activities; physical and mental health; employment; and transition services. Ultimately, research is required to inform policy and create a unified, integrated system of care that speaks to the diverse needs of youth and adults with ASD, their families and communities.

Findings from our recent Ontario study of 480 youth (16 years and older) and adults with ASD, family members, and professionals (Stoddart et al., 2013) revealed that respondents were frustrated with uncoordinated, inaccessible, and insufficient ASD services and supports. They also indicated that few professionals were knowledgeable about working with youth and adults with ASD.

Caregiver concerns regarding staff training were also reported in a study by Krauss, Seltzer, and Jacobson (2005). Likewise, Bruder and colleagues (2012) surveyed primary care physicians and found that the majority of physicians felt they had insufficient training to care for their adult patients with ASD; both physicians who had adult patients with ASD as well as those who did not have patients with ASD expressed the need for further training. Overall, capacity building across service sectors is needed to promote ASD awareness, understanding, and skills among a variety of professionals.

The service provision needs of youth and adults with ASD permeate all facets of adult life and do not only relate to their core ASD characteristics, but also to multiple co-existing challenges. This continuum of services includes residential supports (Krauss et al., 2005), employment opportunities (Hendricks, 2010), socialization experiences (Graetz, 2010), health care needs (Lunsky, Gracey, & Bradley, 2009), transition support (Stoddart et al., 2013), and advocacy training (Clark et al., 2004; Feldman et al., 2012). A survey of caregivers’ perceived opportunities for their family members with ASD indicated needs in the areas of socialization, employment, and residential living (Graetz, 2010). According to the same study, the greatest caregiver needs were in the areas of lifelong planning and for additional services. Dissatisfaction with adult services was expressed by a majority of the participants – particularly those caregivers whose family members were more severely affected by ASD (Graetz, 2010).

Not only is it important to consider how individuals with ASD can be integrated into the existing systems, but also the ways in which society can be sensitive to the needs of individuals with ASD and accommodate them (Newsom, Weitlauf, Taylor, & Warren, 2012). Provision of stable funding is an important component in delivering successful ASD services throughout an individual’s lifespan (Bryson & Autism Society Ontario, 1991). Furthermore, the integration of funding and service provision must be tailored to the unique needs and strengths of each individual with ASD (Newsom et al., 2012).

Challenges to Developing and Accessing Effective and Relevant Services and Supports:

  • Lack of stable funding for individuals and families which may increase financial and emotional stress upon the family
  • Uncertainty around funding for service providers may result in lack of consistent, high-quality programs
  • Inadequate integration between service providers and institutions across different domains (e.g., educational services, mental health services, developmental services, employment services, health services)
  • Insufficient data on the service use and needs of youth and adults with ASD in Canada and the effectiveness of programs to support these individuals

 

Recommendations for the Community:

  • Promote and fund integrated approaches to service delivery to improve cross-system service coordination and program implementation. Examples of services that could be integrated include: social skills intervention; employment support; psychological and pharmacological intervention; behavioural support; residential services.
  • Develop funding mechanisms that encourage program evaluation and increase data collection on the services and supports use and needs. Organizations that offer evidence-based services will continue to do so, and those that do not, will be encouraged to evaluate their services and take measured steps towards improvement.
  • Develop standards and guidelines for youth and adult service providers so that they have clear benchmarks on how to deliver quality services. 
  • Increase ongoing collaboration between training institutions (e.g., colleges and universities) and current service providers through internships, cooperative learning programs, and collaborative projects. As a result, young professionals entering the field of ASD will have the current knowledge and skills essential to work with this unique population. Likewise, service providers already in the field of ASD will remain current regarding new research and effective interventions.
  • Encourage cross-discipline knowledge exchange and training to enable professionals from a range of disciplines to increase their understanding of ASD and how to serve their clients with ASD more effectively. For example, cross-discipline information exchange may occur between the following professions: career counsellors at post-secondary institutions; physicians and medical students; adult mental health services providers; social workers; psychologists; occupational therapists
  • Explore alternative and complementary methods of in-person service delivery, (including the Internet-based delivery) to increase service accessibility and options, especially to remote areas of the province (e.g., online individual intervention, video conferencing and team consultations). Encourage research and evaluation on the effectiveness of these new methodologies.

 

Recommendations for the Individual and Family:

  • Connect with your local Developmental Service Ontario agency, service providers, and advocacy groups.  Avoid isolating yourself or your family member. The encouragement and knowledge sharing that occurs within the local community are powerful tools to obtain support and information about relevant services. 
  • Embrace a spirit of collaboration with service providers to identify the services and supports that are a priority for you or your family member.
  • Provide feedback on the quality of the services and supports that you receive thereby allowing service providers to continue doing what they do well, while simultaneously facilitating improvement in areas of their delivery models/programs requiring further development.
  • If you are still in high school, participate in developing your transition plan and consider enrolling in transitional services that focus on life skills training, independent living, and employment support.
  • If you are not sure about the quality or the effectiveness of the service(s) or support(s) that you are receiving, talk to your friends, family members, counsellors, or support workers. Share your concerns and seek their help.

 

References:

Bruder, M. B., Kerins, G., Mazzarella, C., Sims, J., & Stein, N. (2012). Brief report: The medical care of adults with autism spectrum disorders: identifying the needs. Journal of Autism and Developmental Disorders, 42(11), 2498-2504.

Bryson, S. E. & Autism Society Ontario. (1991). Our most vulnerable citizens: Report of the Adult Task Force. Toronto, ON: Author.

Clark, E., Olympia, D. E., Jensen, J., Heathfield, L. T., & Jenson, W. R. (2004). Striving for autonomy in a contingencygoverned world: Another challenge for individuals with developmental disabilities. Psychology in the Schools, 41(1), 143-153.

Feldman, M. A., Owen, F., Andrews, A., Hamelin, J., Barber, R., & Griffiths, D. (2012). Health selfadvocacy training for persons with intellectual disabilities. Journal of Intellectual Disability Research, 56(11), 1110-1121.

Graetz, J. E. (2010). Autism grows up: Opportunities for adults with autism. Disability & Society, 25(1), 33-47.

Hendricks, D. (2010). Employment and adults with autism spectrum disorders: Challenges and strategies for success. Journal of Vocational Rehabilitation, 32(2), 125-134.

Krauss, M. W., Seltzer, M. M., & Jacobson, H. T. (2005). Adults with autism living at home or in nonfamily settings: Positive and negative aspects of residential status. Journal of Intellectual Disability Research, 49(2), 111-124.

Lunsky, Y., Gracey, C., & Bradley, E. (2009). Adults with autism spectrum disorders using psychiatric hospitals in Ontario: clinical profile and service needs. Research in Autism Spectrum Disorders, 3(4), 1006-1013.

Newsom, C. R., Weitlauf, A. S., Taylor, C. M., & Warren, Z. E. (2012). Parenting adults with ASD: Lessons for researchers and clinicians. Narrative Inquiry in Bioethics, 2(3), 199-205.

Piven, J., & Rabins, P. (2011). Autism spectrum disorders in older adults: Toward defining a research agenda. Journal of the American Geriatrics Society, 59(11), 2151-2155.

Shattuck, P. T., Roux, A. M., Hudson, L. E., Taylor, J. L., Maenner, M. J., & Trani, J. F. (2012). Services for adults with an autism spectrum disorder. Canadian Journal of Psychiatry, 57(5), 284-291.

Stoddart, K.P., Burke, L., Muskat, B., Manett, J., Duhaime, S., Accardi, C., Burnham Riosa, P., & Bradley, E. (2013). Diversity in Ontario’s youth and adults with Autism Spectrum Disorders: Complex needs in unprepared systems. Toronto, ON: The Redpath Centre.


About the authors:

Claudia Accardi, MSW is Research Assistant at The Redpath Centre and a research consultant specializing in survey design and data analysis, proposal and grant writing, the use of technology in counselling, and research in ASD, developmental disabilities, and learning disabilities.

Priscilla Burnham Riosa, PhD is Clinical Research Coordinator at the Hospital for Sick Children, Research Assistant, The Redpath Centre and a Behaviour Consultant supporting children and youth with ASD. She is also a sessional instructor at the University of Guelph-Humber and Brock University. She has worked with individuals with ASD and their families for over ten years.


 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.15. Medication use for mental health, neurological and behavioural problems

By: Kevin P. Stoddart, PhD and Lillian Burke, PhD, The Redpath Centre

This article summarizes some of the information contained in the report entitled: “Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: Complex Needs in Unprepared Systems”.

Medication use in youth and adults with ASD is fairly unexplored terrain; specifically, we know little about frequency of specific medication/class of medication use, dosing practices, service pathways to prescription of medication, and those symptoms that are targeted and monitored in clinical practice (Stoddart, Burke, & King, 2012). However, compared to medication use for physical ailments that exist in ASD (such as gastrointestinal and respiratory problems), medication targeting mental health, behavioural dysregulation, irritability and inattention are better researched. Given we know there is no pharmacological remedy to alter the core features of ASD, here we focus on medications used to reduce mental health struggles, neurological symptoms or disorder(s), and behavioural problems.

Research and reviews of the usefulness of medications examine their ability to target specific behavioural or mental health symptoms commonly associated with ASD (Sloman, 2005; Stoddart, Burke, & King, 2012; Towbin, 2003). A review of research on 13 to 30 year olds with ASD found only eight relevant studies—four were of ‘fair’ quality and four were labeled as ‘poor’ (Dove et al, 2012). A similar systematic review published five years earlier found only five double-blind, randomized controlled trials (Broadstock, Doughty, & Eggleston, 2007). In the absence of multiple, well designed research studies, “...many clinicians rely on results from treatment of other psychiatric disorders (ADHD, schizophrenia, OCD) and extrapolate these findings to the [ASD] population” (Blankenship, Erickson and McDougle, 2010, p. 208). This may be helpful and appropriate, but caution is also warranted as some youth and adults with ASD may have idiosyncratic responses to medication (Burke & Stoddart, in press) or respond optimally to lower doses (Sloman, 2005). As well, individuals with ASD may have difficulty articulating or recalling subtleties in feeling states, in response to questions by their support team.

During the introduction of any medication it is therefore imperative to: (1) start with lower than normal doses of any medication and increase (if appropriate) very slowly, (2) define clear, expected outcomes of medication administration (e.g., reduce anxiety), (3) target accompanying specific and idiosyncratic mental health or behavioural symptoms (e.g., reducing repetitive speech and behaviours), (4) monitor the increase or decrease of these symptoms using narrative medication diaries or specific repeated quantitative measures, and (5) discuss the above regularly with all individuals on the support team (e.g., medical personnel, parents, group home staff, etc.). 

Selective serotonin reuptake inhibitors (SSRIs) are one of the main treatments for depression and anxiety and other mental health disorders in the general population. Examples of SSRIs include Prozac, Luvox, Paxil, Zoloft, Cipralex and Celexa. A study in Toronto that examined medication use found these medications, sometimes combined with others, were frequently used to manage anxiety, behaviour and depression in adults on the autism spectrum (Stoddart, Burke & Temple, 2001). Studies of this group of medications for adults are at an early stage; they are often at an open label, small uncontrolled trial, or case report level (Dove et al, 2012; Stoddart, Burke, & King, 2012) although they are routinely used in clinical practice.

A second class of medications used in the youth and adult ASD population are anti-psychotics. The newer, atypical antipsychotics include Risperdal, Seroquel, Zyprexa, and Abilify. Many of these are used to address behavioural problems, irritability, anxiety, and psychosis. Again, compelling research on the usage, dosing and symptoms successfully treated in youth and adults is early, but promising results have been found for Risperdal, for example (Dove et al., 2012). Third, stimulants have gained increasing use with higher-functioning youth and adults with ASD (such as Asperger Syndrome) since we have recognized that distractibility and inattentiveness may successfully be reduced by medications such as Ritalin, Dexedrine, Adderal, Strattera and Concerta (Sloman, 2005; Stoddart, Burke, & King, 2012,).

Due to the medication sensitivity experienced by many individuals with ASD, and as a result, anxiety about the use of medications, many are drawn to alternative medical treatments.  Some of these have been useful, such as Melatonin, in assisting with sleep issues (Paavonen, Neiminen-von Wendt, Vanhala, Aronen & von Wendt (2003).  However, as many “natural” remedies are sold under different names, and as there are side effects to these (as there are with prescribed medications), we caution individuals to speak to their physician, pharmacist or naturopath to ensure the product they are taking is safe, does not interact with other products, and that they are using appropriate doses.

For our recent study of youth and adults (16+) who had been diagnosed with ASD (Stoddart et al., 2013), we asked if they were prescribed medication and if so, what the medication(s) were. Of 480 individuals, 36.9% were on no medication, 19.0% were taking one, 17.3% were taking two, 9.8% were taking three, and 17.1% were taking four or more. The average number of medications was 1.65 with 63.1% of the sample taking medication for a range of psychological, neurological and medical disorders. There were 12 medications taken by the sample 10 times or more. In order of frequency they included: 124 subjects on SSRIs (Zoloft, Celexa, Prozac, Cipralex and Paxil), 26 on benzodiazepines (Lorazepam and Clonazepam), 22 subjects on anticonvulsants (Divalproex and Tegretol), 19 subjects on Effexor (SNRI), 11 on antipsychotics (Risperdal, Seroquel and Abilify), 10 on Wellbutrin (NDRI), and 10 on a stimulant (Concerta).

Considering that medication is routinely used in the treatment of some of the mental health, behavioural and neurological symptoms related to ASD in youth and adults, research and education on their use in Ontario remains an urgent priority for this underserved group.

Challenges to Developing and Accessing Effective and Relevant Services and Supports:

  • Lack of expertise in the community when prescribing medication for mental health, neurological or behavioural disorders
  • In the absence of research, practitioners may use existing research which does not take into account unique symptoms and responses in ASD
  • Lack of Canadian research on older youth and adults with ASD
  • Lack of medical expertise available, even in specialist centres

Recommendations for the Community:

  • Develop resource listings for those with experience prescribing medications in ASD
  • Create professional networks for clinicians who are faced with medication requests from the public
  • Participate in research on medication and ASD

Recommendations for the Individual and Family:

  • Target specific symptoms (e.g., anxiety, depression) and monitor them closely with healthcare provider(s)
  • Decide with the healthcare team what behaviours may be suggestive of specific disorders in situations where the individuals cannot express their internal symptoms (e.g. repetitive pacing, self-injury, isolation)
  • Have realistic expectations of what medication can accomplish over a certain period of time, taking into consideration that many SSRIs take several weeks to show therapeutic effects
  • Ask your healthcare provider about his or her experience prescribing to individuals with ASD
  • Use symptom checklists or rating scales repeatedly (e.g. for anxiety or depression) to assess the effectiveness of specific medications over time 

References:

Blankenship, K., Erickson, C. A., & McDougle, C. J. (2010). Pharmacotherapy of autism and related disorders. Psychiatric Annals, 40(4), 203–209.

Broadstock, M., Doughty, C., & Eggleston, M. (2007). Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder. Autism: International Journal of Research and Practice, 11(4) 335–348.

Dove, D., Warren, Z., McPheeters, M. L., Taylor, J. L., Sathe, N. A., et al. (2012). Medications for Adolescents and Young Adults with Autism Spectrum Disorders: A Systematic Review. Pediatrics, 130(4), 717–726.

Paavonen, E.J., Nieminen-von Wendt, T., Vanhala, R., Aronen, E. T. & von Wendt, L.  (2003). Effectiveness of melatonin in the treatment of sleep disturbances in children with Asperger disorder. Journal of Child and Adolescent Psychopharmacology, 13(1), 8395.

Sloman, L. (2005). Medication use in children with high–functioning pervasive developmental disorder and Asperger syndrome. In K. P. Stoddart (Ed.), Children, youth and adults with Asperger syndrome: Integrating multiple perspectives (pp. 168–183). London UK: Jessica Kingsley Publishers.

Stoddart, K. P., Burke, L., & King, R. (2012). Asperger Syndrome in Adulthood: A Comprehensive Guide for Clincians. New York, NY: Norton Publishers.

Stoddart, K.P., Burke, L., Muskat, B., Manett, J., Duhaime, S., Accardi, C., Burnham Riosa, P. & Bradley, E. (2013). Diversity in Ontario’s Youth and Adults with Autism Spectrum Disorders: Complex Needs in Unprepared Systems. Toronto, ON: The Redpath Centre.

Towbin, K. E. (2003). Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome. Child and Adolescent Psychiatric Clinics of North America, 12(1), 23–45.

About the Authors:

Kevin P. Stoddart, PhD is Founding Director, The Redpath Centre and Adjunct Professor, Factor-Inwentash Faculty of Social Work, University of Toronto. For over twenty years, his clinical focus has been children, youth and adults with ASDs, primarily Asperger Syndrome, and the co-morbid social and mental health problems that affect them.

Lillian Burke, PhD is Psychologist at The Redpath Centre in London, Ontario. Her primary clinical activity is assessment of adults who have ASDs. She has a special interest in assessment of and support for women with Asperger Syndrome and other developmental disorders, as well as parents with Asperger Syndrome.


 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.16. Fidget Toys

45 Ideas for Classroom Friendly Fidget Toys

By Bec Oakley

** View or download the attached pdf for visuals examples of these toy types

What are fidget toys?

Kids who have trouble regulating sensory input can easily become distracted, seeking out sensation to either stimulate or calm their nervous system. Fidgeting gives them this input, usually in a way that is disruptive to both them and their classmates - wriggling, biting their nails, doodling, moving about the classroom.

A fidget toy is an object that the student can use to get this input in a less distracting way. They can help improve concentration and attention to tasks by allowing the brain to filter out the extra sensory information.

Who needs them?

Most children can be fidgety at one time or another, but kids with ADHD, autism and sensory integration disorder are particularly prone to be distracted in this way. 

What makes a good fidget toy?

A good fidget toy is one that is both effective at helping the student to concentrate and can easily fit into a classroom environment. That means that it needs to be:

  • Safe
  • Small
  • Quiet
  • Inexpensive
  • Able to be used without distracting others

Choosing a toy that will be a satisfying fidget replacement for your students will depend on their individual abilities, challenges and sensory needs:

  • Which times of the day do they most need one?
  • What are their fine motor skills like?
  • Do they have the hand strength to manipulate the toy?
  • What sensations and textures do they seek out?
  • Which ones do they avoid?
  • Do they tend to put objects in their mouth?
  • Do they like to throw things?

Tips for Using Fidget Toys

Use them intermittently Students can often become desensitized to the sensory benefits of an object, so use it for short periods at times when concentration is most needed or swap between toys over the course of the day.

Try toys with a variety of surfaces Lumpy, squishy, different materials, bits that move

If they’re likely to lose it or throw it... Attach the toy to a ribbon and let them wear it as a bracelet or necklace. You could also attach a retractable cord and clip it to their belt, so they can easily access it when they need to.

Tactile Fidget Toys

  • Sponges
  • Bumpy shells
  • Play dough
  • Origami Packing away toys
  • Bull or alligator clips
  • Unfilled balloons
  • Silly putty
  • Pencil grips
  • Stress balls
  • Bubble wrap
  • Tactile fidget toys
  • Abacus
  • Smooth stones
  • Beads
  • Plush and beanie toys
  • Rubber bands Bumpy piping Paper clips
  • Hide toys in a
  • bucket of sand
  • or rice
  • Tactile fidget toys
  • Bean bags
  • Push puppets
  • Rubber duck
  • Linking rings
  • Newton’s cradle Slinky
  • Bendable dolls
  • Pin art
  • Fill balloons with sand, rice, or play dough using a funnel or squirt bottle
  • Visual fidget toys
  • Snow globe
  • Chewable fidget toys
  • Spinning top
  • Flashlight
  • Sand timer
  • Lava lamp
  • Glow sticks
  • Drinking straws Plastic piping
  • Chewable jewellery

Vestibular & Deep Pressure Fidget Toys

  • Mini trampoline
  • Fill socks to make a weighted lap toy
  • Hacky sacks
  • Wrap an elastic bungee cord around the chair leg for student to pull with her feet
  • Microwaveable wheat heat packs Fingerless gloves with weights attached
  • Toys with a rubber mallet

 www.snagglebox.com

I hope this guide has inspired you to make fidget toys for your students from things you can find around your classroom!

For more tips on kids with sensory needs (especially autism), visit my blog at See you next time!

Bec Oakley

 

 

All images © Microsoft except the following images used under Creative Commons license:

Pin Art from Flickr user jrhugs - http://www.flickr.com/photos/68386867@N05/6221504711/

Hacky sacks from Flickr user ikayama - http://www.flickr.com/photos/ikayama/7497340794/

 

 
 
---------------
Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.17. Sensory Strategies for Teens and Adults

By Jennifer Cantello Daw and Suzanne Murphy

People of all ages can require strategies that help regulate (stimulate or calm) their nervous systems. “Sensory-seeking individuals often continue to crave input as they get older…sensory-seeking can impact an individual’s work, leisure and self-care. Remember the need for intense input does not automatically disappear just because a person is older.” 1

What are fidget items?

A fidget item is a small object used to provide input into any of the senses and “may help improve concentration and attention to task”. 2 Unless specific items are identified and used in a planned way, people may engage in a wide range of sensory behaviour, that at least can be distracting to others and at worst, harmful.

Guidelines for selecting and using fidget items:

A good fidget item is one that provides the input being sought, helps maintain a calm, alert state and can be used in a variety of environments, while not causing distraction for the user or those around him or her.

Additionally, the item should be safe, quiet, relatively small and portable.

Selection should be based on a number of considerations:

  • The sensations and textures the person seeks out or avoids;
  • When and where the fidget items are most likely to be needed;
  • The person’s fine motor skills and hand strength;
  • The suitability of the item to be used in a public place;
  • Behaviour that can be socially stigmatizing or dangerous (e.g., putting objects in mouth, throwing items, etc.);
  • Items that the person is interested in or motivated to use;
  • Have a variety of items available and continue to expand possibilities. Avoid relying on a limited number of very specific items.

Guidelines for introducing and using fidget items:

  • Identify where the items will be kept (e.g., in a specific place, in their backpack/pocket/desk/locker, etc.), as well how and when the person can access them and when they need to be put away.
  • Pair accepting and using the fidget item with reinforcement.
  • Attach the item to prevent it from being lost.
  • Monitor (or teach the person to self-monitor, when possible), not only the effectiveness of the fidget item in meeting sensory needs but also how socially acceptable it is.

Examples:

Tactile Fidget Items


  • Origami
  • Shells, smooth or shiny stones
  • Worry beads, dolls, stones
  • Jewellery (necklace, bracelet, anklet, digit fidget/ring, earrings, charm bracelet)
  • Paperclip/paperclip chain
  • Rubik’s cube
  • Key chain
  • Paper clips, rubber band
  • Linking rings
  • Small piece of specific fabric
  • Hacky sacks
  • Leather bracelet
  • Visual Fidget Items
  • Pen toppers or pens with moving parts
  • Small sand timer
  • Lava lamps
  • Glow sticks
  • Apps
  • Picture books
  • Video clips on phone/iPad (e.g., waterfalls, car races, nature, etc.)
Oral Fidget Items


  • Hard candy
  • Sour candy
  • Gum
  • Straws
  • Crunchy/chewy snacks available
  • Pen toppers designed to be chewed
Scented Fidget Items


  • Locket with scent inside (necklace or bracelet)
  • Preferred air freshener (e.g., in the car, on a timer)
  • Incense
  • Scented candles
  • Essential oil sachet/pillow
Auditory Strategies


  • Earphones, earplugs, headphones
  • Jewellery/key rings with chime or soft bell
  • Ticking watch
  • Music on iPod
Movement (vestibular) and deep pressure


  • Daily physical activity/physical education class
  • Weight room
  • Heavy backpack
  • Tie a resistance band to chair or desk legs
  • Sit and move cushion
  • Fingerless gloves
  • Clothing that provides deep pressure
Sensory Strategies Across the Day

One of the most effective ways of meeting a person’s sensory needs is to incorporate individualized items and activities into daily routines or to teach them to access activities that provide the sensory input they require, such as:

  • Make favourite scents, colours and textures part of activities;
  • Consider sensory needs in self-care routines (e.g., loofa sponge, scented soap, heavy towel, electric toothbrush);
  • Incorporate exercise and movement routines (e.g. dancing, stretching, yoga) at intensity needed;
  • Allow standing or other alternative seating;
  • Create calming routines before bedtime.

1 Jordan, K.A. (May, 2014). Sensory Strategies for Older Students- Sensory Seeking in Teens and Adults. Indiana Resource Centre for Autism. http://www. iidc.indiana.edu/irca

2 Oakley, B. (August, 2012). 45 Ideas for Classroom Friendly Fidget Toys. Retrieved from http://www.Snagglebox.com/articles

SaveSave
1.18. 5 Tips for Young Adults to Ease Transition into Adulthood

By: Patricia O’Connor

Growing up is a tough job for everyone! But if you have an Autism Spectrum Disorder (ASD) you usually need more time to adjust to the idea (it’s that difficulty with change/transition thing) and more direct teaching to learn what you have to do to live your life as independently as possible. There are no quick fixes but here are a few tips to move you forward into a positive new schedule and a healthy lifestyle once you leave the comfort of that secondary school nest.

WARNING: This information contains an attempt at humour scattered with some sarcasm!

Meaningful schedules are powerful tools to get us moving in the right direction. Get to bed at a decent hour and 3:00 am is not decent. If you want to live in the land of the living you have to be awake during the day since that is when most work and post-secondary opportunities are available. Remedy - reduce video game/computer time, schedule bed and wake times daily and reward yourself for sticking to it! Get some help with this one – I know it is a tough one to break! I work with many nocturnal people who struggle to get back on track!

Get some outside social contacts – and I am not referring to Facebook friends and the question I have is…are they really friends?? Get involved with small groups and/or people with similar interests and get connected with other people outside your home on a weekly basis.

Learning new life skills is something that everyone has to do if they ever intend to live on their own. Here are a few for you to learn while in the comfort of the family abode or by immersion once you move out.

Meal planning, grocery shopping, food preparation and clean up. You can start small with one meal a week and it doesn’t have to be fancy. (Pizza, pasta, grilled cheese and canned soup can sustain life but remember variety is the spice of life.)

Laundry – the whole deal – sorting, washing, drying (yes the wrinkles do stay there until the next time you wash the shirt – if you leave it in the dryer for days!) and last but not least, folding and putting them away. Please don’t leave clean clothes in the basket and start piling your dirty clothes on top!

Shower daily and then learn the skill of shower and bathtub cleaning. (It is hard to believe that this does not occur on it’s own! I think that every young adult thought there was a bathtub-cleaning fairy until they moved out on his or her own. Why not learn the technique in the comfort of your own home under the guidance of a master - mom?)

Public Transportation: How do you get around your town or city? If mom or dad is the answer – time to learn how to use public transportation.

Money management: Where does one begin? With money… yes but, if you don’t have a job yet – start with the first point - meal planning and grocery shopping for your family. It will teach you the fine art of how much food costs and will begin the budgeting process.

Get involved in your community. Never underestimate the value of volunteering your time to help others. Not only does this assist the organization that you are volunteering for but it also provides real experience and builds your resume. It is a definite TWO-FOR (Two for one deal!)

Include daily exercise into your schedule. Anyone who has ever worked with me knows how much I harp about this one… (Blah, Blah, Blah …Pat!) Exercise is important for people with ASD who continually deal with anxiety. Yes - there are many other ways to combat your anxious neurological state of being but begin here. It really works!

Really the most important thing to remember is that being an adult has tons of benefits! So learn the necessary skills, get into a positive schedule and enjoy the ride!


About the Author: Patricia O’Connor is the author of the course and has a Training/Coaching Centre for young adults. She could be called the Director or Founder but thinks a more appropriate title for the work she does is Change Agent!

Integrated Autism Consulting provides coaching and training for young adults with Autism Spectrum Disorders to assist them to live independent, engaged and meaningful lives. One of the programs offered is the Transition to Life course. https://www.integratedautismconsulting.com/transition-to-life-about.html This life preparation course is designed for people with Asperger Syndrome aged 18-28 who require support with the transition into adult life.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.19. Supporting Success and Safety in Relationships
Smith, L., Szidon, K., & Hedges, S. (2015, June). Supporting Success and Safety in Relationships (Autism at-a-Glance Brief). Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, CSESA Development Team.

Autism at-a-Glance is a publication of the Center on Secondary Education for Students with ASD (CSESA)

Autism at-a-Glance is a series of practitioner and family-friendly documents created by the Center on Secondary Education for Students with ASD (CSESA) designed for high school staff members supporting students on the autism spectrum, as well as family members of adolescents with ASD. The purpose of the Autism at-a-Glance series is to provide a current summary of topics relevant to high school students with ASD as well as practical tips and resources for school and community personnel and family members.
This Autism at-a-Glance was designed to support high school staff, family members, and individuals on the autism spectrum in understanding and supporting success and safety in dating relationships.

Like other teens, many teens on the autism spectrum desire friendships and romantic partners. Due to challenges with social communication, some teens with ASD may have limited experience dating and could benefit from explicitly learning skills associated with successful and safe dating experiences. Teens with ASD may benefit from developing skills in the following areas: basic dating readiness skills, safety skills related to dating, and social skills related to dating. School staff and families both play important roles in supporting these skill areas.

Basic Dating Readiness Skills

  • Identify the purpose of dating. Educators should spend time discussing what dating is. For example, dating is a shared experience between two people and it should involve someone who the teen likes and who likes them back.
  • Establish a shared understanding of the dating process. Teens may need support in understanding a reasonable timeline for dating and how a dating relationship typically develops. For example, a dating relationship usually evolves over time, starting as acquaintances which may develop into a casual friendship over several months, and finally become a romantic relationship.
  • Understand the differences between acquaintances, friendships and dating. Teens should be able to demonstrate an understanding of expected behaviors in different relationships including how to behave with strangers, community members/ helpers, family, friends, and romantic partners.
  • Demonstrate dating readiness. Teens with ASD also might benefit from discussing dating readiness including grooming habits, independent skills, and confidence.
  • Be aware of, and develop a plan for, dealing with sensory sensitivities. Often, teens with ASD have hypo- or hyper-sensitivities to sensory information such as sound, smell, and touch. These sensory differences can impact social relationships and should be discussed to develop strategies for coping in the context of a dating relationship.
Teens with ASD may benefit from developing basic dating readiness skills, safety skills related to dating, and social skills related to dating.
 

Scenario 1: Possible Challenges Associated with Basic Dating Readiness Skills

Sam was interested in dating girls at his high school. He had talked to his teacher and guidance counselor about his disappointment at not ever having had a date. Sam’s teacher and Teens with ASD may benefit from developing basic dating readiness skills, safety skills related to dating, and social skills related to dating.
 

Safety Skills

  • Identify abusive behavior and illegal sexual behaviors and how to avoid them. Teens with ASD are vulnerable to being abused by others. Due to immaturities in social understanding, some teens with ASD might be more likely to behave inappropriately themselves. Teaching teens to identify abusive and illegal behaviors, as well as the “grey” areas to consider, protects the teen with ASD and others.
  • Discuss relationship dangers faced on the internet. Since many teens with ASD have access to the internet and enjoy online communication, it is essential to instruct teens with ASD on ways to avoid danger on the internet.
  • Discuss the consequences of sexual activity. Although sex education is typically embedded in middle and high school education, it is important to ensure that teens with ASD have a clear understanding of potential consequences of sexual activity, including STDs and pregnancy.
Scenario 2: Possible Challenges Associated with a Lack of Safety Skills
Lenore is a fan of manga. She spends a lot of time reading manga online and participating in a manga fan website. She and her online friends often discuss their favorite characters. Lenore’s parents saw that in a recent conversation, Lenore was asked to send a photo to an online friend. Lenore’s parents were alarmed to find that she had shared several photos with a stranger on the fan website. At a team meeting, Lenore’s parents discussed their concerns about internet safety with Lenore’s special education teacher. The team decided that it was critical that they spend instruction time reviewing behaviors in different relationships including how to behave with strangers, community members/helpers, family, friends, and romantic partners. They wanted to make sure that Lenore understood how to protect herself from people who might want to take advantage of her.
 

Safety Skills

  • Demonstrate perspective taking and social communication skills for dating. Teens with ASD need instruction and practice in the conversation skills associated with dating including how to express interest, give compliments, share appropriate information about themselves, and understand the communication of others.
  • Identify social mistakes related to dating. Dating is a complex social interaction for any person, so it is not surprising that teens with ASD might make social mistakes when dating. Educators can help teens to avoid potential dating mistakes by teaching skills such as identifying appropriate places to meet potential dates, evaluating whether a potential partner is interested in dating, choosing where to go on a date, assessing whether a date was successful, and following up on or ending a dating relationship.
Scenario 3: Possible Challenges Associated with Lack of Social Skills
Ren wanted to go out on a date with a girl he knew from his physics class. He remembered from his social skills class that it was important to maintain eye contact with people to indicate that you are interested in what they are saying. Ren was careful to remember to look at Stacy when he was in class with her. He frequently asked her questions about herself and about classwork. The third week of class, Stacy complained to the science teacher that Ren talked to her too much and was staring at her all the time. She considered his behavior creepy and wanted to switch classes. Ren’s science teacher met with Ren and his special education teacher to discuss Ren’s behavior. The special education teacher realized that he needed to help Ren understand the social mistake he made with Stacy and find ways to help him evaluate whether a girl is interested in dating him. The special education teacher also helped Ren to work on his social skills, sharing the importance of reading social cues (e.g., facial expressions, body language) and discussing the fact that too much eye contact can also be uncomfortable.

4 Key Strategies for Supporting Success and Safety in Relationships and Dating

1. Visual supports: visual examples of concepts you intend to teach to support comprehension of target skills.
  • Use photos to provide practice in identifying people’s emotions.
  • Use visual scripts to rehearse key dating concepts like asking someone on a date.
  • 2. Video Models: video examples to demonstrate appropriate relationship and dating behaviors.
  • Use video examples to reinforce social skill development such as correct body language used in initiating conversations or flirting.
  • Use video models to demonstrate and reinforce the steps of a complete hygiene routine.
3. Social Narratives: stories that can provide insight into social situations. Narratives emphasize the important social cues in the targeted social situation. The story provides teens with examples of appropriate social responses.

 

  • Use social narratives to explain the importance of skills like good grooming, being independent, and showing confidence and how these skills can relate to successful dating.
  • Use social narratives to discuss the idea of the “hidden curriculum” to emphasize important dating rules that everyone knows, but no one is taught. This includes assumed rules and social expectations. For example: “When you ask someone on a date and they SAY that they are busy, they often MEAN that they do not want to go out on a date with you, not that you should pick a different time to ask them again. If someone tells you that they are busy, you should not ask them on a date again.”

 

4. Role Play: practicing key social communication behaviors associated with safety and relationships.

 

  • Use role play to demonstrate and practice nonverbal communication behaviors.
  • Use “social autopsy” to analyze social errors committed and choose alternative solutions to correct the errors in the future.

 

Important Reminders

Don’t forget to reinforce correct behaviors!

Make a point of catching teens doing things well. Specific feedback will help teens remember the skills you are working on.

  • “Great job giving your friends enough space. Other people like it when you stand an arm’s length away when you talk to them.”
  • “I noticed that you listened to Kayla when she talked about her weekend and you were able to ask her what her favorite part of the movie was. You showed her that you were interested in what she had to say.”

Check in regularly with teens with ASD and the people that support them.

Developing relationships in high school is a complex process which takes practice.

 

  • Use errors as opportunities to teach new skills.
  • Open communication with families can help identify student needs and reinforce the skills you are trying to teach.

 

Additional Resources

Baker, J. (2006). Social Skills Picture Book for High School and Beyond. Future Horizons.

Davies, C., Dubie, M., Mesibov, G. B. (2012). Intimate relationships and sexual health: A curriculum for teaching adolescents/adults with high-functioning autism spectrum disorders and other social challenges. Shawnee Mission, KS: Autism Asperger Publishing.

Hafner, D., (2005). Healthy and Ready to Work: A Series of Materials Supporting Youth with Special Health Care Needs, S.A.F.E. Safety Awareness for Empowerment. A Training Guide for Safety at Home, at Work, and in Public. http://www.waisman.wisc.edu/cedd/pdfs/products/health/SAFE.pdf.

Laugeson, E. A. (2014). The PEERS Curriculum for School-Based Professionals Social Skills Training for Adolescents with Autism Spectrum Disorder. www.taylorandfrancis.com/books/details/9780415626965

Myles, B. S., Trautman, M. L., & Schelvan, R. L. (2004). The hidden curriculum: Practical solutions for understanding unstated rules in social situations. Shawnee Missions, KS: Autism Asperger Publishing.
Permission is granted to reprint this Autism at-a-Glance if you acknowledge CSESA and the authors of this document. For more information please visit CSESA at http://csesa.fpg.unc.edu/ or www.facebook.com/csesa.asd.

The work reported here was supported by the Institute of Education Sciences, U.S. Department of Education through Grant R324C120006 awarded to UNC-Chapel Hill. The opinions expressed represent those of the authors and do not represent views of the Institute or the U.S. Department of Education.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.20. Facts and Tips for Interacting with People on the Autism Spectrum – Indiana Resource Center for Autism

Organized by Dr. Cathy Pratt BCBA-D, Director, Indiana Resource Center for Autism, Indiana Institute on Disability and Community. Visit our website at http://www.iidc.indiana.edu/irca or visit us on Facebook.Rev. 2015.

According to the CDC (Centers for Disease Control), Autism Spectrum Disorder (ASD) commonly co-occurs with other developmental, psychiatric, neurologic, chromosomal, and genetic diagnoses. The potential impact on our schools and other service delivery systems continues to be tremendous. The strain on families is very real and significant. Costs include health care, education, ASD-related therapy, family-coordinated services, and caregiver time. It is important to note that education services and an array of supports are needed for children and adults on the autism spectrum to live, learn, and work successfully in our communities.

General Tips* to Help Support Someone on the Spectrum

Carefully consider communication needs. If an individual has difficulty communicating wants and needs or requesting help, they may become frustrated or upset. Don’t assume that because an individual is highly verbal that they have skills to cope and adequately communicate when stressed or in unfamiliar situations.

Think about “showing” rather than “telling” when you are trying to teach something new. Presenting the individual with an object, picture, or written information (if he or she reads) will be more effective than just verbally instructing.

Visual supports are beneficial even after the individual no longer seems to “need” them. Many of us need and use them as well. Consider how to transition visual supports to life skills for scheduling, organization, and self-management. In times of stress, these visual supports may be a great support throughout their lifetime. Do not discontinue their use without a conversation with the individual’s team.

Think of individuals on the spectrum as having a limited amount of energy available to them each day. Their energy “reserve” can vary from day to day. What seems like a simple task to us may be overwhelming and exhausting to them.

Individuals on the spectrum will read our emotional level about a situation. Use a calm tone of voice, even in the midst of a behavioral outburst. An over-excited reaction from you may yield heightened emotional responses in those you support. Practice your poker face.

Be consistent with praise and positive interactions. Minimize negative comments and punishment. Individuals with an ASD learn by being told what to do and what is expected in a positive fashion. Telling an individual what not to do does not teach them what to do and frequently makes matters worse. It is easy to resort to negative comments and punishment because you are frustrated and convinced the individual is not listening and/or is choosing to disobey because “they have been told many times and they should know better.” Realize the individual on the autism spectrum is likely frustrated also and cannot figure out “what to do,” especially when emotions are high.

Work with and build upon the individual’s interests. Learn to enjoy his or her unique perspective. Using their interests may be the best way to teach important skills. Be creative. These interests and strengths, when used to help a person learn, can lead to exciting accomplishments.

When trying to extinguish unacceptable behavior, always identify an alternative skill or replacement behavior. And when you are targeting a behavior for change, be sure to choose your battles carefully. Sometimes focusing too much attention on a behavior may actually intensify that behavior.

Social Communication

Individuals on the spectrum often have difficulty with social skills. It is part of the diagnosis. However, simply teaching social skills is insufficient. The goal should be to facilitate relationships and establish connections. Many individuals on the spectrum want to date, develop friendships, and even have families. Their desires are often not so different from ours.

The manner in which an individual conveys a message may not indicate its significance or true meaning. Individuals may use a monotone voice with little facial expression to discuss an item of importance or even urgency. To detect the true meaning of a message, listen to the individual, interpret what he/she is saying literally, and probe.

When trying to foster friendships for teens or adults with ASD, connecting them with people who have similar interests (e.g., attending a Japanese Anime conference or enrolling in a chess club), is likely to be more effective than attempting to teach them to interact around interests that seem more typical for their age group, such as team sports.

Consider teaching the individual how to engage in “small talk” which is a quick way to connect with others about informal topics. One can have a short reciprocal conversation about the environment, a weekend experience, the weather, sports, television shows, or a movie they recently saw. This is a good way to help the individual to start to feel comfortable around various types of people and to learn how to start and end a conversation.

Sensory Processing and Anxiety

Sensory differences can manifest in sensory seeking, sensory avoiding, hyper-responses, and hypo-responses. Carefully consider an individual’s sensory needs when developing strategies to help them adapt to their environment and to respond purposefully. The sensory strategies chosen should match the need, with the ultimate goal being for an individual to respond adaptively and to maintain an optimal arousal level. Consult with an OT (Occupational Therapist), when possible, for strategies.

Anxiety is a game changer for individuals on the autism spectrum. Remember that sensory issues can also manifest as anxiety. Provide opportunities to manage anxiety through providing embedded sensory strategies, such as movement breaks, calming input, and through self-monitoring with visual supports. One example of self-monitoring would be to create or use an anxiety scale (www.5pointscale.com).

Uncertainty creates anxiety that, in turn, reduces the person’s ability to attend and learn. It also increases the risk of tantrums, rage, and meltdowns. Individuals on the autism spectrum need reassurance and information about upcoming events and changes.

Teach a person early in life the difference between private and public places. Private is only in your bedroom with the door closed. All other places are public (e.g., school bus, school restroom, classroom, living room, etc.). This information will be especially helpful as they continue through puberty.

Remember:

The transition process begins at the moment of diagnosis. We are continually transitioning people across grade levels and settings and, ultimately, into adulthood. Be sure to plan for all transitions and begin with the end in mind. What are the ultimate and desired outcomes? Consider the skills and behaviors individuals will need as adults and begin teaching at an early age. Set priorities and make a plan. Identify the top few concerns and needs for your child and your family. Start addressing these concerns and needs, and let everything else wait. While focusing on top concerns, you need to remember to leave time to focus on fun and “typical” activities, whatever those are for your family.

Stay in close contact with family members and physicians about what is working and what is not, especially when individuals are on medications.

Acknowledge and celebrate accomplishments, yours (regardless of your role), family members (siblings, spouse/partner) or the individual’s. For some on the autism spectrum, small steps are a major accomplishment. Be proud and remember that all accomplishments, whether small or large, are important.

* Tips: Remember that each person is different, and specific tips may not apply to all.


1.21. Video Modelling: Creating Videos at Home

CREATING VIDEOS AT HOME: FROM SCRIPTING TO THE FINAL CUT

By: Leslie Cohen and Antoinette Falco

Why Use Video to Teach?

Video modelling is a well-established tool that many parents, teachers and other caregivers have used to help children with ASD learn. Video modelling is a preferred learning modality for individuals with strong visual processing, which includes a majority of people with ASD. Making videos gives family and/or educational team members a chance to practice playing, have some fun, and interact with one another in a positive way.

Video also has some unique advantages when compared to “live” instruction. On video, a child can view consistent samples of complex interactions and events. In other words, videos are less variable than we can hope to be when repeatedly modelling or when more than one person acts as a model. Viewing videos gives children many opportunities to rehearse in private before trying out new skills with peers or in less familiar surroundings. Using close ups and camera angles, we can also highlight critical environmental features and contingencies that a child might miss when looking at a more complex situation.

There are some commercially available, pre-made videos intended for children with ASD, and we’ve included a short list of links to these products at the end of this chapter. It’s been our experience that custom-made videos aimed at particular children can be most effective. We are amazed and excited about the wide variety of topics, approaches and content that parents choose for their own children. Many report that they really enjoyed the experience and that it helped them think of learning from their child’s perspective.

Tips for Making Effective Videos

 

  • Show positive outcomes in the video. (The actor playing the child’s role should receive rewards or access to preferred activities.)
  • Start with actions and interactions already in the child’s repertoire.
  • Limit verbal demands in initial videos.
  • Guide action with a gentle “teaching touch.”
  • Choose a highly preferred model, or one the child has followed or imitated in the past.
  • Avoid talking when the video is taping, except when required by your role (if any) in the video.

 

Is Your Child Ready to Try Video Modelling?

In our practice, we have used video modelling with children as young as three. In order to begin, children should have mastered at least one-step imitation with an object. They should be able to attend from a distance, and have an interest in videos, television or computers.

A Word of Caution

It has been well-documented that children under two years of age should not watch any television, and many psychologists and pediatricians recommend that children should not watch at all until they are three. Early viewing has been linked to delays in learning language and in the development of social, emotional and cognitive skills. (Thakkar, 2006) It has also been shown to increase the risk of attention problems in later life. (Johnson, 2007)

Extensive screen time (in excess of 2 hours a day watching TV, playing video games, or using the computer) is not recommended for typically developing children of any age, and has been linked to problems with violence and aggression, body concept, nutrition, obesity and substance abuse. (Committee on Public Education, 2001) For individuals with ASD, this situation is further complicated by the risk of increased stereotypic behaviour, such as repeated rewinding and viewing very small segments of preferred movies or games. As a general rule, we don’t recommend allowing children with ASD unmonitored access to screen time.

Limiting access to videos and TV may also increase the effectiveness of video teaching by increasing the value of screen time. Remember, we are teaching children to imitate what they see on the screen. For that reason, children should not view violent video games, movies, TV, or cartoons. (Bandura, 1961)

What kind of video?

Videos can help children learn many skills, including independent and interactive play, beginning speech, and conversation. Base your choices on your child’s interests and personality.

Some goals to consider:

 

  • Improving joint attention and imitation – use nonverbal play videos with objects and movement.
  • Supporting emerging speech – make videos with speech sounds, animal sounds, short words and phrases embedded in play sequences or songs.
  • Developing imaginative play skills – model independent or interactive pretend play sequences.
  • Preparing for life events & changes – show what it will be like on holidays, at doctor and dentist visits, in new schools, on vacations, or in new social situations.

 

It’s a good idea to include items that your child enjoys in the video. Props can help children pretend while they give opportunities to practice using toys and other materials in new, more functional ways. Some good choices are objects with cause and effect features, costumes, and actual items from the child’s environment, such as cooking tools. It’s also helpful if the materials lend themselves to the creation of a sequential narrative and are easy to generalize to other toys, people, and settings.

Scripting

Once you’ve chosen your basic subject matter and props, you are ready to write the script. Scripts should be tailored to the individual child in content, length, and language. It is important to have some kind of narrative thread. This could be the demonstration of a sequence (such as getting dressed for school in the morning), the telling of a simple story by setting up a problem and then resolving it, or the modelling of a process (such as preparing a particular dish). If your video includes non-child roles (adults or peers), use them to model more complex language or actions.

Casting

As mentioned above, your video will be more effective if the person on the video the child is intended to copy is someone whom he likes and/or has copied in the past. This person can be a parent, sibling, peer, teacher, or cartoon character (represented by a doll or puppet).

The Shot List

Before you begin shooting, you will need to make a shot list. This is a list of everything you are going to record with your camera. Work from the written script to make your list. Think about what actions, toys, and/or body parts you want to draw the child’s attention to. Wide shots work best when it is important for the child to see the entire body, or when there are a lot of people in the scene. Medium shots are good for recording talking and facial expressions. Close-ups can help children see hands, fingers, lips, writing, drawing, or other close work.

Equipment

The only two things you must have to make a video are a camera and some sort of media (something to record onto). People use a variety of cameras –ranging from VHS, compact VHS, and a variety of Digital Video cameras that record on mini DV tapes, hard drives, memory cards, or mini DVDs. All of these cameras are capable of taping effective videos. If you want to transfer your footage onto a computer for editing, this is most easily done using a Digital Video camera. Inexpensive cameras range in price from about $20 for a used VHS camera (often found at garage sales and thrift stores) to $200 for a new mini-DV camera.

Other optional equipment includes tripods, microphones, and lights. Using a tripod can help make the picture steadier, but a stack of books or similar objects or your own locked forearm will also do. An external microphone can cut down on camera noise and echoes. Extra light will help make your picture clearer.

The Set

You also need to decide where to shoot. The set should be quiet, simple and free of visual clutter. Remove anything in the background that could distract the child when she views the video. When possible shoot the video in a natural setting, such as the kitchen for a cooking video. The location, or one very similar to it, should be available for the child to use when viewing and copying the video.

Lighting

Treat lighting a video shot as if you are taking a still photo. Avoid shooting into a light or window; locate the light source above or behind you. The better the light, the clearer your picture will be. The most important thing is that the viewer can see what you are asking him to imitate. Most consumer cameras sold over the past 15 years have an “Auto” setting. This means that the camera will perform most functions for you, such as focusing the lens and adjusting the aperture to let in the right amount of light. You can help the “Auto” functions perform well by avoiding shooting directly into a light source, framing people tightly (don’t leave a lot of room above your subject’s head or below their feet), and watching out for shadows.

Costumes

Our goal is to get the child to watch people, actions, and expressions and listen to verbal communication. For that reason, actors should avoid wearing plaids, stripes, or checks and stay away from distracting jewelry, buttons, and pins. The color of clothing should contrast with the background so that it is easy to make out the positions of the actors’ bodies. Set up contrasts for feet, face, and hands as needed.

Acting

It is most effective to speak more clearly and slowly than feels natural, and to leave long pauses between chunks of action and/or language. This allows time for children to process what they hear and respond. You should also use clear, slightly exaggerated facial expressions and gestures. As always, tailor what you do to meet the specific needs of the child you are teaching.

Other Useful Elements

You will probably find it useful to write what you are planning to say and do on cue cards. Even with rehearsals, people often forget their lines. Position the cards near the camera, so that actors appear to be looking in the camera when reading them. Making movies is a group activity; in the case of a Hollywood film, making a single movie can sometimes take the contribution of literally thousands of people. Have team or family members act as production assistants by holding cue cards, handling props, or keeping track of the shot list. It makes shooting easier and usually results in a better-finished product.

Steps for Shooting

 

  • Allow the camera to run for a few sections before the “action” begins. Establish a nonverbal cue to get things started. Remember, all the sounds in the environment will be recorded by the camera.
  • If you are planning to edit your footage after you shoot, shoot the entire script from beginning to end using an establishing shot. This is usually your widest-angle shot.
  • Use medium shots to show people talking.
  • Use wide shots to capture large movements.
  • If you are not planning to edit after you shoot, shoot the shots in the order you want the child to see them. Press the pause button between shots. Set up the next shot and then release the pause. Do not use the stop button.
  • Use your shot list to make sure you get all of the close ups and medium shots you need.

 

Computer Editing

Editing your movie with a computer adds an extra step to the video making process. The advantage you get is that you can shoot faster, cut out unintended errors, and add music and special effects.

Video editing steps:

 

  • Import the movie to computer.
  • Select and arrange your clips.
  • Add music, titles, and special effects.
  • Export your finished movie to tape or DVD.

 

Hardware & Software for video editing:

 

  • Computer with a Firewire port and a DVD burner
  • Macintosh
  • iMac, G4, G5, MacPro or MacBook
  • iMovie or Final Cut
  • PC
  • XP Professional or higher compatible desktop or laptop (Minimum Pentium IV 3 GHz recommended)
  • Moviemaker or Adobe Premier

 

Basic Teaching Procedure

 

  • Encourage independence by allowing the child to gather and set up the materials.
  • Remain silent, except when modelling verbalizations (if needed).
  • On first presentation, show the child the video in its entirety.
  • For an early learner, start by showing the first 3 to 6 steps.
  • If imitation occurs immediately, continue rolling.
  • If it doesn’t;
  • Briefly pause the video;
  • Gently guide actions from behind;
  • Use a (soft) verbal or textual cue to facilitate speech.
  • Stop helping as quickly as possible.
  • As soon as a sequence is mastered, try it without the tape; also, try playing in other settings and with other people.
  • When a sequence has generalized, move on to the next sequence.
  • When an entire video has been learned, introduce variety in sequence, materials, and perspective.

 

Make it FUN!

 

  • Find ways to encourage children and let them know they are on the right track.
  • Resume playing the paused video as soon as imitation occurs. The desire to move to the next sequence can be very motivating.
  • Put an enjoyable segment at the beginning and the end of the video.

 

 

VIDEO MODELLING RESOURCES

Articles & Books

Bandura, A., Ross, D. & Ross, S.A. (1961). Transmission of aggression through imitation of aggressive models. Journal of Abnormal and Social Psychology, 63, 575-582.

Charlop, M.H. and Milstein, J.P. (1989). Teaching autistic children conversational speech using video modelling. Journal of Applied Behavior Analysis, 23, 275-285.

Committee on Public Education. Children, Adolescents, and Television. Pediatrics. 2001 107:423-426.

Johnson, J.G., Cohen, P., Kasen, S., Brook, J.S. Extensive television viewing and the development of attention and learning difficulties during adolescence. Arch Pediatric Adolescent Medicine. 2007; 161(5): 480-486.

Krantz, P.J., MacDuff, G.S., Wadstrom, O., McClannahan, L.E. (1991). Using video with developmentally disabled learners. In P.W. Dowrick, Practical Guide to Using Video in the Behavioral Sciences (pp. 256-266). Oxford, England: John Wiley & Sons.

LeBlanc, L.A., Coates, A.M, Daneshvar, S., Charlop-Christy, M.H., Morris, C. & Lancaster, B.M. (2003). Using video modelling and reinforcement to teach perspective-taking skills to children with autism. Journal of Applied Behavior Analysis. 36, 253-257.

Neuman, Lisa. Video Modelling: A Visual Teaching Method for Children with Autism. Willerik Publishing. http://ideasaboutautism.com/video.html

Sherer, M., Pierce, K.L., Paredes, S., Kisacky, K.L., Ingersoll, B. & Shreibman, L. (2001). Enhancing conversation skills in children with autism via video technology. Which is better, “self” or “other” as a model? Behavior Modification, 25, 140-158.

Taylor, B.A., Levin, L. & Jasper, S. (1999). Increasing play-related statements in children with autism toward their siblings: effects of video modelling. Journal of Developmental and Physical Disabilities, 11, 253-264.

Thakkar, R.R., Garrison, M.M. & Christakis, D.A. A systematic review for the effects of television viewing by infants and preschoolers. Pediatrics. 2006; 118(5): 2025-2031.

Pre-Made Videos

Fitting in and Having Fun: http://difflearn.com/prodinfo.asp?number=DRV%20108

Model Me Kids: http://modelmekids.com

Watch Me Learn: http://www.watchmelearn.com

Used with permission. Leslie Cohen and Antoinette Falco, 2012.

1.22. Four Tips to Get the Most Out of Pokemon Go for Your Child with Autism

By Maureen Bennie

As you all know by now, Pokemon Go has become this summer’s sensation. Not only is the game making headlines as being beneficial play for those with autism, but the game’s creator has autism himself. Fifty year old Satoshi Tajiri (from Japan) almost didn’t’ graduate from high school because of his obsession with bugs and video games…an obsession that later turned into the multi-billion dollar Pokemon franchise.

How Pokemon Go can be used to help those on the spectrum

This game takes the original idea of catching Pokemon creatures (imaginary animals with different kinds of “powers”), and takes it outside into the real world. Tajiri has created a FREE app for your mobile device that allows you to walk around your city, town, or neighbourhood, while looking for virtual creatures to appear on your phone. The game is map-based, and challenges the user to find PokeStops which have been created globally by using local landmarks in each community. Personal interactions with other Poke-users are encouraged through the technology at the various PokeStops.

While there have been a number of stories of the pitfalls of walking around while staring intently at your phone, there have also started to be heartwarming stories of people with autism and anxiety finding a drive or purpose to get out into the real world and practice their life-skills. Many people with autism have a fascination with technology; in fact, the hard part is to get them away from it, outside and interacting with others. This app has the best of both worlds. It is showing so much success that it is even being used in some schools for children with ASD. Below are some tips that outline how best to use this new game safely and to the most benefit.

1) Supervise

This might seem obvious, but going with your child/youth while they explore is essential. Either you or a caregiver should be around them while they explore and “catch’em all”. Many PokeStops are near bodies of water, or require crossing busy streets, etc.…

2) Encourage your child to come with you on errands by giving them a chance to play

One of the best ways to supervise is to offer your child/youth a chance to play in environments where you have errands to run. This allows the person with autism to be included in day-to-day activities while doing something that is engaging for them. There will be opportunities to connect with other players, and give your child/youth a chance to practice social interactions with people who are interested (and maybe just as fascinated) with the game as they are!

3) Take the opportunity to teach road safety and stranger danger

This app can create the perfect platform to highlight some basic life skills such as road safety and “stranger danger”. Making these lessons an integral part of the gaming experience is one of the best ways to learn. Help your child decide who to speak to, and what is appropriate when dealing with strangers.

4) Have some fun bonding with your child doing something you can both enjoy

Let’s face it, this app is fun! Sometimes it can be hard to find mutual points of interest with our children. We might not be able to get consistently excited over patterns of floor tiles, the many names and levels of Jedi Knights, or dinosaur types, but this app provides a game you can both enjoy. The Pokemon animals are cute and the game is designed to provide lots of entertainment for all ages.

Summer is the perfect time to explore an outdoor activity that offers a great learning platform wrapped in a fun game.

For more articles written by Maureen Bennie, go to www.autismawarenesscentre.com.

1.23. Riding on the Autism Spectrum

No. 121, June 2017

By Shona Casola

Taking public transit can be challenging for anyone, but can be even more so when a rider has difficulty with waiting, loud noises, strong smells, or confined space. This is the reality for many individuals with Autism Spectrum Disorder (ASD) who ride school buses and city transit routes every day.

ASD is a life-long neurological disorder that affects the way a person communicates and relates to the people and world around them. ASD can affect behaviour, social interactions, and one’s ability to communicate verbally and non-verbally (through gestures, facial expressions or body language). ASD is a spectrum disorder, which means that, while all people with ASD will experience certain difficulties, the degree to which each person on the spectrum experiences these challenges will be different. Individuals diagnosed on the autism spectrum can experience difficulty with both social communication1 and restricted and repetitive patterns of behaviour2 in varying degrees of severity. (American Psychiatric Association, 2013). This can result in difficulties with new environments, new people, unfamiliar routines, processing verbal and non-verbal communication and navigating unwritten social “rules” that most of us can intuitively follow. In some cases, individuals may experience anxiety or increased sensitivity to sensory information and as a result, may engage in self-regulatory behaviours as a way to cope with and manage this stress or anxiety.

As drivers, educators and bus company managers, there are many things you can do to help make the ride a smooth one for individuals on the spectrum. With back-to-school in mind, I will focus this article on children riding the school bus; however, many of these strategies may be applicable to those of all ages riding on other types of transit as well.

  1. Have an assigned or regular seat. Individuals on the autism spectrum typically thrive on routine and consistency. Since the predictability of a regular seat can help to calm anxiety, place the student in a location that is least intrusive to their sensory needs. A designated spot can also help facilitate social skills as they may be located around the same children daily and might begin to interact and build relationships. 
  2. Be conscious of their sensory needs. Noises, smells and/or the temperature on a bus may be challenging to a rider on the autism spectrum. The individual may also be very sensitive to touch and may appear to overact if someone lightly touches them, or bumps into them in the aisle. While there is little you as a driver can do to prevent smells, sounds, crowding or to control the temperature, it is important to acknowledge the potential impact these variables can have on your rider. Imagine trying to concentrate on parallel parking the school bus while listening to nails scratching on a chalkboard. The regular sensory information on your bus may be this intrusive to someone on the autism spectrum. Knowing this can help you approach them with a greater degree of understanding, should they begin behaving inappropriately on your bus.
  3. Post visual supports and a list of bus rules. Many individuals on the spectrum have difficulty processing verbal information, however, when information is presented visually, they are better able to understand and make sense of instructions and expectations. Working with parents, caregivers, and educators, you can learn to use a calming routine or visual support that may be helpful to your rider on the autism spectrum. These routines and expectations can be posted at the front of the bus (where they will be of benefit to all riders) as well as in the individual student’s seat or in another place that you feel would be helpful for them.
  4. Words can be tricky to process. While you can put up visual supports for things you can predict, there are times when verbal instructions are still necessary. In this case, it is important to acknowledge that some people diagnosed with autism need short, clear sentences, particularly when they are upset. Being calm, clear and direct with your instructions (such as “sit down” rather than “please take your seat like you’re supposed to”) can be beneficial. It is also important to provide time for the individual to process the instructions, so try to count to five or ten in your head before repeating your instruction. For some people, it can take much longer than ten seconds to process and respond appropriately to the instruction and adding words, such as “I said, SIT DOWN”, may delay processing time even more because there is new information for the child to consider. In an emergency situation, be as calm, brief and clear, as possible, with your instructions, while balancing your responsibility to get them out safely.
  5. Routines and changes. With regular riders, the route itself can become part of their routine. There can be things along the way that become comforting to see, such as a particular building, or counting the number of fire hydrants the bus passes. Construction, collisions and route changes can disrupt this. It is important to give riders as much notice as possible about these changes and to recognize that there may be an upset reaction as a result. Having comfort objects, toys or electronics that keep students busy during the ride can help with this frustration when it does occur. Connect with parents, caregivers, or educators to arrange for comfort objects to travel with your rider.
  6. Do not force eye contact. For many of us, eye contact is a sign that people are listening to what we are saying. For many people living on the autism spectrum, however, looking a person in the eye can mean they are unable to listen and focus on what you are saying because it is too distracting. Rather than insisting on eye contact, you can ask individuals to repeat back to you what you have asked if they are able to, to confirm they have heard you. Asking them to say it in their own words can also help to confirm they have understood you.
  7. Behaviour. When riders act out this can be very disruptive and distracting for the driver and other passengers. Individuals on the autism spectrum may have times when they experience sensory overload (too much sensory input) or stimulation, when disruption to their routine has occurred or when they are having a difficult day and these experiences can lead to unwanted behaviour on a bus. When this happens, try to remember that their behaviour is a form of communication that is telling us about the difficulty they are experiencing. When you need to intervene; calm, clear instructions are best, paired with any visual supports you may have available. Sometimes it is as simple as writing your expectation down on a paper and giving it to the student. It is also important to recognize that individuals may behave or respond in ways that are unexpected for someone their age.
  8. Build relationships! When you make a point of remembering a person’s name, a favourite item or special things they have told you, they become more comfortable and this can help the ride go more smoothly. Relationships are also important to establish with parents and caregivers, as well as siblings who may also ride on the bus. Building relationships is not always easy but is well worth it!

By working to make riding the school bus or public transit easier for individuals on the autism spectrum, you make life easier for the people who care for them as well. You create opportunities for people to have equal access to their community and to feel included. This is invaluable.

 

[1] Social communication challenges refer to persistent difficulty with social interaction across multiple contexts and include frequent struggles with understanding another persons’ perspective, non-verbal communication, and difficulty establishing and maintaining relationships. 

[2] Restricted and repetitive patterns of behaviour, interests or activities can include motor movements, insistence on sameness and inflexibility, highly restricted passions frequently in uncommon interest areas and sensory sensitivity.